From the specific story Pinki Pramanik, we now move onto the larger discourse around intersexuality and the way it plays out in sports, the queer movement and the medical establishment. Find out why intersexuality is after all a feminist issue. An interview with sports researcher, Dr.Payoshni Mitra.
What drew you to the intersex discourse?
There are 2 answers to this question. Firstly, Paromita Chakravarti (Director, School of Women’s Studies, Jadavpur University) was visiting London in 2010 and she wanted me to participate on this panel on the ‘Body’ at the IAWS (Indian Association of Women’s Studies) conference 2011 in Wardha. I had always wanted to work with Santhi Soundarajan, meet her, interview her. In 2006, when she “failed” the sex test at the Doha Asian Games, I was interning with the Women’s Sports Foundation, New York. Back then, I did not have much information and I discussed it with my Ph.D. supervisor Prof. Supriya Chaudhuri and decided to not pursue the case. But in 2010, two years after I had completed my Ph.D., I was in London, and had access to the British library which had a sizeable collection of books on intersexuality. So I began some research on the issue. Then I called up Santhi one day and fixed an interview in June-July 2011 and came to India. That’s how I started working on the subject. We started working together, presented a paper together in Turkey at a sports lawyers’ conference. I started speaking to people at the athletics federation, the Olympic association and at the ministry and see if they could help Santhi. And that is how I also met Pinki because both of them represented India at the same time and were very good friends. Santhi came to meet me in Kolkata in January 2011 as we were planning to file an RTI for her medical report from Doha, which was never handed out to her. So she had put up with Pinki and I went to meet her at Pinki’s place and that’s how we met.
The other answer is, I was always interested in body issues for a while. I was a badminton player myself. In my early years, I was a complete ‘tomboy’ with closely cropped hair. I used to wear those tiny sporty shorts and loved being mistaken for a boy in my early teens. So I was always curious about these grey zones, you know. And my parents were extremely supportive and wanted me to do well in sports. In fact they were disappointed that I couldn’t. By the time I was 15-16, they knew that I wouldn’t make it big as a badminton player.
So how did this ‘tomboy’ disappear?
By the time I went to a new school in Class XI, I had stopped playing badminton. I started growing my hair long. My old teachers were like, “What’s wrong with you? Here’s a new person.”In fact, my experiences as a young female badminton player inspired me to work on gender and sport later. The fact that I had an abusive coach who was partly responsible for me dropping out of sport made me think about how a lot of abuse and harassment, verbal to physical to sexual happened in sports and these were not highlighted and so I wanted to research on the subject years after I stopped playing the sport seriously. Now was this transformation because I stopped playing a sport or because I suddenly began to realize that such ‘tomboyishness’ would not help me get any male attention, I do not know. I guess, everyone goes through these phases in life and it takes a while before you know what you want to be like – ‘just yourself ’.
So before the Wardha conference happened, what was your research question?
It was very vague because my doctoral research was in a way kick-starting the discourse of gender and sport in India. I wasn’t much interested in the history of women’s involvement in sports but my mentors wanted it and so I had a chapter on that… it was a long chapter not just on sport but women’s involvement in any kind of physical activity in the 20th century which included the scout movement and also Gurusaday Dutt’s bratachari. Then there was a chapter on the representation of female athletes in the media, then quite a bit on policies plus I went to the US and Canada and had to write about their policies and where India compared with them. So there wasn’t one single question I was answering but several. However, one main question was how sports could be ungendered. My thesis was titled ‘Ungendering Sports: Towards a re-evaluation of the female athlete in India’. It was very broad, not specific but I guess it was needed then because there was no precedence, no substantial work on gender and sports in India before mine and therefore one needed to touch on these points.
So you met Pinki in 2011, a year and a half before the rape charge was made against her. Did you have an idea about her intersex variation?
