I got an idea to create this write-up on an area where I see violence against women. It is not necessary to overstress the fact that violence need not only be physical. It can be mental, emotional, and sexual and now I wish to introduce this concept of health violence.

Health Violence: What is that?

     Our traditional perception of violence is use of force exerted for the purpose of violating, damaging, or abusing. For us violence is usually physical, mental or emotional. However there are other forms of violence also in any given society. I am introducing here a concept of violence not found in traditional paradigms. It is the concept of health violence. Briefly, it can be any act on the part of the society in general and family members and “friends” in particular which can violate health of a human being is health violence. In reference to health violence against women, this seems to be very big challenge to the right-minded people. This is because as a woman she is very vulnerable to health violence. This write up may not necessarily be an exhaustive complete list. It is only a platform on which others can contribute their experience.

New Wife Cheaper Than a Bottle of Blood:

     As an obstetrician who has dealt with life-threatening emergencies all throughout my life, I have found countless pregnant subjects who need blood transfusions for whatever causes. Blood has always to be donated by someone to get blood for the patient as a replacement. In such a life threatening crisis it is the family to whom we have to request for blood. As soon as such a request is made especially in public hospitals, the large body of relatives who were present as accompanying persons quickly starts shrinking. All those who passed off as brothers, brothers-in-law and what not, quickly start disowning the relationship “We are not true brothers. We are just Rakhi - brothers”. Some others predictably say “We are neighbors. Not related in any way”.

     The husband is the first to run away if he gets the opportunity. If by chance he is unable to do so, his predictable response is “I am sick. I am in no position to give blood”. It is superfluous to state that by an overview itself we as doctors can judge if the potential donor is healthy enough to donate blood. Only when found to be apparently fit, are such requests made. The “sickness” of the husband is never defined. Many of these husbands are smart enough. They would announce that just a couple of weeks ago they had jaundice or such a contraindication to giving blood. The mother-in-law of the pregnant subject for whom blood is to be arranged too, comes with folded hands, crying and using all possible dramatic emotions pleading that her son should not be told to give blood.

     The climax comes when the husband ruthlessly tells “Doctor let her die. For me to get a new wife would be easier and cheaper than my giving blood for her”.

“You Get the Pregnancy Terminated I Will Pay for It”

     One more ruthless form of health violence which also involves a big element of emotional violence is when a conception occurs out of wed-lock. The woman who has conceived has hardly any opportunity, scope or right to decide if she wants to continue the pregnancy. The decision almost always is for termination of pregnancy. However the violent part also magnifies when the entire responsibility of the pregnancy and getting it terminated is thrown at the door of the pregnant subject. This becomes worst when the father of the conceived child just refuses to accompany the pregnant woman for medical care. He plainly offers money to her and unabashed tells “You get this pregnancy (“headache”, “mess”, “problem” etc) terminated. I will pay for it”.

Health Violence In Female-Only Emergency Contraception

     The medical science always makes it repeatedly clear that emergency contraception is only for emergency. This means those absolutely rarest of rare situations when the couple had an unplanned sexual intercourse and no contraception was available or could be used, should emergency contraception be used. For unplanned sexual intercourse, modern medical science promotes the use of condoms for males. However in actual clinical practice emergency contraception has become elective contraception. By this it is meant that emergency contraceptive measures are used routinely. These methods almost always involve high doses of sex hormones. They can have (though not frequently) extensive effects on her menstrual regularity and amount of blood lost.

     All methods of emergency contraception are for use in females. Thus once again there occurs health violence against females. In situations where the male had a chance and opportunity to use a condom but instead an emergency contraception had to be used by the female, in my mind is an act of health violence by males against females.

