domestic abuse

Ten years after it was implemented, how is the Domestic Violence Act faring?

Dearth of data, improper implementation and long-drawn cases have impeded the success of an important legislation.

It was two months into their marriage when the abuse began. Mohan, 30, slapped his wife Ragini, 27, for giving a lower dowry than expected by her parents-in-law (names changed to maintain anonymity.) “First he used to be sarcastic about our class difference – I was from west Delhi and he from a posh south Delhi society – but then one day, he attacked at me”, said Ragini, an energetic woman, who now teaches at a school in New Delhi. “I tried to attack him back at times, but all that I could do was scratch him.”

When Ragini told her mother-in-law about the abuse she was told that “all this is normal”. It was when Ragini’s husband dragged her and beat her up so severely that it left her with wounds on her head that she left the house and registered a complaint with the Delhi police under the Protection of Women from Domestic Violence Act, passed in 2005.

“I was in a dilemma then, because filing a case meant that my marriage is going to break and we are going to have a divorce,” she said. But her family’s support firmed her resolve for justice. The court has provided partial compensation to Ragini, while divorce proceedings are still ongoing.

In the 10 years since the Protection of Women from Domestic Violence Act, a civil act, was passed, more than 1,000,000 cases have been filed across the country under sections pertaining to “cruelty by husband” and dowry, data from the National Crime Records Bureau shows. Cases registered under the abetment of suicide of women, collected by the Bureau since 2014, increased by 34%, from 3,034 the previous year to 4,060 in 2015, the data shows.

For a decade from 2005 to 2015, 88,467 women, or an average of 22, died each day in dowry-related cases. In 2015 alone, 7,634 women were killed over dowry, data shows.

Source: Crime in India report from 2006-2015
Source: Crime in India report from 2006-2015

Missing, incomplete data under the prevention of domestic violence act

Though the domestic violence legislation was enacted in 2005, the National Crime Records Bureau only started collecting data under the law in 2014, according to this 2017 Lok Sabha answer.

Today, data under Protection of Women from Domestic Violence Act, as collected by the National Crime Records Bureau, includes only criminal violations of court orders under the legislation, such as the violation of a protection order passed by the court while the case is ongoing. Cases registered under the violation of the Protection of Women from Domestic Violence Act increased by 8%, from 426 in 2014 to 461 in 2015, according to data.

This does not include actual incidents of domestic violence that are recorded under three sections of the Indian Penal Code – section 498 A for cruelty by husband and his relatives, section 304 B for Dowry deaths and section 306 for abetment of suicide.

Further, cases dealing with protection from husband and relatives, and maintenance in cases of domestic violence, are registered directly with the court, under the Protection of Women from Domestic Violence Act and are not recorded by the National Crime Records Bureau. This data on court cases has remained inaccessible after repeated attempts by women’s rights groups.

More than a decade since the act has been implemented, data on its success or failure of is skewed, said Swati Maliwal Jaihind, the chairperson of the Delhi Commission for Women. “What I have observed all these years is that the fight to justice is a tedious one with often justice delayed is justice denied,” she said, explaining that courts don’t collect numbers on outcome of these cases.

Even in cases recorded by the Bureau , there is high pendency.

As many as 35,260 (83%) out of 42,410 cases filed under dowry deaths in 2015 and left over from 2014 were pending at the end of 2015, as were 11,319 (99.9%) of 11,320 cases recorded under abetment of suicide, 44,4367 (83%) of 534,431 cases filed under cruelty by husbands and his relatives, and 846 (99.8%) of 847 cases filed under the Protection of Women from Domestic Violence Act, according to data from the National Crime Records Bureau.

Numbers may not reflect reality

In 2015, more than 113,000 cases were filed under the section called “cruelty by husband and relatives” by the National Crime Records Bureau, up 80% from 2006, when about 63,000 cases were filed, data shows. The increase in number of cases could be because of an actual increase in crime or because of a rise in reporting of such cases, as awareness of the law grows, and more women are empowered to report abuse to the police, rather than an increase in the number of crimes.

Trends differ from state to state. For instance, in Andhra Pradesh, cases under “cruelty by husbands and relatives” decreased from 9,164 to 6,121, a 33% fall between 2006 and 2015, while dowry deaths decreased 66% from 519 in 2006 to 174 in 2015. Cases under “cruelty by husbands and relatives” increased by over 171% in West Bengal from 7414 in 2006 to 20,163 in 2015. There was little change in the number of dowry deaths recorded in Bihar from 1,188 in 2006 to 1,154 in 2015.

