Violence against women is prevalent worldwide and sexual violence has to be looked at as a serious public health issue. According to the National Crime Records Bureau of India, reported incidents of crime against women increased 6.4% during 2012, and a crime against a woman is committed every three minutes. Furthermore International Centre for Research on Women found that 65% of Indian men believe women should tolerate violence in order to keep the family together, and women sometimes deserve to be beaten. Whether it is dowry related, acid attacks or domestic violence, often the first stop for victims is the hospitals and clinics. Thus, our medical centre has an important role to play in curbing violence against women.
India’s medical system needs to be more responsive to the needs of women who have been victims of interpersonal violence or sexual violence. In addition to loud calls for legal, police and social reforms in India, there is an urgent need to overhaul medical guidelines; there is no standard national protocol for medical examinations of victims of sexual violence and treatment for them. We have cursory, ad-hoc medical examinations that are mostly degrading and counter-productive. A report by the Human Rights Watch highlight the new in-famous “two-finger” test often used by Indian doctors to test the elasticity of rape victims’ hymens to gauge their sexual activity.
In India, most doctors and nurses are not trained to treat violence against women as a larger health threat. Victims typically receive no guidance on legal aid and police procedures nor psychological counselling. “There is a huge gap in training and in medical curriculum. Doctors and nurses graduate without this training.”, said Claudia Garcia-Moreno, team leader in the Department of Reproductive Health and Research at WHO.
Surprisingly, India disregards the concept of forensic nursing, which forms the first line of victim care in the West with sexual assault nurse examiner (SANE) and sexual assault forensic examiner (SAFE) offering comprehensive health care to victims. SAFE performs physical assessment, provides first aid/ medications and helps in psycho-social counselling, forensic sample collection, preparation of medico-legal reports and work with victim-care centres, police, hospitals and forensic laboratories.
However, efforts have been made since the brutal gang-rape of 2012. The capital’s one-stop centre for rape victims was inaugurated by the Lieutenant-Governor Najee Jung in August last last. Similarly, earlier this year three civic hospitals in Mumbai started their one-stop crisis centres for survivors of sexual assault. The Ministry of Health has created an excellent two part document containing guidelines and protocols for survivors/victims of sexual violence. Dr Rajesh Pande, Director of Centre for Critical Care at B L K Memorial Hospital, New Delhi says, “It is important that medical officers working in the government or private hospitals are actually aware about this document and training workshops should be organized for them for this purpose by the Government of India Medical Association or the Medical Council of India.” He further adds, “I have not seen any such drive in the form of continual medical education (CME) or training or awareness drive for the RMP.”
Health professionals need to respond comprehensively to the needs of survivors. It is crucial that the government must mandate the deployment of forensic nurses/examiners, invest in forensic and rape-crisis facilities and sensitize professionals to facilitate evidence collection and victim counselling. In view of extreme under-reporting and acute shortage of physicians, every healthcare professional must be included in victim-care surveillance teams.
Madhumita Pandey is an Associate Fellow and Academic Researcher at the Anglia Ruskin University.