privacy and dignity violation has become a common practice for health care providers which is hampering the mental health of patients. we discuss measures to stop this malpractice

1. NISA
RIGHT TO FIGHT

2. HEALTH

3. HAMPERING WOMEN’S HEALTH
• LACK OF AWARENESS
• LIMITED POWER OF DECISION MAKING
• DISCOURAGED TO ENTER FIELDS LIKE SURGERY AND
RADIOLOGY
• DEPENDANCY ON MALES (patients and doctors)
• SHY TO SPEAK OUT
• LACKING GUTS TO SAY ‘NO’
• KEEPING CLOSED ROOM MISHAPPENINGS TO
THEMSELVES

4. IS PRIVACY A CONCERN
• AUTHENTIC REPORTS
• “Women are reluctant to go to the PHC for gynaecological problems
because the centres are staffed largely by male doctors. So most
women rely on home and herbal remedies or do not go to a doctor
till the illness becomes seriously debilitating. The NFHS data reveals
that of the total number of women who reported that they had
some kind of gynaecological problem, 68 percent have never
sought any kind of medical treatment.”
Human development report, Chhattisgarh, 2005, Govt. of Chhattisgarh.

5. IS PRIVACY A CONCERN
• AUTHENTIC REPORTS
• “About two-thirds (65% ) of the symptomatic women had not
taken any treatment. The majority among those not seeking
treatment thought that the symptoms were ‘not alarming’,
hence not necessitating treatment. Other reasons for not seeking
treatment included absence of a female healthcare provider at
the nearby facility, lack of privacy and distance of the facility
from home.”
GENDERED VULNERABILITIES: WOMEN’S HEALTH AND ACCESS TO HEALTHCARE IN INDIA, 2006,
MANASEE MISHRA, Ph.d. The Centre for Enquiry into Health and Allied Themes (CEHAT),
Mumbai

6. IS PRIVACY A CONCERN
• AUTHENTIC REPORTS
• “For a variety of reasons, in many parts of the world, pregnant
women and their families prefer that childbirth care be provided by
a woman. Evidence is also mounting that the quality of woman-towoman care is oftentimes seen as superior. Women report greater
comfort and higher satisfaction with the care they receive from other
women.”
• “A 2009 analysis of Demographic and Health Surveys from 41
developing countries found that nearly one quarter of women listed
not having a female health provider as a reason that they did not go
to a health facility to give birth.”
Lee, anne et al. “Linking Families and Facilities for Care at Birth: What Works to avert intrapartumrelated Deaths? ” International Journal of Gynecology and Obstetrics. Volume 107, supplement
(october 2009) intrapartum-related Deaths: evidence for action 4. pp.s65-s66

7. IS PRIVACY A CONCERN
• AUTHENTIC REPORTS
• “A study in northern Ethiopia found one reason women would not seek
treatment for malaria was that the community health workers were male
and the women feared the perception of sexual disloyalty.”
Ghebreyesus et al. Community participation in Malaria Control in tigray region ethiopia.”
Acta Tropica. Volume 61, issue 2. april 1996. pp.145-156.
• “In Nepal, female facilitators organized monthly meetings where women
gathered to solve shared problems related to pregnancy, childbirth and
care of newborn babies. The groups devised their own strategies to tackle
challenges, and the result was more prenatal care, more trained birth
attendance, more hygienic care, and dramatically fewer newborn and
maternal deaths.”
Manandhar et al. Effect of a participatory intervention with Women’s groups on Birth outcomes in
Nepal: Cluster-randomised Controlled trial. The Lancet. Volume 364. september 2004. pp. 970-979

8. IS PRIVACY A CONCERN
• AUTHENTIC REPORTS
• The same approach was tested in very poor areas of India. The
groups were facilitated by women recruited in the local area who
tended to be married with some schooling, were respected
members of the community, but were not health care professionals.
• The results were dramatic: by the second and third years of the
trial, the newborn mortality rate in the areas where participatory
women’s groups existed had fallen by 45 percent. These areas also
saw a significant drop (57 percent) in depression among mothers.
Tripathy et al. Effect of participatory intervention with Women’s groups on Birth outcomes and
Maternal Depression in Jharkhand and orissa, india: a Cluster-randomised Controlled trial. The
Lancet. Volume 375, issue 9721. april 3, 2010. pp1182-1192

9. IS PRIVACY A CONCERN
• AUTHENTIC REPORTS
• Another key component of these Asian successes was putting
women on the front lines of health care. For example, Malaysia
and Sri Lanka invested in mid-wives, increasing their numbers and
status with well-run training and certification programs.
• Thailand instituted a successful safe motherhood program that
made skilled birth attendance nearly universal by 2001. Thailand
also trained many more nurses and midwives, growing their
numbers from about 10,000 in 1971 to 85,000 in 2002.
Women on the Front Lines of Health Care State of the World's Mothers 2010, Save the children,
Bangladesh.

