The Responses of Health Systems to Marital Sexual Violence – A Perspective from Southern India

ABSTRACT

Marital sexual violence is a serious problem in India. However, marital rape and most other forms of marital sexual violence are not criminalized in the country. This qualitative study with healthcare providers (physicians and nurses), lawyers, members of a non-profit organization that offers domestic violence support services out of a hospital, a journalist and two lawyers suggest that the majority of care providers recognize that marital sexual violence is a serious concern, and agree that health systems can play a vital role in addressing both the immediate biomedical concerns of survivors, and also overall well-being. The study reveals several systemic and internal factors that hinder responsiveness of Indian health institutions. These include, the absence of a protocol or uniform internal guidelines in most hospitals, a lack of screening programs to capture the presence of violence occurring when patients visit hospitals for other reasons, a large patient load, a lack of gender sensitivity in providers’ education, an absence of domestic violence shelters, and poor interlinkages between support services such as counseling and legal services. Notwithstanding these challenges, some exemplar physicians and nurses assist survivors of sexual violence, sometimes risking their own safety. The Indian health system can be made more responsive, provided these factors are addressed, and crucially budgets are allocated for interventions.

KEYWORDS:

• Domestic violence
• feminism
• gender
• health systems
• India
• interventions
• law
• marital rape
• sexual violence

Acknowledgments

The author wishes to acknowledge the support of her home institution, Srishti Institute of Art, Design and Technology, Bengaluru, for giving her the time required to do fieldwork and write this manuscript. Thanks are due to the head of the Community Health Department in a Bangalore hospital, which allowed her to interview its staff as well as to other doctors and nurses across Karnataka who responded to the call for participation. The author would sincerely like to thank Dr. Aditi Iyer of the Public Health Foundation of India and Dr. Jyothsna Latha Beliappa for providing valuable inputs to the study as well as Feminism in India for hosting the call for participations on their website. Last but not the least, the author would like to thank her partner Nitish for providing emotional support without which this difficult study would not be possible.

Notes

^1. The lifetime prevalence of 29% domestic violence in NFHS-4 is lower than the figure of 37% reported in NFHS-3 (2005–06). However, domestic violence reported in the last 12 months, is similar across both at 24% (NFHS-3) and 22% (NFHS-4).

^2. In 2000, the Centre for Inquiry into Health and Allied Systems (CEHAT), a non-profit organization established Dilaasa in a state hospital with a multidisciplinary team. Dilaasa currently operates in 4 cities across India, and 11 across the state of Maharashtra.

^3. The details of this committee have not been made public but the recommendations can be found here: http://wcd.nic.in/documents/hlc-status-women.

^4. The guidelines comprise a 100-page document issued by the Indian Ministry of Health and Family Welfare with the participation of organizations like Dilaasa and CEHAT, mental health experts, and medical doctors. However, this framework is either not implemented because of a lack of awareness or funds or other practical constraints in under-resourced hospitals. For further information, see: https://mohfw.gov.in/sites/default/files/953522324.pdf.

^5. The WHO defines stunting as minus two standard deviations away from the median WHO child growth standards according to the referenced population. Clinically wasted is more than minus two standard deviations away from the median. 38% of children below 5 years of age are stunted in India [http://unicef.in/Whatwedo/10/Stunting]. For this population, the rate of stunting and severe stunting is more than1.5 times that of the reported national averages, indicating extremely high levels of poverty and starvation.