Domestic Violence and Health Care in India

238 Pages·2018·2.95 MB·English

by  Meerambika Mahapatro

Meerambika Mahapatro
Domestic
Violence and
Health Care in
India
Policy and Practice
Domestic Violence and Health Care in India
Meerambika Mahapatro
Domestic Violence
and Health Care in India
Policy and Practice
123
Meerambika Mahapatro
NationalInstituteofHealthandFamilyWelfare
NewDelhi
India
ISBN978-981-10-6158-5 ISBN978-981-10-6159-2 (eBook)
https://doi.org/10.1007/978-981-10-6159-2
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Preface
This book is an attempt to raise the awareness of academics and to enable
health-care professionals to intervene in a timely and appropriate way when a
patientpresentswithsignsandsymptomsofdomesticviolence.Domesticviolence
is a recurrent problem and highly prevalent in almost all segments of the society.
The frequency of domestic violence episodes and its severity increase over time.
Although the medical community is the frontline intervener in the aftermath of an
episode,health-careresponseinIndiaisstillpoorandcharacterizedbyinattention,
blame and disbelief. It is only recently that organizations and institutions have
become involved in responding to violence against women. However, many
health-care professionals lack training on how to identify abuse, what tool they
should use to intervene after identification and where they should refer the victim
for additional assistance. Though there are many articles, manuals and books
addressing intervention issues, there is hardly any single, compact source of
information on this aspect in the Indian context. This book provides comprehen-
sive, practical tools, including a brief questionnaire template, to help health-care
personnel approach a victim for an examination process. In addition, the book
provides vital information on the safety of health-care staff and patients while
gathering evidence and providing care.
As a social epidemiologist with many years of work experience in the field of
domesticviolence,myobjectiveincreatingthisinterventionistoultimatelyprevent
subsequentviolence.Ihopethatviewingtheoverallprocessfromtheperspectiveof
this book will enhance health-care professionals’ understanding and potential
involvement. I also hope that the interventions mentioned in this work will help
victims overcome the effects of violence. The thrust of the book is towards
extending the domestic violence discourse beyond the feminist and gender dis-
course. In order to do so, the book corroborates evidence to establish imperatives
for dealing with the consequences of domestic violence on women’s health.
Through its extensive literature and in-depth case analysis, the book shows the
impending need to establish integrated care and cure for the victims of domestic
violence. An examination of policy and practice calls for a collaborative interven-
tionstrategyamonghealthsystems,thejudiciaryandothersystemsofsocialjustice.
v
vi Preface
The focus of health providers and the police needs to go beyond the prejudice
against and personal problems of women.
The book comprises five chapters. Chapter 1 presents a discussion on key
concepts, forms, causes and prevalence of domestic violence, covering global and
national perspectives. It seeks to explore the contextual framework and the multi-
plicityoffactorsthatcollectivelyconstructdomesticviolence.Chapter2focuseson
theoretical perspectives, emphasizing widely used and cited contemporary view-
points, the women empowerment and the methodological issues pertaining to the
research on domestic violence. Chapter 3 focuses on the consequences of various
types of violent experiences on women’s health. It also opens possibilities of
exploring the correlations that may exist between violent experiences and health.
Chapter 4 reviews the evidence for clinical intervention models and discusses the
components of a comprehensive health systems approach that would help
health-care providers identify and support women subjected to domestic violence.
Chapter 5 offers a critical analysis of institutional, ideological and social obstruc-
tions. It focuses on policy and planning, and discusses a range of legal initiatives
and various prevention programmes designed to address domestic violence.
Thebookhasbeenwrittenlucidlysothatacademicsandpractitionerscanreadit
easily,obtainthekeyinformationprovidedthereinandapplyittotheirworks.The
book is of particular use for health-care professionals who are serving in the field
currently and students who will deal with such patients in future.
New Delhi, India Meerambika Mahapatro
Acknowledgements
My academic journey is filled with unparalleled support and guidance. First and
foremostaremyteachers,colleagues,friendsandmyparentswhohaveinspiredand
encouraged me over the years. I owe special gratitude to Dr. R.N. Gupta, Former
Chief, Department of Social and Behavioural Research Unit, Indian Council of
MedicalResearch(ICMR),whohasbeenmymentorandmotivatedmetoworkin
the area of domestic violence and health care in India. Working in this field has
givenmetheopportunitytomeetsomeofthemostintelligent,dedicatedandcaring
individualsIhaveeverknown.Themostinspiringandmotivatingmemoriesduring
mytimeoffatiguewereofthevictimsandthesurvivorsofdomesticviolencewho
taught me the importance of love, supportive relationships and compassion.
