Gender Violence in India 2014: Domestic Violence

The United Nations General Assembly addressed domestic violence in Resolution 58/147, ‘Elimination of domestic violence against women’. This resolution defines domestic violence as occurring ‘within the private sphere, generally between individuals who are related through blood or intimacy’, and notes that it is ‘one of the most common and least visible forms of violence against women’. Domestic violence can involve ‘physical, psychological and sexual violence’ as well as ‘economic deprivation and isolation’.[1] Thus, domestic violence occurs in the home or other private space; victims usually share a household with perpetrators. In many cases, victims of domestic violence experience more than one form of abuse. While domestic violence can occur across genders, the United Nations and other organizations have recognized that victims are predominantly women.

A crucial subset of domestic violence, intimate partner violence (IPV), refers to abuse by one’s spouse or partner. The World Health Organisation defines IPV as including ‘acts of physical aggression, psychological abuse, forced intercourse and other forms of sexual coercion, and various controlling behaviours such as isolating a person from family and friends or restricting access to information and assistance’. While IPV can occur in both heterosexual and homosexual relationships, and can affect both men and women, the overwhelming majority of victims are women abused by male partners[2].

In India, IPV is seldom recognised as a distinct gender violence category. Women in abusive marriages may be reluctant to report the abuse because of societal perceptions that married women must ‘adjust’ to their husbands’ behaviour, and that speaking publicly against their husbands will bring shame to their families; on the other hand, unmarried women facing IPV may be dismissed as ‘asking for it’ by being in premarital relationships.

Know the law

The 2005 Protection of Women from Domestic Violence Act (PWDVA) is a civil law that aims to provide relief and compensation to victims of domestic violence. It does not provide for punishment of perpetrators, aside from possible payment of monetary compensation. It applies to women living in a ‘domestic relationship’ with an abusive man; it can thus be used by wives, sisters, widows, mothers, etc.[3] Crucially, this law also extends to women who live with their partners ‘in a relationship in the nature of marriage’, referring to women in live-in relationships. Moreover, a complaint can also be filed against the male and/or female relatives of the victim’s husband or intimate partner. The PWDVA defines domestic violence as actual abuse, or the threat of abuse, of a physical, sexual, emotional, verbal or economic nature.[4] This act also addresses harassment of women over dowry payments, or any other ‘unlawful demand’.[5]

Under the PWDVA, a magistrate or court can provide protection to the woman by barring the offender from committing violence within and outside of the home, from taking away the woman’s assets, from intimidating her and her family and from communicating with the woman. Additionally, the woman cannot be evicted from a shared residence, and can claim damages for mental and physical injuries. The magistrate can order maintenance, and grant her temporary custody of children.[6]

Complaints can be registered with a Protection Officer, a service provider, the police, or a magistrate. A Protection Officer is appointed by the state government and facilitates access to the services provided by the PWDVA. Service providers are non-profits and hospitals that can also aid the woman in accessing legal aid and medical services.[7]

In 2012, the Lawyers Collective Women’s Rights Group reported that it received an ‘extraordinary and unprecedented’ 22,255 orders from magistrates under the PWDVA, showing that women ‘have been turning up in the tens of thousands to invoke … the PWDVA as a shield against abuse and violence in their homes’.[8] However, it must be noted that as a civil law, the PWDVA cannot be utilised to pursue criminal proceedings against perpetrators of domestic violence.

Crucially, Section 375 of the Indian Penal Code, which addresses rape, includes an exception stating that ‘sexual intercourse or sexual acts by a man with his own wife … is not rape’.[9] Thus, a married woman cannot legally accuse her husband of rape. While Section 375 can be utilised by unmarried women who have been sexually assaulted by their intimate partners, there is a pervasive belief that rapists are not personally known to their victims, which makes it more difficult to prosecute such cases.

Married women do have the option of filing a criminal case against their husbands or his relatives under Section 498A of the Indian Penal Code, which addresses marital cruelty. Section 498A vaguely defines ‘cruelty’ as any conduct that ‘is likely drive the woman to commit suicide or to cause grave injury or danger to life, limb or [mental or physical] health,’ as well as ‘harassment … with a view to coercing her … to meet any unlawful demand for any property’.[10]

Keeping Count

The last National Family Health Survey (NFHS-3), conducted in 2005-06, surveyed married women on the incidence of spousal violence. More recent data from the survey are as yet unavailable, as the NFHS-4, 2014-15, is currently being conducted. According to the NFHS-3, 39% of currently married women have experienced physical, sexual or emotional violence by their current husbands, of which more than two thirds reported experiencing violence within the last twelve months.[11] Roughly one in three women report having been slapped by their husbands, and 10% of women report that their husbands have physically forced them to have sex. Between 11% and 15% of women surveyed report having their arms twisted or being pushed, shaken, kicked, dragged or beaten.[12] Only one in four women who experience violence have sought help to end the violence, and very few women report seeking help from the police or social organisations.[13] Moreover, the survey found that 54% of women and 51% of men between the ages of 15 and 49 believed wife-beating to be acceptable for one or more reasons.[14]

The study also reports a greater likelihood of spousal violence among women whose fathers beat their mothers, and among women whose husbands get drunk often.[15] In addition, women who are employed and earn money are much more likely to experience spousal violence, particularly if they earn more than their husbands.[16] For women who make household decisions jointly with their husbands, including how to use their own earnings, the odds of experiencing violence are lower than for women who either make these decisions alone, or do not have a major say in such decisions.[17]

The National Crime Records Bureau (NCRB) tracks reports of ‘Cruelty by Husband or his Relatives’. Table 1 and Figure 1 show the number of cases reported each year nationally from 2002 to 2013. Not all cases resulted in a trial or conviction; some cases are still pending.

Table 1: Reported Cases of Cruelty by Husband or his Relatives, NCRB[18]

Year 2002 2003 2004 2005 2006 2007
Number of cases reported of cruelty by husband or relatives 49237 50703 58121 58319 63128 75930
Year 2008 2009 2010 2011 2012 2013
Number of cases reported of cruelty by husband or relatives 81344 89546 94041 99135 106527 118866[19]

 Figure 1

DV I

The 2013 figure of 118,866 cases reported is an 11.6% increase from the number reported in 2012, and a 316% increase from the 28,579 cases first mentioned in 1995 by the NCRB. Of the cases from 2013, the highest proportion came from West Bengal (15.2%), followed by 12.7% each from Rajasthan and Andhra Pradesh.[21] Moreover, crimes under Section 498A represent roughly 40% of all crimes against women recorded by the NCRB under the Indian Penal Code.[22] While the NCRB data includes complaints filed by married women against not only their husbands, but also their husbands’ relatives, it does not extend to unmarried women in intimate relationships.

A recent study by the World Health Organisation (WHO), in partnership with the London School of Hygiene & Tropical Medicine and the South African Medical Research Council, titled ‘Global and Regional Estimates of Violence against Women: Prevalence and Health Effects of Intimate Partner Violence and Non-Partner Sexual Violence’, found that globally, 30% of women have experienced IPV.[23] Based on an analysis of data from 155 studies in 81 countries, the report does not provide country-specific information, but presents consolidated data from low- and middle-income countries in six different WHO-defined ‘regions’, in addition to a separate category with high-income countries from the different regions.[24] The South-East Asia Region, which includes India, has the highest rate of IPV among surveyed women, at nearly 38%.[25]

The report also reveals that 38% of all murders of women around the world are committed by their intimate partners,[26] and that women facing IPV are about 16% more likely to have babies with low birth-weight,[27] twice as likely to have an abortion,[28] almost twice as likely to experience depression and have alcohol-use problems,[29] and in some regions, 1.5 times more likely to contract HIV.[30]

[1] ‘Elimination of domestic violence against women’, United Nations General Assembly Resolution 58/147, 19th February 2004, http://daccess-dds-ny.un.org/doc/UNDOC/GEN/N03/503/40/PDF/N0350340.pdf?OpenElement, accessed 20th November 2014.

[2] ‘Intimate partner violence: facts’, World Health Organisation, p. 1, http://www.who.int/violence_injury_prevention/violence/world_report/factsheets/en/ipvfacts.pdf, accessed 29th October 2014.

[3] Protection of Women from Domestic Violence Act, 2005, Section 2, http://wcd.nic.in/wdvact.pdf, accessed 29th October 2014. Section 2(a) defines an ‘aggrieved person’ as ‘any woman who is, or has been, in a domestic relationship with the respondent’ and who alleges to have experienced domestic violence. Section 2(f) defines a ‘domestic relationship’ to include living together ‘in a shared household’ as well as relationships of consanguinity, marriage or adoption.

[4] PWDVA. See above note 3. Section 3(Explanation I)(i-iv) defines physical, sexual, verbal and emotional and economic abuse.

