Gender Violence:The Health Impact – Adopting a Survivor-Centric Attitude to Medical Care

by Aparna Gupta

Gender-based violence, apart from being a human rights violation, is also a major public health concern. In addition to physical injury that would require immediate medical attention, violence can lead to life-long psychological and physical health problems, along with social and occupational impairment. Therefore, providing effective medical care and support is crucial to mitigate the short- and long-term health effects of gender-based violence on survivors and their families.

Keeping this in mind, it is heartening to note that the State has tried to improve medical care for survivors through various interventions. The Supreme Court in Pt. Parmanand Katara v. Union of India, for example, ruled that doctors in both private and government hospitals have a paramount obligation to extend their services to protect the life of a victim of sexual assault.[i] Taking this judgement forward, the Criminal Law (Amendment) Act, 2013, inserted section 357C in the Code of Criminal Procedure, according to which all hospitals, both public and private, shall have to provide immediate first aid or medical treatment, free of cost, to the victims of sexual violence.[ii]  Refusal of medical care to survivors of sexual violence and acid attacks is a punishable offence under Section 166 B of the Indian Penal Code.

In December 2013, the Ministry of Health and Family Welfare took a significant step by issuing detailed guidelines for providing medico-legal care to survivors of sexual violence.[iii] Briefly, these guidelines include the following:

1. Compulsory informed consent of the survivor regarding examination, treatment and police intimation
2. Specific guidelines on dealing with marginalised groups such as persons with disabilities, sex workers, LGBT persons, children, persons facing caste-, class- or religion-based discriminations

• Ensuring gender sensitivity in the entire procedure and refraining from mentioning the survivor’s past sexual behaviour.

1. Standard treatment protocols for managing health consequences of sexual violence
2. Guidelines for provision of first-line psychological support

While commendable, these guidelines must be implemented in letter and spirit, to help in putting an end to the horrendous medical process that victims are subjected to after sexual abuse, and to prevent a miscarriage of justice, by ensuring the proper collection of evidence; laws, policies and guidelines, though a significant part of the solution, cannot guarantee tangible results by their mere existence. Thus, despite the existence of praiseworthy legal tools, survivors of gender violence have been repeatedly denied the much needed compassionate and sensitive post- violence medical care. The first point of contact for any survivor of violence is a medical establishment. However, doctors usually prioritise the collection of forensic evidence, and often insist on filing a police complaint as soon as survivors approach them for medical care, which can intimidate survivors and discourage them from pursuing treatment (Human Rights Watch, 2010)[iv] . Too often, survivors are forced to make gruelling trips from one hospital or ward to another, and receive multiple examinations at each stage. Medical workers frequently collect evidence inadequately, or insensitively, or both. While the provisions of trauma counselling and psychological care for survivors and their families are minimal, even basic medical care such as treatment for injuries or infections is denied to survivors at times (Nita Bhalla, 2013)[v].

Therefore, it is necessary that the existing policies and regulations are supplemented by certain urgent measures. The government should conduct sensitisation programmes in hospitals and for medical practitioners, in order to train them on the possible health consequences of violence against women and how to address such health consequences. The Justice Verma Committee suggested that each district should have a ‘Sexual Assault Crisis Centre’, with at least one female gynaecologist and one professionally qualified counsellor available on the premises. Subject to the survivor’s physical health and choice, their first interaction should be with the counsellor, then the doctor.[vi]

India can draw on the experience of other countries in this regard. For instance, the United Kingdom, the United States and Canada have specialised sexual violence crisis intervention centres equipped and staffed with trained professionals to provide integrated services, with a special focus on the therapeutic needs of survivors. Furthermore, South Africa provides specialised training for medical students on how to treat and examine survivors.

There is a need to recognise that gender violence is a complex problem with varied dimensions, and hence requires multi-sectoral interventions for prevention and management. In the fight against gender violence, strengthening medical health capacities  can go a long way towards providing empathetic and survivor-centric care for addressing survivors’ immediate health concerns and rebuilding their lives after assault.

[i] Pt. Parmananda Katara v. Union of India, 1989 4 SSC 289

[ii] Criminal Law (Amendment) Act, 2013

[iii] Guidelines & Protocols: Medico-legal care for survivors/victims of Sexual violence, Ministry of Health and Family Welfare, Government of India, December 2013.

[iv] ‘Dignity on Trial’, Human Rights Watch, September 2010.

[v] ‘How India’s police and judiciary fail rape victims’, Nita Bhalla, Shakti Vahini, January 2013,

http://shaktivahini.org/shakti-vahini-2/analysis-how-indias-police-and-judiciary-fail-rape-victims.

[vi] ‘Report of the Committee on Amendments to Criminal Law’, Justice J.S Verma, January 2013.

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Aparna Gupta is currently a fellow with PRS Legislative Research’s Legislative Assistants to Members of Parliament programme. An engineer by degree, and student of policy by day, Aparna aspires to work in the field of human rights and gender violence.