‘Medical Examination and reporting sexual abuse 805 «+ Asking about her history of violence, her to talk (care should be taken {interpreters are involved) «+ Helping her access information about services that she might think helpful + Assisting her to increase safety for herselfand her children, where needed «+ Providing or mobilizing social support- If doctors are unable to provide first line support, they sho re that ic valableto do ssl of pidelnes Creating an enabling atmosphere and establishing trust ‘The health professional should + Speak to the survivor in a private space. c Bee ae ain in — ‘yOu as she has overcome several barriers. + Recognise the dilemma faced by survivor in reporting violence. Do not Inbel ton- reporting to police as false case. ae + asthe sro at er een wil ecm + Inform survivor of available resources, referals, legal rights so that she take an informed decision. ae bated 4. Sexual violence is known to cause physica, emotional, social and economic consequences, which can jeopardise the well-being of survivors and their families. Fear of police investigation procedures, shame related to the sexual violence, lack of support from the ‘community, fear that nobody will believe them and lack of information about negative health consequences may lead survivors to hide such incidents. ’. Reasons for not wanting to report to police could range from fear about community reactions, fear that nobody would believe them, felings of Shame and threats from perpetrators. With children, there could also be 2 possibility that survivor has not disclosed the assault to parents! guardians. Facilitation and demystfication of medical procedures ‘The health professional should: + Prepare the survivor for an internal examination, + Explain the various stages of the examination. + Communicate the rationale for referal for X-ray, USG, age estimation amongst others a. Any incident of sexual violence leads to a feeling of powerlessness ‘amongst survivors. Itis therefore important to recognise such covert feelings and explain the purpose of medical examination. Explaining the purpose of internal examination and steps in conducting it can help survivors to make sense of what is happening to them. This can help in regaining control over the situation. i . Currently each health seting may not have the infrastructure for fcditional services such as age estimation, laboratory. for assessing infections, sonography machines to detect intemal injuries! pregnancy and so om: While making referals, providers must ensure confidentiality and privacy of survivors, so that they are not embarrassed due to being ‘identified asa “survivor of sexual violence”. listening carefully, but not pressuring when discussing sensitive topics when I resouees, including legal and other806 Chapter 32—Sexual Offences Addressing survivor's emotional well-being ‘The health professional should: + Recognise that survivors may present varied emotions. *+ Encourage the survivor to express her feelings. + Encourage survivors to seek crisis counselling, + Assess for suicidal ideation, + Make a safety assessment and safety plan. + Involve family and friends in healing process of survivor. a. Each survivor copes with the assault differently. Coping is gy dependent on whether survivors have parental/ spousal” ‘community support, job security, economic wherewithal for ltigatn and several such factors. Most survivors may not openly express ther feelings. A good sang point is to explain range of feelings that survivors may experience suck as sleeplessness, anxiety, nervousness, crying spells, feelings of ending ‘one's life, anger and flash backs (RTS, emotional reactions post-raps) afler an assault. It must also be discussed that such reactions are norma) ater a traumatic episode. Crisis counselling can help in overcoming trauma. Providers mut explain tothe survivors that: i. “Rape” is a violation of bodily integrity and nota loss of honour, ji, Assault is an abuse of power and not an act of lust. iii, Positive messaging such as "You are not responsible for ape", “Itis not about the clothes you wea iv. This would enable the survivor to discard feelings of self-bl as it is the perpetrator who should fe! ashamed about the act help in rebuilding survivor's confidence in herself Safety assessment must be done: If assessment reveals that she is unsafe and fears reoccurrence of Violence, health professional must offer her altemate arrangements for stay as temporary admission in the hospital or referral to shelter servi some survivors may want to go home particularly if there are chil dependents. A safety plan must be made, which may include su making a police complaint about threats received, building su neighbourscommunity and temporary relocation ftom the old res Role of family, friends and community i Recovery from sexual violence is dependent on the extent of sup from family, fiends and community. Health professionals are b engage with family and