All Terminations of Pregnancy Are Acts of Health Violence against Females

     With excellent and safe methods of contraception available freely and easily in any society including India, if a couple married or unmarried sires an unwaunted pregnancy, it is just not acceptable. Worst still if any pregnancy is terminated it constitutes health violence against the females. No method of termination is fool-proof and absolutely safe. Contraception doesn’t kill but termination of pregnancy can kill. The irony of this entire situation is always by law of nature, a female conceives the offspring. Therefore all terminations of pregnancy are performed on females. It makes the woman vulnerable to potentially fatal consequences. This is not to say that fatality in modern methods to pregnancy termination is high. But whatever be the statistical number, the risk is borne only by the female.

     One may indeed ask: “What about pregnancy following rape?” Well rape is the worst form of violence. It involves all forms of violence – physical, mental, emotional, sexual and health violence. When rape itself is so violent, pregnancy termination following rape is bound to be health violence notwithstanding the fact that the need to terminate it is a must.

Not one pregnancy should be an unwanted pregnancy. All unwanted pregnancies are preventable. In that case any need for termination of pregnancy is health violence against females.

Societal Preference for Female Methods of Permanent Sterilization:

     Amongst methods of male and female sterilization, male methods like vasectomy are safer, easier and with fewer complications. Also they are less cumbersome than female sterilization. In spite of these well known advantages, in a country like India, female sterilizations far outnumber male sterilization.

     Causes behind this are many: a male dominant society, concept that pregnancy occurs only in females - so it is her responsibility to stop it, unfounded fear of sexual handicaps after male sterilization surgery, etc. These are absolutely wrong and condemnable but very popular concepts. These make female sterilization methods popular. With much easier and safer methods in males exposing the female partners to the risk of female sterilization surgery is an act of health violence.

Seeking Recanalization When Male Child Has Died Is Health Violence against Females

     Even an average obgyn practitioner periodically gets request from couples where female sterilization has been done for “reopening” surgery. This request is maximum when the male child of this couple has died. Any day recanalization surgeries (as “reopening’ surgeries are called) are a major surgical procedure. It involves risk to the woman’s life as any major surgery may involve (there is no added risk though). In such a situation of death of a male off-spring, subjecting the woman who has undergone female sterilization surgery to recanalization surgery is an act of health violence against females..

All Acts of Prenatal Sex Determination Are Acts of Health Violence against Two Females in One Act:

     It is not intended to go into the details of already known aspects of the barbaric acts of prenatal sex determination. The matter is condemnable beyond words. However one different angle emerges when prenatal sex determination is perceived from the angle of health violence. This is an act which only the female subject undergoes as she is pregnant. At the same time the female fetus once its sex is exposed prenatally gets terminated and annihilated. Thus this one act of terminating and even determining the sex of on unborn child is an act of health violence not against one woman but two women at one stroke.

Females Willing Partners in Acts of Health Violence against Them

     In no act of violence except probably some bizarre religious rituals or sexual perversions does the victim willingly involves himself /herself in violence against one’s own self. However in acts of health violence stated above the victim are most of the times a willing and cooperative partner. To give examples; many females feel that pregnancy is their responsibility so termination is also their responsibility. More often than not prenatal sex determination is sought by the pregnant woman herself. More often than not the female herself is willing to take the risk of major surgery if her son has been lost.

     Thus female health violence is very rampant, more rampant than physical or mental violence and the tragedy is many times the victim is a willing party.


  1. Interesting concept of violence. It does exist in other specialities also. I am an Ophthalmologist and I see health violence much more frequently. An elderly retired close relative comes with a complaint of decreased vision accompanied by bread winner of the family a son or a daughter. On examination when found to have a cataract causing almost 90% decrease in vision in one eye and 50% in another, but still able to manage due to limited activities of retired life, but when a surgery to improve vision is suggested, straight comes the answer from the attendant bread winner, he/she does not need to do anything active and does not need good vision. so, please do not advice surgery, if needed just write some medication ONLY IF NEEDED. They think that the money and time spent on elderly is wasted as they do not have any productive years in them. What they do not understand that, most of hip fractures which happen at home, in bathrooms are also contributed by poor vision causing them to trip and break their hips, which is a direct ticket to heaven, as it leads to confinement to bed and illhealth and in the end, death.

