Government data indicates that 40 percent of all Indian women have experienced domestic violence, but activists believe the figure is closer to 84 percent. Credit: Stella Paul/IPS

By Shai Venkatraman
MUMBAI, Feb 27 2015 (IPS)

“One time my husband started slapping me hard on the face because I had not cooked the rice to his satisfaction,” Suruchi* told IPS. “He hit me so hard that my infant daughter fell from my arms to the ground.”

For 20 years 47-year-old Suruchi, a resident of India’s coastal megacity Mumbai, faced physical and verbal abuse within the walls of her home. Her husband would often lock her out of their apartment through the night and one day even tried to strangle her.

“I had hoped all along that by obeying [my husband] things would eventually get better. While recovering in hospital I understood [...] that I owed it to myself and my children to walk out.” -- a domestic violence survivor in Mumbai
“I never knew what would set him off – it could be talking to a neighbour or looking out of the window. I would get ready for work in the morning and he would suddenly announce that I had to stay home all day.”

Suruchi had no access to her earnings as she was expected to hand her salary over to her in-laws. “On the rare occasion that I spoke out, I would get beaten up.” Her parents sensed that she was unhappy but Suruchi never told them the full story.

She was just 20 when she got married, she told IPS, and the constant abuse has left a profound impact on her and her children, especially her son who is anxious and largely uncommunicative.

It was only after she suffered a nervous breakdown following an especially violent assault that she finally acted.

“I had hoped all along that by obeying him things would eventually get better. While recovering in hospital I understood that my attitude had fuelled the abuse and that I owed it to myself and my children to walk out.”

Today Suruchi has put the past behind her. She lives independently and is pursuing a degree in law. However, her story is all too common in millions of homes across India.

A 2006 government survey, the last time the state collected comprehensive household data, stated that 40 percent of Indian women faced domestic violence.

Considering that women comprise over 48 percent of India’s population of 1.2 billion people, this means that hundreds of millions of people are living a nightmare in what is considered the world’s largest democracy.

However many experts believe that a 2003 survey conducted by a non-profit and supported by the Planning Commission of India that threw up a figure of 84 percent paints a more accurate picture.

“It tells us that many cases are going unreported,” says Rashmi Anand, a domestic violence survivor who runs a free legal aid and counseling service for victims in the capital, New Delhi, in collaboration with the police.

Interestingly, figures for domestic violence reported in crime statistics in many states are significantly higher than those that find their way into national-level databases.

An abundance of violence, too few solutions

In a 2013 study by the New Delhi-based think tank National Council for Applied Economic Research, over half of the married women surveyed said that they would be beaten up for going out of the house without permission (54 percent); not cooking properly (35 percent) and inadequate dowry payments (36 percent).

Indian law bans dowry, but the practice remains widespread.

Studies also indicate that economic and social gains have put women at far greater risk in a deeply patriarchal country like India.

A 2014 report in Population and Development Review, a peer reviewed journal, shows that women who are more educated than their husbands are at higher risk of domestic violence as men see in it a way to re-assert their power and control over their wives.

In 1983 domestic violence was recognised as a criminal offence under Section 498-A of the Indian Penal Code. However only in 2005 was a separate civil law to deal with the specifics of domestic violence introduced.

Among other things, the law defines domestic violence and widens the scope to verbal, economic and emotional violence. It also takes into account a woman’s need for financial support and protects her from being thrown out of her home and provides for monetary relief and temporary custody of children.

Since it came into force, activists say there has been a gradual rise in the number of women seeking help.

“Earlier women would seek legal help only when they were thrown out of their marital homes”, says New Delhi-based lawyer C.P Nautiyal, who counsels victims of domestic violence.

“Most women believe that suffering verbal abuse or being slapped by their husbands is expected behaviour. Since the law came into being there is greater awareness regarding domestic violence.”

However, there is still considerable stigma attached to being divorced and this prevents many women from reaching out.

“Economically women in India have made great progress but not so much when it comes to personal growth,” says Anand. “The attitude remains skewed when it comes to relationships. A woman continues to be defined by marriage and this cuts across all classes.”

Veteran lawyer and women’s rights activist Flavia Agnes agrees.

“There is a lot of pressure to stay married,” she tells IPS. “I have found that even highly placed women don’t like to reveal that they are divorced or separated. It’s like being raped, they will hide it as much as possible.”

Experts say that it is women from under-educated or underprivileged backgrounds who are reaching out for help in greater numbers. “Those who come from the upper classes are generally more reluctant to walk out as they stand to lose social status or a certain lifestyle,” Agnes says.

However it is precisely those women who are reaching out in greater numbers that the system is failing the most.

Most keenly felt is the lack of adequate government-run shelters. Barring the southern state of Kerala where shelter homes for domestic violence victims have been set up across 12 districts, authorities in other states have been neglectful.

