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|Year : 2015
: 57 | Issue : 6 | Page
|Violence against women
Neena Bohra1, Indira Sharma2, Shruti Srivastava3, MS Bhatia3, Uday Chaudhuri4, Sonia Parial5, Avdesh Sharma6, Dinesh Kataria7
1 Holy Family Hospital, New Delhi, India
2 Department of Psychiatry, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
3 Department of Psychiatry, University College of Medical Sciences and Guru Tegh Bahadur Hospital, Shahdara, New Delhi, India
4 Department of Medicine, Vivekanand Institute of Medical Sciences, Kolkata, West Bengal, India
5 Dhanwantri Hospital, Old Dhamteri Road, Raipur, Chhattisgarh, India
6 Department of Psychiatry, Mind Vision Centre for Mental Health, New Delhi, India
7 Department of Psychiatry, Lady Hardinge Medical College, New Delhi, India
Click here for correspondence address and
|Date of Web Publication||27-Jul-2015|
| Abstract|| |
Violence against women (VAW) is a major public health problem in the country. The problem is grossly under-reported. A number of factors have been blamed for crimes against women. An inefficient law enforcing machinery has often been targeted for the increasing number of cases being reported. There is little recognition that psychiatric morbidity can perpetuate such crimes. Of late, there appears to a continuous increase in the number of crimes committed against women; especially the very serious ones like gang rapes. The latter have shaken the very conscience of people. Even harsher legislation does not seem to have made any effect. One wonders how this could be possible in a society heading toward high education, economic and technological development. Media has played a pivotal role by highlighting the problem to the masses. The need for the hour is for mental health professionals to take the challenge and present a comprehensive proposal for definite action to prevent all forms of VAW.
Keywords: Rape, violence, women
|How to cite this article:|
Bohra N, Sharma I, Srivastava S, Bhatia M S, Chaudhuri U, Parial S, Sharma A, Kataria D. Violence against women. Indian J Psychiatry 2015;57, Suppl S2:333-8
| Position Statement: Indian Psychiatric Society|| |
President: T. V. Asokan; Immediate Past Presidents Indira Sharma, Roy Abraham Kallivayalil; Vice President: V. Watve; Secretary N. N. Raju; Immediate Past Secretary Asim K. Mallick.
Task forces on Violence against women: Chairperson: Neena Bohra; Convener: Manjeet Singh Bhatia.
Speciality Section on Women Mental Health: Chair person: Uday Chaudhury; Convener: Shruti Srivastava.
| Introduction|| |
Violence against women (VAW) dates back to the history of mankind. Several forms of abuse have been described in our ancient epics, like Mahabharat and Ramayana. There have been efforts at global level to eliminate VAW. The United Nations (UN) Declaration on the Elimination of VAW (1993) states that "VAW is a manifestation of historically unequal power relations between men and women, which have led to domination over and discrimination against women by men and to the prevention of the full advancement of women, and that VAW is one of the crucial social mechanisms by which women are forced into a subordinate position compared with men." 
The UN prepared documents for the purpose of eliminating VAW and to bring women to an equal status with men. In all countries, across all cultures, efforts should be made, that UN Declaration is known and respected.
| Forms of Violence Against Women|| |
The Protection of Women from Domestic Violence Act (PWDVA), 2005 recognizes four types of VAW in domestic relationships: Physical, sexual abuse, emotional or verbal abuse, and economic violence. This categorization is also applicable for VAW in other settings.
| Epidemiology|| |
Overall 35% of women worldwide have experienced either physical and/or sexual intimate partner violence or nonpartner sexual violence. Intimate partner violence is reported in most of this violence. Globally about one-third (30%) of all women who have been in a relationship have experienced physical and/or sexual violence by their intimate partner.  WHO figures quote that 38% of all murders of women are committed by intimate partners. 