[5] PWDVA. See above note 3. Section 3(b) includes in its definition of domestic violence harassment intended to ‘coerce [a woman] … to meet any unlawful demand for any dowry or other property’.

[6] Lawyers Collective Women’s Rights Initiative, ‘Frequently Asked Questions on the Protection of Women from Domestic Violence Act 2005’, p. 3, http://www.lawyerscollective.org/files/FAQonProtectionOfWomen1.pdf, accessed 2nd September 2014.

[7] PWDVA. See above note 1. Section 2(n) defines a ‘Protection Officer’, and Section 2(r) defines a ‘service provider’.

[8] Gopal, M. G., ‘The Big Picture’, from Staying Alive: Evaluating Court Orders, Sixth Monitoring and Evaluation Report 2013 on the Protection of Women from Domestic Violence Act, 2005, Lawyers Collective Women’s Rights Initiative, p. ix, http://www.lawyerscollective.org/wp-content/uploads/2012/07/Staying-Alive-Evaluating-Court-Orders.pdf, accessed 2nd September 2014.

[9] Indian Penal Code, Section 375(Exception), http://indiankanoon.org/doc/623254/, accessed 29th October 2014.

[10] Indian Penal Code, Section 498A, http://indiankanoon.org/doc/538436/, accessed 29th October 2014.

[11] Kishor, S. & Gupta, K., ‘Chapter 10: Spousal Violence’, ‘Gender equality and women’s empowerment in India’, National Family Health Survey (NFHS-3) India 2005-06, Ministry of Health and Family Welfare, p. 96, http://www.rchiips.org/nfhs/a_subject_report_gender_for_website.pdf, accessed 28th October 2014.

[12] See above note 11, p. 97.

[13] ‘Key Findings Report’, National Family Health Survey (NFHS-3) India 2005-06, p. 21, http://www.rchiips.org/nfhs/NFHS-3%20Data/NFHS-3%20NKF/Report.pdf, accessed 28th October 2014.

[14] See above note 11, p. 74.

[15] See above note 11., p. 102 (for correlation with parental domestic violence) and p. 104 (for correlation with husbands’ drinking often).

[16] See above note 11, p. 100.

[17] See above note 11, p. 100.

[18] ‘Cases registered and their disposal under Cruelty by Husband or his Relatives during 2001-2012’, Crime in India 2012, National Crime Records Bureau, http://www.data.gov.in/catalog/cases-registered-and-their-disposal-under-cruelty-husband-or-his-relatives#web_catalog_tabs_block_10, accessed 29th October 2014. Table 1 and Figure 1 data up to 2012 are from this report; for 2013 statistics, see above note 18.

[19] ‘Chapter 5: Crimes against Women’, Crime in India 2013, NCRB, p. 81, http://ncrb.gov.in/CD-CII2013/Chapters/5-Crime%20against%20Women.pdf, accessed 26th September 2014.

[20] Figure 1 was generated using the data from Table 1.

[21] See above note 18, p. 84.

[22] See above note 18, p. 81.

[23] ‘Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence’, World Health Organisation, 2013, p. 2, http://www.who.int/reproductivehealth/publications/violence/9789241564625/en/, accessed 29th October 2014.

[24] See above note 23, p. 9-10.

[25] See above note 23, p. 17.

[26] See above note 23, p. 2.

[27] See above note 23, p. 23.

[28] See above note 23, p. 23.

[29] See above note 23, p. 24-25.

[30] See above note 23, p. 29.

*****

This series of posts were researched, drafted and edited by Divya Bhat, Shakthi Manickavasagam, Titiksha Pandit and Mitha Nandagopalan.

December 2014

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Gender Violence: The Health Impact – Blog Symposium Index of Links

A consolidated index of all the posts from the Blog Symposium on Gender Violence and Health that was part of the 2014 Prajnya 16 Days Campaign against Gender Violence can be found below.

Gender Violence:The Health Impact – Training Health Workers to Respond to GV – The Dilaasa Model

by Rashi Vidyasagar

World over, gender based violence has been accepted as a public health issue. As per the World Health Organisation (WHO), “The principles of public health provide a useful framework for both continuing to investigate and understand the causes and consequences of violence and for preventing violence from occurring through primary prevention programmes, policy interventions and advocacy.” This is because violence has severe physical and mental health consequences – both short term and long term, which includes bruises, cuts, and wounds, lacerations to depression, anxiety, nightmares, pregnancy, STIs, HIV, and even, death. All of these require a visit to the health facility where if proper care and treatment is provided, the survivor can begin the process of healing. Moreover, there is evidence to show that women are more likely to visit a hospital after an episode of violence rather a police station or a counselling centre.

Interventions carried out at the public health level (individual as well as community) can help mitigate violence and help deal with its consequences. However, medical professionals are ill- equipped to sensitively respond to the issue of violence against women. Lack of training and education on this issue, general indifference to dominant societal norms that legitimise violence against women are only some of the reasons for the inability of the professional to respond effectively to the needs of victims of violence. There is evidence that, even when women facing violence are identified within the health care system, providers have a tendency to focus on the physical consequences of abuse, to be condescending and distant, and to blame women for the violence they face. [Campbell and Lewandowski 1997; Kurz and Stark 1988; Layzer et al 1986; Vavarro et al 1993; Warshaw 1989, Daga 1998]. Within the medical context, violence is understood as a social problem and/or private family matter, as it does not fit into the traditional illness model. As noted elsewhere, “The concern for violence is conspicuous by its virtual absence in medical discourses. The special medical needs and rehabilitation of victims and survivors of violence are hardly ever discussed by doctors” (Jesani 1995). Thus, training becomes an integral part of any intervention with the health care system to fill the void left by the medical education.

It was with this view that Dilaasa, a hospital based crisis center was set by Municipal Corporation of Greater Mumbai (MCGM) in collaboration with CEHAT. Today, Dilaasa is a fully functional department within a 400+ bed hospital in the heart of Mumbai.

When CEHAT did the need assessment while setting up Dilaasa, a hospital based crisis centre in 2001, the need to develop a training module emerged clearly. This training was not only for doctors but also for hospital administrators, nurses and every health care professional. Between 2001 -2003, a module of adult peer to peer learning was created. A mixed group of doctors and nurses were selected with the hope that they would go on to train their own cadre. Despite this, referrals were low. This prompted the need to have continuous training of all medical professionals rather a one-time training. In 2006, Dilaasa started expanding and more and more health care providers were interested in providing services, however, the current healthcare system was not able to sustain their interest. It was then when it was decided to set up a training cell. It was formed to share resources and experiences of HCPs dealing with domestic violence, as well as provide them with formal roles of trainers with the aim of mainstreaming the training cell in the current health system.

The impact of this training can be seen in the steady growth of referrals by the health system. Along with training, it was also essential to give certain information-education-communication (IEC) material to these health care providers to supplement their referrals. Visiting cards, brochures, posters, pamphlets with messages of how violence is not their fault or that suicide is not the way out were printed. All of these were displayed prominently in the hospital or given to the doctors. It was realised that doctors don’t necessarily ask women patients about abuse in the OPDs. Women who reported abuse were being referred but no effort was made to draw out those who may have been abused but did not report it. That is when checklists of health consequences for each department and how could they ask about violence were printed and placards were made.

In the 14 years that Dilaasa has been functioning in a public hospital, training has been the cornerstone of the work that is being done. Continuous training with the hospital staff gives them a sense of identification and association with the project. The role of a medical professional is to identify, document and refer a survivor of violence. There should be no ambiguity in the expectations from the training. Training can provide tools that are required to identify the abuse and can also provide an important document if the woman takes the legal road. However, for the provision of comprehensive healthcare, this needs to be supplemented by a counselling centre where the doctors can refer the woman and/or organisations that provide services like shelter, counselling and legal aid to the survivor.

The following case study shows the importance of training all the hospital staff to recognise signs of abuse

Amma was referred to the Occupational Therapy Physiotherapy (OTPT) department by the orthopaedic department for the injuries that she had sustained. Amma had reported that she had fallen and hurt herself. At the OTPT she had received therapy for her hand and shoulder for a week. During this period, the physiotherapist found time with her alone and told her about Dilaasa and what it does. She then asked her if she would like to go there. Amma said, “No, I do not need it”. The following day, the physiotherapist asked her how she had sustained her injuries. Amma repeated the same story about a fall. The physiotherapist suspected abuse but did not want to probe further as she feared that the woman might not come back for treatment. She then asked one of the Dilaasa counsellors to come to OTPT department and speak to her. Amma then talked about the abuse she had suffered and subsequently sought Dilaasa services

Amma’s story is a testimony to the effect that training can have. Since 2001, Dilaasa has responded to over 3000 women, most referred by health care professionals. This has been possible through continuous support of the hospital staff, the trainers and the administrators who have ensured that a comprehensive health care response to survivors can be provided.

