在马哈拉施特拉邦的一家三级公共卫生机构为性暴力幸存者提供敏感的法医学护理。
Provision of Sensitive Medico-Legal Care to Sexual Violence Survivors in a Tertiary Public Health Facility of Maharashtra.
作者信息
Gadappa Shrinivas N, Deshpande Sonali S, Gaikwad Rupali A, Arora Sanjida, Gaddikeri Meghana, Muralidhar Kavya, Deshmukh Ajinkya
机构信息
Department of OBGY, Government Medical College, Aurangabad, Aurangabad, Maharashtra India.
Cehat, Mumbai, Maharashtra India.
出版信息
J Obstet Gynaecol India. 2025 Apr;75(Suppl 1):152-158. doi: 10.1007/s13224-024-02042-z. Epub 2024 Aug 17.
BACKGROUND
Healthcare providers play an important role in responding to violence against women. The healthcare providers have an important role as expert witness in trials related to sexual violence. In India, several policy and legal reforms like MoHFW guidelines and Criminal Law Amendment have been done to establish a sensitive response to survivors of sexual violence. However, several gaps continue to exist in health systems' response in cases of sexual violence. To fill this gap, this paper presents the findings from a tertiary health facility which has implemented evidence-based standardized guidelines for providing care to sexual violence survivors.
METHODS
The study was carried out in the OBGY department of a tertiary public health facility of Aurangabad, Maharashtra. The findings are based on the analysis of medicolegal records of 78 cases of sexual violence which came to hospital over a period of 6 months. The information about the profile of survivors, nature of violence, health consequences and compliance to standardized guidelines for medico-legal care was assessed. Additionally, the study also presents findings from in- depth interviews with trained doctors to understand their experiences of providing care and testifying in court in cases of sexual violence.
RESULTS
About 42% of survivors were adult and majority of them gave history of violence from a known abuser (83%). In 82% cases, the survivors reported penetrative sexual violence. The analysis of records indicated sensitive medico-legal care in form of operationalization of informed consent in all cases, collection of relevant samples for evidence collection (93%), and mention of irrelevant comment on hymen in 10 cases. The interviews with providers indicated the need to sensitize police and judges about relevance of medical evidence.
CONCLUSION
Inservice training of HCPs and system level changes are essential for sensitive medico-legal care.
背景
医疗服务提供者在应对针对妇女的暴力行为中发挥着重要作用。在与性暴力相关的审判中，医疗服务提供者作为专家证人有着重要作用。在印度，已经进行了多项政策和法律改革，如卫生与家庭福利部的指导方针和刑法修正案，以建立对性暴力幸存者的敏感应对措施。然而，在性暴力案件中，卫生系统的应对仍存在一些差距。为填补这一差距，本文介绍了一家三级医疗机构的研究结果，该机构已实施基于证据的标准化指南，为性暴力幸存者提供护理。
方法
该研究在马哈拉施特拉邦奥兰加巴德的一家三级公共卫生机构的妇产科进行。研究结果基于对6个月内到医院就诊的78例性暴力案件的法医学记录的分析。评估了幸存者的概况、暴力性质、健康后果以及对法医学护理标准化指南的遵守情况。此外，该研究还介绍了对经过培训的医生进行深入访谈的结果，以了解他们在性暴力案件中提供护理和出庭作证的经历。
结果
约42%的幸存者为成年人，其中大多数人报告称施暴者为熟人（83%）。在82%的案件中，幸存者报告遭受了插入式性暴力。记录分析表明，在所有案件中均以实施知情同意的形式提供了敏感的法医学护理，收集了用于证据收集的相关样本（93%），10例案件中提到了关于处女膜的无关评论。对医疗服务提供者的访谈表明，有必要提高警察和法官对医学证据相关性的认识。
结论
对医疗保健人员进行在职培训和系统层面的变革对于提供敏感的法医学护理至关重要。
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