The US-driven and NGO-mediated prosecutorial approach to address trafficking prioritizes efforts to convict the accused and foregrounds victim-witness testimony as the central piece of evidence to do so. Though training rescued women to testify against alleged traffickers is thus a key component of donor-driven NGOs’ efforts, the author’s ethnographic research revealed that this is a rare occurrence. This chapter explores the multiple and complex reasons why most rescued women don’t testify, by situating them in the broader Indian sociolegal context. In juxtaposition, it tracks the case of a trafficked woman, Sunaina Das, who testified for the prosecution in a New Delhi trial court, to also explore the constellation of factors that lead some women to testify and the challenges they face. It follows Sunaina’s encounters with the Indian criminal justice system and the support she received from both NGOs and Indian legal actors. Finally, it explores how an NGO-led training session for Indian judges impacted her case. Through these contributions, this chapter challenges prevalent assumptions in global anti-trafficking campaigns about the victimhood of Global South sex workers, about criminal justice necessarily benefiting trafficked sex workers, and about the Indian criminal justice system necessarily lacking the ability to address sex trafficking.

The author reflects on some significant legal and policy developments – on the newly expanded scope of anti-trafficking, on the rehabilitation of sex workers, and on the escalated targeting of Bangladeshi migrants – that have emerged since her ethnographic research. Through these updates, she revisits some of the key themes outlined in the Introduction and tracked through the book: the excess of legality around the governance of prostitution and trafficking in India, the central role played by NGOs in these forms of governance, and the impact of these forms of governance on the women they target. It is argued that even as the legal framework of anti-trafficking now exceeds that of anti-prostitution, they continue to remain deeply connected, through the work of anti-trafficking NGOs, and through existing models of intervention established under India’s anti-prostitution law (the ITPA). The author also discusses how the anti-immigrant sentiments against Bangladeshi women that shaped the implementation of anti-prostitution and anti-trafficking imperatives during her research have been greatly magnified and exacerbated by India’s Hindu right wing-led government in the decade since.

Enzyme-inducing antiepileptic drugs (EI-ASMs) such as phenytoin, carbamazepine, oxcarbazepine, and phenobarbital may decrease contraceptive efficacy. When considering contraception for women with epilepsy (WWE), the intrauterine device (IUD) is a first line choice. It is important to keep in mind that hormonal contraception with estrogenic components induces the metabolism of lamotriginePreconception counseling should be started early and revisited frequently for WWE of childbearing age. Pre-partum optimization of ASMs ideally should be done 9−12 months before a planned pregnancy. The majority of WWE are likely to have a safe pregnancy and a healthy newborn.

During the 1980s, the AIDS crisis unleashed a torrent of animosity against gays and lesbians. As hatred rose, so too did physical assaults. Most of the perpetrators were teenagers, who did not just torment queer adults – they also directed their anger and hatred at their peers. As a result, a substantial percentage of gay and lesbian youth dropped out of school, abused alcohol and drugs, and attempted suicide. Two types of violence consequently plagued queer life: violence from attackers and self-harm. Some advocates responded by focusing on preventing attacks on the streets. They worked with police to improve their responses and lobbied legislators to enact hate crimes protections, which helped make antiqueer violence visible. Others, typically teachers and parents of queer children, focused on creating support systems in schools, so that gay and lesbian teens would not give up hope for a better future.

Three scenarios ranging from simple to complex show how appointments with primary care clinicians can include useful conversations about stress and treatments that work.

This chapter emphasizes how therapy can be a resource for Black women in their mental health and wellness goals, including personal growth and resilience, recovery, and reinvigoration. We present therapist and client stories to illustrate the benefits of psychotherapy. We also discuss our joys working with Black female clients and how these relationships can enrich therapists’ lives.

A 35-year-old G2P1 with chronic hypertension is referred by her primary care provider to your tertiary-care center for prenatal care of a singleton intrauterine pregnancy at 8+2 weeks’ gestation by dating sonography. The patient has no obstetric complaints to date. Her last pregnancy was 10 years ago.

You are seeing a 29-year-old G2P1 with a singleton pregnancy at 34+6 weeks’ gestation for a routine prenatal visit. Pregnancy dating was confirmed by first-trimester sonography. She reports normal fetal activity and has no clinical complaints. Your colleague following her obstetric care is now on a two-month leave. Although mode of delivery was addressed early in prenatal care, your colleague left you a note to discuss a trial of vaginal birth after Cesarean delivery (VBAC) with the patient.

