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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 8  |  Issue : 2  |  Page : 107-109

Perceived difficulties of the family member of a survivor of rape with multiple disabilities in accessing care and support


1 Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
2 Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
3 Betterfly, Kottakkal, Kerala, India

Date of Submission20-Oct-2022
Date of Decision02-Nov-2022
Date of Acceptance07-Nov-2022
Date of Web Publication16-Dec-2022

Correspondence Address:
Dr. Mysore Narasimha Vranda
Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru - 560 029, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjp.tjp_39_22

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  Abstract 


Gender-based violence against women and girls is a major public health issue. Women with multiple disabilities are more vulnerable to experience sexual violence due to pre-existing vulnerability factors than non-disabled. In this case report, we are present a case report of perceived challenges and difficulties experienced by the family member of a 26 years old survivor of sexual assault with multiple disabilities in availing health and psychosocial services in the community.

Keywords: Barriers, disability, violence, women


How to cite this article:
Vranda MN, Kumar CN, Febna M, Ammapattian T, Shiri SS. Perceived difficulties of the family member of a survivor of rape with multiple disabilities in accessing care and support. Telangana J Psychiatry 2022;8:107-9

How to cite this URL:
Vranda MN, Kumar CN, Febna M, Ammapattian T, Shiri SS. Perceived difficulties of the family member of a survivor of rape with multiple disabilities in accessing care and support. Telangana J Psychiatry [serial online] 2022 [cited 2023 Feb 4];8:107-9. Available from: https://tjpipstsb.org/text.asp?2022/8/2/107/363975




  Introduction Top


Women with disabilities (WwDs) are more vulnerable toward experiencing gender-based violence (GBV) compared to those without disabilities.[1] Person with disabilities were 1.5 times more likely to be victims of violence than those without disabilities, and those with disabilities associated with mental illnesses were at nearly four times higher risk of experiencing violence.[2] The WHO[3] defines sexual violence as “any sexual act, attempt to obtain a sexual act, unwanted sexual comments, or acts to traffic, or otherwise directed, against a person's sexuality using coercion, by any person regardless of their relationship to the victim, in any setting, including but not limited to home and work.” A survey in India revealed a sharp increase in sexual violence among young women aged 18–29 years, from 10.3 in 2014–2015 to 11.0 in 2019–2021.[4] Studies have identified several risk factors for violence against WwDs such as lack of knowledge about sexuality, low literacy, feelings of powerlessness, communication skills deficits, physical and financial dependence,[5],[6],[7] and communication difficulties, which increases their vulnerability to violence and discrimination.[5] WwDs and their families undergo unique challenges and barriers to reporting and accessing to medico legal healthcare services. Social discrimination, and rejection in the community impede people with disabilities from availing assistance and likely to increase their risk of experiencing abuse.[5],[8] In the present paper, the authors present a case report on perceived difficulties and challenges faced by the family member of a survivor of sexual assault with multiple disabilities. The written consent for the publication was obtained from the client and her family member.