More information on setting up Dilaasa, the process of training the health care providers and other work related to Domestic Violence and Sexual violence can be found here: http://cehat.org/

*****

Rashi Vidyasagar is a Criminologist who is currently engaged in research on issues around violence against women including domestic violence and sexual assault. She is a Crisis Interventionist who works with CEHAT (Centre for Enquiry into Health and Allied Themes) in Mumbai.

Gender Violence: The Health Impact: Gender-Based Violence and LGBTQI communities

by L. Ramakrishnan

Background

We understand violence as the “intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation” (Krug et al., 2002). Gender, as a fundamental axis of power difference privileging men over women, serves as a basis for much of the violence we see in the world today.

While gender-based violence has come to signify violence against women, the violence faced by lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) communities is perpetuated by the same patriarchal rules that work to keep the categories ‘women’ and ‘men’ and the norms and expectations associated with these, separate and unequal (Pharr, 1988).

Glossary

Gay: Persons (usually men) exclusively or predominantly attracted to members of their own gender, regardless of their sexual behavior or relationship status

Lesbian: Women exclusively or predominantly attracted to other women, regardless of their sexual behavior or relationship status

Bisexual: Persons significantly attracted to individuals of more than one gender, regardless of their behaviour or relationship status

Transgender: Persons whose personal gender identification runs contrary to the gender associated with their biological sex assignment, regardless of their sexual behavior, attraction or relationship status

Gender-nonconforming: Individuals, particularly children, who, by their external appearance, mannerisms, behavior or activities, fail to conform to the gender associated with their assigned biological sex. Some gender-nonconforming children may grow into a transgender identity as adults, others lesbian, gay or bisexual, and yet others heterosexual.

Cisgender: Persons who are not transgender

Queer: Often used as an umbrella term for people of non-normative sexualities or genders

Intersex: Persons whose biological sex is intermediate between male and female, as defined with respect to chromosomes, genitals, gonadal tissue and/or typical levels of sex hormones.

For a more detailed explanation of these terms, please click here.

LGBTQI people, by virtue of sex, gender or sexuality, encounter violence of varying intensities, from ridicule to physical, emotional and sexual assault, to murder. Scales of violence range from the inter-personal to the state-sanctioned. Some examples and their impact are below. 

Families

“What will others say?”

 “No son of mine is going to be that way”

Families are often the first sites of violence against LGBTQI people, with many parents perpetuating differential treatment commencing from the moment the child is determined to be a boy or a girl, and enforcing gender-specific expectations on the child at every stage of development.

Embarrassment, shame, anger, emotional and occasionally physical violence meet the child or young adult who is does not conform to the behavior expected of his/her gender, whether a girl-assigned child who does not manifest the nurturing, domestic and compliant qualities required for ascension into traditional heterosexual womanhood and motherhood, or a male-assigned infant who does not grow up to be an athletic boy and dutifully transform into a ‘real’ man a.k.a. breadwinner, husband, and father who will ensure continuity of the family line.

“Paro’s mother reads her personal diary, finds out she has had relationships with women, and calls up all her friends asking them if they have had sexual relations with her…[t]he subsequent shame Paro experiences because of her mother’s action caused the termination of many of these friendships. This episode also triggers a series of physically violent cycles between the mother and the daughter, where Paro is beaten up.” (Fernandez and Gomathy, 2003)

Visibly gender-nonconforming children, or those whose romantic and sexual interests as adolescents or young adults approaching “marriageable” age appear to be directed towards the same gender, are often taken by anxious parents to healthcare providers, in the hope that medical interventions will help restore their children to normative sexuality or gender (Ramakrishnan, 2011).

Perhaps the most insidious violence perpetrated by families of LGBTQI people on those whose romantic/sexual attractions lie elsewhere is forced marriage to individuals of the other sex. This is a crime whose victims extend beyond the gay/lesbian individuals and include their spouses who are often unaware of this incompatibility until after marriage, and – in some cases – children.

Individuals who are same-gender attracted, but who are not otherwise conspicuous with respect to non-conforming gender expression, find it arguably more difficult to have their sexual orientation taken seriously within the family and elsewhere. Invisibility and dismissal by family of one’s orientation as inconsequential, or as a phase that can be overcome by marriage, can be as oppressive as other forms of violence.

Educational Institutions

“[Homophobic bullying] is a moral outrage, a grave violation of human rights and a public health crisis” – UN Secretary-General Ban Ki-moon in 2011

Policing of gender roles and punishment for transgression extends to LGBTQI young people in educational institutions. Bullying from peers disproportionately targets children who are gender-nonconforming, overweight and/or living with disabilities (UNESCO, 2012). Violence may also be perpetrated in the form of physical and sexual abuse from teachers.

In one large-scale longitudinal study of over 9800 youth in the US, childhood gender-nonconformity predicted increased risk for sexual, physical, and psychological abuse and lifetime probable post-traumatic stress disorder (Roberts et al., 2012). Closer to home, a study of kothis (feminine same-gender attracted males) in six cities of India and Bangladesh indicated that 50% of the 240 respondents had experienced harassment and violence from classmates, teachers and non-teaching staff in school and college (Bondyopadhyay & Khan 2005).

Hostile educational environments, coupled with unsupportive families, lead many transgender or gender-nonconforming children to drop out of the educational system, resulting in lost opportunities for gainful employment as adults (MSJE, 2014).

Workplace

Barring community-based organisations, progressive NGOs, and multinational companies that enforce LGBTQI-inclusive diversity and anti-harassment policies, most Indian workplaces are hostile to LGBTQI employees.

Violence against lesbian, gay and bisexual people in the workplace takes the form of homophobic comments and innuendo, directed at individuals who do not flaunt proof of their heterosexuality (Philip, quoted in Sriram, 2014). If the company includes sexual orientation in its diversity policy, individuals who are openly lesbian, gay or bisexual may be dealt with more cautiously for fear of punitive action, but may have to contend with sniggers and homophobic comments behind their back. Individuals who are in the closet may be subjected to the same heterosexist or homophobic water-cooler conversations as their heterosexual colleagues (Pai, 2013).

While very few openly transgender people make it through the educational system and are in a position to enter the formal workforce, anecdotal experiences suggest that transgender individuals trying to transition while employed contend with much resistance and hostility.

“Angel Glady, a transgender woman working in a private software firm in Chennai, … narrated the agony that she had gone through in her initial years as an [transgender] employee living as a man. Despite having disclosed to the Team Leader about her gender identity, she was forced to come to work in male attire. In addition, she also had to undergo physical discomfort such as using the male restroom. She then made a decision to quit after her failed attempts to make the Team Leader understand her situation. But Glady’s hard work and commitment paid off, when she was offered the same position in the same company again, post her transformation to a woman. The second time she made it clear that she would identify herself only as a woman… However, when she got back to work as a woman, she had to endure uncomfortable and piercing stares from her colleagues. Except for a few close friends, the others stayed away from her.” (Kannan and Deepthi, 2011)

Healthcare

Like most other institutions in society, healthcare institutions – including medical education – are grounded in heterosexist assumptions that are reflected in clinical practice. Many Indian medical textbooks echo antiquated and incorrect understandings of homosexuality as pathology or as psychiatric disorder, notions that have been discarded since 1992, when the World Health Organisation removed homosexuality from its International Classification of Diseases (ICD-10).

“Female homosexuality is known as tribadism or lesbianism … [t]he practice is usually indulged in by women who are mental degenerates or those who suffer from nymphomania (excessive sexual desire) … lesbians who are morbidly jealous of one another, when rejected may commit homicide, suicide or both”- excerpt from The Essentials of Forensic Medicine and Toxicology, 21st edition, 2002, by Dr. K. S. Narayan Reddy, MD, DCP, PhD, FAMS, FIMSA, FAFM, FAF Sc., FIAMS, cited in Guha Thakurta, 2014.

Little wonder that those lesbian, gay and bisexual people who can afford to conceal their sexuality when seeking healthcare, do so! This concealment is not without its hazards, though. Gynecologists routinely make assumptions of exclusive heterosexuality while seeing lesbian or bisexual clients and fail to ask vital questions about sexual activity or relationship status. Specialists in sexually transmitted diseases assume heterosexuality when the client appears gender-normative and neglect to assess sexual health and exposure to risk in a comprehensive manner.

Despite decades of scientific evidence confirming that sexual orientation (APA 2009) and gender identity (Lev, 2004) are not amendable to external attempts at modification, ignorant and unscrupulous medical providers in India continue – to this day – to subject LGBTQI adolescents and young adults to psychotropic drugs, electro-shock therapy and other unscientific and discredited practices that  achieve  little more than undermining the physical and mental health of the clients. Such aversion therapy is often carried out at the behest of the parents of the client, but occasionally clients request it for themselves, unable to bear the ordeal of struggling to survive in a homophobic world.