The situation in India with respect to VAW is alarming. The prevalence figures of India, during the year 2011, as reported by National Crime Records Bureau  are: Cruelty by husband and their relatives - 43.4%; molestation - 18.8%; rape - 10.6%; kidnapping and abduction - 15.6%; sexual harassment - 3.7%; dowry death - 3.8%; Immoral Traffic Act - 1.1%; Dowry Prohibition Act - 2.9%; and others - 0.2%.
The Thomas Reuters Foundation expert poll in 2011, reported  that India is the fourth most dangerous country in the world after Afghanistan, Congo, and Pakistan. "Female foeticide," child marriage and high levels of trafficking and domestic servitude make India the world's largest democracy the fourth most dangerous place for women.
One hundred million people, mostly women and girls, are involved in trafficking in one-way or another, according to Madhukar Gupta former Indian Home Secretary. 
Up to 50 million girls are "missing" over the past century due to female infanticide and foeticide. 44.5% of girls are married before the age of 18. 
The "Children in India, 2012 - A Statistical Appraisal" study reported that during 2001-2011, the share of children to total population declined; the decline was sharper for female children than male children in the age group of 0-6 years." 
Manifestations of VAW occur throughout the lifespan from prebirth, infancy, childhood, adolescence, adulthood to old age.  Violence is inflicted on children, adults with disabilities, and severe mental illness and occurs in different settings such as at home, workplace, hospitals, jails, governmental and nongovernmental homes for the under privileged, and in the community. It occurs in all socioeconomic and cultural groups. World Health Organization advocates action plans to be implemented at national level to prevent violence as a global campaign.  Of major concern are increasing cases of domestic violence, sexual harassment at work place, dowry-related violence, honor killings, acid attacks, and gang rapes.
| Violence Against Women and Indian Legislation|| |
Crimes against women are classified in the Indian Penal Code (IPC) and special and local laws.
Some of the crimes under the IPC are mentioned below:
- Rape (Section 376 IPC): Over the years there has been a trend of increasing number of cases being reported. 9.2% increase was reported in the year 2011 over the year 2010. Rape cases have been divided into two categories: Incest rape and other rapes. Delhi has often been addressed as the rape capital of India
- Kidnapping and abduction (Section 363-373 IPC): Delhi has shown the highest rate
- Dowry death (Section 302, 304B IPC) and Dowry Prohibition Act, 1961: Highest rate has been reported in Bihar
- Torture (Cruelty by Husband and Relatives of Husband) (Section 498-A IPC): The highest crime rate was reported in West Bengal
- Molestation (Section 354 IPC): Madhya Pradesh has reported the highest incident, and Kerala has reported the highest crime rate
- Sexual harassment (Section 509 IPC): Sexual harassment of women is a violation of the fundamental right of women to work in a safe environment
- Importation of girls (Section 366-B IPC).
The gender specific laws for which crime statistics is recorded are as follows:
- Immoral Traffic (Prevention) Act, 1956. Daman and Diu reported the highest rate
- Dowry Prohibition Act, 1961
- Indecent Representation of Women (Prohibition) Act
- Sati Prevention Act, 1987
- The Protection of Women against Domestic Violence Act (2005).
An increasing trend in cases of rape was observed during 2007-2008. A mixed trend in the incidence of rape has been observed during the periods 2008-2011. 
| Consequences of Violence Against Women|| |
Wyatt et al. reported that once afflicted with violence, the chances of re-victimization are higher and more traumatizing. Depression, suicidal ideation, low birth rates, abortions, and risk of infections have been reported after violence. 
| Causal Factors of Violence Against Women|| |
The factors contributing to VAW can be intrinsic, within the individual, in the victim or in the perpetrator; or extrinsic, in the environment. The latter could be in the immediate environment (e.g., family) or in the community. The important causes of violence are listed below.
Early and young age, illiterate or low level of literacy, poverty, urban domicile, and women with no income of their own, unmarried, separated or divorced status or being in a live-in relationship have been cited as risk factors for domestic violence. India ranks at 101 position in the list of 136 nations in the disparity index in terms of economic, political, health care, and educational opportunities for women and their participation in such services (Times of India, October 26, 2013). 