IwishtoexpressmyheartfeltgratitudetomysonMokshMahapatraPrasadand
my husband Prof. Avanish Kumar for their critique and unending support. I am
indebted to Dr. Amit Kumar Gupta, Public Health Expert, for his critical insights
andcommentsonthemanuscript.Theenthusiasticinterestofmyfriendshasbeena
perpetual source of encouragement. I am thankful to myfriend Surabhi Shukla for
her help and support.
I take this opportunity to convey my sincere thanks to Prof. N.K. Ganguly,
Former Director General, ICMR; Dr. Shiv Lal, Former Special Director General,
Health Services, Ministry of Health and Family Welfare, Government of India;
Prof. J.K. Das, Director, National Institute of Health and Family Welfare, New
Delhi;Prof.SudhaPrasad,Director,IVF&ReproductiveBiologyCentre,Maulana
Azad Medical College, New Delhi; Smt. Kalpana Shrivastava, Commissioner,
Women Empowerment, Bhopal; and Mr. Sudhir Pratap Singh, General Secretary,
NGO SAPNA, New Delhi.
Ihavegreatlybenefittedfrommeetingandinteractingwithmanyindividualsand
organizationsthathaveshapedmythoughtsandassistedmeinstimulatingpassion
andperspectivethatwentintothecreationofthisbook.Thisbookwouldnothave
beenpossibleandtakenitsshapewithoutconstantsupportfromtherefereesandthe
editors. I can never thank them sufficiently.
vii
Contents
1 Understanding Domestic Violence. . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1 Concept and Types of Domestic Violence . . . . . . . . . . . . . . . . . . 1
1.1.1 Defining Domestic Violence. . . . . . . . . . . . . . . . . . . . . . 1
1.1.2 Defining Domestic Violence under the Domestic
Violence Act of India. . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.1.3 Forms of Domestic Violence . . . . . . . . . . . . . . . . . . . . . 4
1.1.4 The Perpetrator and the Victim. . . . . . . . . . . . . . . . . . . . 5
1.1.5 Abuse in Other Intimate Relationships . . . . . . . . . . . . . . 6
1.1.6 The Life-Course Perspective. . . . . . . . . . . . . . . . . . . . . . 11
1.2 Reasons for Domestic Violence. . . . . . . . . . . . . . . . . . . . . . . . . . 14
1.2.1 Sociocultural Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
1.2.2 Customs and Tradition . . . . . . . . . . . . . . . . . . . . . . . . . . 18
1.2.3 Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
1.2.4 Economic Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
1.2.5 Alcohol, Betting or Gambling, and Drug Abuse. . . . . . . . 25
1.2.6 Institutional Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
1.2.7 Reasons for not Leaving the Abusive Relationship. . . . . . 28
1.2.8 Myths and Misconceptions About Domestic Violence . . . 29
1.3 Prevalence of Domestic Violence . . . . . . . . . . . . . . . . . . . . . . . . 32
1.3.1 Global Scenario . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
1.3.2 Indian Scenario . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
1.3.3 Physical Violence in India . . . . . . . . . . . . . . . . . . . . . . . 35
1.3.4 Psychological Violence in India . . . . . . . . . . . . . . . . . . . 35
1.3.5 Sexual Violence in India . . . . . . . . . . . . . . . . . . . . . . . . 36
1.3.6 Risk and Protective Factors of Domestic Violence. . . . . . 37
1.4 Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
ix
x Contents
2 Theoretical and Methodological Issues and Perspectives. . . . . . . . . . 47
2.1 Theoretical Issues and Perspectives . . . . . . . . . . . . . . . . . . . . . . . 47
2.1.1 Social Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
2.1.2 Social Control Theory . . . . . . . . . . . . . . . . . . . . . . . . . . 50
2.1.3 Cultural Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
2.1.4 Psychological Perspective. . . . . . . . . . . . . . . . . . . . . . . . 52
2.1.5 Dependency Framework. . . . . . . . . . . . . . . . . . . . . . . . . 53
2.1.6 Social Learning Theory . . . . . . . . . . . . . . . . . . . . . . . . . 54
2.1.7 Feminist Theory. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
2.1.8 Ecological Model. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
2.2 Women Empowerment: A Strategy for Moving Forward . . . . . . . 58
2.2.1 Victimization in Violence: A Case Study . . . . . . . . . . . . 61
2.2.2 Connecting the Dots: Practice to Theory . . . . . . . . . . . . . 63
2.3 Methodological Issues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
2.3.1 Cross-Cultural Studies in Plural Society . . . . . . . . . . . . . 67
2.3.2 Definitional Challenges: Issues in Conceptualization,
Language and Interpretation . . . . . . . . . . . . . . . . . . . . . . 67