A gay man in Bangalore who was subjected to aversion therapy explained: “She connected some wire to my left hand and tried the machine, but it didn’t work for some time. She repaired it and then asked me to look at man’s photo. I saw the photo for some time and she gave me a shock. Then she asked me to change and look at a woman’s photo. Like this she kept asking me to change and giving me shock when looking at the man’s photo. The shock was very painful. I couldn’t continue after two or three and told her I wanted to stop.” (Mr V, client, cited in Narrain and Chandran, undated)

Treatment meted out by healthcare establishments to transgender clients is worse. It is not uncommon for doctors, upon seeing a transgender woman in the clinic or ward, to summon all colleagues and students, and make the person expose her genitals to the crowd without consent, for a supposedly educational demonstration. Transgender people in India who seek medical (hormonal or surgical) intervention find it an uphill task to locate providers who are both clinically competent and sensitive to their gender issues.

Intersex infants born with ambiguous genitalia face violence through the scalpel of pediatric surgeons who believe they know best for the infant in terms of surgery and gender assignment, despite increasing evidence that the patients, as adults, are often dissatisfied with the outcome of these surgical decisions (Guterman, 2012).

Law

State-sanctioned violence against LGBTQI people is manifested most prominently in Section 377 of the Indian Penal Code. A relic from India’s colonial past, IPC 377 criminalises all forms of penetrative sexual activity that do not involve a penis and vagina. The charge of criminality applies even if these acts involve consenting adults in private, thus undermining the LGBTQI communities’ constitutionally granted rights to freedom, equality, dignity, and privacy. A frequent claim by opponents of LGBTQI rights is that IPC 377 has been infrequently used to prosecute community members. The reality is that it makes the community vulnerable to blackmail and extortion, and to harrassment from the police.

The Delhi High Court, in its path-breaking Naz Foundation verdict of 2009, ruled IPC 377 unconstitutional and asked for it to be read down to exclude consensual adult relationships. However, the Supreme Court reinstated the Section, in its original form, in Dec 2013, after the four-year reprieve granted by the Naz judgement.

A subsequent judgement, NALSA vs. Union of India, passed in April 2014, asserts the rights of transgender people to enjoy full citizenship, and directs all ministries and their state counterparts to ensure inclusion of transgender people within the ambit of their schemes, provisions and entitlements.  Viewed globally as one of the most far-reaching judgements in the domain of transgender law, the NALSA judgement, however, will fall short until it is implemented in its entirety, and as long as IPC 377 continues to be valid, denying sexual rights to many in the transgender community.

Law-enforcement

Violence perpetrated by the law enforcement against LGBTQI people is not limited to use of IPC 377. Community members, especially working class transgender women, are routinely picked up on charges such as ‘public nuisance’ and incarcerated and/or exploited. In 2006,  Pandian/Pandiammal, a transgender person who was repeatedly and brutally sexually abused by the police in Chennai, chose to immolate herself in front of the police station. In their 2007 ruling, Justice AP Shah and Justice P Jyothimani ordered the Government of Tamil Nadu to provide compensation to the next of kin (MSJE, 2014): this case became one of those cited by Justice Shah in his subsequent judgement of 2009.

Way forward

Some strategies to be implemented within the short- and medium- term include:

  • Developing peer- and professional support systems including mental health interventions for LGBTQI people bearing the brunt of violence
  • Instituting psychosocial support for parents of LGBTQI individuals to better understand their children and deal with them in non-violent ways.
  • Strengthening capacities of health care providers to ensure gender- and sexuality-sensitive, stigma-free and clinically competent services to LGBTQI people in need
  • Making conversion therapy a punishable offence
  • Policy advocacy towards zero-tolerance for bullying and other forms of violence in educational institutions, with mechanisms for redressal
  • Decriminalisation of consenting sexual relationships among adults
  • Comprehensive Non-Discrimination laws that include sexuality and gender identity within their scope, and are enforceable across institutions in the public and private sector

In the long term, addressing violence against LGBTQI communities requires one to tackle the root causes of this violence, i.e. the tyranny of gender roles and their imposition across all institutions from family to law and society. All movements engaged in social justice and dismantling oppression have a stake in this, and need to work in solidarity with each other.

References

APA Task Force on Appropriate Therapeutic Responses to Sexual Orientation. 2009. Report of the Task Force on Appropriate Therapeutic Responses to Sexual Orientation. Washington, DC: American Psychological Association.

Bondyopadhyay, A. and S. Khan. 2005. From the front line: A report of a study into the impact of social, legal and judicial impediments to sexual  health promotion, care and support for males who have sex with males in Bangladesh and India. Naz Foundation International

Fernandez, B. and N.B. Gomathy. 2003. The nature of violence faced by lesbian women in India. Mumbai: Research Centre on Violence Against Women, Tata Institute of Social Sciences.

Guha Thakurta, T. 2014. The homophobic doctor. Varta Blog. Online at http://varta2013.blogspot.com/2014/03/the-homophobic-doctor.html

Guterman, L. 2012. Why Are Doctors Still Performing Genital Surgery on Infants? Open Society Foundations blog. Online at http://www.opensocietyfoundations.org/voices/why-are-doctors-still-performing-genital-surgery-on-infants

Kannan, D. and S. Deepthi. 2011. LGBT Voices: Report of a panel discussion held during Chennai Pride 2011. Online at http://orinam.net/lgbt-voices-report-of-a-panel-discussion-held-during-chennai-pride-2011

Krug E.G., L.L. Dahlberg, J.A. Mercy, A.B. Zwi and R. Lozano. Eds. 2002. World report on violence and health. Geneva, World Health Organization

Lev, A.I. 2004. Transgender Emergence: Therapeutic Guidelines for Working with Gender-Variant People and Their Families. Haworth Press.

MSJE, 2014. Report of the Expert Committee on the Issues relating to Transgender Persons. New Delhi, Ministry of Social Justice and Empowerment. Online at http://socialjustice.nic.in/transgenderpersons.php

Narrain, A. and V. Chandran. Undated. “It’s not my job to tell you it’s okay to be gay…” Medicalisation of Homosexuality: A Queer Critique. Manuscript.

Orinam, 2014. Sex, Gender and Sexuality: a primer. Online at http://orinam.net/content/wp-content/uploads/2011/10/Orinam_GSS101.pdf

Pai, N. 2013. Inclusion without Explosion. The Orinam blog. Online at http://orinam.net/inclusion-without-explosion/

Pharr, S. 1988. Homophobia: a weapon of sexism. Arkansas, Chardon Press.

Ramakrishnan, L. 2011. Why Women Need To Ally With The LGBT Cause. Women’s Web. Online at http://www.womensweb.in/articles/women-ally-lgbt-cause/

Roberts, A.L., M. Rosario, H.L. Corliss, K.C. Koenen and S.B. Austin. 2012. Childhood Gender Nonconformity: A Risk Indicator for Childhood Abuse and Posttraumatic Stress in Youth. Pediatrics. http://pediatrics.aappublications.org/content/early/2012/02/15/peds.2011-1804

Sriram, H. 2014. Corporate India is not ready for gay employees as yet. Hindustan Times. Online at http://www.scribd.com/doc/203510405/Hindustan-Times-Delhi-2014-01-29

UNESCO, 2012. Education Sector Responses to Homophobic Bullying. Paris: United Nations Educational, Scientific and Cultural Organization. Online at http://www.lgbt-education.info/doc/unesco/UNESCO_Homophobic_bullying_2012.pdf

*****

L. Ramakrishnan is a biologist by training. He is affiliated with the NGO SAATHII that works towards access to healthcare, legal and social services for marginalised populations, including those affected by the HIV/AIDS epidemic and LGBTQI communities.  

Gender Violence: The Health Impact – Female Genital Mutilation in India

by Zubeda Hamid

It’s called the haram ki boti: the clitoral hood that is cut away or nicked before a girl reaches puberty. Known primarily as a practice prevalent in some parts of Africa and among immigrant communities in Europe, the United States and Australia, female genital mutilation, cutting or ‘female circumcision’ as it is sometimes known, is practiced in India too. The brutal, non-medical procedure is carried out for a variety of reasons and causes immense physical and psychological damage. It can even be fatal. The World Health Organisation estimates that more than 125 million girls and women alive today have been cut in the 29 countries in Africa and the Middle East where FGM is concentrated.

In India, FGM is practiced by the Dawoodi Bohra community, an Ismaili Shia sect who live primarily in Gujarat, Maharashtra and Rajasthan. The practice probably originated when the community migrated from Yemen, Egypt or other parts of that region to India some centuries ago, or was brought over by a priest and thus gained religious sanction. The community, about 10 lakh strong are mostly wealthy traders and well educated. Due to the intense secrecy in which it is shrouded, it is unclear how many in the community practice FGM.