Women engaged in small business and farming were more likely to be abused than women who were housewives or who had occupational status equal to that husbands. Where women have a higher economic status, than their husbands and are having sufficient power to change traditional gender roles, violence is at its highest. In predisposed persons, marriage can contribute to mental health problems. Mentally ill women are subjected to different forms of violence in a marital unit without the appropriate steps being undertaken for the management of their mental illness, further contributing to marital disharmony and limited family functioning. 
Exposure to harsh physical discipline during childhood and witnessing the father beating the mother during childhood is a predictor of victimization and perpetration of violence against his wife in adulthood. Women, who reported experiencing harsh physical punishment during childhood and had witnessed their fathers beat their mothers, were at increased risk of spousal physical violence (beat, hit and kick). 
There is robust evidence to suggest that alcohol has been the factor associated with perpetration of several forms of VAW. A recent meta-analysis provided a strong evidence for association between alcohol and intimate partner violence among women.  Prevalence of aggression is higher among psychiatric patients especially those suffering from severe mental illness like schizophrenia.  The most pathological cluster type personality contributes to more anger experience.  Other morbidities like paranoid schizophrenia, delusional disorder, bipolar disorder, and antisocial personality have been linked with perpetration of sexual VAW.
Persons with intellectual disability form a particularly vulnerable group as in them a higher prevalence of sexual assault than in general population has been reported.  Likewise, women suffering depression, severe mental illness, and mental retardation would be at high risk for various types of abuse.
Women with severe mental illness constitute an extremely vulnerable population at risk for various types of violence. Women with mental illness are often rejected by their families, usually when the mental illness manifests soon after marriage, or the fact of mental illness before marriage comes to light, primarily because of the widespread stigma of mental illness. According to the Indian legislations like Hindu Marriage Act, 1955,  and Special Marriage Act, 1954,  a severe, recurrent and disabling mental illness is a ground for nullity of marriage. Thus, many husbands reject their wives with mental illness as they know that in a patriarchal society they would always be able to remarry. However, as many of these women are married with hefty dowry and also because the marriage is considered to be a permanent union, the women and their families may adopt all sorts of measures to prevent nullity of marriage. Thus, when social measures fail, legal measures may be adopted. Complaints may be made under their Dowry Prohibition Act, the PWDVA or 498A IPC (of cruelty by husband and relatives of husband). ,, Although in such cases the allegations are of violence and/harassment for dowry, the main concern is the restitution of conjugal rights, not dowry. Dowry is a nonissue in most of the cases, because both the giver and receiver of dowry were in agreement. Various forms of violence may be inflicted on the women so as to drive them out of the matrimonial homes. It is usually a no-win situation. All along the treatment of mental illness of the women is neglected which worsens the situation and closes the gates for reconciliation. Many marriages end up in separation or divorce; children are the worst sufferers.
Sociocultural traditions (deep rooted)
Patriarchy, traditions like dowry, family honor, witnessing family violence etc., have continued through the ages and have put women in disadvantaged positions.
Media and pornography
Media plays a pivotal role. Repeated exposure to violence in the media has been associated with increased incidence of aggression, especially in children. Television and cinemas are portraying sexual material for making fast money. Pornographic material is easily available to many on the internet and through other ways.
Easy availability of addicting substances (especially alcohol, bhang, and ganja) is also responsible.
Hindu Marriage Act (1955)
Deficiencies in certain legislations are noteworthy. According to two major legislations on marriage the Hindu Marriage Act (1955) and Special Marriage Act (1954) presence of mental illness at the time of marriage or in the past, if concealed, can become a ground of nullity of marriage. The marriage is voidable if the person "is incapable of giving a valid consent to it in consequence of unsoundness of mind" or is "suffering from a mental disorder of such a kind, or to such an extent, as to be unfit for marriage and procreation of children" or "has been subject to recurrent attacks of insanity." These words have not been clearly defined and have been differently interpreted both by people and legal professionals. During the past 50 years the prognosis of severe mental illness has improved considerably. Very few persons would meet the conditions laid down in the marriage Acts. However, because of mention of the word "mental disorder" and "insanity" many husbands and their families and lawyers take the stand that they are justified is rejecting their wives.