discuss ways of promoting survivors’ well be discussed with all care-zivers that survivor should not be held es the assault. Judgments such as: “she should have been careful”, resisted,” make the survivor's journey o recovery more dificul GUIDELINES FOR INTERFACE WITH OTHER AGEN( AS POLICE AND JUDICIARY: Health professionals have to interface with other agencies such as th public prosecutors, the judiciary and child welfare committees 10 Comprehensive care to survivors of sexual violence. Specific guidelines been provided in this section for this interface for smooth interag coordinationMedical Examination and reporting sexual abuse 807 Interface of health systems with police + A standard operating procedure outlining the interface betw A sa Tae i iting erie even he te police must take her/him to the nearest health’ facility for medical Examination, treatment and care, Delays Ps related to the medical examination and treatment can jeopardize the health ofthe sunivers a + Health professionals should also ask survive ™ sat areca cee ti hy were amin ro aepotigg up and if survivors are earrying docum: ofthe same. If this is the case, health professionals, ‘must refrain ftom carrying out an examination just because the police have brought a requisition and also explain the same to them, + The health sector has a therapeutic role and confidentiality of informati and privacy in the entire course of examination and treatment must be censured. The police should not be allowed to be present while details of the incident of sexual violence, examination, evidence collection and treatment are being sought from the survivor. + The police cannot interfere with the duties of a health professional. Gann take-away the survivor inediately afer evidence cllecton, bat ‘must wait until treatment and care is provided. : + In the case of unaccompanied survivors brought by the police for sexual violence examination, police should not be asked to sign as witness in the rmedico-legal form, In such situations, a senior medical officer or any health professional should sign as witness in the best interest ofthe survivor. + Health professionals must not entertain questions from the police such as ‘whether rape occurred”, “whether survivor is capable of sexual intercourse”, “whether the person is capable of having sexual intercourse”. They should explain the nature of medico-legal evidence, its limitations, as well as the role of examining doctors as expert witnesses, CLA, 2013 and POCSO Act, 2012 both recognise that any registered medical practitioner can carry out a medico-legal examination and provide treatment and record ofthat health provider will stand in the court of law (Section 1644 CrPC). Interface of health systems and public prosecutors + The doctor must review the notes of the case to equip hinvherself with the history that has been provided by the survivor to the doctor, the police and the magistrate. In case there is a difference in the histories, the same should be clarified in advance with the public prosecutor. It is possible that a survivor revealed additional information to the doctor based on her ‘comfort, rather than to the police or the magistrate. + Examining doctors should prepare themselves well in time with the case documents before reaching the court. Efforts must be made by doctors to dialogue with the public prosecutor and also ask them about the role that they need to play. This would help them to be well-prepared and respond to questions asked in the court, erface of health systems and the judiciary * Doctors are termed as “expert witness” by law. As per Section 164 A, CrBC, an examining doctor has to prepare a reasoned medical opinion without delay, + A medical opinion has to be provided on the following aspects ~ = Evidence that survivor was administered drugs/psychotropic substance/aleohol, etc ~ Evidence that the survivor has an intellectual, or mental disability; Lb Oa~ 808 Chapter 32—Sexual Offences ences such as bruises, ¢ ~ Evidence of physical health consequences su . Say eS wound endermess. sling pa in mi ain in defecation, pregnancy. ete = ‘hge of the survivor if shorhe does not have a birth cetiiate gy it mandated by the court z + Absence of injuries on the survivor has tobe interpreted by the examin devi inthe sottoon based on medical knowledge and dewalt te episode provided by survivor to the doctor. Lack of injuries havea fe Brae onthe ine lpn Hever th nde! and eporing io hep ation pertaining to luring the child or , O factor tk tare and Suprie gr etheeirimatances hat rendered the each sins amber te prea + The examining doctor will also have to provide a medical opinion gq Tr song doo ilo ve i pei iw laboratory results may be duc to: ‘ ~ Delay in reaching a hospital/health centre for examination and ~ Activities undertaken by the survivor after the incident of sex violence, such as urinating, washing, bathing, changing clothes douching, which lead to loss of evidence; ~ Use of