Said to be done when the girl is seven, the procedure is usually carried out by an older woman in the community, a dai or a midwife with little or no medical training using crude instruments such as blades and no anaesthesia. Of late though, reports suggest some women take their daughters to hospitals and ask for the procedure to be performed by a doctor or get it done at birth. Accounts by women who have been through the procedure, a recent documentary on the subject titled ‘A Pinch of Skin’, several blog posts and online forums all suggest this is the only Muslim community in India to practice ‘khatna’.

According to the World Health Organisation, female genital mutilation comprises all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons. It is classified into four types:

  • Clitoridectomy – partial or total removal of the clitoris
  • Excision which is clitoridectomy and removal of the labia minora with or without excision of the labia majora
  • Narrowing of the vaginal orifice with the creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora
  • All other harmful procedures such as pricking, piercing, incising, scraping and cauterization.

The Dawoodi Bohras practice the first type –clitoridectomy. Cutting off the hood of the clitoris exposes sensitive nerve endings and potentially limits the possibility of sexual pleasure through clitoral stimulation. Women who have undergone it describe female relatives holding down their legs, their fear, the excruciating pain and burning as they scream and the applying of a home remedy afterwards. The procedure is then never mentioned they say, and women are expected to ensure their daughters undergo it too.

A number of reasons are given by the community about the practice according to several posts: claims such as it prevents cancer to reasons such as it is compulsory in Islam and that it is tradition and has to be done in order to be respected in the community. It is also considered a means of ensuring that the girl becomes ‘pure’ and that her marriage goes through.The Quran has no mention of female genital mutilation or circumcision, and its mention in the Hadith is ambiguous at best.

Female genital mutilation has no health benefits, says the World Health Organisation. It can cause a number of health problems including severe pain, bleeding and shock, difficulty in urinating, cysts, infections, abscesses, infertility, difficulties in child birth, HIV, scar tissue formation and genital ulcers among others. This is apart from the psychological damage including post-traumatic stress disorder and long-term sexual effects such as decreased sexual enjoyment and painful sexual intercourse.

What the practice attempts to do, much like communities that kill young men and women for marrying outside their castes, is exercise control over women, specifically over female sexuality. As Tasleem, an activist from within the community who, a few years ago, started a petition against FGM has put it, “This is essentially done to prevent homosexuality, masturbation, and to subdue a girl’s desires so that she doesn’t marry out of the community or have extra-marital relationships.” Tasleem claims 90 per cent of the community continues to practice this custom, and that in many cases, the men are unaware it takes place. Maker of the documentary Priya Goswami has said to DNA: “Since the community was predominantly merchants, men travelled a lot. Removing the haraam ki boti, as it is called, was a way to control the sexual urges of women and keep them from infidelity.”

Not just does FGM constitute an extreme form of discrimination against women in deeply patriarchal societies it is also part of a larger culture where violence against women and in this case, girl children is perhaps the norm. In some parts of Africa, women are cut repeatedly: before puberty, before marriage, and after childbirth, in an attempt not just to reduce the woman’s libido, but also to make her vaginal opening tighter for the enhanced pleasure of men and to discourage illicit sexual intercourse. And while in India this extreme form of FGM is not practiced, the fact that a girl’s genitalia is cut to any degree at all points to the extreme mistrust of female sexuality and the need to maintain control over it.

The immense reluctance of the community to talk about this subject even within families has, to some extent, been broken recently, with Tasleem’s petition. Going only by a first name Tasleem launched a campaign online asking for signatures to petition the community’s high priest, Syedna Mohammad Burhanuddin to ban this custom. The petition was picked up by the ‘Indian Muslim Observer’, a website on Muslim affairs, whose founder-editor Danish Ahmad Khan has also supported the campaign. “The issue of FGM…is surely an important one, particularly when it is being practiced in the name of Islam. This also brings into sharp focus the unholy and absurd role being played by the Bohra clergy…,” a note of his said, adding that awareness was needed to stop this “condemnable practice”. The late Dawoodi Bohra reformist writer Asghar Ali Engineer had also spoken out about the practice, calling it an “attempt to suppress sexuality so that women do not go astray”, in an interview to ‘Outlook’.  As of October 6, 2013, the petition had received 2,500 signatures with a several women who have undergone FGM supporting it. However, so far, the high priest has refused to respond to the petition.

The fact that FGM violates a child’s body makes it an important human rights issue. Globally, there are several campaigns to stop the practice, and many countries have legislations making it an offence. The European Union, the United States, Australia, Ireland, New Zealand, Canada and several other countries have laws against it, while in Africa several countries including Ethiopia, Togo, Uganda, Kenya and Egypt have banned it. In 1993, the United Nations General Assembly included FGM in its resolution on violence against women, and since 2003 has been sponsoring a day on zero tolerance to FGM every year. In 2012, the Assembly adopted a resolution on the elimination of FGM. On October 30 this year, the United Nations secretary general, Ban Ki-moon, announced a global campaign to end it within a generation. Amnesty International runs an ‘End FGM’ campaign and there are many others in several parts of the world.

These organisations have attempted to get religious leaders to speak out against the practice and tell people that it is not compulsory in any religion. While some leaders have proclaimed it un-Islamic, other local clerics continue to sanction it or turn a blind eye. The fact that many African communities believe their daughters are unmarriageable unless cut, adds to the difficulty of stopping the practice. In July this year, ISIS, the Islamist terrorist group allegedly ordered FGM to be carried out on all women in Iraq between the ages of 11 and 46. A UN coordinator said, this potentially affect an estimated four million women. There were later reports that the ISIS dismissed this order, calling it false propaganda.

In India however, a lack of knowledge about this practice, the fact that it seems to be practiced by just one community and the reluctance of the community to speak out against it has allowed it to continue. While there is no law specifically banning the practice in India, it could be punishable under sections of the Indian Penal Code if a complaint is made, ‘Business Line’ has reported. Section 326 – causing grievous hurt, could be used to penalise the parents and person performing FGM if a minor girl is involved, it said.

Will anyone ever use the law though, is debatable. Members of the community have told publications that they fear excommunication if they defy community traditions, and some of whom do not practice it, lie about the fact to avoid trouble. Because, as one father put it in an interview, “Who wants to take up a fight with the community?”

Clearly, more than just laws are needed – a movement to end FGM both within and outside the community are crucial.

Sources:

1. Articles in publications:

Outlook: http://www.outlookindia.com/article/The-Yin-Wounded/279088

DNA: http://www.dnaindia.com/lifestyle/report-a-pinch-of-skin-a-documentary-that-attempts-to-lift-the-silence-on-female-genital-mutilation-1986973

Times of India: http://timesofindia.indiatimes.com/entertainment/hindi/bollywood/news/NID-students-film-on-female-genital mutilation/articleshow/19304011.cms

Hindustan Times: http://www.hindustantimes.com/india-news/mumbai/bohra-women-go-online-to-fight-circumcision-trauma/article1-779782.aspx

Business Line: http://www.youthkiawaaz.com/2012/04/female-genital-mutilation-an-open-secret-in-india/

Dawn: http://www.dawn.com/news/712748/female-circumcision-anger-aired-in-india-fm

New York Times: http://www.nytimes.com/2014/11/17/opinion/fighting-female-genital-mutilation.html?emc=edit_ty_20141117&nl=opinion&nlid=54889929&_r=1

2. Blogs, Facebook posts and online forums/news portals and agencies:

http://breakthesilencespeakthetruth.wordpress.com/

http://indianmuslimobserver.com/2014/04/27/female-genital-mutilation-is-not-circumcision/

https://www.facebook.com/notes/sijo-k-jose/uproar-over-female-genital-mutilation-bohra-muslim-woman-activist-launches-campa/329191643829952

http://www.india.com/whatever/female-genital-mutilation-what-is-fgm-know-more-about-the-brutal-practice-102516/

http://makinghealthmatter.wordpress.com/2011/12/10/fighting-female-genital-mutilation-in-india/

http://www.ipsnews.net/2012/01/pakistan-india-women-expose-secret-genital-cutting-rite/

http://dawoodi-bohras.com/forum/viewforum.php?f=1

http://www.youthkiawaaz.com/2012/04/female-genital-mutilation-an-open-secret-in-india/

3. The petition:

https://www.change.org/p/h-h-dr-syedna-stop-female-circumcision-ladkiyon-par-khatna

4. Campaigns, non-governmental organisations:

http://www.ipu.org/wmn-e/fgm-prov-i.htm

http://www.endfgm.eu/en/

http://www.forwarduk.org.uk/campaigns/end-fgm

http://www.equalitynow.org/fgm

http://www.stop-fgm-now.com/

http://www.actionaid.org.uk/endfgm

5. WHO, UN

http://www.who.int/topics/female_genital_mutilation/en/

http://www.who.int/mediacentre/factsheets/fs241/en/

http://www.who.int/reproductivehealth/topics/fgm/overview/en/

http://www.un.org/en/events/femalegenitalmutilationday/

http://www.unfpa.org/topics/genderissues/fgm

*****

Zubeda Hamid is a correspondent with The Hindu covering health and disability rights.