“I am constantly looking for places where I can send impoverished, battered women to stay,” says Anand. Of the five shelters for women in crisis in the capital New Delhi, only two are functional. Even these can accommodate just 30 women each, and not for more than a month.

“Women are kept like prisoners there,” Agnes tells IPS about the shelters. “They can’t leave, not even to go to their places of work. Children above seven cannot stay with their mothers. Only those who are utterly destitute and desperate consider staying there.”

Another critical need is for fast-track courts to ensure cases get heard rapidly. The Indian legal system is notoriously slow and cases drag on for years, even decades.

However tougher laws alone cannot stem the tide of domestic violence as long as attitudes stay rooted in patriarchy.

The last government study done in 2006, the National Family Health Survey (NFHS), revealed that over 51 percent of Indian men didn’t think it wrong to assault their wives. More shockingly, 54 percent of the women themselves felt such violence was justified on certain grounds.

Activists say such biases are reflected every time a victim of domestic violence comes seeking help.

“We see it on the part of the police, NGOs, stakeholders and religious authorities,” points out Agnes. “The protection officer is supposed to collect evidence, file an order and take the victim to court. Instead the tactic is to tell her, ‘He slapped you a few times that’s all. Don’t make a big deal and sort it out’, and she is sent back to the hellhole.

“We have to stop this current approach of putting a Band-Aid on a gaping, bleeding wound [if we want] change to come about,” she stressed.

*Name changed upon request

Edited by Kanya D’Almeida

Of the 100 patients seen at Kashmir’s psychiatric facilities each day, roughly 75 are women. Credit: Shazia Yousuf/IPS

By Shazia Yousuf
SRINAGAR, India, Nov 19 2014 (IPS)

It was almost midnight when Mushtaq Margoob woke up to the incessant ringing of his phone. It was his patient, a young woman whom Margoob, a renowned Kashmiri psychiatrist and head of the department of psychiatry at the only psychiatric hospital in Kashmir, had been treating for depression for many years.

“See me now. I don’t have time till tomorrow,” the patient screamed down the phone. “I might have killed myself by then.”

The woman was educated, had a PhD in Bioscience and came from a rich family. After her marriage last year, the symptoms of her depression had begun to fade away, and she had started crawling back to a normal life.

“I have gifted lifelong sadness to my daughter.” -- Shahzada Akhtar, a Kashmiri woman living with PTSD
But the day she made the hasty phone call to the doctor, she had learned something that shattered her life into fragments all over again.

“I have been diagnosed with Premature Ovarian Failure [POF],” she said to Margoob at his home. “If I cannot have any children, what should I live my life for?”

Although Margoob was able to pacify her with timely counseling and medication, the diagnosis and the constant reminder of being infertile have taken his patient back into deep depression.

“The mental stress due to ongoing conflict has taken a toll on the physical health of young women, especially their maternal health,” explains Margoob.

Downward spiral of mental and maternal health

The conflict here, which dates back to the 1947 partition of India and Pakistan, has claimed some 60,000 lives as Indian armed forces, Pakistani troops and ordinary Kashmir citizens struggle to assert control over the bitterly contested region.

The “pro-freedom” uprising of 1989, launched by Kashmiris who resented the presence of Indian and Pakistani troops, morphed into a long-standing resistance movement that has left deep scars on Kashmiri society.

As a result, the area known as the Kashmir Valley, tucked in between towering mountain ranges in the northern Indian state of Jammu and Kashmir, is witnessing an alarming increase in childlessness and infertility among local women.

Infertility is becoming increasingly common among young Kashmiri women, who are suffering from stress and trauma due to the long-standing conflict in the region. Credit: Shazia Yousuf/IPS

Physical and mental health experts cite conflict-related stress as the main cause of the health crisis among women, which has robbed thousands of their fertility.

The most recent Indian National Family Health Survey (NFHS) indicates that 61 percent of currently married Kashmiri women report one or more reproductive health problems.

This is significantly higher in comparison to the national average of 39 percent. The percentage of POF among infertile women below 40 years of age is also abnormally high – 20 to 50 percent – when compared to the nationwide rate of one to five percent.

“Stress causes structural changes in the brain and disturbs the secretion of various neurotransmitters. These changes lead to various physical ailments including thyroid malfunction, which in turn can cause infertility among women of childbearing age,” Margoob explains to IPS.

According to statistics available with the Government Psychiatric Diseases Hospital, 800,000 Kashmiris are suffering from Post Traumatic Stress Disorder (PTSD) and most of them are women. PTSD, like many other mental health disorders, directly affects women’s childbearing capacity.

