by Louise Gannon
After years of struggling with the aftermath of her own rape, PAVAN AMARA quit her journalism job to open a pioneering clinic for survivors of sexual violence. She tells Louise Gannon why it was her way of taking control.
Some weeks ago, Ella (not her real name), the daughter of a wealthy diplomat, contacted the very first maternity clinic in the UK to deal with survivors of sexual violence. What she said was truly shocking.
The well-educated, impeccably dressed 20-something had been brutally raped by her respected and influential father. She was now several weeks pregnant. She felt she could neither confide in her mother nor contact the police (‘No one will believe me and I’m not strong enough’).
She wanted someone she could talk to; someone she could trust. But more urgently, she needed a medical professional to guide her through the gynaecological examination and discussion of her pregnancy.
She still had to make the gut-wrenching, head-spinning decision about whether to keep the baby – and she could not even bear to be touched.
Pavan Amara, who set up the clinic at the Royal London Hospital, says: ‘If you have been raped, the process of being examined brings everything back, even decades later.
You are sitting on your own in a doctor’s surgery, and you feel you have no control of what is happening to you, and so the cycle [of fear] continues. ‘The maternity clinic is part of the My Body Back Project, which Pavan established in 2015 to deal with sexual health and body image concerns of women who have been raped.
The clinic offers specialist cervical screening, STI testing and contraceptive care, as well as regular sessions for women to meet and discuss their relationships. Since its launch it has been inundated with women like Ella looking for someone who understands and can help.
Pavan is that person. The former journalist – now training to be a nurse – is responsible for revolutionising the way the Health Service treats women who have suffered sexual violence.
For the past three years, she has worked a seven-day week, 52 weeks a year, to get the clinic up and running. When she started, she had no medical experience or expertise, yet she managed to convince senior NHS executives to give her the necessary funding for the project.
In the case of the maternity clinic, this included the engagement of consultant obstetricians and gynaecologists with specific training as well as midwives and healthcare assistants.
Fine-boned and slight, Pavan, who grew up in North London with four siblings, has the fragile beauty of Audrey Hepburn and the reserved manner of someone younger than her 28 years.
But she is a quiet storm. ‘In my experience,’ she says, ‘you cannot imagine what anyone has been through – or what anyone is capable of – just by looking at them.’ The reason Pavan knows this is because 11 years ago, she too was raped.
She was 17 and working part time in a pub. She reported the crime and had counselling, but remained bathed in shame. She didn’t talk about it, lost confidence and admits she coped by drinking too much.
She says: ‘You feel you have been thrown into a whole new dimension. Everything is the same, but nothing is the same. You see things, people and yourself in a very different way.
You can’t get back to ‘normal’ because you have lost your normal – you are now this person who sits in a room with a counsellor and a box of tissues and you don’t want to be that person.
So you try to bury it deep inside but it’s hurting all the time.’ The bleak statistics from the Ministry of Justice tell us that one in five women in the UK aged 16 to 59 has experienced some form of sexual violence.
It happens with horrifying frequency (the figures have risen by 29 per cent in the past three years, according to the British Crime Survey) to women from council estates and country houses, to schoolgirls, students, mothers, teachers, lawyers – even doctors.
Only about 15 per cent report the attack to the police, and although there is initial counselling, it is largely focused on the trauma rather than the lasting effects. By the age of 21, Pavan was moving forward with her life.
She was in a relationship and had a job working on a local newspaper in Camden. She had good friends and had won a national journalism award. Then in 2014, on her way to cover a story, everything changed.
‘I was at Holloway Road tube station,’ she says, ‘and there were two guys on the platform making a joke about rape. This complete rage overtook me. I started screaming and yelling at them. They looked shocked and scared. I wasn’t scared of them – I just kept shouting and raging.
‘They went away and I got on the train, but it was like everything in my life had changed. I knew I had to do something with this fire inside me. For the first time since my attack I felt fearless and powerful.
Before that, I’d sat in pubs or watched movies where remarks about rape had been made but said nothing. Now there was no turning back.’ Using her journalism training, she set up interviews with 30 women who had been raped.
‘They were all ages, all backgrounds. I explained that I had been raped, too. I asked them questions about everything from their fears to their self-esteem, their sexuality and their health worries.
The things that kept coming up were health and sexuality. Many of them hadn’t had a cervical smear – neither had I. The whole idea brought back that memory of sitting on a cold, plastic bed being tested for forensics.
There were women who wanted to use a contraceptive coil, but couldn’t bear the thought of having it fitted – I was exactly the same. Another woman had lived for 18 years with the fear that she was HIV positive following her rape, but had never been able to face a police examination or any intimate testing.’ (When she was finally screened at the My Body Back clinic, she was HIV free.)
Pavan knew she had to do something to help these women. A few months after that confrontation at Holloway Road tube station, she quit her job to focus full time (paid a minimal salary from the NHS) on setting up My Body Back.
