Too far to go still: India’s struggle against gang-rape continues

This was cross-posted to my professional blog.

In the worst news you’ll read today, yet another gang-rape – of another tourist, and the second one this week – has surfaced in India.

An 18-year-old German was allegedly raped on Friday after falling asleep on a train heading to Chennai in southeastern India, where she was going to do volunteer work with a charity.

“The young lady took several days to muster courage to report to the police,” Inspector General of Police Seema Agarwal told NDTV. “Though it’s too late for medical examination, we have handled the case in a very sensitive manner.”

The attack brings the toll of publicized rapes on foreigners in the country to two in just a week, after a 51-year-old Danish woman was allegedly gang-raped in New Delhi on Tuesday.

En route to do charity work – they say no good deed goes unpunished, but damn.

Rape in general, and gang-rape in particular, has been the subject of a lot of scrutiny, and (thankfully) a whole lot of national soul-searching in India since the report of a brutal gang-rape on a bus in New Delhi made international headlines in 2012. Naturally, the stories involving tourists tend to garner more attention that those of locals, but there have been plenty of those to go around. Take the case of the German tourist raped by her yoga instructor in December. Or the British woman who jumped from her hotel window to escape a rape by the hotel manager. Or the Swiss woman who was brutalized by five tribesmen while her husband was tied to a tree. All of these news article mention, and often link to, stories of multiple other women who went through similar ordeals. You could spend all day following the links and questioning the humanity of humanity, or seriously wondering if Antoine Dodson had it right after all.

In response to the 2012 Delhi case and subsequent uproar, the Indian government worked very quickly to strengthen existing rape laws and increase punishments for perpetrators. However, while cases involving foreigners are seen through, too many cases reported by Indian women are just dropped, or completely ignored. Meanwhile, no one can really explain why this keeps happening.

A few obvious things spring to mind. Feminists in the west wage a never-ending battle against rape culture and victim-blaming, but the terms take on a whole new light in Indian culture, which is dominated by men and dictated by strict social rules. In the Delhi case, the defendants’ lawyer offered this gem to the press:

“Until today I have not seen a single incident or example of rape with a respected lady,” Sharma said in an interview at a cafe outside the Supreme Court in India’s capital. “Even an underworld don would not like to touch a girl with respect.”

Sharma said the man and woman should not have been traveling back late in the evening and making their journey on public transport. He also it was the man’s responsibility to protect the woman and that he had failed in his duty.

“The man has broken the faith of the woman,” Sharma said. “If a man fails to protect the woman, or she has a single doubt about his failure to protect her, the woman will never go with that man.”

A spiritual guru and a politician offered a different perspectives:

A spiritual guru, Asharam, sparked an outcry earlier this week when he said the New Delhi victim was equally responsible and should have “chanted God’s name and fallen at the feet of the attackers” to stop the assault.

Mohan Bhagwat, the head of the pro-Hindu Rashtriya Swayamsevak Sangh that underpins the country’s main opposition political party, said rapes only occur in Indian cities, not in its villages, because women there adopt western lifestyles.

Pearls of wisdom, to be sure.

One factoid that has been indicated is the stark gender imbalance, propagated by sex-selective abortions and female infanticide. Another issue is the widespread prevalence of abject poverty; the perpetrators are bored, desensitized, and have nothing to lose. An October article in the New York Times examined the issue in depth through coverage of a case in Mumbai:

One problem is that perpetrators may not view their actions as a grave crime, but something closer to mischief. A survey of more than 10,000 men carried out in six Asian countries — India not among them — and published in The Lancet Global Health journal in September came up with startling data. It found that, when the word “rape” was not used as part of a questionnaire, more than one in 10 men in the region admitted to forcing sex on a woman who was not their partner.

Asked why, 73 percent said the reason was “entitlement.” Fifty-nine percent said their motivation was “entertainment seeking,” agreeing with the statements “I wanted to have fun” or “I was bored.” Flavia Agnes, a Mumbai women’s rights lawyer who has been working on rape cases since the 1970s, said the findings rang true to her experience.

“It’s just frivolous; they just do it casually,” she said. “There is so much abject poverty. They just want to have a little fun on the side. That’s it. See, they have nothing to lose.”

MNCH Innovations: Video Review

This new video from UNICEF starts with the story of an Indian woman who safely delivered a healthy baby in a clinic, under medical supervision, thanks to a partnership between UNICEF and her local government. Prior to their intervention, the majority of women in her district in the Indian state of Madhya Pradesh were delivering babies at home because health facilities were few and far away, and there was no transportation available.

Over five years, UNICEF worked with the Madhya Pradesh government to make major changes, including:

  • Upgrading health centers
  • Providing new equipment
  • Hiring new nurses
  • Improving hospitals with a newborn care units
  • Funding an ambulance service
  • Creating a call center to coordinate ambulance trips

Now, five years after UNICEF began their work, the woman’s district reports the lowest maternal mortality rate in the entire state. Every year, half a million women use the ambulance service to ensure safer deliveries, and 50,000 newborns are saved in the newborn care units. UNICEF’s work has been so successful that the Madhya Pradesh government is scaling up and replicating it elsewhere in the state and other Indian states are also interested in implementing the programs.