  2. very truly written dr pankaj desai , health violence is a new term for me


    CONGRATULATIONS for coining such a good term for the daily neglect that we see in the practice, but women need to stand up for herself,to take the decision for contraception and the economic independence for herself. also, matters a lot. These educative directions need to be more frequently given to men. One great step women in India need to take is not to go to the mother's place for delivery, and involve the husband in child birth. You are absolutely right that women are involved in the abuse / voilence of women. Dr Agnes Mathew

  4. Gr88 concept sir.... All these burning issues that we come across in our day to day work were yearning to be addressed. These social factors are a big hinderence in achieving any reasonable health indices in maternal Health.

  5. You have very nicely n correctly expressed what we face every day.This is the real status of a woman in the family n in society n one of a very imp. cause of high mat. mortality n morbidity.She is not included for the decision taken for the pregnancy she has to bear,how many times? she is responsible if the new born is not he.No Abhiyan like Beti Bachao Kanya Bhrun hatya will be of any use without a real change in the attitude Leela


    You are absolutely right. Blood donation - majority of husbands behave in the same way more so in Government institutions. Prenatal Sex determination is governed by the family. Choice of or need for medical help is mainly decided by the Mother-in-law or the husband.

    All other facts I agree with you.


    I appreciate your write up on "Health Violence"
    if you scan the Indian scenerio, you will find that we worship women only on paper. In real life, women are considered as second class citizens.
    Our scriptures even undermine women. Examples are as follows.

    1 Animals, Harijan and women are entitled for punishment. (Prani,gamar ane stri tadan ka adhikari)

    2 Manu-Smriti verses also undermine women
    It is time we shade our hypocracy and learn from other cultures how to respect women.


    Thank u sir for this wonderful & mind-blowing article. I'm just spell-bound. We all had experience of the same but had never thought those as health violence.


    This is a serious and good topic . There are endless examples of health violence against women that we Doctors could narrate with our observations. For sterilization surgeries women take it as their responsibility,and would sometimes themselves refuse to let their husbands undergo it.Then again in infertility many men with oligospermia who require varicocoele repair refuse it and would rather the wives undergo IUIs ,or even IVef if IUI fails!!!!!

    Is it that we havnt explained to them the difference in degree of risk involved in these individual procedures,or ours and most societies in the world want to remain oblivious to them?


    I read your mail regarding: Concept of health violence against females. Every word I have experienced personally... Especially that new wife cheaper than a bottle of blood: part...I used to get so angry. Maine khud 3 bar blood donate kiya hai during residency just because relatives absconded... But never come across prenatal sex determination part in residency... But in private hospital every day 2 or 3 patients per day regarding prenatal sex determination.....just because of that I didn’t buy a USG machine yet...


    Sir,Your article was very thought provoking indeed but women themselves have to think of their own wellbeing,have to assert the need to go to a health care facility.Indian womenfirmly believe in self abnegation,that is why no matter how much you counsel no one returns for contraception,patients who were near miss mortlities only return if they have another life threatening complication.Women do get their husbands to buy them their favourite jewellery or clothes,I pray they start giving the same priority to their health.

  12. nicely mentioned ,I would like to add one more form of health violence specially affecting professionals or working females.In spite of high education ,after marriage her dreams of respectful n comfortable life are shattered.Not only family even husband expects a lot from her ,poor females sacrifices a lot and neglect their mental n physical health in the hush bush of dual responsibilities.I have noticed that educated females are actually in bad condition because of wrong mindset and family pressure.chronic stress invites variety of health ailments and again a vicious cycle which is difficult to break.


Post a Comment

Popular posts from this blog

A Teacher In Life.....A Teacher In Death

Blood Relatives…WHO?