Source: National Crime Records Bureau
Source: National Crime Records Bureau

It is unclear whether data from the National Crime Records Bureau shows actual trends in domestic violence. Almost 30% of married Indian women between the ages of 15 and 49 years reported experiencing spousal violence at least once, according to the National Family Health Survey-4, conducted over 2015-2016. This proportion has reduced from 27.2% of women who reported violence by spouses in 2005-2006.

Though cases recorded with the National Crime Records Bureau reduced in Andhra Pradesh, a higher proportion of women (43.2%) reported facing spousal violence in 2015-2016 over 2006-2006 (33%), according to National Family Health Survey data.

Source: National Family Health Survey-4
Source: National Family Health Survey-4

As many as 60% of men admitted to violence against their wife or partner at some point in their lives, according to a study by Washington-headquartered International Centre for Research on Women and United Nations Population Fund, as IndiaSpend reported in November 2014.

Other signs of the continuing domestic abuse against women is reflected through other indicators. For instance, more Indian women are prone to fire-related deaths than any other country – 18 times more than Pakistani women and 38 times more than Chinese women – according to an analysis of global disease data by the Institute for Health Metrics and Evaluation, a research body based at the University of Washington in the US, as IndiaSpend reported in January 2017.

As many as 17,700 Indians died due to fire accidents in 2015, of which 10,925 (62%) were women, National Crime Records Bureaudata revealed.

Further, though Indian men are twice as likely as women to kill themselves, of all the methods of suicide, self-immolation is the only one that claims more women than men, according to national crime data, with 5,832 women committing suicide by fire, compared to 3,723 men in 2015.

Ritual self-immolation is an Indian tradition, noted this 2003 study, which identified dowry as the modern motivating factor. “When dowry expectations are not met, the young bride may be killed or compelled to commit suicide, most frequently by burning,” wrote the author, Virendra Kumar, a forensic professor.

Why domestic violence is common and justice slow

After a case has been filed, many different kinds of organisations play a role in ensuring justice and rehabilitation to the victim.

“It is important to understand that there are multiple stakeholders involved in the implementation of the law ranging from protection officers – who issue protection orders as a relief to the victim, an order of monetary relief, a custody order, residence order and compensation order, service providers – who aid in conducting medical examination, record the incident of violence, and forward it to the magistrate while also providing the aggrieved with a shelter home, and a lawyer”, said Anuradha Kapoor, Director of SWAYAM, a non-governmental women’s rights organisation in Kolkata.

There are problems at each level of implementation.

Protection officers are often overloaded with work and are not provided with guidelines in implementing certain provisions in the law,” said Suneeta Thakur, counselor with Jagori, a women’s resource centre headquarted in Jagori.

Moreover, “there is hardly any change over time in the notion that domestic violence is a family affair,” with at least 57% of the protection officers surveyed regarding it as a family affair, according to a 2012 report studying the implementation of protection under the domestic violence act in Delhi, Rajasthan and Maharashtra by the Lawyers Collective, a New Delhi public interest law firm.

Ragini Sharma’s experience with the police seems to bear this out. “The system is not very clean when it comes to filing a domestic violence complaint,” she said. “Many times the police urged us to sort out the matter amongst ourselves as this was not simply a matter of violence but dowry demand as well.”

Thakur of Jagori said that patriarchal attitudes remains very much a part of our family structures and the State is reluctant to change this.

Another flaw in the implementation of the law is that there is no uniform protocol for service providers. Service providers in this case are mostly NGOs, and often have no link with the police or with protection officers, according to the Lawyers Collective report. Service home authorities are not trained under the Protection of Women from Domestic Violence Act or taught to handle cases of domestic violence, the report said.

Further, these organisations lack adequate funding, the report said.

“When an aggrieved woman reaches us, after counselling her, we direct her to a shelter home” but “shelter homes remain flooded with women,” said Thakur. Often, a woman can stay at a shelter home for a maximum of two months, after which she has to either find another shelter home or remain homeless, explained Maliwal of Delhi Commission for Women. “I strongly believe that there should be some vocational training courses for women in these homes so that they can earn a livelihood for themselves”, adds Maliwal.

