Redressing violence against women in COVID 19: Experiences of hospital-based centres in Mumbai, India

Written by Sangeeta Rege, Padma Bhate Deosthali, Sujata Ayarkar, Anupriya Singh, Anagha Pradhan and Dilaasa teams

The experience of the Dilaasa centres underscores the importance of the continued provision of VAW services in hospitals even during a pandemic and the recognition of VAW as a public health issue. 

A multi-sectoral response to this pandemic would have increased support for survivors through an effective and consistent set of network services.

Read the blog in Spanish and French.

The COVID 19 pandemic has led to deaths, disruption of lives, loss of incomes, and uncertainty across the world in the last few months. While lockdown as a public health strategy helps contain the spread of infection, it disrupts access to violence against women (VAW) services. Like in other countries, and with past pandemics (Ebola and SARS), India’s National Commission for Women  reported an increased risk of violence against women (VAW).

Health systems have continued to be an important point of contact for survivors of VAW, and it is imperative that they receive adequate budgets, appropriate infrastructure, have trained personnel and set up teams equipped to provide psychosocial/crisis intervention services.  Continuing to actively run intervention services in health settings, - during the COVID crisis, sends a vital message that VAW during humanitarian crisis require immediate and ongoing attention.

Adapting services to deliver during lockdown

Dilaasa, a crisis intervention program for survivors of violence against women in Mumbai, is making efforts to mitigate the impact of violence against women during the pandemic. Through the World Bank/SVRI 2019 Development Marketplace: Innovations to Address Gender-Based Violence, researchers from Centre for Enquiry into Health and Allied Themes (CEHAT) have been reviewing the scale-up of Dilaasa centers, a hospital-based flagship program of Ministry of Health and Family Welfare.

The Dilaasa and helpline services, were recognised as “Essential Services” and were able to stay open during the lockdown. However, lockdown meant that Dilaasa centres services had to adapt service delivery methods to accommodate the new environment. While psycho-social support services at public hospitals continued to operate, remote counselling was introduced for those who could not access face to face services. Contacts were also established with shelter homes to enable access for women whose safety was at stake. Other measures included arrangements with police to facilitate emergency travel passes for women, mobilising private transport providers, and engaging with community housing committees to assist women facing violence.

Reported levels, types and responses to VAW during lockdown

During April and July 2020, Dilaasa centres across 13 hospitals assisted 495 VAW and VAC survivors. These numbers are lower than the usual number of women seeking services in pre-COVID time.  Most survivors were adults; while 75 women reached hospitals with different health complaints as a result of violence, 14 rape survivors were brought by police for medico-legal care. An additional 3 rape survivors came to hospitals seeking abortion services.  Four hundred and three survivors sought telephonic services. Fifteen percent (15%) of survivors   suffered severe physical assaults resulting in cuts, bruises, head injuries, all of which required medical attention. While the experience of violence predated the pandemic, the reporting survivors spoke about increased restrictions on their mobility and some were even denied use of phones. Counsellors facilitated travel to safe places – these were often parental families and, in some instances, formal shelter services.

Forced sex was a concern expressed by women in telephonic counselling. Negotiating with partners for safe sex proved to be a challenge for survivors. While counsellors offered to speak to their partners, the counsellor handling the issue required a high level of skill. In one instance when the woman refused to have sex, the abuser walked home stark naked and refused to wear clothes. When the woman questioned him, he beat her so badly that she had to visit the nearest hospital to get stitches. She expressed not wanting to stay with the abuser and so safe passage to her brother was negotiated.

In another instance, constant verbal abuse and threats of being thrown out of the house drove a woman to walk almost 10 kilometres to reach her parents. She had to leave her infant behind given that there was no transport facility during the lockdown. It was upon reaching her parents that she contacted Dilaasa because she wanted to bring her child to safety. Negotiations with the police, seeking permission to travel, and engaging senior police officials helped bring the child back to her mother.

Challenges to accessing services during lockdown

While a multi sectoral approach is known to be most effective especially in humanitarian crisis, collaboration across multiple sectors - education, justice systems, health, etc. - was limited during lockdown. Critical services such as shelter homes, one Stop Centres, police and legal services did not have joint protocols for providing safe services. Responses by services was ad hoc and sometimes unhelpful for women. For example, COVID test reports were being demanded mandatorily by shelter homes across India, even though they are expensive and outside the reach of most women. Most One Stop Centres – which are services run by the Women and Child Department - were too afraid to admit women in their temporary shelters owing to COVID fears. Availability of abortion services were difficult to access in public sector hospitals. Whilst the private health sector refused to provide services - abortion as well as other essential services - private clinics and nursing homes in many parts of Mumbai city were closed and no reasons were cited for their sudden closure.