Stress and stigma

In Kashmir, psychiatry OPDs are run at two hospitals – the Shri Maharaja Hari Singh (S.M.H.S) facility in Srinagar, and the Government Psychiatric Diseases hospital – six days a week. Of almost 100 patients seen at each OPD every day, 75 are females.

One of the many women who frequents these facilities is 20-year-old Mir Afreen, who grew up watching her mother battling mental illness. In 1996, when Afreen was only two, her mother, Shahzada Akhtar, received a message about the death of her cousin brother in cross-fire.

“I had met him only a day before. I couldn’t believe he had died. I tried to cry out his name but had lost my voice,” recalls Akhtar.

Akhtar never recovered from the sudden, devastating news, and soon developed PTSD.

In consequence, her daughter’s childhood quickly slipped into darkness. Afreen often saw her mother sedated, sleeping for days at a time, going without food, and crying for no apparent reason.

She was always taken along to psychiatric clinics, hospitals and faith healers where her mother searched for a cure for her condition. Happiness was far, far away from their home.

“I have gifted lifelong sadness to my daughter,” Akhtar tells IPS tearfully.

Her statement is not too far from the truth. For the last several years, Afreen has been complaining about chest pains and breathlessness. Akhtar first thought it was due to stress, or her daughter’s recent obesity.

But when Afreen developed facial hair and her monthly cycles became irregular, Akhtar took her to a gynecologist.

“The doctor uttered a long name which I couldn’t understand, so I asked her to explain the [condition] to me,” Akhtar says. “She told me if this is not treated, Afreen will never have children.”

Afreen was diagnosed with Polycystic Ovarian Syndrome (PCOS). Unknown and almost non-existent before the conflict, the syndrome now affects 10 percent of Kashmiri females including teenagers.

A major endocrine disorder in women of reproductive age and one of the leading causes of infertility across the world, PCOS has emerged as another major cause of infertility among Kashmiri women in recent years.

Medical experts have identified stress as one of the main reasons for the emergence of PCOS in Kashmir. A study conducted by Sher-i-Kashmir Institute of Medical Sciences (SKIMS), the major tertiary healthcare facility in Kashmir, on 112 women with PCOS, found that 65 to 70 percent of them had psychiatric illnesses including PTSD, depression and Obsessive Compulsive Disorder (OCD).

Akhtar feels helpless. Unlike other ailments, Afreen’s particular health issue is not up for discussion, not even with her own siblings. If the word spreads, she thinks, it will ruin her daughter’s marriage prospects and thus destroy her life.

“Even when I take her to the doctor, I make sure that no one sees us,” reveals Akhtar. “I first check the place and then let my daughter in.”

Afreen does the same. She has not revealed anything about her condition to her friends. When the girls talk about their grooms and life after marriage, she keeps mum. When it is the time for her medication, she secretly swallows the pills without water.

Current trends predict a bleak future

Nazir Ahmad Pala, an endocrinologist at SKIMS, says that more and more young females visit the endocrinology department for various disorders. A good number of disorders, he says, are born from depression.

Anxiety over the possibly loss of male breadwinners is prompting many women to choose education and employment over marriage. Credit: Shazia Yousuf/IPS

“In the past, the department received mostly older patients but now around 20 percent of our patients are school and college going girls with endocrine abnormalities. This trend is disturbing,” Pala tells IPS.

The young girls mostly complain of obesity and ovulatory disturbances that bring a temporary halt in their menstrual cycles.

The condition is called Central Hypogonadism and is common in depressed women, explains the doctor. Another equally frequent ailment is galactorrhea, a spontaneous secretion of milk from the mammary glands due to an abnormal increase of prolactin levels in the body caused by antidepressant intake.

“Unfortunately most of the [conditions], in one way or the other, lead to infertility. And the root cause of all these [conditions] is the stressful life that women have been living in the post-conflict era,” Pala asserts.

Experts here are sounding warnings about the catastrophic shape that women’s health in the Valley is taking. A study conducted at SKIMS on maternal health indicates that 15.7 percent of Kashmiri women of childbearing age will never have an offspring without clinical intervention.

Another conflict-related cause of infertility among Kashmiri women is late marriages. Over the war years, the marital age has risen from an average of 18-21 to 27-35 years. Because of economic insecurity and anxiety over the prospect of losing male breadwinners, women are choosing education and employment over marriage.

“Economic instability and insecurity is eating our society like termites,” says Margoob.

The doctor reveals that cut-throat competition in schools and colleges to earn a secure future has hugely disturbed the mental health of young girls as well.

Dissociative Disorders (DD), marked by disruptions or breakdowns in identity, memory or perception, are rapidly increasing in young school- and college-going girls, along with conditions like Panic Disorder, all of which interrupt the “smooth journey to motherhood”, Margoob says.

*Patients’ names have been changed on request.

Edited by Kanya D’Almeida