I had a vague idea from what I heard from some people in the Sports Authority of India but their notions were mostly based on appearance. After I interviewed Santhi and made a short documentary, I showed the film to some doctors at SAI. While I sensed their level of insensitivity and inadequacy of knowledge on intersex variations, I took note of the names of some other athletes they mentioned who they said might have some intersex variation but were not certain.
So this kind of private information was in circulation?
In India, especially in cases of athletes with intersex variations, confidentiality protocols were hardly ever maintained. Both Pinki and Santhi, as well as, Bony Pal suffered due to this. This is why I supported the clause of confidentiality while working on the Standard Operative Procedure for better management of female athletes with intersex variations in India However, in an Indian context, it comes with its own problems. As a researcher and probably the only one specifically working on the issue, I need to know of these stories of discrimination so that I can fight them. The confidentiality clause in fact makes it easier for the sport officials to discriminate against such athletes and get away.
What is the crux of the intersex question? Is it about the multiplicity of bodies, looking beyond gender binaries, the medicalisation of the body…?
The intersex question hasn’t been completely answered as yet. Medically, doctors are still trying to tell you how many intersex variations there are. Also, the way we look at intersexuality in India must be different from the way the West looks at it because in India, a lot of babies are born without adequate access to so-called modern, western medical facilities, in situations incomparable with the West. Thus the questions asked in the West are different from what we must ask here.
I believe the constant pathologization of the’ intersex’ is a Western phenomenon. It is sad that the medical fraternity in India is promoting the western medical practices in connection to children born with intersex variation. We must understand that intersexuality is not a disorder; it is simply a variation or different kinds of variations. Surgery is required only when one has a disease or a life-threatening medical condition. Not when one is different. With advancement of science and with the current fascination with cosmetic surgeries, human beings are able to change their body and appearance at will and without any need for it. What modern scientific endeavours and discoveries often lack is ethics. Bioethicists elsewhere are talking about the problems of such scientific research. In case of the intersex, bioethicists have or socio-medical researchers in different parts of the world have raised the issue of unethical values of the medical procedures, the biasness of the logic behind surgically shaping bodies in order to fit them into a box. The problem is advanced medical procedures which are criticized for being unethical are gradually going to be popular and accessible to certain section of the population in India as the medical fraternity here look up to modern scientific methods as supreme and are unable to judge their shortcomings.
In India, the intersex issue should be approached, not from the medical point of view but from a social point. And since it is still an emerging area, we may be able to have some impact if we talk about it now. By that I mean increased dialogue between the medical community and researcher/ activists like us.
In India, a child born with intersex variations is often being given away to hijra groups. Parents often bring up their intersex children as girls – this has been noticed in the west as well. So where there are doctors available and where there are no doctors, everywhere intersex children are often assigned female gender at birth and brought up as girls. There is a clinical, surgical argument that it is easier to cut things off and make it look like a female genital rather than add something to make it like a male genital. But everywhere, whether in traditional societies with limited access to western medical science, or in ‘advanced’ countries with ample access to medical science, female pain is not considered as important or as deep as male pain.
Anyways, my stance is clear. I am completely against the medicalization of the intersex people and that is why even for the film (a documentary on Pinki Pramanik by Payoshni and Debalina), we were very clear that we would not interview a doctor. That is not the kind of definition that I am looking for because that’s how the intersex people have always been defined. The intersex issue is much more than that. And also, do we necessarily need to come up with a specific answer? This quest for one specific answer is something that quantitative science has taught us to believe in. For someone like me the answer lies in trying to understand intersexuality, people with intersexuality without possibly looking for a definite answer.