Gender Violence:The Health Impact – Immediate Medical Care for Burn Victims

by Rishabh Raj

A report by Acid Survivor Trust International (ASTI) aptly says “acid violence rarely kills … [it] always destroys lives.” The very gruesome nature of the violence coupled with the fact that an acid attack takes only five seconds to cause superficial burn and thirty seconds to escalate into  deep burns and that India also accounts for a major share of global burn deaths makes it extremely important to discuss immediate medical care available to burn victims.

Acid attacks inevitably lead to excruciating physical ordeals for the survivors. Upon contact, the acid melts through flesh, muscle, and even bone, until thoroughly washed. Eighty percent of these attacks are directed at women and between 40 per cent and 70 per cent of them target women less than 18 years of age[1].

But acid attacks are not the only form of gendered violence that causes burn injuries. In India, several women are burned alive by their partners, or other close relatives. According to a report by Acid Survivors Foundation of India, this is the most common form of dowry deaths.[2]

In India, about 700,000 to 800,000 people per year sustain significant burns, though very few are looked after in specialist burn units. The highest rates occur in women aged 16-35 years of age[3]. Compare this to the US where annually 500,000 cases receive burn treatment with an average of about 3,300 deaths[4].

Need for appropriate medical care
The medical care available immediately after such an incident is crucial in determining the extent of damage and loss. Hence, it becomes extremely important to understand the complexities of burn injuries and rehabilitation. The most common cause of death for burn patients is infection. The burn skin is very sensitive and can be very easily infected if not taken care and cleaned properly. Hence throughout the course of treatment, strict hygiene measures have to be followed until the wounds are completely healed.

Hospitals not properly equipped
Women who are unable to access proper medical care after the attack could die. Unfortunately, hospitals in India are ill-equipped to handle such complexities. Many hospitals have no facilities to handle acid violence and burn emergencies. Some doctors are not even aware of basic first aid measures such as flushing acid out of the body immediately after the attack. The number of trained burn and plastic surgeons is less than 1100 for more than 1200 million population of India.[5] The situation becomes further grim due to the absence of organized burn care at primary and secondary health care levels, where a woman is most likely to first go after such an incident.[6]

No defined protocol for treating burn victims
In 1998, India was the only country in the world where fire (burns) was classified among the 15 leading causes of death[7].  There is no defined protocol in India for immediate medical attention to burn victims. Burn management remains a relatively new concept here. The concept of legal rights of a burn survivor and the family is also slowly emerging in India.

Under the 11th Five Year Plan, a new initiative was rolled out at the national level to leverage available resources for more effective and standardized delivery of treatment for burn victims. The National Programme for Prevention of Burn Injuries (NPPBI) was started with a goal to ensure capacity building of infrastructure and manpower at all levels of health care delivery system in order to reduce incidence, provide timely and adequate treatment to burn patients to reduce mortality, complications and provide effective rehabilitation to the survivors.

This pilot project was converted into a full-fledged national programme under the 12th Five-Year Plan providing burn management facilities in 67 State Government Medical Colleges at a cost of Rs. 407.21 crore.[8]

It is important to recognize that there is a difference between an accidental burn injury and an acid/dowry burn attack and the approach to medical care has to be based on these factors. While it may be easy for an accidental burn victim to access a health care facility, a victim of acid attack faces intense emotional and psychological fears which hinders the treatment at all the stages.

Finally, burn rehabilitation is an extremely difficult and time-consuming effort. Women have to cope with enormous physical pain and deal, at the same time, with low self-esteem and lack of motivation due to their altered looks and social rejection. Medical care available to the victim in the aftermath of an incident can play a crucial role in minimizing the extent of the loss and needs to be accelerated by the Government as well as the medical professionals in the field with due diligence.

WHO has issued guidelines on burn management broadly outlining the first-aid and a set of checks to estimate the severity of burn. The table below provides a list of Dos and Don’ts for providing immediate relief to a victim.

Do's and Don'ts

[1] Trauma Informed Care, Sourcebook, Acid Survivors Foundation India

[2] http://www.asfi.in/upload/media/SOURCE_BOOK_12_feb.pdf

[3] Burns in developing world and burn disasters – Rajeev B Ahuja

[4] Chapter 4: Prevention of Burn Injuries – Total Burn Care

[5] Arun Goel and Prabhat Srivastav, Post-burn Scars and Scar Contractures, Indian Journal of Plastic Surgery, Medknow Publications, September 2010

[6] National Programme for prevention of burn injuries – JL Gupta, LK Makhija, SP Bajaj – Department of Burns, Safdarjung Hospital, Dr RML Hospital, New Delhi

[7] Burn Mortality : recent trends and socio cultural determinants in rural India

[8] National Programme for Prevention and Management of Burn Injuries, CCEA – Press Information Bureau

*****

Rishabh Raj is currently a fellow with PRS Legislative Research’s Legislative Assistants to Members of Parliament programme. An engineer from IIT Kanpur, Rishabh is interested in finding technological solutions to social problems.

Gender Violence: The Health Impact – The Gendered Nature of Acid Attacks

by Vaibhav Gupta

An acid attack is a form of violence that affects women and girls disproportionately. The Law Commission of India reports that most of the acid attacks registered in India have been against women[1]. A report from the Cornell Law School[2]on combating acid violence published in January 2011 corroborates this. According to this report, 72 per cent of acid and burn attack victims in India are women, clearly indicating the gendered nature of such attacks.

Acid and burn attacks in India need to be understood in the context of the socio-cultural transformation that is taking place across the nation. This requires a study of the reasons behind such attacks and their prevalence in our society. However such a study is difficult to undertake because until recently, India did not even recognise acid attacks as a separate offence.

Trends from neighboring Bangladesh, though, point to a shocking fact: in 78 per cent of acid attacks reported in Bangladesh, the motive behind the crime is cited as the victim’s refusal to marry the perpetrator or her denial of a sexual advance[3].

The 2013 data from India’s National Crime Records Bureau lists 57 cases of acid attacks on women in 2010, 77 in 2011 and 83 in 2012.The upward trend is similar to other gender based offences in India including rape, kidnapping and abduction of women, cruelty by husbands and assault on women.  [4].

Laws against Acid Attacks

India recognised acid attacks as a criminal offence in 2013 when the Parliament passed The Criminal Law (Amendment) Act, 2013. Under the amended legislation, an attempt to throw acid can earn the perpetrator a prison term of five to seven years (Section 326B)[5], while causing permanent or partial damage or deformation can result in a jail sentence of no less than 10 years and up to a maximum of life imprisonment (Section 326A)[6]. The law also stresses that the victim should be compensated by the perpetrator[7]as well as by the respective state government.[8]However, it should be noted that while offenses under Section 326A require the fine imposed to be proportional to the medical expenses incurred by the victim, this is not the case for offences committed under Section 326B.

Implementing Laws: Impossible?

The problem is not just one of legislation, but its implementation and monitoring as well. According to the Supreme Court’s directives[9]on the regulation of acid sales:

1) A buyer must provide a government-issued identity card showing he/she is over 18 years of age
2) Every seller must maintain records of every buyer of acid

However, in practice, this does not seem to be regulated. Individuals are easily able to purchase acid for household purposes bypassing any such process. Even the government seems casual about the severity of these incidences, their investigation, compensation, and punishment; the Delhi High Court in April 2014 highlighted a case where compensation to the victim was delayed for over 6 months. This begs the question: Can the Government afford to be so casual about such a serious crime?

What can be done?

India also lags behind its neighbors in providing protection against acid offences. Bangladesh’s Acid Offences Prevention Act 2002 and the Acid Control Act 2002 banned the open sale of acids, and imposed stringent punishment (including the death penalty) and a fine on offenders. The law further outlays that investigations have to be completed within 30 days and the trial within 90 days. Dedicated Prevention Tribunals have been set up with the sole objective of looking into these crimes. In Pakistan, perpetrators of acid attacks may be punished with a maximum of life imprisonment.

The National Commission for Women prepared a draft proposal in 2008 that specifically dealt with acid attacks in India; in addition to classifying an acid attack as a separate and most heinous form of offence, the law intended to make provisions to:

1) Assist the victim of an acid attack by providing her with medical treatment services;

2) Provide social and psychological support;

3) Provide legal support to survivors;

4) Arrange rehabilitation mechanisms/schemes, taking into account the specific needs of the victim; and

5) Regulate and control acid and other corrosive substances

However, the law was never discussed. We still lack a comprehensive piece of legislation on acid attacks that deals with prevention, regulation of acid sales, punishment, medical care and rehabilitation.

