Following a sexual assault, the survivor and her family go through more trauma and humiliation at the hands of social service providers — hostile police, inquisitive court personnel and insensitive hospitals. This secondary victimisation is "victim-blaming" and places the needs of the organisation above the needs of patients. Along with a judgmental society, it can lead to victims feeling various health and mental issues and having suicidal thoughts, according to a study by PADMA BHATE-DEOSTHALI, SANGEETA REGE and SANJIDA ARORA..—-."She is quite scared; she gets scared even if the phone rings. As soon as there is a phone call, she will come and ask me, "Do we have to go to court again?"–Mother of seven-year-old Riya (names changed). ."She still complains of pain in the abdomen (after six years of incident)"–Mother of 12-year-old Megha."She has stopped going to college and refuses to do any other activity."–Mother of 21-year-old Rita.THESE are instances of the trauma suffered by rape survivors and shared with their family members as part of a study conducted by the Centre for Enquiry into Health and Allied Themes (CEHAT). The study is the first of its kind as it systematically delves into the impact of reporting sexual violence on survivors and their families through in-depth interviews with 66 survivors and family members..Undertaken in 2018, the study reveals the fault lines that have existed for decades with institutional response to sexual violence survivors. CEHAT's study shows that victim-blaming attitudes continue unabated..Of the 66 respondents, only three decided not to enter the criminal justice system and these were considered decisions, one decided not to proceed after the hostile response of the police and in hospital and two did not go ahead as the perpetrator could not be found..Most of the 63 survivors faced several obstacles in their quest for legal justice. Only 19 of them had a final court outcome, but the rest were in the process even after 4-7 years after the incident..Formal Institutions.Survivors told us that surviving sexual violence is gruelling and the entire family suffers at various levels. What emerges is the impact of secondary victimisation that survivors and their families have to cope up with..Secondary victimisation refers to behaviours and attitudes of social service providers that are "victim-blaming" and insensitive, and which traumatise victims of violence. Institutional practices and values that place the needs of the organisation above the needs of clients or patients are part of the problem. .*Out of 62 respondents who filed a complaint, only 20 reported that the FIR was filed in one visit. Forty-two out of 66 survivors reported facing continued harassment from the perpetrator and/or his families and relatives after they filed an FIR, but they received no police protection nor were steps initiated for cancellation of bail. Calling them repeatedly to the police station and asking them to repeat what happened were common experiences too..*Only seven of the 47 survivors who were eligible under the state victim compensation scheme received the amount. This is the Manodhairya compensation scheme issued by Maharashtra in 2013. Other survivors were not even informed by the police about the scheme..*The health system also did not create a conducive environment for many survivors. They have reported denial of treatment or making treatment conditional to the recording of an FIR. None went back to the hospital for follow-up care..*The court experience was overwhelming for most as they were left to themselves to deal with the criminal justice system and its procedural rigmarole. Multiple visits to courts, delay in trials, being asked uncomfortable and repetitive questions, insensitive remarks by judges, uncooperative and disinterested public prosecutors were part of the problem..This re-traumatisation increases stress and prevents recovery from rape as evidenced by the fact that the survivor and/or her family members were still suffering even after 4-7 years of the incident..It affects every aspect of an individual's life, including health, education, employment, and economic well-being. These effects are primarily due to secondary victimisation and complete neglect of the needs of survivors by formal institutions and communities..In recent times, the Hathras rape case and the Tarun Tejpal sexual assault case have highlighted the problems of institutionalised biases, misogyny, victim-blaming and denial of justice to survivors. The rape survivors in the CEHAT study have similar experiences..Impact on Health .The health consequences of sexual violence are not only acute but persist for a long time after the incident..All the survivors who participated in the study reported persistent physical and mental health consequences even after several years. Survivors attributed these to the incident of sexual violence..These health consequences included weakness, nausea, vomiting, giddiness, stomach ache, white discharge, tuberculosis, blood pressure, pain in the thighs, backache, weight gain, irregular menstrual cycle, vaginal discharge and fibroids..Fear, feeling depressed, stress, loss of sleep, appetite and suicidal ideation were common mental health consequences reported by survivors. Children experienced nightmares and becoming quiet for three months to two years after the incident. Changes in the behaviour of children like the habit of chewing clothes, touching the genitals, not maintaining any boundaries with strangers and taking money from them were also informed by some caregivers..Re-living Trauma .One thing that emerged consistently in cases of child sexual abuse is that the survivors had not forgotten the details of the incident. The caregivers said that frequent visits and questioning of survivors in court and by the police made it difficult for them to forget the incident and recover from it..Adult survivors had feelings of guilt, shame, stress and isolation. Some reported feeling suicidal. A 28-year-old survivor, sharing her ordeal with the researcher, said: "The police harassed me so much, I have told madam (the counsellor) that I feel like ending my life, I cannot live like that, where do I go? I don't feel like talking to anyone, I cannot concentrate on my work, I have stopped going to work, I am surviving on the savings and I have stopped eating." .Four survivors reported attempting suicide. One of them died this way and her family said she had no other choice. By burning herself, she had proved her innocence to society and the court, they said..Concerns About Future.Young girls and caregivers spoke about health concerns related to marriage and childbearing. The mother of a 17-year old survivor said: "Will the husband find out about