10. IS PRIVACY A CONCERN
• DOCTOR’S PERSPECTIVE
• Even a simple examination of a patient is often carried out
without the privacy she deserves. The state of affairs in the
operation theatre is even more appalling.
• It is common sight to see the patient lying exposed on the
operation theatre prior to anesthesia in such a vulnerable state
that there is either no voice of protest or, if there is one, it is
so feeble that it is hardly heard or respected.
Aabha Nagral. Privacy in public hospitals Med Ethics.1995 Jan-Mar;3(1).
(Dr Abha Nagral works in the Department of Gastrointestinal Medicine ,Tata Memorial
Hospital, Parel 400012)

11. IS PRIVACY A CONCERN
• DOCTOR’S PERSPECTIVE
• Clearly there is no system in place to ensure that female patients,
especially in private clinics, are comfortable and secure when being
examined by a health provider.
• The point is that while public health facilities face criticism, just or
unjust, the health system remains blind to the procedures followed
in a private healthcare facility.
• Those visiting private health services may be viewed as using them
out of choice, not compulsion. They pay more, anticipating better
services. But they are also left humiliated and helpless.

12. IS PRIVACY A CONCERN
• DOCTOR’S PERSPECTIVE
• It is true that the status of urban women is generally better than
that of rural women. However, that elevated status does not
empower her enough to raise her voice against the doctor, seek
an explanation for actions that distress her, and refuse treatment
when it is uncomfortable for her.
Neetu Purohit1, Dipti Govil. Dignity of women patients in health clinics. Indian J Med Ethics.2011
Apr-Jun;8(2).

13. IS PRIVACY A CONCERN
• DOCTOR’S PERSPECTIVE
• How much importance is given to a patient's privacy in India?
The Constitution of India does not confer, in express terms, any
constitutional guarantee to the right to privacy.
• Many times doctors adopt an authoritarian approach when
interacting with patients. It would not be surprising to find that
female patients in particular bear the brunt of the doctor's
dominance.
Shailaja Tetali. The importance of patient privacy during a clinical examination.
Indian J Med Ethics.2007 Apr-Jun;4(2).

14. IS PRIVACY A CONCERN
• PATIENT’S PERSPECTIVE/ CASES
Bhavana Gupta, Auditor, O/o Local Audit Officer, Air Force, 411-Air Force Station, Cottongreen, Mumbai
Mo:9324980412.
• I want to bring to your notice the attrocity towards female patients in
hospitals which is a slam on our society:
• (A) During antenatal check-up, an internal examination of most private
organ of the pregnant woman is done in which doctors see/touch her
most private organ. Surprisingly, male doctors also do this kind of antenatal checkup.
• (B) In other indoor treatments (operation etc.), female patient remains
without clothes before male doctors. The darkest aspect of the both
above circumstances is that male doctors do not bother to pay heed to
whether the female patient is willing to be examined by male doctors or
not.

15. IS PRIVACY A CONCERN
• PATIENT’S PERSPECTIVE/ CASES
• During delivery of my child, my internal check-up was done by male
gynaecologists in Nowrose Ji Wadia Maternity Hospital, Parel,
Mumbai. When I opposed it and requested for female doctor, they
did it forcibly saying that one female assistant doctor was standing
with them. Had I known it earlier, I would have preferred to be
without child throughout my life.
• Presence of a female assistant does not change the sex and natural
desire of male doctors which is almost same in all males.
http://www.karmayog.org/messages/message.aspx?id=3715
http://www.womensforum.in/society-culture/6392-dignity-female-patients.html

16. IS PRIVACY A CONCERN
• PATIENT’S PERSPECTIVE/ CASES
•
Manish Kaushik, Ghaziabad, 2008.
• Two month back, my wife underwent a surgery. She has to go with
gown, which is usually very open. Even then that is also removed
when they start operating her. Now can you imagine 6 males were
present in the OT.
• Initially there were 6 males only, then after 25 minutes a lady
surgeon came in OT, she went away in another 25 min. After another
20 min my wife came out. After that when she was in private room,
lady
doctor
come
with
junior
male doctors and asks me to move out so that they both can
examine her.
• I have been facing trauma since operation. From that time I am not
able to take complete sleep and also I am facing other health issues.
http://www.sukh-dukh.com/forums/showthread.php?t=8452

17. CASES IN NEWS
AIIMS turns blind eye as women face sexual harassment
NEETU CHANDRA NEW DELHI, AUGUST 4, 2011 | UPDATED 11:52
• The sexual harassment committee of AIIMS that was constituted in
2008 and completed its tenure in July 2011 received 15 complaints
of sexual harassment.
• One complaint reads: "He brought my report of HIV test and told me,
'Let's celebrate because your report is negative.' I asked, 'What kind of
celebration?' He told me in a vulgar way, 'I want you.'" According to her
complaint, the doctor told her that he was going to Hyderabad and she
should accompany him. He promised to fly her to Hyderabad and book
her in a five-star hotel where they would "enjoy" and "celebrate".
• "He also used many indecent words for me. I was shocked to listen to how
such a senior doctor can talk with a female patient in such a manner.