This devastating form of violence continues to take place against the girls and women of this country without stirring the conscience of lawmakers and people in positions of power. As the Cornell Law School report says, ‘Acid attacks are social phenomena deeply embedded in a gender order that has historically privileged patriarchal control over women and justified the use of violence.[10] It is high time policymakers initiate steps to address the issue through advisories, amendments and legal directives.

[1] Law Commission of India Report to Supreme Court on Writ Petition 129 of 2006, Laxmi vs. Union of India

[2]‘Combating Acid Violence in Bangladesh, India and Cambodia’, Cornell Law School, 2011

[3]‘Combating Acid Violence in Bangladesh, India and Cambodia’, Cornell Law School, 2011

[4]Crime in India 2013, National Crime Records Bureau

[5]Sec 326B of IPC

[6]Sec 326A of IPC

[7]Sec 326A of IPC

[8]As per section 357B of Criminal Procedure Code

[9]Law Commission of India Report to Supreme Court on Writ Petition 129 of 2006, Laxmi vs. Union of India

[10]‘Combating Acid Violence in Bangladesh, India and Cambodia’, Cornell Law School, 2011, Foreword by Yakin Erturk

*****

Vaibhav Gupta is currently a fellow with PRS Legislative Research’s Legislative Assistants to Members of Parliament Programme. When he’s not volunteering with organisations that work on everything from education to disability, Vaibhav dreams of building his own start-up in the policy field. 

Gender Violence:The Health Impact – Child Marriage as Gender Violence: Social & Health Consequences

by Mouli Banerjee

It has been argued that law itself, as a political product, doesn’t always have the capacity to pursue ‘justice’, given the qualification that “while many of the juridical forms of power continue to persist, these have gradually been penetrated by quite new mechanisms of power that are probably irreducible to the representation of law”[1]. Child Marriage, as a social practice, is one such example, where laws, even if inadequate, have been put in place, but somehow the practice has continued for decades. However, it is important to understand the legal structure in place against child marriages, in order to tackle the issue properly.

Prohibition of Child Marriage: The System in Place

The current law in place to tackle the crime of child marriage is the Prohibition of Child Marriage Act, 2006 (PCMA). It defines a child, if female, as one who has not completed 18 years of age and if male, as one who has not completed 21 years of age. It includes punitive measures against all those who perform, permit and promote child marriage. The law also has a provision for annulment of a child marriage and gives a separated female the right to have a residence and maintenance costs (from her husband if he is above 18 years of ages, and from her in-laws, if the husband too is a minor), until she is remarried.[2]

However, there are major loopholes in the PCMA.

Most importantly, it makes a distinction, declaring some marriages void (in cases where the marriage is conducted by use of force, fraud, deception, enticement, selling and buying or trafficking) but in other cases simply giving the option that one may declare one’s marriage “voidable” even up to two years after attaining adulthood. This is a contradiction, for if the law doesn’t see a ‘child’ as capable of consent, then every act of child marriage must by definition involve force, fraud, deception or enticement, and thus, must be void.[3] It is obvious that most child marriages, once solemnised, will not be reported and hence will go unchecked.

India is now a part of the UN Resolution on Child, Early and Forced Marriage, and several Action Plans and Policies fielded by the Ministry of Women and Child Development in the last decade have also been geared towards this end.

In this context, it becomes crucial to redefine child marriage as a form of severe gender violence, thus understanding the practice as not just a restriction of a girl child’s choices in marriage, but as violence inflicted on female bodies and minds.

Child Marriage as Gender Violence

The United Nations defines violence against women as “any act of gender-based violence that results in, or is likely to result in, physical, sexual or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life.”[4]

A quick look at the social and health consequences of child marriages promptly validates the assumption of child marriage as an active act of gender violence on many levels.

Threat of violence, coercion or ‘arbitrary deprivation of liberty’

As explained in the previous section, the very fact that a child is not seen as capable of consent makes child marriage an act of coercion. It restricts a girl’s choices on both social and physical levels by taking away her liberty to choose her age of marriage and robbing her of her reproductive rights, long before she has even understood them clearly.

Current statistics suggest that as of 2013, 43% of women aged 20-24 were married before 18. Moreover, UNICEF suggests that there are 23 million child brides in India, and this makes for approximately 40% of the child brides globally.[5]

‘Physical, Sexual or Mental Harm’

The Danger of Marital Rape

While marital rape is a threat all married women face, and legal debates pushing for the criminalisation of marital rape still rage in India, in the context of child marriage, this can be viewed as a contradiction in laws. The Criminal Law (Amendment) Act, 2013, amended Section 375 of the IPC to redefine ‘rape’, but Exception 2 to this amendment states that sexual intercourse or acts by a man with his own wife, the wife not being under 15 years of age, is not rape. Thus, all married women, between the ages of 15 and 18, who are child brides under the PCMA 2006, if subjected to marital rape, cannot consider it a criminal violation. This brings into question the legal concept of ‘consent’ which is considered implicit in a marriage and is incidentally the argument given for not criminalising marital rape.This is in contradiction to the assumption that a ‘child’ is not capable of sexual consent and violates the PCMA 2006 and the Juvenile Justice (Care and Protection of Children) Act, 2000 (which defines a ‘child’ as any person below 18 years).

This contradiction is currently being contested in the Supreme Court by a PIL filed by Independent Thought (www.ithought.in) in a Writ Petition [Independent Thought vs. Union of India (W.P. Civil 382 of 2013)].[6]

Severe Health Consequences of Child Marriages

Apart from the health concerns implicit in any act of sexual violence upon a woman, Child Marriage also has specific health consequences that mandate special attention.

The vicious cycle of Fertility and Sterilisation

A study conducted by NCBI in 2009 suggests that a significantly larger number of women in India married as minors are less likely to use contraception in their first year of marriage (thus leading to higher fertility), when compared to women who married as adults . They have limited or no access to contraception and also displayed higher incidence of rapid repeat childbirths, higher unwanted pregnancies and hence, higher rates of pregnancy terminations (which has health complications of its own). Furthermore, women who have undergone multiple childbirths at a young age are also more likely to get sterilised. Approximately, one in ten women reporting both child marriage and sterilization (9.7%) were sterilized prior to age 18 years. [7]

Thus, child marriage has considerable immediate and long-term impact on the reproductive health of women’s bodies, often causing permanent damage to their health.

Higher Rates of Death at Childbirth

Young girls are at greater risk of death at childbirth than older women. The data from the International Centre for Research on Women shows that girls who are younger than 15 years are five times more likely to die in childbirth than women who are in their 20s. Pregnancy is seen consistently to be one of the leading causes of death for girls ages 15 to 19 worldwide.[8]

Premature labour, Still Births children and New Born Deaths

UNICEF estimates that rates of still births and new-born deaths are 50% higher among mothers under 20 than in mothers who give birth in their 20s. [9] Child marriage often entails a very violent introduction into sexual relations, which can cause long-tern health issues for women.

Obstetric Fistula

This is a dangerous medical condition in which a fistula or a hole develops between the rectum and the vagina or the bladder and the vagina, due to severe or failed childbirth, when proper medical care is not given. Young mothers are consequently at much higher risk of developing this otherwise-preventable condition. A report by the Ministry of Women and Child Development shows that as of 2013 over two million girls and young mothers are affected by this complication in India.[10]

Risk of HIV and other Sexually Transmitted Diseases

Since child brides are often married to older, sexually experienced men, they are also at risk of being affected by sexually transmitted diseases.

Thus Child Marriage is an act of gender violence with severe health consequences, which also has myriad social implications. Marrying as a minor often stultifies one’s education, meaning not just abrogated mental growth but also implying financial dependence on the husband, thus facilitating further oppression of women who are married off before adulthood.

While eradicating the evil of child marriage has been an integral part of the government’s plans- it is a part of the current 12th Five Year Action Plan, the National Population Policy 2000, the National Youth Policy 2003, the National Adolescent Reproductive and Sexual Health Strategy and the National Plan of Action for Children 2005- a lot still needs to be done. Schemes such as the Rajiv Gandhi Scheme for Empowerment of Adolescent Girls (SABLA) aim at eradicating the practice, but as government estimates show, the incidence of child marriage in India has gone down by only around 5% between 1995-96 and 2005-06. This is proof of how much more needs to be done, to increase social awareness and eradicate this practice.

[1] Nivedita Menon. “Rights, Bodies and the Law: Rethinking the Feminist Politics of Justice.”. Gender and Politics in India. New Delhi: OUP, 1999. 262-291.

[2]Prohibition of Child Marriage Act, 2006 (PCMA).  http://wcd.nic.in/cma2006.pdf , accessed in November 2014.