The judiciary also plays an important role in implementing the law. “Over time, in our trainings, we have often come across unaware lawyers and judges, “said Kapoor of Swayam, whose organisation runs awareness trainings on the Act for lawyers. “Most of the times they don’t know how (the) law works and how to utilise the law as an effective instrument to reduce abuse.”

Most lawyers are not aware of the concept of service providers and therefore do not coordinate with them in providing adequate legal services, according to the Lawyers Collective report. Furthermore, the judiciary is hardly aware of the role of the service providers, for either filling in the Domestic Incident Report, or for counselling, the report said.

Further, speedy trials – the Protection of Women against Domestic Violence Act mandates that the magistrate shall endeavour to dispose of every application filed, within a period of sixty from first day of its hearing – are not a reality.

Ragini Sharma, who filed her case against her husband and his parents for domestic violence about a year ago, had only received partial compensation after nine months, while the rest will be given once the divorce proceedings are finalised, she told IndiaSpend.

“None of the Courts have been able to achieve the Protection of Women from Domestic Violence Act provision of a timeline of 60 days for passing of orders and this creates delays in justice”, according to the Lawyers Collective report.

“We are making definite efforts to decrease this file over file load. There is already a pendency of cases from previous governments, if it continues to linger, they will be an indeterminate delay in the whole process”, said Maliwal of Delhi Commission for Women.

Source: National Crime Records Bureau
Source: National Crime Records Bureau

Domestic violence still seen as an internal family affair

Domestic violence is often treated as a family affair requiring counselling both by the police and the courts, according to the 2014 Quest for justice report by the Tata school of Social sciences. This has become the approach of both agencies that discourage women from proceeding with legal remedies and instead recommend they “settle” matters”, the report explained.

In Tamil Nadu, All Women Police Stations did not register crimes in cases of domestic violence immediately. Instead they registered the cases in the Community Service Register and attempted to resolve the dispute through informal mechanisms, the report said.

This article first appeared on IndiaSpend, a data-driven and public-interest journalism non-profit.

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What hospitals can do to drive entrepreneurship and enhance patient experience

Hospitals can perform better by partnering with entrepreneurs and encouraging a culture of intrapreneurship focused on customer centricity.

At the Emory University Hospital in Atlanta, visitors don’t have to worry about navigating their way across the complex hospital premises. All they need to do is download wayfinding tools from the installed digital signage onto their smartphone and get step by step directions. Other hospitals have digital signage in surgical waiting rooms that share surgery updates with the anxious families waiting outside, or offer general information to visitors in waiting rooms. Many others use digital registration tools to reduce check-in time or have Smart TVs in patient rooms that serve educational and anxiety alleviating content.

Most of these tech enabled solutions have emerged as hospitals look for better ways to enhance patient experience – one of the top criteria in evaluating hospital performance. Patient experience accounts for 25% of a hospital’s Value-Based Purchasing (VBP) score as per the US government’s Centres for Medicare and Mediaid Services (CMS) programme. As a Mckinsey report says, hospitals need to break down a patient’s journey into various aspects, clinical and non-clinical, and seek ways of improving every touch point in the journey. As hospitals also need to focus on delivering quality healthcare, they are increasingly collaborating with entrepreneurs who offer such patient centric solutions or encouraging innovative intrapreneurship within the organization.

At the Hospital Leadership Summit hosted by Abbott, some of the speakers from diverse industry backgrounds brought up the role of entrepreneurship in order to deliver on patient experience.

Getting the best from collaborations

Speakers such as Dr Naresh Trehan, Chairman and Managing Director - Medanta Hospitals, and Meena Ganesh, CEO and MD - Portea Medical, who spoke at the panel discussion on “Are we fit for the world of new consumers?”, highlighted the importance of collaborating with entrepreneurs to fill the gaps in the patient experience eco system. As Dr Trehan says, “As healthcare service providers we are too steeped in our own work. So even though we may realize there are gaps in customer experience delivery, we don’t want to get distracted from our core job, which is healthcare delivery. We would rather leave the job of filling those gaps to an outsider who can do it well.”

Meena Ganesh shares a similar view when she says that entrepreneurs offer an outsider’s fresh perspective on the existing gaps in healthcare. They are therefore better equipped to offer disruptive technology solutions that put the customer right at the center. Her own venture, Portea Medical, was born out of a need in the hitherto unaddressed area of patient experience – quality home care.