Protection of Women from Domestic Violence Act (2005)
This Act does not recognize mental illness as a cause of domestic violence. The perpetrator of domestic violence is not permitted to plead any defense. He is to be counseled to stop violence. There no provision in the code of civil procedure for mandatory psychiatric assessment and treatment.
Dowry Prohibition Act (1961)
Although many complaints under this Act  are genuine, there is evidence that frivolous complaints are also made against the husband and relatives with the sole purpose of saving the marriage, when is on the verge of breakdown. This is most often done when there is underlying mental illness in the women. In a typical case the husband rejects the woman because of mental illness, while the woman's family denies mental illness and alleges that the abnormal behavior is because of cruelty meted out to her to fetch more dowry. In most of the cases treatment of the mental disorder remains neglected leading to more violence. There no provision in the code of civil procedure for mandatory psychiatric assessment and treatment.
Psychosocial stress relating to poverty, education, career, unemployment, work, marriage, and corruption etc., can contribute to violence by resulting in maladaptive coping responses and/or triggering mental illness in vulnerable individuals.
Recreation and sports
Lack appropriate facilities for recreation/sports and development of creative abilities and social networking also have some role.
Law enforcement machinery
An insensitive, inefficient, unaccountable and corrupt law enforcement machinery (including administrators, police, and judiciary) loses its role as a mechanism for redress of complaints and deterrent for commission of crimes. Often, it has rightly been said that "justice delayed is justice denied."
Religious and ethical values
Deterioration of religious and ethical values are also important.
Multiple risk factors
Multiple risk factors may be present in some individuals making them at risk for perpetrating violence or of becoming victims of the same. For example, men living away from home, residing with an unhealthy peer group, facing multiple stresses, and having access to pornography and alcohol, may be particularly vulnerable.
| Prevention of Violence Against Women|| |
The dictum is "violence is preventable."
Gender sensitization should focus on the sensitivities and boundaries of man-woman relationships, code of conduct with respect opposite gender in different settings, and strategies to prevent violence at unusual places and times. Awareness and education can be done by parents at home, teachers in school and colleges,  employers at work place and nongovernmental organizations (NGOs) in the community. Workshops, lectures and street plays, videos can be organized in schools, colleges, and public gatherings for this purpose. Relationship handling, violence prevention, and communication skills should be instilled in youth through training workshops at schools, colleges and at community level. A national workshop was organized by Maitri (NGO) on April 5, 2012 in Delhi on VAW. Medical and para-medical workers and medical students should be sensitized on the topic for tackling gender sensitive issues. Sex education needs to be taught at the level of schools, colleges, and community. Training of different stakeholders like police personnel, judiciary, administrators, and legal professional is also needed.
Treatment of mental illness
Good mental health care facilities are needed for early identification, treatment and rehabilitation of those with severe mental illness. Persons with mental illness with active symptoms must be kept in a protected environment till substantial improvement takes place. Some patients with chronic illness such as mental retardation and schizophrenia may have to be kept life-long in protected environments under the care of their guardians. Mass awareness needs to be created among people in this regard. Involuntary treatment of persons with alcohol dependence should be carried out.
Restriction on the use of addicting substances
Concerted efforts must be made to restrict the use of alcohol, bhang, and ganja especially in young people. There should be decrease in the number of alcohol outlets and prohibition on alcohol use in mass gatherings, in institutions, and in public places like trains and buses. The age for purchasing alcohol may be raised to 30 years. Special checks on festive occasions are recommended with the help of breath analyzers.
Media campaigns can help to reverse social attitudes that tolerate VAW. Collaboration with the media needs to focus on creating new messages and new responses to prevent domestic violence.