2.3.3 Development of Research Instrument . . . . . . . . . . . . . . . 71
2.3.4 Recruitment, Induction and Decentralized Training
of Field-Investigators . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
2.3.5 Quantitative–Qualitative Data . . . . . . . . . . . . . . . . . . . . . 77
2.3.6 Analysis and Interpretation . . . . . . . . . . . . . . . . . . . . . . . 79
2.4 Ethical Issues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
2.4.1 Ethical Approval from the Institutional Review Board . . . 81
2.4.2 Written Consent of the Respondent. . . . . . . . . . . . . . . . . 82
2.4.3 Identification of Respondents and Maintaining
Confidentiality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
2.5 Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
3 Impact of Domestic Violence on Health . . . . . . . . . . . . . . . . . . . . . . 93
3.1 Health Consequences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
3.2 Physical Health Consequences. . . . . . . . . . . . . . . . . . . . . . . . . . . 94
3.3 Reproductive Health Consequences . . . . . . . . . . . . . . . . . . . . . . . 97
3.3.1 Violence during Pregnancy. . . . . . . . . . . . . . . . . . . . . . . 98
3.3.2 Direct and Indirect Causes of Violence and Adverse
Pregnancy Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
3.3.3 Violence during Pregnancy in India . . . . . . . . . . . . . . . . 99
3.3.4 Antenatal Care, Food Intake and Rest during
Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
3.3.5 Domestic Violence during the Postpartum Period. . . . . . . 102
3.3.6 Pregnancy Outcome and Demand for Male Child . . . . . . 103
Contents xi
3.3.7 Missing Girls and Sex-Selective Abortions . . . . . . . . . . . 104
3.3.8 Contraceptive Use and Unintended Pregnancy . . . . . . . . . 106
3.3.9 Sexual Violence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
3.3.10 Sexual Violence during Pregnancy . . . . . . . . . . . . . . . . . 109
3.3.11 Sexual Violence and Sexually Transmitted Infections
(STIs)/Reproductive Tract Infections (RTIs). . . . . . . . . . . 110
3.3.12 Sexual Violence and HIV/AIDS . . . . . . . . . . . . . . . . . . . 111
3.4 Psychological Health Consequences. . . . . . . . . . . . . . . . . . . . . . . 113
3.4.1 Maternal Health, Stress and Adverse Outcome
of Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
3.4.2 Infertility and Domestic Violence . . . . . . . . . . . . . . . . . . 117
3.5 Impact on Children. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
3.6 Other Consequences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
3.6.1 Access and Utilization of Health-Care Services . . . . . . . . 120
3.6.2 Socioeconomic Consequences. . . . . . . . . . . . . . . . . . . . . 122
3.6.3 Traditional and Cultural Practices and Their
Consequences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
3.7 Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
4 Health-Care Provisions and Responses in Practice Settings . . . . . . . 137
4.1 Health-Care System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
4.1.1 Causes of Failure in Detection . . . . . . . . . . . . . . . . . . . . 138
4.1.2 Capacity Building and Training of Health-Care
Professionals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
4.1.3 Indian Health-Care System . . . . . . . . . . . . . . . . . . . . . . . 142
4.1.4 Accident and Emergency Care . . . . . . . . . . . . . . . . . . . . 144
4.2 Role of Health-Care Providers. . . . . . . . . . . . . . . . . . . . . . . . . . . 144
4.2.1 Development of Trust with the Victim
and Maintaining Confidentiality . . . . . . . . . . . . . . . . . . . 147
4.2.2 Showing Non-Judgemental Support. . . . . . . . . . . . . . . . . 148
4.3 Key Factors in Health-System Response . . . . . . . . . . . . . . . . . . . 149
4.3.1 Identification of the Victim and the Perpetrator . . . . . . . . 149
4.3.2 Assessment of Risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
4.3.3 Safety Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
4.3.4 Documentation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
4.3.5 Sexual Assault: Indian Law . . . . . . . . . . . . . . . . . . . . . . 161
4.4 Indicators for Action to Address . . . . . . . . . . . . . . . . . . . . . . . . . 164
4.4.1 Do’s and Don’ts for the Health-Care Providers . . . . . . . . 166
4.4.2 Coping Mechanism . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
4.4.3 Intersectoral Coordination and Response . . . . . . . . . . . . . 170
4.5 Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175