  Case Report Top


A 26-year–old female, having speech and hearing impairment with mild intellectual disability disorder, appeared to be pregnant when they consulted in a general hospital for her sudden weight gain. On examination, the client was found to be 6 months pregnant and it turned out to be a medical–legal case. The client and her mother were immediately referred to the One Stop Centre (OSC) situated in the premises of general hospital for further management. The mother was in a state of shock when they found out client's pregnancy. On further interviewing with the help of mother, the client reported that she was raped by a 65-year-old elderly man. The client narrated the incident using sign language to mother and the mother translated the same to the police. The family member did not have any clue about the incident, and it was difficult for the client to explain what had happened. It was found that an elderly man in the same locality raped her on multiple occasions when she was alone at home and also in the field where she had gone for cattle grazing. Following the revelation of the incident, the client was referred to a government hospital for medical examination, and immediately, a FIR was registered against the accused at the local police station. The mother was the interpreter of client testimony at the police station, as there were no professional interpreters or special educators. The accused was immediately arrested, and the client was able to recognize him and also co-operated with the forensic team in evidence collection. The family reported that the incident came in the media, and to prevent the stigma and humiliation from society, the mother and client moved to a local nongovernment organization and stayed till the child's birth. Currently, the child is being taken care of by the client's maternal aunt, who is staying in another village as the family does not want to keep the child due to various psycho-social factors such as stigma and discrimination. While reporting the incident, local media failed to keep up the family's privacy, which led to stigma and social isolation from the community. The family has contemplated ending life due to the stigma. The family expressed fear of being harmed by the accused family as he belonged to the upper caste community, and is politically influential. The mother reports that the accused came out on bail and is staying in the same village. Seeing the accused walking free was reported to be traumatic for the family. The family reports nothing has happened in the last 2 years. The court proceeding has also been delayed, and the family lost faith in the legal system. For court hearings, the family spends a lot of money on traveling and other court-related expenses. In one such hearing, the victim was called inside alone by the judge, and the mother has no idea what had happened inside the courtroom. There was no special educator/sign language interpreter either in the OSC/police station/or in front of the magistrate while recording the victim's statement. The family also feared that the accused might escape from the clutches of law, as the statement was recorded without the assistance of a special educator/interpreter. The family has received victim compensation money worth Rs. 5000 from the government, which was insufficient to bear the client's medical expenses. Following this incident, the mother reports that the client has been emotionally withdrawn from others, looks sad, becomes fearful, cries without reason, and becomes irritable toward others.


  Discussion Top


The above case scenario indicates the issues of the family member of a survivor of rape in accessing services. A recent report by Human Rights Watch Report[9] revealed that survivors of rape with disabilities in India find it difficult to register police complaints, go through victimization at the police station and hospital, and courtroom, and find difficulties obtaining compensation. Family members complained of a lack of sensitivity in registering the FIR, evidence collection, and reporting from the police as they failed to provide a special educator/sign language interpreter to assist the survivor in reporting the incident.

The experiences of the family member have been in concordance with recent studies[10],[11] where survivors and family members reported systemic barriers such as delayed judicial procedures, trauma and victimization at the hands of the defense, loss of income and job due to repeated visits to the courts, and insensitive role of the judges in not preventing the intimidation.

There are persistent gaps in enforcing the laws, relevant policies, and guidelines to ensure justice for the women survivors of sexual violence with disabilities. Some of the strategies to mitigate the issues of the survivors and service providers are:

Awareness creation

There are several myths that exist in the society and among professionals that persons with disabilities are asexual resulting in exclusion from sexuality education, prevention, and support services. It is crucial to provide WwDs and their families with procedure of accessing care, support, and justice in cases of sexual violence by ensuring that information is made available in accessible formats, including braille, audio, sign language, video, and easy-to-understandable forms.

Specialized Mental Health Care

There is a need to have specialized services for the survivors in providing health and emotional support for court appearances, practical help to deal with trauma secondary to violence, practical help, and linkage of survivors and their families with other agencies. There are several suggested ways to work with survivors using psychotherapeutic modality to address the trauma, including normalizing and validating feelings, being nonjudgmental, and showing compassion. Trauma-focused cognitive behavioral therapy focusing on psychoeducation, relaxation skills, affective skills to handle emotional dysregulation, and safety planning are the strategies to work with survivors of sexual assault. It has been reported that Supreme Court and MHFW guidelines were not followed especially by not having a special educator or sign language interpreter while collecting forensic information by the police and even in the courtroom by the judiciary.[9],[10],[11] The SOPs should be formulated based on the specific needs of WwDs at every phase of the investigation. The police officers, judges, magistrates, and special educators and interpreters also need to be trained to accommodate the specific needs of WwDs.

