Health Systems Strengthening

Breaking the Silence

Posted On
Monday, February 25, 2019


Dipankar Bhattacharya



Once in every five minutes, a case of domestic violence is recorded in India as physical or sexual cruelty is inflicted on a woman by her husband, partner or relatives. Domestic or intimate partner violence can take different forms, including physical, sexual, verbal, emotional, and economic. Abuse can lead the survivor to try and justify the reasons for their abuse—to make sense of what is happening to her, she may begin to think it is due to her mistake. Thus a horrifying journey begins, which continues with her helplessness, compromise with the wrath of the perpetrator and sinking into silence.

Domestic violence has intergenerational effectshealth and demographic consequences. Beyond her physical injuries, the survivor suffers from anxiety and trauma and a range of health problems including chronic pain, gastrointestinal issues, sleeping disorders, mental health problems, and reproductive health consequences. Children who are exposed to domestic violence demonstrate delayed development and learning, distorted parental relationships, social withdrawal and even juvenile delinquencies. Although domestic violence affects different socio-economic and cultural sub-groups of the population, including both poor and wealthy, poor women living in the slum areas of cities are more vulnerable to this. Incidences go unreported frequently, and so there is little information available on the extent of the problem amongst this sub-group of the population at the national level—which leads to a lack of strategies to deal with this complex problem.

The National Family Health Survey 2015–16 (NFHS-4) provides reliable and ethical estimates pertaining to violence that women face in India. During NFHS-4, a total of 79,729 women responded to the module on domestic violence. Disaggregated data from NFHS-4 using a Wealth Quintile-based approach unravel the vast disparities within urban areas, between poor and better off sections.

At least a quarter (23%) of urban poor women face violence during pregnancy by their spouses.

NFHS data reveals that urban poor women are more prone to domestic violence by their spouses, partners or other relatives. The data suggests that 26% of urban poor women (women from the poorest 40% of the population) faced any form of physical violence, compared to 12% of better-off urban women. Further, 6% of urban poor women faced any form of sexual violence, as against 3% of better-off women. In about half of the domestic violence cases in the urban poor households, perpetrators are husbands (50%), followed by women’s own or husband’s family (26%). The frequency of spousal violence rises with the spouse’s level of alcohol consumption. Even more appalling is the fact that at least a quarter (23%) of urban poor women face violence during pregnancy by their spouses.

Domestic violence has been recognised as a criminal offence chargeable under Section 498-A of the Indian Penal Code. However, there was no separate civil law that protected women against domestic violence until the enactment of the ‘Protection of Women from Domestic Violence Act’ (PWDVA), which was passed in 2006. The law recognises a larger ambit of domestic violence beyond physical or sexual violence, including mental, economic and emotional violence, and provides recourse to both married as well as unmarried women. The Act provides protection for both wives and female live-in partners at the hands of husbands or male live-in partners and their relatives.

Despite passing the PWDVA in 2005, which encourages women to speak out, NFHS-4 data further reveals that nearly nine-tenths (87%) of urban poor women who experience physical or sexual violence, neither seek help nor inform anyone. The majority of those who seek help reach out to their own family (67%), or husband’s family (29%), followed by neighbours (20%) or friends (9%). In a negligible proportion (less than 5%) of cases, the urban poor domestic violence survivor seeks help from the police or social service organisations. It also appears from NFHS-4 data that urban poor survivors of domestic violence generally lack freedom of movement and autonomy. Although a majority of these women reach out to their families to intervene, in nine out of ten cases their access to their own family is restricted by their spouse.


A still from Breakthrough’s landmark ‘Ring the Bell’ campaign, encouraging the community to intervene when  they are aware domestic violence is taking place.


Though the PWDVA came into force after a decade-long battle by advocates, lobbyists and rights groups, experts have raised several questions regarding its success so far. A study carried out by the Bhumika Women’s Collective in Telangana recorded that 65% of survivors did not get a proper response from police. A consultation held a couple of years ago in the national capital by Oxfam India and Centre for Social Research (CSR) concluded that the inadequate number of Protection Officers and service providers, lack of coordination between different stakeholders, failure of police and judiciary, and meagre budget allocations have been some of the key gaps in implementation of the PWDVA. While the legal provision guarantees that cases will be recorded, comprehensive participation by different actors is crucial in managing the complexities around domestic violence beyond filing of the case. According to Dr. Ranjana Kumari from CSR, “Statistics show a consistent decline in the number of cases registered at a recent time”. Further, the Act does not mention any special provisions for urban poor women.

The National Urban Health Mission (NUHM), launched in 2013, acknowledged that there are higher rates of domestic violence in the slum areas of cities and is a cause of concern. NUHM planned for Counselors in urban slums to tackle relationship issues in urban poor households using social and behavior change communication. NUHM also relies on domestic violence centres in slum areas to provide a broad range of services. Despite a considerable emphasis, progress on implementation has been uneven so far. In the current circumstances, the Mahila Arogya Samiti (MAS)—a community-based federated group of around 50–100 households in urban slums, which is involved in health promotion, interpersonal communication and linkages with services and referral—could also play an effective role in dealing with domestic violence issues, at an individual as well as group level.

The voice of an urban poor domestic violence survivor could be silenced due to economic dependence on the perpetrator, or the mistaken deduction that it is in the best interests of her children to keep the family together. In this, the survivor’s level of education has no bearing on her likelihood of speaking up—NFHS-4 data suggests that there is only a marginal rise in the proportion of urban poor women who sought help with rising level of education. Therefore, education alone does not necessarily enable her to access the appropriate support system when needed.

Reinforced by the assurances provided by the NUHM, proper implementation of the PWDVA will provide safety to survivors physically and mentally. At the same time, awareness of the support system and conviction that speaking out is the better path will clearly help survivors to be more self-assured and independent to speak up. Nevertheless, we are all responsible — her family, friends, neighbours, service providers, police, judiciary—to intervene and help the urban poor woman domestic violence survivor to speak up, and come out of her prolonged silence.

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Breaking the Silence

Domestic violence continues to be inflicted on women from urban poor households disproportionately.