the rape?" "Will she get pregnant?" "What will happen if they find out that she was raped?".Survivors either delayed seeking treatment for their physical health problems or didn't seek it at all. Fear of reliving the traumatic incident was a major factor for this..Survivors perceived that the role of public hospitals is limited to facilitating police procedures in terms of medico-legal examination and evidence collection..Consequently, they didn't return to public hospitals for their health complaints. Instead, survivors accessed treatment from private providers. The mental health needs of survivors were not addressed at all. None of the caregivers who shared about the psychological impact of the incident on their children had sought any treatment..The impact of sexual violence also extends to the health of family members and caregivers who support survivors in their journey to seek justice..The mother of a child survivor said: "I cannot forget the incident that happened to my child. Can't sleep, keep thinking of what worse could have happened that day if I had not come in time". Owing to constant worrying, I have developed severe weakness. My daughter's weight is better than mine. I am 22 kg and she is 24 kg.".Disruption of Social Functioning.Support from the family and community is important for the healing of survivors. Family members are often the ones to whom survivors make the first disclosure and reach out for their immediate needs..In this study, we found that in a majority of cases, survivors received support from one or more family members. .The family supported survivors by recognising distress and asking about abuse, being non-judgemental, encouraging survivors to continue their education and supporting them in the legal battle despite threats from the abuser..There were some cases of adolescents and adults where the family supported the recording of complaint but restricted the survivor's mobility and blamed her for what had happened. In one case, the family institutionalised the girl as she was pregnant..Except in cases of very young children, the response of the community was not supportive. Survivors spoke about facing social exclusion and taunting from neighbours and distant relatives. In some cases, neighbours even denied giving a statement to the police. Fourteen survivors had to relocate because of constant harassment from the community..The police didn't pay any attention to repeated complaints of survivors about the threat to their safety..The impact of continued threats was so extensive that Meena (name changed) stopped stepping out of the house alone even to use a public toilet. The abuser, who stayed in close vicinity, continued to harass her by staring at her and following her..Education and Employment .Out of 66 survivors, 45 were of the school- and college-going age group. After the incident, seven dropped out of school. The school authorities dissuaded survivors from attending school as they did not want police or media attention. They gave excuses such as the survivor needed a break from school and would not be able to focus on studies. Such an attitude compelled Sana (name changed) to sit at home for two years as the school insisted that she would not be able to cope with studies until court proceedings were over. Continuing schooling would have helped Sana to overcome the trauma, but suspending her from school was akin to blaming her for the assault..Schools which didn't explicitly prevent survivors from coming there made no efforts to create an enabling environment for the continuation of their education. Caregivers said their child was singled out and became the target of victim-blaming by teachers and classmates. .There were only two cases where schools made some proactive efforts by speaking to fellow students and assuring the parents about the safety of survivors. This is a matter of concern as schools can play a pivotal role in the recovery of survivors by re-integration and continuing schooling. Older girls quit college primarily due to concerns about safety..Workplace Situation.Many challenges were faced by survivors and caregivers at their workplaces too. Daily wage earners and owners of small shops had to stop their work for a few weeks to a few months post-incident of their children. They were required to make frequent visits to the police station and court for various procedures. Parents said that considerable time was spent with survivors to support them to come out of the painful incident..On average, it took more than four months for caregivers to get back to work. Many mothers stopped working after the incident to be with their children. Three survivors were employed in the formal sector before the incident. Two of them were terminated suddenly without even the settlement of dues. In one instance, the sexual assault was at the workplace and the survivor had to struggle to file an FIR and find another job..Seeking Justice .Survivors who decide to enter the criminal justice system bear the financial cost too. Due to lack of support from formal institutions, including hospitals, police and court, survivors and their family members ended up making repeated visits to these institutions, losing daily wages and jobs due to frequent absenteeism in the workplace, incurring travel and other incidental expenses..At hospitals, survivors incurred expenses due to denial of treatment there and accessing treatment from private facilities. In one case, a survivor spent about Rs 60,000 for a surgery required after the assault. Even though survivors are entitled to get free medical treatment from both public and private health facilities, it is yet to become a reality for many of them..The study emphasised that sexual violence has a profound impact on the survivors..Although rape laws, including Protection of Children Against Sexual Offenses, 2012, and Criminal Law Amendment to Rape, 2013, have laid down provisions for speedy redressal, the latter remained a distant dream for a majority of survivors. .The costs associated with the legal rigmarole poses an additional barrier for survivors in their long road to justice. Many of their families were forced to mortgage their homes, seek loans from relatives and quit their jobs. Finding alternate jobs was also not an option for the survivor and their family members as there was uncertainty in their lives..The ordeal of rape survivors doesn't end with sexual violence. It is important to provide them and their families much-needed support for recovery and through various stages of their struggle to access justice..(Padma Bhate-Deosthali is Senior Advisor, CEHAT and Consultant Care India, Sangeeta Rege is Coordinator, CEHAT and Sanjida Arora is research officer, CEHAT. The views expressed are personal.)
