Written by Sangeeta Rege and Surbhi Shrivastava.
A growing number of news reports and commentaries from across the globe are shedding light on the possible rise in cases of violence against women (VAW) in the wake of COVID-19.
This disease outbreak, unbeknownst to the world a few months ago, has been accompanied by various aggressive strategies to ‘flatten the curve’, of which physical distancing by way of complete national lockdowns has been the most drastic.
India was one of the first to implement such a lockdown, which continues to be the largest sanction commanding a population of over 1.3 billion to ‘stay at home and stay safe’. The sentiment behind this logic presumes that the home is a safe place, to begin with. However, the steep rise in calls reporting violence and abuse to the National Commission for Women and Childline (the latter received over 92,000 calls in 11 days) indicates that while women in India may avoid contracting the virus, their home environment is not necessarily safe.
VAW is being widely recognised as a shadow pandemic, as the UNFPA and its partners assume a 20% increase in violence during an average three-month lockdown in all 193 United Nations (UN) member states. The increasing cases of violence are exacerbated by the gendered dimension of COVID-19 and lockdowns (such as the unequal division of domestic labour, in addition to caring for family members). This public health concern has drawn advisories from the UN and several public health groups, urging countries to incorporate measures which prevent and redress VAW in conjunction with their COVID-19 response.
In the absence of normal social interaction, mobility, and regular functionality, strengthening the existing mechanisms of crisis intervention to help and support survivors of domestic and sexual violence is an effective measure.
The role of efforts like Dilaasa (which means ‘reassurance’) crisis centres (an initiative funded by the National Urban Health Mission and run jointly by the Municipal Corporation of Greater Mumbai [MCGM] and Centre for Enquiry into Health and Allied Themes [CEHAT] in 11 municipal hospitals) has become more pronounced in current times, as practically all other avenues of redressal of VAW are plugged.
Dilaasa Crisis Centres: Pivoting in the time of COVID-19
Dilaasa is a hospital-based crisis centre offering intervention services to survivors of violence against women and children. Established as an out-patient department (OPD) of the hospital, it has linkages to legal aid agencies, police stations and shelter homes. The objective of these crisis centres is to establish violence against women and children as a legitimate public health issue. Following the principles of feminist counselling with the needs of the woman at the core of its functioning, the Dilaasa model aims to empower women to make decisions on how to stop domestic and sexual violence.
The importance of advocacy for VAW services during times of crisis
The experience of Dilaasa centres, that have been providing psychosocial support to women survivors of violence for nearly 20 years, over the last few weeks is of considerable importance. Dilaasa’s development and execution of special guidelines for responding to VAW during COVID-19 merit a closer look as they attempt to make ‘staying at home’ safer for women.
The presence of Dilaasa centres within a hospital and CEHAT’s constant engagement with the state machinery to declare them as essential health services has played a key role in ensuring their continued functioning during this pandemic. This is a welcome move by the MCGM as it maintains access to in-person counselling services for survivors. Moreover, many counsellors have been undertaking other roles within the hospital, in solidarity with frontline health care providers.
Caring for and supporting staff
These are not normal circumstances and the Dilaasa staff have been equipped with knowledge of safety protocol and equipment like masks and sanitisers to protect them from COVID-19 while providing services to survivors. Dilaasa staff are also trained on infection control, including discussions on specific aspects of the virus and its transmission and steps to prevent infections through proper handwashing, use of masks, and physical distancing. The staff are reminded to seek medical attention and advice in case they feel unwell in the slightest.
Bearing in mind the travel restrictions during lockdown, many women may not be able to physically access the Dilaasa centres. Therefore, counsellors have been contacting women over the phone. Recognising that the perpetrators of abuse may be around the survivor, a dialogue is initiated about preventive measures against COVID-19, allowing counsellors to assess relief requirements and formulate questions about the woman’s safety within this dialogue.
Any intervention with survivors of domestic and sexual abuse, and sometimes even their perpetrators, can get overwhelming for counsellors, even outside of a pandemic. The mental health, well-being and safety of both counsellors and survivors is of primary importance to the Dilaasa centre. As such, the CEHAT team conducts daily debrief calls, giving the Dilaasa staff an opportunity to share experiences and feelings, acknowledging the extraordinary circumstances in which work is being carried out.
Strategies for face-to-face crisis intervention
When women physically arrive at a Dilaasa centre, all staff are reminded that women have most likely had to overcome multiple challenges to reach the centre, and how it is important to ask about and address survivors’ most pressing needs. Needs vary, for some it may involve safe passage to a shelter home or being connected to relief services in their geographical communities.
Dilaasa staff undertake a safety assessment with all survivors to determine if the woman is secure in going back to her home environment, has access to a mobile phone and the ability to reach out to a trusted person for support. If the survivor decides to stay in a shelter home or with relatives, the staff arrange for her smooth arrival in coordination with the police. In either case, financial instability due to the loss of wages during the lockdown is an important consideration. Counsellors maintain and regularly update a list of organisations they can connect the survivor to for relief and resources.
In addition to women’s experience of violence, counsellors also assess for psychological and physical stressors due to increased household burden. Since children and other family members are at home during lockdown, women’s time devoted to caretaking and domestic chores has increased manifold. The idea of sharing the burden has not permeated to many Indian households and women continue to bear the brunt of it. The survivor’s mental health including suicidal ideation are assessed by the Dilaasa staff. The survivor is counselled on self-care, strategies to address conflict in the home and provided with information on available services including both professional like helplines and non-professional such as talking issues through with a trusted friend or family member.
In one case, a survivor approached Dilaasa preceding the lockdown disclosing an unwanted pregnancy because of incestuous abuse. She did not wish to return home and the counsellor arranged her stay at a shelter home. She did not wish to continue with the pregnancy and abortion was scheduled on her behalf. However, before her appointment, the country went into a sudden lockdown, leaving her in limbo without anyone to bring her to the hospital. Dilaasa’s continued presence enabled transport for her to the hospital, ensuring that she got MTP service.
A major concern during this period of increased domestic violence is the reality that many women will be raped, the frequency of which may have risen while under lockdown. Dilaasa centre counsellors are aware of this and the potential risk of unwanted pregnancies and infections. Counsellors discuss possible scenarios with survivors on negotiating safe sex with their partners. Sadly, during COVID-19, women in need of medical termination of pregnancy (MTP) are unlikely to be a priority for hospital staff. So, the counsellors coordinate with other hospital departments and advocate for urgent care and treatment, which may get overlooked if the survivors approach the department themselves. This is done so that the survivors’ health is prioritised as per the existing government protocols, and their wait time can be minimised.
Learning from Dilaasa’s experience
In this period of a double threat to women’s health, best practices encapsulated in a set of guidelines for crisis intervention during COVID-19 have enabled Dilaasa counsellors to provide maximum support to survivors, while ensuring their safety. As a multitude of women in India continue to live under lockdown with restrictions on mobility, Dilaasa has exhibited a way to address violent factors inside the home which endanger women’s health. Similar efforts are needed to strengthen health services for women while simultaneously fighting the novel coronavirus. Especially during an infectious disease outbreak, the services provided by Dilaasa crisis centres are valuable and essential to the improved health outcomes of survivors, which will continue to firm up the response to VAW long after this contagion has been contained.
The blog has been developed by Ms Sangeeta Rege and Dr Surbhi Shrivastava on behalf of CEHAT -Dilaasa. We thank Dr Padma Prakash and Ms Elizabeth Dartnall for critically reviewing it. We thank Dilaasa counsellors who are in the frontline every day and continue to help women survivors in difficult times.