[3] ‘Child Marriage in India: Achievements, Gaps and Challenges’. HAQ: Centre for Child Rights. http://www.ohchr.org/documents/issues/women/wrgs/forcedmarriage/ngo/haqcentreforchildrights1.pdf

[4] ‘Violence Against Women’, Media Center, Updated on October 2013, accessed in November 2014. http://www.who.int/mediacentre/factsheets/fs239/en/

[5] Cf. ‘National Strategy Document on Prevention of Child Marriage, Ministry of Women and Child Development.   http://wcd.nic.in/childwelfare/Strategychildmarrige.pdf (page 1) Data http://www.unicef.org/protection/files/Progress_for_Children‐No.8_EN_081309(1).pdf

[6] Independent Thought vs. Union of India (W.P. Civil 382 of 2013).http://www.ithought.in/download/2014/PIL-Short-Note.pdf

[7] Donta Balaiah, Anita Raj, Niranjan Saggurti,Jay G. Silverman. ‘Prevalence of Child Marriage and its Impact on the Fertility and Fertility Control Behaviors of Young Women in India’. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2759702/

[8] Cf. ICRW, http://www.icrw.org/child-marriage-facts-and-figures

[9] WHO media centre: ‘Child marriages: 39 000 every day’. http://www.who.int/mediacentre/news/releases/2013/child_marriage_20130307/en/

[10] ‘National Strategy Document on Prevention of Child Marriage . http://wcd.nic.in/childwelfare/Strategychildmarrige.pdf

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Mouli Banerjee is currently a fellow with PRS Legislative Research’s Legislative Assistants to Members of Parliament programme. A post graduate in Literature from Delhi University, Mouli is a proud Feminist and LGBTQ rights supporter. 

Gender Violence:The Health Impact – Getting Gender Violence on the Public Health Agenda

by Anupama Srinivasan

The impact of gender violence – and specifically violence against women – extends beyond what a girl or woman endures today, tomorrow or three months from now. Gender violence affects an individual’s ability to go to school, to enter into a relationship with someone of her/his choice, to go out to work, to earn an income, to use public transport and to be financially independent. The threat of violence means that a girl may be withdrawn from school by her parents; that women may lead lives of fear, placing constraints upon their own mobility and that of other girls and women in the family. Most of all, gender violence denies an individual the right to lead a healthy life, free of injury, illness and disease.

In this journey from violence and trauma to (hopefully) healing, healthcare providers – doctors, nurses, hospital administrators, community volunteers – are what the NGO world likes to call ‘key stakeholders’. There is considerable evidence to show that healthcare providers can play a crucial role in responding to gender violence, not just in the provision of health services but also in collecting data on prevalence, risk factors and health consequences; in informing polices to address GBV and in preventing violence[1].

But the fact is, in India, few hospitals (whether in the public or private sector) have in place a comprehensive response system that helps them to identify and support women who have experienced gender and sexual violence. This is despite the fact that globally, gender violence is recognised as a legitimate public health issue, with both immediate and long-term consequences for the health and well-being of women. Violence can potentially impact a woman’s physical, mental, sexual, reproductive and maternal health and ironically, also restrict her access to health care.

Impact of violence on health

VAW Health Impact

Source:  http://www.who.int/reproductivehealth/publications/violence/VAW_health_impact.jpeg?ua=1

Rape, domestic violence and intimate partner violence are particularly insidious for women’s health. For those who face abuse at home regularly, severe abrasions, bruises, broken and dislocated bones as well as burn injuries are not uncommon. Rape can and often does result in unwanted pregnancies, which in turn can lead to unsafe abortions as well as, potentially, subsequent infertility.

Women who are raped are vulnerable to HIV and AIDS. Equally common, but far less publicly discussed are sexually transmitted infections, urinary tract infections, genital injuries and pelvic inflammatory disease. Women are often too ashamed or embarrassed to seek help for any pain or injury related to the ‘private’ parts of their bodies; as a result, these infections can remain both undiagnosed and untreated. In addition, women who have been raped (whether by strangers or partners) can develop an aversion to sex, which they are often reluctant to disclose to anyone, including and especially their husbands. This can, in turn, become triggers for a cycle of violence including marital rape and intimate partner violence.

The long-term impact of gender violence is far more nebulous. Recurring anxiety, increased use of alcohol or other forms of substance abuse, eating disorders, frequent menstrual pain, chronic headaches, fatigue, disturbed sleeping patterns, depression and post-traumatic stress disorder or PTSD are all potential mental health consequences of gender violence. Given the dual stigma associated with both mental illness and sexual violence, women are even less likely to seek medical or psychological support, with distressing long-term results.

Forced and early marriages of both boys and girls also result in several health complications that go unacknowledged by families. Young girls, if married before the age of 18, have little knowledge about sex, the threat of STIs or HIV and AIDS. They also have little negotiating power for contraception use. Inevitably, the earlier a girl is married, the younger she is when she gives birth to her first child. And the more likely she is to have more than her fair share of children, with a multitude of long-term consequences for her own health.

Health sector response to gender violence

Over the last few years, I’ve been part of several training programmes for students at different nursing colleges. The objective of these programmes was to help these young women, mostly between the ages of 17 and 25, understand the role they could play as nurses. After all, nurses are often the first point of contact for those who have experienced violence and require care or treatment for themselves or their children. Worryingly – but unsurprisingly – we found that this was the first time these young women had had an opportunity to discuss either gender or sexual violence; several of them were hesitant to even use the words ‘rape’ or ‘sexual harassment’. This experience illustrates a genuine gap in India’s response to gender violence – inadequate training for healthcare professionals.

The irony is that abused women seek and receive more health care than those who have not experienced violence in their lifetime. The public and private health care system in a country therefore can and must play a vital role in recognising, recording, responding to and documenting instances of gender violence.

Right from the moment a woman enters a health facility with a violence-inflicted injury (irrespective of the severity), every department in that facility has a specific responsibility. This includes doctors on duty at the emergency ward, nurses, gynaecologists, obstetricians, forensics specialists, counsellors, psychiatrists and psychologists. In such cases, their job does not end with merely offering the woman the necessary treatment. They must, first of all, learn to recognise gender violence; equally, they must remember that a woman may seek health care for her injuries, but most often, will not choose to disclose an experience of violence. They must know how to respond to a woman who has been raped or abused, by choosing the right words. What can they say? What should they not say? They must understand their role in helping women seek justice through meticulous and sensitive documentation.

In other words, responding to gender and sexual violence is no ordinary or easy task. It requires knowing how to use a rape kit so as not to cause any further trauma. It requires an understanding of the complexities of violence and the emotional impact it has on those who experience it. It requires a non-judgemental attitude; it is not, for instance, the health worker’s responsibility to verify or question the authenticity of an allegation of sexual violence. It demands discretion and respecting an individual’s confidentiality. It needs, therefore, both the right skills and the correct attitudes.

VAW Health Workers

Source: http://www.who.int/reproductivehealth/publications/violence/VAW_WHO_Intervention.jpeg?ua=1

The guidelines and protocols exist. In 2003, the World Health Organisation (WHO) published ‘Guidelines for medico-legal care for victims of sexual violence’, outlining the roles and responsibilities of the health sector, particularly in treating rape victims.  It draws attention to the range of services needed, including pregnancy testing, emergency contraception, STI services and psychosocial counselling. It emphasises the responsibility of health care professionals in gathering evidence that can help identify and punish a perpetrator.

In 2013, the WHO published a new set of clinical and policy guidelines on “Responding to intimate partner violence and sexual violence against women”.  At the Sixty-sixth World Health Assembly held in May last year (2013), seven governments – Belgium, India, Mexico, Netherlands, Norway, United States of America, and Zambia – declared violence against women and girls “a major global public health, gender equality and human rights challenge, touching every country and every part of society”.

In India, CEHAT has done pioneering work on health sector responses to sexual violence and assault. Last year, the Government of India issued its own set of guidelines, developed by the Ministry of Health and Family Welfare on medico-legal care for survivors/victims of sexual violence.

All these documents are potential blueprints, waiting to be included in the code of conduct and practices of private hospitals and clinics that operate throughout the country. They are also waiting to be incorporated into medical and nursing college curricula.

The idea that someone who has been raped is shuttled back and forth between the police and the healthcare system is hard to accept. And really, why should we accept it? The act of violence, whether rape or domestic violence or sexual assault, is unjust in the first place. The lack of proper response mechanisms to support someone who has experienced this violence only accentuates the ‘unjustness’ of the situation.

It is well past time to put these guidelines into practice and to move from words to action.

[1] Violence against Women: The Health Sector Responds. WHO (2013). Accessed at http://www.who.int/reproductivehealth/publications/violence/NMH_VIP_PVL_13_1/en/

NB: An earlier version of this post appeared in The Alternative.

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Anupama Srinivasan works on issues related to public health and gender. She’s been Programme Director of the Gender Violence Research and Information Taskforce at Prajnya since 2010. She can be contacted at anupamasrinivasan.prajnya@gmail.com