One of the newborns in the video had a lung problem and was also underweight because his mother had not been eating properly. The narrator mentioned that many babies in the unit were underweight. While the video focused on the help the new care unit was able to provide to these newborns, my thoughts went elsewhere. UNICEF’s work has made a big difference, but the small fact about the prevalence of underweight newborns reinforced the fact that there are many larger underlying factors and social determinants at play that will continue to challenge progress and positive changes in developing countries. UNICEF’s innovative programs were definitely successful in tackling the delivery and newborn care issues in the region, but the video also (unintentionally) illustrated the general complexity of global health and development challenges.

“Don’t let complexity stop you. Be activists. Take on the big inequities. It will be one of the great experiences of your lives.”
– Bill Gates

Mahila Mandals: Case Studies from Mumbai, India

The following post was written by Sarah Simpson, MPH-Epidemiology Candidate at the University of Medicine and Dentistry New Jersey. Sarah is an IH section member who has contributed to the blog previously. The following post is about her winter internship in Mumbai, India.


ssimpson_mumbaiHome to more than 18 million people, India’s most populous city, Mumbai, continues to be an attraction for millions looking for a better life for themselves and their families. Migrants from different parts of India, religions and cultures end up in the crowded slum communities around Mumbai. This past winter I had the opportunity to learn about urban health issues in these slum communities along with 20 other students from around the US and the world for three weeks at the Tata Institute of Social Sciences (TISS) in Mumbai.

My project group and I sped around town in rickshaws, trudged through sludge, and dust to study urban health issues in the slum areas of Shivaji Nagar. Located in the M Ward and home to some of the largest slums in India, about 600,000 people live in this area, which is located near the Deonar dumping ground, a man-made mountain of debris and trash. The health of the urban poor is complicated by many issues ranging from waterborne illnesses to infectious and communicable diseases, and when compounded by inadequate nutrition and overcrowded and poorly constructed living conditions makes for a dire situation for millions of people.

During our first day, we were introduced to the “Mahila Mandals” or women’s groups there are instrumental to addressing these public health issues. Parts of Shivaji Nagar are plotted slum areas recognized by the government; however they have minimal access to facilities and services provided by the Brihanmumbai Municipal Corporation (BMC). Imagine sharing 28 bathroom stalls (14 for men, 14 for women) with 1,000 other people and as you can imagine they quickly become unsanitary. The breakdown of government services has lead to the organization of community based organizations such as Mahila Mandals.

Instead of using a needs-based or problems-focused approach which would highlight only the worst aspects of a community, we decided to highlight the community’s assets by writing a case study using SWOT (Strengths, Weakness, Opportunities and Threats) Analysis to help us investigate how to best utilize these important community assets. We interviewed 6 Mahila Mandal groups consisting of some registered and unregistered groups and varying in size and number of members. We concluded that not only do the Mahila Mandals work to solve issues with sanitation, but they also promote immunization of children, maternal and child health education and resolve domestic violence issues. However, their impact is limited mostly due to funding and support from the local community.

At the end of our study, we recommended that the government provide more funding and implement community-based participatory research programs which would allow the communities to identify, support, and mobilize existing resources to create a shared vision of change and encourage greater creativity in solving community issues. Two community organizations like these groups and community engagement are important for continued public health and social change. Further research is needed on how to best utilize these valuable community assets.

Our internship presentation can be found at: http://prezi.com/i0lbgveimbyc/copy-of-indian-urban-slums/

References:

  1. Mili, D. Migration and Healthcare Access to Healthcare Services by Migrants Settled in Shivaji Nagar Slum of Mumbai, India. TheHealth 2011; 2(3): 82-85
  2. P A Sharpe, M L Greaney, P R Lee, S W Royce. Assets-oriented community assessment. Public Health Rep. 2000 Mar-Jun; 115(2-3): 205–211.

Novartis: Court Case in India Begins (MSF Video)

This post was written by Nicolle Rueras.

A recent court case between the Indian Government and pharmaceutical company, Novartis, has caused a stir in the global community. Novartis is challenging Section 3(d) of India’s Patent Act, which requires companies to prove that their drug is more successful than alternative treatments for a disease to receive or extend a patent.

To get around this regulation, many companies begin “evergreening” – making minor changes to a drug that may not improve its efficacy but claim it does in order to extend its patent. If Novartis succeeds, this may open the door for other companies to follow suit, ultimately driving up prices for crucial medicines produced in India and needed around the world.

Global Health Weekly News Round-up

Politics and Policies

Programs

Research

Diseases and Disasters

These headlines were compiled by Vani Nanda, MPH Candidate at West Chester University PA.