Gender Violence: The Health Impact: Child Sexual Abuse & Health Care Systems

An Interview with Vidya Reddy, Tulir

by Meera Srikant

Despite advancements in medicine in the country, there are not enough mid-level mental health professionals trained to work with children who have experienced sexual violence.

1. You work with children who have experienced sexual violence. Is our healthcare system equipped to provide them with the required care?

The healthcare system is definitely equipped where treatment of physical injuries is concerned. It is in fact families who are diffident to seek help unless there is blood and gore. If there are no physical injuries, then they do not even seek medical help. They are worried about the stigma attached to those who experience sexual violence

On the other hand, even medical professionals are diffident in our country to deal with sexual violence. Though treating cases of sexual violence is part of medical curriculum, they are not sufficiently trained.

There is a government guideline from the Ministry of Health, Government of India, specifying that private and government hospitals must provide treatment to those coming to them for treatment following sexual violence. The Government of Tamil Nadu has passed an order based on this advising heads of departments of government hospitals about treatment for such cases. However, while it refers to private hospitals in para 2 of the order, in para 3, it only mentions government hospitals. This can cause some confusion and we are bringing it to the notice of the authorities concerned to have this rectified.

This is required because currently, hospitals are too wary to treat children who come to them because of sexual violence. One, because there is diffidence in our society about discussing sexuality itself, and the doctors and nurses  are drawn from this society and have a similar attitude. There is greater diffidence about discussing sexual violence, and even more so when it is with reference to a child! And then the need to deal with courts since every assault case needs to be reported becomes a deterrent.

But while healthcare in our state, especially, may be equipped to handle the consequences of the assault on the body,  the mental health aspects of sexual assault leaves a lot to be desired.

2. You mean we do not have enough mental health professionals?

We do not have enough mid-level mental health professionals. We have psychiatrists who are pharmacologised in their approach, or counsellors. Anybody in a position to advice is called a counsellor. I think counselling is the most abused word in our country. We have a counsellor for everything, but they don’t have an understanding of the dynamics and effects of sexual violence! One counsellor, for instance, told me that she counselled children who were victims on how to “handle” the situation. They are children, how can they “handle” the situation? The entire society around them needs to be mobilised to give them support and address the situation appropriately, which would also mean making the abuser accountable! The onus should never be on the child.

Even social workers are not trained to deal with cases of sexual violence, and there is also stigma attached to such work. We are a two-member team at Tulir because women who come for interviews back off the moment they hear the work involves sexual violence. They believe their marriage prospects will diminish!

Social sector is dominated with women, with men mostly in managerial positions. Therefore, there are not enough men to address boys experience sexual violence. Sadly, there are almost as many boys as girls who are subjected to sexual violence.

3. What would you say are some of the challenges today?

Only children under 12 are seen by pediatricians. Girls of any age who experience sexual violence are referred to obstetricians and gynecologists and boys to surgeons, and hopefully a pediatric surgeon if one is around. Pediatricians are seldom trained in providing treatment for children who have experienced sexual violence because they need not just treatment for their physical injury, but a sensitive and understanding approach, which is sadly lacking. The doctors especially in the government hospitals cannot be blamed, though, because they also work under tremendous pressure and often in difficult conditions.

4. So does Tulir work with professionals on sensitising them?

We do. The results of a pretest that we conduct before starting a workshop can be very enlightening. We realise that even professionals harbour several misconceptions about child sexual violence. Many think only girls experience sexual violence. In fact, the father of a boy who had been sodomised told me, “I am glad I have a son and not a daughter!” They worry more about the consequences of sexual violence, like pregnancy, as that will bring dishonour to the family (spoil the future of the girl). With a boy, that possibility does not exist and so many families do not care.

But what about the boy’s mind, what goes on in there? Sometimes I think if the risk of pregnancy were not there, many would not even bother about such assaults!

5. So do you see the same stigma attached to children too, like adults?

No, not so much. But there is a reluctance to report cases. Even the police and and allied health professionals discourage the families of the victim from filing cases. They think it will affect their future prospects of marriage.

6. The media seems to be more active these days in reporting the cases. Do you think that helps?

It is superficial. They do not understand the complexities. Hang a rapist! Most of the times the rapist is a family member. Which child will want him or her hung? Media presents a very skewed picture, does not inform or educate the public, but creates paranoia. They are also the reason why many cases do not get reported, as people fear the news being splashed. As professionals who need to inform and educate the society, they need to become more sensitised and ethical when reporting such incidents.

7. How do you compare the Indian scenario with other nations?

There are at least 25 specialisations in addressing sexual violence in developed countries! India has a long way to go. In Tulir we do  all 25 rolled into one because we have no specialised systems to fall back on.

8. How about Tamil Nadu?

I would say our state is far ahead of others in awareness as well as redressal systems. When I go for meetings at the central level, they are discussing issues which our systems have addressed 10 years ago. We are looking to build on these and strengthen the system for better quality of healthcare and support for the children.

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Vidya Reddy is the co-founder of Tulir – Centre for the Prevention and Healing of Child Sexual Abuse. Tulir works to support and participate in local, national, and international efforts to promote and protect the rights of the child. Their work involves raising awareness about CSA, improving policy and practice to prevent and respond to CSA, providing direct intervention services as well as undertaking research, documentation and dissemination of information in the area.

Meera Srikant is a writer and a dancer. Violence of any sort disturbs her deeply, and by associating with Prajnya’s 16-day campaign, she hopes to contribute meaningfully for the cause in whatever little way she can.