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Wednesday, January 19, 2022

Sexual assault survivors must be told of all their options

🔴 Vrinda Shukla writes: Doctors must provide emergency care, including medical termination of pregnancy, to victims of rape.

Written by Vrinda Shukla |
Updated: January 11, 2022 9:47:28 am
POCSO Act, 2012 and Section 357C of CrPC require all registered medical practitioners to render emergency medical care to women who have been subjected to rape.

A 13-year-old girl was 12 weeks pregnant when it was found that her 16-year-old brother had been raping her for months and had silenced her with threats and blackmail.

During the registration of the First Information Report (FIR), the doctor on duty, at the time of medical examination, made no mention to the victim of the option of terminating the pregnancy. She quietly recorded “pregnancy” in the relevant medico-legal documents. The police team, handling the case, attempted to convince the victim and her family to opt for medical termination of pregnancy (MTP). They were made to understand, with persistent counselling, about the potential birth defects in the child-to-be-born because of the incestuous abuse. With the parents and the traumatised victim convinced, it was, shockingly enough, the attending doctor who proved to be the major challenge. Working at an overstretched public health facility, she believed that her duty ended with the medical examination, a mandatory component of medico-legal cases. She perceived the abortion procedure as an additional burden thrust on her. Having made the victim visit the hospital a few times, she finally casually pronounced the victim “too weak” for an abortion. She appeared unconcerned as to how this “too weak” victim would survive pregnancy and childbirth.

There are thousands of such minors from low-income low-literacy backgrounds, who become victims of sexual assault at the hands of family and acquaintances. Pregnancies resulting from such violation remain undetected for long, either due to ignorance of the victims or due to fear of the perpetrators and their own families. There is, thus, an inevitable delay in reaching the health facilities. Medical termination is legally permissible up to 20 weeks of pregnancy. This limit was recently revised to 24 weeks for victims of sexual assault, rape, incest and minors, subject to the approval of a state-level medical board. The permission to abort beyond this duration is provided by the courts.

The Protection of Children from Sexual Offences (POCSO) Act, 2012 and Section 357C of the Criminal Procedure Code (CrPC) require all registered medical practitioners, both public and private, to render emergency medical care to the children and women who have been subjected to rape, including access to abortion. The statute, however, is weakened due to the persistent refusal of the authorities concerned to treat MTP as a matter of right and to accord it due urgency and promptness. Doctors often avoid taking a decision on the matter until 20 weeks are over, compelling victims to knock at the doors of the courts. The subject being a medical one rather than legal, is then referred by the courts to a medical board. The boards can take weeks to review the case and give their decisions while the pregnancy clock ticks on. The boards often lack experts to advise on third trimester abortions. They rarely include mental health experts to assess the trauma of sexual violation, unwanted pregnancy and the lifelong psycho-social impacts of delivering such children. There is also a tendency to gloss over the increased medical risks in minor girls of carrying a pregnancy and of obstructed labour.

It is time it was made mandatory for the doctor conducting the first medico-legal examination, to educate the rape victim and her family about the option of MTP. The doctor must record compliance with this requirement, in writing, in the medical examination form itself and a column must be earmarked in the form for this purpose. A follow-up date for assessment of the case, upon receiving written concurrence from the victim or her guardian, could also be recorded on the medical form. Such entries made on the permanent police and court record of the case would place accountability on the attending doctor. Permanent medical boards could be constituted at state level, consisting of expert obstetricians, representatives from NGOs/civil society, and mental health specialists for a thorough timebound assessment of MTP petitions made by rape victims.

In cases where the crime is reported to the police within 72 hours of the occurrence of rape, the examining doctor must mandatorily offer the victim the emergency contraceptive (EC) pill to prevent pregnancy, and compliance, to this effect, must also be recorded in the medical form. At present, many emergency care facilities fail to even inform the victims that such a remedy is available. Lastly, doctors must be sensitised on the long-term psycho-social impacts of an unwanted pregnancy following rape. They should also be trained in WHO-recommended international best practices for providing abortion care, including in advanced pregnancies.

Overburdened public systems must not trivialise the trauma of a sexual violation. To compel a survivor of such brutalisation to nurture a life borne out of it adds insult to injury.

This column first appeared in the print edition on January 11, 2022 under the title ‘After the assault’. The writer is an IPS officer serving as DCP Crimes against Women & Children in Noida, UP. Views are personal

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