The role of computers and internet is worth mentioning. Pornographic sites should be blocked. CD-ROMS/websites containing such pornographic information quite should be strictly be prohibited.
Law enforcement machinery
24 × 7 helplines for women like Maitri (a New Delhi-based NGO), and Vandrewala in Mumbai are needed. Victims of violence can directly go to the hospitals, can seek referrals from the community centers, and access 24 × 7 helpline numbers. Maitri NGO has provided the helpline number for Domestic Violence +918010512345. Maitri (NGO) through its project "Samvedna" offers free counseling and mediation services to victims of domestic violence and their families. The organization also facilitates legal services for those who opt for legal solutions.
Fast track courts are strongly recommended.
Special cells in police stations with the help of women police officers should be empowered with manpower, latest gadgets like CCTV footage and phone help lines, etc.
Mind set of judiciary
patriarchal mindset of the judiciary must change toward being gender neutral. Indira Jaising, Additional Solicitor General of India, aptly stated "It's time for India's courts to gaze inward and throw out deeply embedded patriarchal notions that stop judgments from being fair to women. Sexism within the system has to go before it does more damage in the country." "It was not possible for a man, acting alone to rape a woman in good health" was stated in a judgment by a Orissa High Court judge.
Hindu Marriage Act, 1955: Mental illness should be removed from conditions of Hindu Marriage. Not informing about past illness of mental illness should not be a ground for nullity of marriage.
PWDVA, 2005 and Dowry Prohibition Act, 1961: Assessment for mental illness should be incorporated in the code civil procedure so that the mental health needs of the victim and the perpetrator are addressed and violence prevented.
Appropriate application of laws in the setting of mental illness
It is evident from many judgments of matrimonial disputes that mental illness is often present in one of the parties, petitioner or respondent. However, it is often missed by the judiciary. As a consequence the case drags on for years and mental illness remains neglected. It is suggested that judiciary have some preliminary training for recognition of common mental disorders so that all doubtful cases may be referred for expert opinion and treatment instituted if needed. This initiative has already been taken in some states. Also, there should a panel of experts (1 or more psychiatrists) for family and civil courts dealing with matrimonial disputes who may be consulted.
Code of conduct
Traditional families have an unwritten code of conduct which prevents intimacy between prohibited relationships (father and daughter and mother and son etc.) in a family. Likewise, in hospitals there is a code of conduct not to examine a female without a female attendant. All institutions should have some guidelines (code of conduct) on how much of closeness is permitted between the two sexes. Adherence to the prescribed code of conduct will prevent sexual misconduct. Also, if the same is violated, it can be easily detected and appropriate measures can be taken.
Improving the socioeconomic status of women
Empowerment of women through improving their education, job opportunities, representation in different sectors, and awareness about their rights and legal provisions would be a step in the right direction.
Promotion of healthy lifestyle including management of stresses of daily living is recommended.
Religious leaders and scholars
Religious leaders and scholars need to re-examine interpretations of religious texts and doctrines from the perspective of promoting equality and dignity for women.
NGOs/social activists/communities/resident welfare organizations (urban)/village panchayats need to be actively involved and sensitized to promptly act if the incidents come to their notice. There services can be utilized in minimizing violence by putting social pressures on the perpetrators of crime. Such organizations can also provide leadership in the local community to oppose VAW.
| Acknowledgements|| |
We acknowledge the inputs from eminent psychiatrists of teaching and private hospitals who participated in the symposium at the 38 th Annual National Conference of Indian Psychiatric Society, North Zone, held in New Delhi on October 26, 2013, where the preliminary draft of this statement was presented and discussed. In addition, inputs were taken from counselors, social activists, and psychologists in preparing the draft. The draft was also widely circulated electronically to mental health professionals in the country for valuable suggestions. After several revisions, the document was finalized. We are indebted to Professor S. C. Malik, and Professor S. Nambi, Past Presidents of Indian Psychiatric Society for being the driving force and for the insights provided in preparing this document.
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