And this hierarchization of pain is patriarchal…
Yes, that’s what I am trying to say. It is more important for a doctor to make sure that a boy child is able to take part in a peeing contest, stand up and pee while a girl child, with an intersex variation can grow up without menstruation, without having a vagina and so on. But that is acceptable. While I do not believe in stereotypes and am completely fine calling a woman a woman whether or not she menstruates or has a vagina, I am asking you to take note of the logic behind sex-assignment at birth in case of children born with ‘atypical’ genitalia. When doctors in so-called modern societies or parents or midwives in traditional societies assign female sex in case of any ‘ambiguity’, they do so because they believe that for a boy child to grow up with a penis which is not big enough or with a urethral opening which is attached to one’s is more painful that a girl child growing up without a vagina or an ability to menstruate. So what they believe and promote is that it is more painful to live as a man who is not man enough rather than being a woman who is not woman enough. This is why I strongly believe that intersex issue is a feminist issue. Period.
Do you think that we are living in xenophobic times where xenophobia is playing out in the womb? Foeutuses are eliminated because they have Down’s or they are intersex…
Yes… The problem is not as big in India so far as intersex is concerned but I am studying this at the moment. In fact I have been discussing this with some gynaecologists in India. One of them told me that they have an anomaly test where they find anomalies in your gene. It’s not clear if it is used to find intersex. If yes, then the test will help the parents with knowledge, which they can use to abort the child. Such elimination is also possible in case of IVF procedures. Bioethicists in the US have been writing about this. Modern societies seem to be against any kind of diversity whereas you actually expect them to be more tolerant.
Nivedita Menon writes that there was a lot of gender fluidity before the British came to India like during the Bhakti Movement but after the British came, there was a strict binary at play. The hijras who had a place in the Mughal Court were marginalized during British rule.This may be true but to think that intersex babies are discriminated against now and that because India has traditionally been a diverse society, there was a lot of acceptance before the British came, is also simplistic.
Hmm… The Intersex Society of North America (ISNA) underlines a few points about how the medical establishment should act when an intersex baby is born. This includes parental counseling, no ‘corrective surgery’ and so on. Do you think there is any such ideal course of action? If yes, what?
No, I don’t think so. The most ideal course of action I can think of is to have no course of action at all.
There has been a lot of writing in the West critiquing the medical establishment, they say early surgery and hormonal therapy should be banned and once the child grows up and can choose what she wants to be, there can be such procedures. But there are some people who are happy with early surgeries while others who have faced problems because of them. So there are contradictory views on this.
While I think ISNA set the precedence of working in this area in the 90s when nobody was working on this and whoever is studying the history of intersexuality has to read about ISNA, one must also understand that there are contradictory views, people with different experiences. Having said that, I am against any kind of surgery, especially in the case of those who are not in a position to decide like children, unless it’s for a life-threatening situation. Surgery is cosmetic because I doubt if you can ‘fix’ an intersex child. You might ‘fix’ the body but if I can go by what I have come to know from athletes I work with, intersex is also a state of being, something that not only cannot be fixed but also need not be fixed either.
Could you elaborate that?
Yes. Imagine having a body that you are told is neither clearly male nor female. Imagine growing up with a consciousness that you are neither male nor female in a binary world. Imagine being perceived as a girl now and a boy a moment later. Imagine experiencing this everyday since you first realized you did not fit in. That is a state of being which cannot be altered or done away with by surgery. Again, trying to define it is a futile exercise – whether it is biological, social, both or something else…
It took me a while before I could see it in that light. This knowledge was not gained from books or written materials. This was gained from having had the opportunity to know someone like Pinki. The other day, Pinki and I were discussing this. In fact, this comes up pretty often in our conversations. Pinki often tells me, ‘why do they have categories like the male and the female? Who has come up with these categories? Aren’t these man-made?’ Her experiences teach her to question the very basis of sex. And we are talking about sex here, not gender. That sex is constructed too. That biology is constructed. She could come up with such a profound question without having to study sex/gender studies. One day we were talking about transitioning. About what if someone does not feel happy after going through all the medical procedure needed to become a transman or a transwoman. She said that for someone who is born intersex, as an adult, when s/he chooses her/his gender, whether the same as assigned or not, one can do so with full knowledge of what it means to be a man and a woman, because one has seen both unlike someone who transitions from being a man to woman or vice versa.. That state of being that she refers to here is not necessarily your body or your physical appearance. It is also the psyche of an intersex person. To grow up as someone in between is an experience, a value that cannot be and need not be ‘fixed’ by a surgeon.