There are enough examples of hospitals that have gained significantly by partnering with or investing in such ventures. For example, the Children’s Medical Centre in Dallas actively invests in tech startups to offer better care to its patients. One such startup produces sensors smaller than a grain of sand, that can be embedded in pills to alert caregivers if a medication has been taken or not. Another app delivers care givers at customers’ door step for check-ups. Providence St Joseph’s Health, that has medical centres across the U.S., has invested in a range of startups that address different patient needs – from patient feedback and wearable monitoring devices to remote video interpretation and surgical blood loss monitoring. UNC Hospital in North Carolina uses a change management platform developed by a startup in order to improve patient experience at its Emergency and Dermatology departments. The platform essentially comes with a friendly and non-intrusive way to gather patient feedback.

When intrapreneurship can lead to patient centric innovation

Hospitals can also encourage a culture of intrapreneurship within the organization. According to Meena Ganesh, this would mean building a ‘listening organization’ because as she says, listening and being open to new ideas leads to innovation. Santosh Desai, MD& CEO - Future Brands Ltd, who was also part of the panel discussion, feels that most innovations are a result of looking at “large cultural shifts, outside the frame of narrow business”. So hospitals will need to encourage enterprising professionals in the organization to observe behavior trends as part of the ideation process. Also, as Dr Ram Narain, Executive Director, Kokilaben Dhirubhai Ambani Hospital, points out, they will need to tell the employees who have the potential to drive innovative initiatives, “Do not fail, but if you fail, we still back you.” Innovative companies such as Google actively follow this practice, allowing employees to pick projects they are passionate about and work on them to deliver fresh solutions.

Realizing the need to encourage new ideas among employees to enhance patient experience, many healthcare enterprises are instituting innovative strategies. Henry Ford System, for example, began a system of rewarding great employee ideas. One internal contest was around clinical applications for wearable technology. The incentive was particularly attractive – a cash prize of $ 10,000 to the winners. Not surprisingly, the employees came up with some very innovative ideas that included: a system to record mobility of acute care patients through wearable trackers, health reminder system for elderly patients and mobile game interface with activity trackers to encourage children towards exercising. The employees admitted later that the exercise was so interesting that they would have participated in it even without a cash prize incentive.

Another example is Penn Medicine in Philadelphia which launched an ‘innovation tournament’ across the organization as part of its efforts to improve patient care. Participants worked with professors from Wharton Business School to prepare for the ideas challenge. More than 1,750 ideas were submitted by 1,400 participants, out of which 10 were selected. The focus was on getting ideas around the front end and some of the submitted ideas included:

  • Check-out management: Exclusive waiting rooms with TV, Internet and other facilities for patients waiting to be discharged so as to reduce space congestion and make their waiting time more comfortable.
  • Space for emotional privacy: An exclusive and friendly space for individuals and families to mourn the loss of dear ones in private.
  • Online patient organizer: A web based app that helps first time patients prepare better for their appointment by providing check lists for documents, medicines, etc to be carried and giving information regarding the hospital navigation, the consulting doctor etc.
  • Help for non-English speakers: Iconography cards to help non-English speaking patients express themselves and seek help in case of emergencies or other situations.

As Arlen Meyers, MD, President and CEO of the Society of Physician Entrepreneurs, says in a report, although many good ideas come from the front line, physicians must also be encouraged to think innovatively about patient experience. An academic study also builds a strong case to encourage intrapreneurship among nurses. Given they comprise a large part of the front-line staff for healthcare delivery, nurses should also be given the freedom to create and design innovative systems for improving patient experience.

According to a Harvard Business Review article quoted in a university study, employees who have the potential to be intrapreneurs, show some marked characteristics. These include a sense of ownership, perseverance, emotional intelligence and the ability to look at the big picture along with the desire, and ideas, to improve it. But trust and support of the management is essential to bringing out and taking the ideas forward.

Creating an environment conducive to innovation is the first step to bringing about innovation-driven outcomes. These were just some of the insights on healthcare management gleaned from the Hospital Leadership Summit hosted by Abbott. In over 150 countries, Abbott, which is among the top 100 global innovator companies, is working with hospitals and healthcare professionals to improve the quality of health services.

To read more content on best practices for hospital leaders, visit Abbott’s Bringing Health to Life portal here.

This article was produced on behalf of Abbott by the marketing team and not by the editorial staff.