A 37-year-old nulligravida with a one-year history of well-controlled essential hypertension is referred to your high-risk obstetrics clinic for preconception counseling. Recent comprehensive investigations are free of end-organ dysfunction. Maintaining a healthy lifestyle, she lost weight over the past year; her body mass index (BMI) is now 31 kg/m2. She uses condoms for contraception and is adherent to long-acting nifedipine once daily; folic acid–containing prenatal vitamins were initiated last month.

A healthy 23-year-old G2P1 presents for prenatal care at 12+0 weeks’ gestation by dating ultrasound. Her last pregnancy was cared for by your colleague, who is currently away. Pregnancy was uncomplicated, and she had a spontaneous vaginal delivery at term. You learn from the antenatal notes that the patient had a flu-like illness in early pregnancy; investigations were unremarkable, and symptoms resolved with supportive care. She tells you her healthy two-year-old son has been attending daycare since six months of age and is meeting his developmental milestones.

You are seeing a new patient in consultation for transfer of care to your high-risk obstetrics unit at a tertiary center. She is a 27-year-old primigravida at 14+3 weeks’ gestation with an incidentally positive surface antigen to the hepatitis B virus (HBsAg) on routine prenatal testing. A copy of the original laboratory report has been provided to you. Although detailed serological investigations were performed, results are not available. The patient is aware of the results. Referral to a hepatologist has also been instigated. The patient’s first-trimester sonogram and aneuploidy screen were unremarkable. She has no obstetric complaints.

A 37-year-old G6P3A2 at 20+3 weeks’ gestation is referred from a community hospital center for consultation at your tertiary center’s high-risk obstetrics unit for ‘anterior placenta previa with abnormal features’ reported on ultrasound evaluation of the morphologically normal female fetus. First-trimester sonography performed in the same center, integrated with maternal serum biomarkers, revealed a low risk of fetal aneuploidy.

A 34-year-old G2P1 with long-standing multiple sclerosis (MS) is referred by her neurologist for prenatal care of a spontaneous pregnancy at 10 weeks’ gestation by dating sonography. She takes prenatal vitamins and has no obstetric complaints.

This chapter is a fictional account of several people talking about aspects of their lives that are impacted by variations in sex development at a support group meeting. In their exchanges about past, present and future medical encounters, the author draws out both the opportunities and the dilemmas presented by medicine. Through the characterizations, the author also teases out some of the most pertinent psychological themes in the field, such as how to decide about “normalizing” surgery for a child and how to talk about bodily differences in relationships. These themes are centralized in Chapters 9–14 and explored in the literature summaries and practice vignettes therein.

Chapter 6 summarizes the changes to medical care in recent years. There is now a greater recognition that the projected social and psychological challenges of genital variations cannot be fixed by surgery. The first international consensus statement on intersex was published in 2006. The statement makes a number of recommendations to improve care. Controversially however, a new term disorders of sex development (and, later, differences in sex development, or DSD) was introduced to replace intersex and hermaphroditism. Biotechnological developments have been advancing rapidly. More has been learned about “normal” and “abnormal” sex development. However, parents still struggle to talk to children about their bodily variations, young people still worry about getting into relationships, childhood genital surgery is still considered the only way out of stigmatization, psychological expertise is still a low priority in specialist services and the huge potential of peer support is not fully realized.

How to talk about variations in sex development is a major theme for impacted individuals and families. This is the topic of Chapter 12. The author summarizes the research literature with caretakers and with adults about the difficulties of disclosure. Considerable criticism has been levied at health professionals for failing to role model affirming communication. For sure there are gaps in health professionals’ talk, but the biggest contributor to the difficulties is to do with the widespread misunderstanding about the biological variations. Psychological care providers are not there to put a cheerful gloss over clients’ negative expressions. However, they can be part of the favorable social condition in which a wider range of meanings about bodily differences are negotiated. In the practice vignette, the author highlights how tentative and uncertain the enabling process is, where a negative view of sex variations is still widely endorsed in the social context.

Chapter 8 begins by pointing out the current lack of collective clarity about the role of psychological care providers (PCPs) and suggests that researchers and practitioners make collective effort to develop the role of PCPs in sex development in future. Meanwhile it outlines the psychological consultation process that is generic and familiar to most PCPs. The author provides an initial assessment template and summarizes the popular psychotherapeutic interventions. The template is visible in several of the practice vignettes in the ensuing chapters of the book. The author ends the chapter by arguing that the tertiary environment is set up for diagnostic workup and treatment and unsuitable for the kind of ongoing psychosocial input that is needed by individuals and families living in their communities. The author makes a case for PCPs in DSD centers to collaborate with peer support workers to enable nonspecialist providers in the community to contribute to ongoing support for individuals and families.