So do you think that this state of being is what is not addressed by organizations like the ISNA?
The limitation of these organisations lies with the overemphasis on correcting the medical management of children born with intersex variations. The debates surrounding the intersex issue in western countries focus too much on how the medical fraternity is managing such cases. I understand that it is important to critique the existing system to stop early surgery. While I was working as a consultant for the Ministry of Youth Affairs and Sports in order to create a Standard Operative Procedure for better management of athletes with hyperandrogenism, I had to sit with a group of doctors from AIIMS. They believed that they knew it all, that intersexuality is an issue that only doctors can understand, so who was I to tell them that they were wrong! On top of that, there’s a tendency to uncritically follow what western medical science tells us in the name of ‘progressive thinking’. So they did not listen to the ethical issues I was raising. There are many who are affected by these medical practices which are so western. But in India, the situation is even more complex because there are also children who are born outside the medical set-up. Issues of class, caste, religion further complicates the situation. Have you seen the film Bol? The first section was all about an intersex child in Pakistan.
So far as India is concerned, what do you think is a crying need for the intersex population? On a different note, with the impending elections every party is putting up posts for citizens’ demands…
The fact that a large number of people in India know about the intersex people is mainly because of the experience of some athletes. Not that some people did not know about it before but they did not openly discuss about it. The fact that we are becoming less and less diverse needs to be addressed. Invoking tradition to be intolerant could be a misinterpretation of tradition or simply something being traditional doesn’t mean it has to go on. To be a progressive society, you have to accept people the way they are. The Supreme Court judgment on Section 377 says the LGBT community is “miniscule”. If that is the case, then where do we place people with intersex variations, who are hardly represented, hardly seen? The intersex people are few and the fact that they are fewer because they are scared to come out needs to be addressed. Some of them who are sportspersons make headlines and you get to know about them but there are others too who are not mobilized. They do not feel safe to come out. Let’s be realistic. Political parties are interested in a vote bank, so intersex issue alone cannot be an issue for them. However, to be part of larger LGBT concerns may solve the problem.
Do you think our queer movements have somewhat failed to integrate the intersex issue within its fold?
I don’t think they have completely failed. This is still an emerging area. There are too many issues at hand. There is very little presence of intersex people too. Only if they come up, you can talk about them, people will know that you have an issue. There are marginal groups within the queer community also. So for example, the voices of females transitioning into male are hardly heard and similarly intersex people, most of whom are growing up as female. To come out and talk about something so personal is difficult. Also, intersexuality is not a choice. Neither is homosexuality but you can choose to not talk about it, try and deny it. Intersexuality is something you wear on your body in most cases, so on one hand you cannot hide it and you lack the agency to not talk about it but it is also difficult to speak about it. So intersex people often silently continue to struggle alone.
Is it also about the difference between sex and sexuality? The fact that the queer movement is predicated upon desires, upon sexuality?
Yes… that’s what I was driving at. Also, the fact that the intersex issue is different from the transgender issue. Many people, who are otherwise aware of sexuality issues, use these 2 terms interchangeably. Often I have heard people talking about the athletes I work with as transgender athletes but they aren’t transgender. Here’s a body you are born with, that you live with. Also, one must understand that there’s a contradiction between the intersex and transgender movements. For the transperson, surgery and medical intervention helps you get your desired body which defines your identity. And for the debates around intersex, we are speaking against surgery or hormone therapy.
But why should we see that as a contradiction? It’s the requirement for different kinds of bodies…
I am asking you to note the contradictions in the way the two groups would look at medical intervention. But the fact that the basic idea of multiplicity, of choice, of choosing to change one’s body in case of a transperson or of choosing to retain one’s body in case of an intersex person – that basic principle is the same. And it is because of that I think these different communities can come under one umbrella to fight for their rights.