Justice sector responses

The police force was overwhelmed with enforcing the implementation of lockdown. As a result, they did not have the bandwidth nor inclination to respond to reports of VAW. Several women disclosed that they could not get their complaints recorded with the police.

An alternate model to this was identified in Pune (a city in Maharashtra, India). Pune’s district council directed village-level committees to track cases of domestic violence. In instances where domestic violence occurred, council members spoke to the abusive person and asked them to stop such behaviour. If the abuser did not change his behaviour, the council directed them to be put in institutional quarantine facilities as punishment. This is an important example of government actions to respond to domestic violence survivors even during a pandemic, which does not require additional resources but rather a strategy to demand accountability to and protect women from abusers.

The need for multi-sectoral responses

The experience of the Dilaasa centres underscores the importance of the continued provision of VAW services in hospitals even during a pandemic and the recognition of VAW as a public health issue. A multi-sectoral response to this pandemic would have increased support for survivors through an effective and consistent set of network services.

Several European countries issued directives and protocols for keeping shelter homes operational. Some countries announced additional financial packages to implement norms of physical distancing and requirements for prevention of COVID. Some countries directed hotels to accommodate and offer shelter services to survivors when shelter homes were fully occupied. Virtual courts have been set up in a few countries to hear survivors of VAW and - in countries that could not set these up - extension of protection orders for survivors were issued (UN Women, 2020).

India needs to urgently recognise that the current COVID 19 pandemic poses unique challenges. From lockdowns and curfews to containment zones and physical distancing, the situation on the ground is likely to remain dynamic. India needs to deliver a coherent response to VAW and cannot wait for the pandemic to be over. In fact, the VAW response should be integrated into pandemic preparedness and call upon different sectors to ensure services for VAW along with a message of ‘Zero tolerance’ so that survivors are able to speak out.

References

  1. India witnesses steep rise in VAW amidst the lockdown, 587 complaints received: NCW. (2020, April 17). The Economic Times. Retrieved from https://economictimes.indiatimes.com/news/politics-and-nation/india-witnesses-steep-rise-in-crime-against-women-amid-lockdown-587-complaints-received-ncw/articleshow/75201412.cms
  2. Municipal Corporation of Greater Mumbai. (2015). Health services. Retrieved from https://portal.mcgm.gov.in/irj/go/km/docs/documents/MCGM%20Department%20List/Public%20Health%20Department/RTI%20Manuals/Health%20Info%20Eng.pdf
  3. Peterman, A., Potts, A., O’Donnell, M., Thompson, K., Shah, N., Oertelt-Prigione, S., & Gelder, N. V. (2020). Pandemics and violence against women and children. Centre for Global Development, Working paper 528. Retrieved from https://www.cgdev.org/sites/default/files/pandemics-and-violence-against-women-and-girls.pdf
  4. UN backs global action to end VAW and girls amid COVID-19 crisis. (2020, April 6). UN News. Retrieved from https://news.un.org/en/story/2020/04/1061132
  5. UN Women. (2020). COVID-19 and violence against women and girls: addressing the shadow pandemic, Policy brief no. 17. Retrieved from https://www.unwomen.org/-/media/headquarters/attachments/sections/library/publications/2020/policy-brief-covid-19-and-violence-against-women-and-girls-en.pdf?la=en&vs=640

 

Contributors to the Blog- Sangeeta Rege, Padma Bhate Deosthali, Sujata Ayarkar, Anupriya Singh, Anagha Pradhan and Dilaasa teams.

  • Sangeeta Rege is Coordinator CEHAT and is engaged in research, advocacy and interventions for health systems response to VAWC
  • Padma Bhate Deosthali is an independent researcher and a senior advisor to CEHAT and consultant with CARE Bihar
  • Sujata Ayarkar and Anupriya Singh are crisis counsellors responding to VAW/C
  • Anagha Pradhan is a senior research officer implementing comprehensive health care response to VAW in public hospitals in Mumbai.

 

 

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