‘I told my colleagues at the newspaper what had happened to me all those years ago and why I needed to leave. Their response was so positive and incredible – I didn’t feel in any way ashamed. I just felt a different life was beginning.’
But she quickly realised from talking to women attending the MBB clinic that pregnancy and childbirth were specific concerns. Many said they had decided not to have children because they couldn’t deal with the tests, or even the idea of a baby being inside them.
One woman told how – while on gas and air during the delivery of her baby – she hallucinated that the doctor and medics were the rapists who had violated her a decade before. Traumatised and unable to bond with her child, she had spiralled into postnatal depression and had not been able to consider having a second baby.
Pavan consulted NHS maternity doctors about their experiences with women who had been raped, and was put in touch with Dr Jill Zelin, a consultant at St Bartholomew’s Hospital specialising in sexual health, and Louise Cadman, a consultant nurse researcher in the same field.
‘These were strong, professional women who wanted to help,’ she says. ‘They didn’t wring their hands and say, ‘How awful.’ Their response was, ‘What can we do?’
Within weeks, the idea for the MBB maternity clinic was born. The immediate success of the clinic speaks volumes about the need for its services. Within hours of the news of it opening, hundreds of women from Sunderland to Wales had either contacted or had been referred to the service by the police or by NHS practitioners.
You find yourself wondering why the beautiful, eloquent Pavan has chosen to keep such a relatively low profile. Her story has all the elements of a movie – a woman raped, fighting for the rights of other women and changing the way the NHS views rape survivors.
As a spokesperson there could be few better choices. But Pavan rarely reads the plaudits about her on social media where she is described as ‘awesome’, ‘brave’ and ‘incredible’.
She does not go into the details of her own rape, refusing to be defined by her past. Rather than act as a full-time ‘face’ of her clinics at conferences and awards ceremonies, she has chosen to train as a nurse.
‘My hours at the clinics count towards my training,’ she explains. ‘I want to be able to do things that help. ‘Setting up this project hasn’t been about going to dinners and making book deals; it’s been about emailing hundreds of people every day, creating spreadsheets, dealing with contracts, hitting deadlines.
So much of it has been hard, boring and frustrating, but that’s what you have to go through to make a clinic happen. You have to speak to people, do your research, check the stockroom, fill in endless forms, tell your friends you are too busy to see them.
‘I’m not a saint,’ she adds, laughing. ‘I get bad tempered. I sometimes get drunk. I can say and do the wrong things,’ and look – she points down to the plate in front of her – ‘I have cake, chips and hot chocolate for lunch. I’m a normal woman. You have to beware of developing an ego because once you do, the project comes second.’
Pavan pauses. ‘My grandmother lives in a tiny village in Northern India. Life is pretty harsh there, and I used to go and stay every year when I was a child. She always told me, ‘If you are going to do a good thing, don’t speak about it. Just do it.’ It’s a motto I try to live by.’
The MBB maternity clinic offers advice for women who are considering conception, as well as appointments and antenatal classes for those already pregnant – plus counselling for women like Ella who have to make a decision about continuing or terminating a pregnancy resulting from rape.
‘The fact that you can discuss all these issues, make your own decisions in a space where people understand, is all about taking back control,’ says Pavan.
‘And that helps diminish what has happened to you in the past and makes what is happening to you now more important and more yours.’
She has never once cried over the cases she comes across. ‘It doesn’t help. It turns the woman into a victim. This is about her reclaiming control and her life.’ As she sips hot chocolate, she tells me two stories.
One is about a woman in her 50s who had never had any health screenings since being raped decades before and was so convinced she had contracted a disease that she had never had any sexual partners.
After being screened in the MBB clinic and found clear, the woman contacted Pavan a few months later to say she had embarked on her first love affair.
Then there was the woman too terrified to have a smear test. ‘She turned up with her boyfriend who had been unbelievably supportive. We started doing the smear and the boyfriend collapsed. Suddenly, everyone was rushing around him. His girlfriend was laughing, we were laughing.
It was supposed to be traumatic for her, but it had turned into a comedy. In the horror of all this there are still moments of humour. And if you can laugh, you know it can be OK.’
Pavan herself has no plans at the moment to have children. ‘My aim is to set up more clinics across the country,’ she says. ‘They feel like my babies. I’ve been involved in every detail, from the chairs to costs to staffing.
The fact that women are coming through our doors – able to talk, to have the right help – means we are doing something that has been needed for far too long.’
I ask her what she would say to her traumatised 17-year-old self and she answers: ‘You don’t know what strength you have – but something is inside you.’ And to her attacker? She pauses.
Pavan would not rewrite her own history. She says: ‘I would tell him: ‘You have no idea who you are messing with and what you will unleash.’ Nothing will stop me now.’
For more details about the My Body Back project and the maternity rape clinic, visit mybodybackproject.com