So have you come across cases where an intersex person identifies himself or herself as transgender?
Yes. One of the athletes I have worked with, someone born intersex, assigned female sex at birth at a later stage said that she wants to live as a man and therefore wanted to transition. Germany is the first country to allow a no gender designation.
What’s your take on that?
On the surface, this is certainly a welcome step but in a society where there is an existing male-female structure, for some children to grow up without a gender… whether it will be difficult for them or not remains to be seen. However it is easier to critique than give an alternative because none of us know what is right. Whatever I am saying is on the basis of my interactions with a few intersex athletes but intersexuality is very diverse. The moment I say that this is it, I am ignoring other experiences. If this was an ideal world where one could choose or not choose a gender, it would have been different but that’s not the case. The intersex people are born in a world, which goes by a two sex model. To live without an assigned gender in a society that already has a male/female divide may be difficult. But then, this is definitely a step up from assigning female sex at birth in case of children born with ‘atypical’ genetalia.
That brings me to the activism of trans people. They have fought for the ‘other’ box beside M and F.
But what is ‘other’? Whether someone like Pinki would want to be tagged as ‘other’ or ‘female’ is something I cannot decide for her and her decision may be different from Santhi’s. ‘Other’ is very easy in a way in set theory, you know. This way, you can easily have the core set. How many people would want to identify themselves as ‘other’? Again, I think we are all trying to find a more inclusive system, but are not sure yet what will work. This is a journey, may be, towards complete ungendering.
Hmm… gender verification tests have been banned in sporting events but what we have in its place is also problematic. Isn’t it?
Yes. The only positive thing is they have stopped determining gender but what they have instead is a policy on hyperandrogenism which is almost equally discriminatory. Currently they are saying that female athletes who have androgen level in the male range cannot compete until they lower their androgen levels or they are allowed to play if they have androgen insensitivity. So they mean that androgen level can tell us whether one is having any so called ‘ unfair advantage’. So the language has changed which is important but the attitude of the IOC (International Olympic Committee) and the IAAF (International Association of Athletics Federation) earlier was let me tell you whether you are a woman and now the attitude is let me tell you if you are woman enough.
So is this test conducted on all female athletes?
No. Only if there are complaints against specific female athletes. So the current IOC document says that either an athlete herself can express concerns over symptoms of her own hyperandrogenism, or a Chief Medical Officer of any national Olympic committee or an IOC Medical Commission member can request a female hyperandrogenism investigation in writing. In India, the standard operative procedure says that such investigation can be requested by an athlete herself or a medical officer in SAI or some national sport governing body or anyone who writes to any nodal officer formally. It is simply ridiculous… A Canadian professor, Bruce Kidd suggested self-declarations. If somebody declares herself to be a woman, let’s not have these tests, allow her to play. This has been applied in some cases in Canada but has largely been unacceptable. I met the IOC medical chairman Prof. Arne Ljungqvist last summer in Stockholm. He said it is important for them to ensure that other female athletes get a level playing field. But this whole rhetoric of unfairness has been created by them. With this whole history of gender verification, some female athletes are bound to feel insecure. But this is created. For instance, Pinki is much shorter than some other female athletes and therefore has a disadvantage but that will not be taken into account. Why is advantage gained through height not unfair, and advantage gained through naturally produced androgen unfair? Why are they singling out testosterone?