condom/vasectomy or diseases of vas of the perpetra ~ Perpetrator did not emit semen if it was a penile penetrative sexual ac, + The examining doctor should clarify in the court that normal examination findings neither refute nor confirm whether the sexual offence occurred rot. They must ensure that « medical opinion cannot be given on whehe, ‘rape’ occurred, because ‘rape’ is @ legal term. + Examining doctors must also ensue that comments on past sexual history, status of vaginal introitus must not be made, as these are unscientific wo the courts to0 have determined them as biased. ‘+ In most health centres because of the constant tumover, the doctor appearing inthe court room could be different from the one who earied cat the medical management of the survivor. In such instances, its cries! that the doctor making the court appearance be thorough with the ease fle et the survivor, such as documentation of history examination findings ad clinical inference drawn by the examining doctor Case law— The Trial Court Rape can be committed only by a man in terms of Section 275 IPC. It is conceptually inconceivable that a woman can be held guilty of committing rape. A woman cannot also be charged with having a common intention with another male to commit the offence of rape, as common intention denotes action in concert. It necessarily postulates 9 pre-arranged plan, a prior mecting of minds and an element of participation in action In Lalita Kumari v. Government of UP," a S-member Bench of the Supreme Court reiterated emphatically that registration of FIR relating to sexual offence x mandatory rithout any more than a preliminary enquiry that it discloses a cognizable offence. Itis {© be recorded in the FIR book by giving a unique annual number to each FIR to enable strict tracking of each and every registered FIR by the superior police officers as well by the competent court, to which copies of each FIR is required to be sent, Reterng 10 the language of “information” used in Section 154, the e St Court said, “Be it noted that in Section 154(1) ofthe Code, the legislature in its collective wledecs has ech 47. State of Rajasthan v, Hemraj, (2009) 12 SCC 43 : AIR 2009 $c 9644 1. 4 Lins Ramar’Goenmcas/ OP AIR SNS an ao Se 220080) SCRee Case law 809 cgausly wwe the expression *informar aod 4H) oF (@) ofthe Code wherein the expan ea ean a ae Eon ons, reason compl el 54(1), unlike in Sections 41(1yoy majestion_ OF thew fr that the police officer should not, roan 3 Ag) ofthe Coss may ie te eid wih te fearless or Geb of te nome Wee i ese “adi oie ani information nt 4 eta) 18 not a condition Zee Cos wil ete Gt he Leite a tn 58 wth those eon information” witout qualiyig the said wera Section Horne ey co rocedre of 18625 of 1861) pase by the Legilaive Ciuneil cra ok Crt empl or normaton”reeed to an ofr in chaye os et sake Irae we Peat rs tsa i fe 1872 Code (10 of 1872), which hereafter ead that vey comp Mint’ cloned inal tter in charge of a police station shal be reduced wring, The wed ne nhch occurred in previous two Codes of T85l and 1472 mas lel and in ‘ort word “ifomation was used inthe Coes of 1982 and 1998, wes rd incl ection 154,153,157 and 190() ofthe presen Cade of 1973 (2 of 19%), mo tS eaingoFall th Codes makes it clear that the contin which Sere rst information report is that there must be an information sa that secording aking reference to Section 166A inserted by the 2013 Amendment, the Bench laid fying the same as in don: “the insertion of Section 166-A was in the light of recent unfortunate ape er See eon Te i ere fe cam us tea ene se Fe a a ae oan chance he gee epee re Ste a Shut eae rte he ese eee eae en ee eee are steno ese: ‘The Court concluded the reference to the S-member Bench: ‘The registration of FIR is mandatory under Section 154 of the Code, if the information discloses commission of a cognizable offence and no preliminary inquiry is permissible in such a situation. (i) Ifthe information received does not disclose a cognizable offence but ihdictes the necessity for an inquiry, a preliminary inquiry may be saatfanted only to ascertain whether cognizable offence is disclosed ot not (Gi) the inquiry rst be register the complaint, a copy of the entry of sucl the fist informant forthwith and not later than one week. It must Gisclace reasons in brief for closing the complaint and not proceeding fier (iu) The police officer cannot avoid his duty of registering offence. if alee fcr aos Action must be taken ais! ering cote oes rege the FIR i nermation received by bith AIbnescogable offence. (0) The weope of preliminary inquiry isnot to vey the veracity or To et rtm eerved, bu nly 0 ascein whee he tnfrmation reveals ny cognisable fen. (ss to what type and in which cases prliinary inguiy is 10 be ‘uucted will Depend onthe fats and circumstances ofeach east, The discloses the commission ofa cognizable offence the FIR red. In cases where preliminary inquiry ends in closing fh elogure must be supplied t0