Training of different stakeholders

There is a need for training of healthcare professionals, police officers, and the judiciary on issues related to WwDs, especially sexual violence. Many studies have reported a lack of privacy in the hospitals; healthcare professionals were insensitive to the needs of the survivors and their families and made the victims wait for longer hours for examination due to the nonavailability of the gynecologists or other medical facilities.[12],[13]

Future research

There is no national data available specifically on GBV against WwDs to frame government policies, programs, and services to address specific needs of target group.


  Conclusion Top


Despite progressive legislation, policies, and programs aftermath of post Nirbhaya incident, women in India continue to experience rape/sexual assault. There is a need to have a proactive approach to prevent violence against WwDs.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

This study was funded by the Indian Council of Medical Research (ICMR), New Delhi, India, No. Adhoc/162/2020/SBHSR dated August 31, 2020.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. World Disability Report. Switzerland, Geneva: The World Bank; 2011.  Back to cited text no. 1
    
2.
Hughes K, Bellis MA, Jones L, Wood S, Bates G, Eckley L, et al. Prevalence and risk of violence against adults with disabilities: A systematic review and meta-analysis of observational studies. Lancet 2012;379:1621-9.  Back to cited text no. 2
    
3.
World Health Organization. World Report on Violence and Health. Switzerland, Geneva: World Health Organization; 2002.  Back to cited text no. 3
    
4.
National Family Health Survey (NFHS-5) 2019-21. India report. Ministry of Health and Family Welfare, Government of India, International Institute for Population Sciences (IIPS) and ICF. India. Mumbai: IIPS.  Back to cited text no. 4
    
5.
Plummer SB, Findley PA. Women with disabilities' experience with physical and sexual abuse: Review of the literature and implications for the field. Trauma Violence Abuse 2012;13:15-29.  Back to cited text no. 5
    
6.
Thomas KA, Joshi M, Wittenberg E, McCloskey LA. Intersections of harm and health: A qualitative study of intimate partner violence in women's lives. Violence Against Women 2008;14:1252-73.  Back to cited text no. 6
    
7.
Corker M. Disability politics, language planning and inclusive social policy. Disabil Soc 2000;15:445-62.  Back to cited text no. 7
    
8.
Gilson SF, Cramer EP, DePoy E. Redefining abuse of women with disabilities: A paradox of limitation and expansion. Affilia 2001;16:20-235.  Back to cited text no. 8
    
9.
Human Right Watch. Invisible Victims of Sexual Violence – Access to Justice for Women and Girls with Disabilities in India; Human Right Watch, US. 2018. Available from: https://www.hrw.org/sites/default/files/report_pdf/india0418_web.pdf. [Last accessed on 2022 Oct 10].  Back to cited text no. 9
    
10.
Humar Right Watch. “Everyone blames me” – Barriers to Justice and Support Services for Sexual Assault Survivors in India; Human Right Watch, US. 2017. Available from: https://www.hrw.org/report/2017/11/08/everyone-blames-me/barriers-justice-and-support-services-sexual-assault-survivors. [Last accessed on 2022 Oct 10].  Back to cited text no. 10
    
11.
In the Supreme Court of India Crimial Orignial Juridiction SMW (CRL). Assessment of the criminal justice system in response to sexual offences. No(s).04 OF 2019. New Delhi. Retrieved from: https://main.sci.gov.in ' supreme court ' 2019 ' 4. 8 October 2022. [Last accessed on 2022 Nov 23].  Back to cited text no. 11
    
12.
Raha S, Sengupta S. Rights of Women with Disabilities under Indian legislations. Published in www.manupatra.com 2018;190-211. Retrieved from: http://docs.manupatra.in/newsline/articles/Upload/7102F404-0902-4EEC-BA55-F8EFC25DA6D4.pdf. [Last accessed on 2022 Oct 10].  Back to cited text no. 12
    
13.
Du Mont J, White D, McGregor MJ. Investigating the medical forensic examination from the perspectives of sexually assaulted women. Soc Scie & Medi 2009;68:774-80.  Back to cited text no. 13
    




 

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