So you mean this has got to do with issues of gender, race…
Well, that is true too. There was this article on Santhi in ESPN magazine which spoke on this and there are researchers working on this who show that these tests are mostly conducted on female athletes from developing countries. Prof. Ljungqvist admitted this. In fact, a couple of days back I got this mail from socio-medical scientist Rebecca Jordan-Young about a recent research report published by a group of scientists/ endocrinologists who investigated 4 such cases of athletes. In the report they confirmed that all 4 athletes were from ‘rural and mountainous regions of developing countries’. They argue that medical facilities are not widely available in these areas and therefore there could be more cases which have not been diagnosed. So there is singling out of athletes from developing countries as it is assumed that intersex cases have already been dealt in advanced countries. Now I do not know whether there was any athlete from India because the whole thing is done under a cloak of confidentiality which doesn’t allow information to reach activists like us, who take a different rights based approach. They can now prescribe all sorts of unethical ‘treatment’ to these young athletes and force them to undergo surgery and hormone therapy only for the sake of competition. The point is if these athletes want to compete, why should surgery be made mandatory for them? If an athlete is born with something, how is that an unfair advantage? She is not doping! She has been born with a certain androgen level! Many athletes still go for these tests because sports means a life to them but they do not realize what impact these interventions can have later in their lives.
What is the state of these tests in India?
I came to India in 2012 with this work. The then minister of sports, Ajay Maken was quite progressive in this regard. I started talking to the AIIMS doctors and in consultation with him and the then Sport Secretary, P.K. Deb who were quite supportive, I started working on the standard operative procedure. But amidst the know all voices of AIIMS doctors, my ethical concerns were hardly noted. I am very disappointed with the outcome but am not giving up the fight. I have made fresh recommendations but they are yet to do anything about that. I have shared my concerns with some members of the IAAF and IOC Medical Commission like Prof. Martin Ritzen, I have also discussed this with Prof. Jordan Young and bioethicist Katrina Karkazis who completely agree with me. Now I will have to get these recommendations officially supported by them. There is a lot of work to do, but persistence can yield positive results.
Take the example of case. The sport authorities banned her from competing after she failed the ‘sex test’ in 2006. She was left to fend for herself. But things are different now. After much lobbying with the government, senior journalist Narayan Swamy, Santhi and I have been able to convince the SAI to fund her coaching course in Bangalore, promise her a job at SAI after completion of the course and let her do so without having to undergo another ‘sex test’. It was absurd, you know. The previous DG told us she must undergo a sex test so that they know which hostel she could live in, men’s or women’s. I had to tell them, again and again that there is no such precedence where a coach had to undergo ‘sex test’. If at all provide her accommodation elsewhere. It was only after the new DG, Jiji Thomson joined that we could convince this to him. He has been very supportive. But you know, this is a success story. Persistence matters.
Finally to the end the chat… the gay gene!There have been scientific studies about it. What are its implications? Are we pathologising sexuality and moving towards “correction”? Is genetics the correct language to talk about sexuality?
It is definitely not the correct way. What one must understand is the danger to this pathologization of homosexuality. Much has been written in the west about the ‘gay gene’ since geneticist Dean Hemar came up with the idea of a ‘gay gene’. In the Indian context, with the recent Supreme Court verdict on IPC 377, there has been a renewed interest in understanding homosexuality and many are arguing it is genetic. I am not happy with calling it genetic or even a choice. We are talking about acceptability here, and why can’t we focus just on that?
I was discussing this with legal activists who are part of the LGBTIQ community or are supportive of the movement here in India, even they see nothing wrong in arguing for it this way. But we must understand the long-term impact such an argument may have. By calling homosexuality genetic, it may have some immediate impact but in the long run it will not change moral or social acceptability because it could still be considered a genetic defect, which can be treated at a pre-embryo state. There have been very rapid advances in genetics and those kind of technology. But there has to be a check somewhere? What if they start genetic selection or modification procedures to straighten your yet-to-be-born child? It could still not be proved that this is possible, but for homophobic parents with access to so-called advanced medicine and genetic technology, this may seem perfectly attainable – giving birth to custom-made children and killing any possibility of diversity in the society. While there are debates among scientists about whether at all there is a gay gene, we must understand, as activists, the kind of implications that such an argument may have in years to come.