18. CASES IN NEWS
• In another complaint, a senior scientist complained to the women
harassment cell and the AIIMS director against a senior doctor in
forensic medicine department for "writing outrageous remarks
against women's modesty" (subject of the complaint) on August 3,
2009.
• An associate professor filed a complaint with the AIIMS chief
vigilance officer against a doctor of laboratory medicine. "(The
doctor) misbehaved with me in such a way that it crossed all limits
which I have been tolerating so far," the complaint reads.
•
http://indiatoday.intoday.in/story/aiims-turns-blind-eye-as-women-face-sexTrauma/1/146991.html

19. CASES IN NEWS
Times of India
Army gets women recruits examined by male docs
Shreya Ray, TNN Sep 23, 2004, 02.51am IST
• Surya Moudgil had applied for a lieutenant's post in the army through the
services selection board.
• In her medical examination in Allahabad on July 8, Surya raised an
objection and requested for a woman gynaecologist. "The president,
special medical board, Lt Colonel Turlapati told me, Doctors only see,
they don't touch'. He also told me that if I had a problem I shouldn't have
applied and that I was the only one with a problem.“
• While the ENT specialist told me that I need to grow up, the eye doctor
told me that for an eye examination he'd have to come very close to my
face.

20. Patrika Raipur, 12-01-2013

21. Patrika Bilaspur, 19-01-2013

22. Patrika Bilaspur, 28-9-2012

23. Bhaskar Bilaspur, 16-10-2013

24. Nav Bharat Bilaspur, 13-10-2013

25. Patrika Durg, 29-9-2013

26. Bhaskar Durg, 29-9-2013

27. 17-7-2013

29. SOLUTIONs ???

30. ISSUES & SOLUTIONS



No practical guidelines by bodies like MCI to protect
physical privacy of female patients from male
attenders in OT even for procedures not involving
sexual organs.
Curtains can be used during pre and post operative
procedures to provide heed from male staff, or
simply males can be kept out of the operating room
during that period.
Such provisions can be included in MCI guidelines
for strict practical application.

31. ISSUES & SOLUTIONS



The are no rules or guidelines for assigning intimate
tasks like cleaning of internal organs, positioning
urinary catheters to health worker of same gender,
hence nothing can be claimed if such procedures on
female patients is performed by male workers.
As in case of physical examination of females in
other places ( airport, mall etc.) only female nurse or
ward aya should be allowed to take intimate care of
female patients inside and outside OT.
Such provisions can be included in MCI guidelines
for strict practical application.

32. ISSUES & SOLUTIONS



Most of the times female doctors take service of
ward boys in even normal childbirth cases which is
humiliating and abusive for patients who are helpless
at that time.
Compulsory appointment of dedicated female staff
like nurse, ward aya and anesthist should be done
for sections like gynecology. No male nursing or
derssing staff should be sent to Gynec section.
Such provisions can be included in MCI guidelines
for strict practical application.

33. ISSUES & SOLUTIONS


There is scarcity of female technicians for X- ray,
sonography and mammography and ultimately the
female patient has to suffer sexual abuse during
examinations.
Females should be promoted to join these fields by
giving them reservation and financial support by the
Government.

34. ISSUES & SOLUTIONS
 Doctors never try hear patient’s dignity concerns and
talk to them rudely in this regard.
 Females should raise their concerns of privacy and
dignity in 1-2 sittings with their doctor, and should
raise their voice if they feel something undignified is
going to happen with them.
 Patients are like consumers for doctors and a
demand for dignified treatment from their side is
necessary to change the reluctant attitude of medical
practitioners in this regard.

35. ISSUES & SOLUTIONS
If at least one fourth of the female
patients start talking about protection of
their dignity and physical privacy with
their physician/surgeon, the system will
change by itself as it will direct effect
the doctor’s pocket.

36. *
* Govt.
of India has started all female banks,
then why not hospitals and diagnostic centers.
* Supreme
court has up holded the right of
respectful treatment for all.
* Currently
many new laws and provisions are
being to safe guard the dignity of females.
* Govt. has launched ad campaign for promotion
of toilets to protect dignity of females, then
why not ward ayas in place of ward boys during
child delivery.