In February 2024, a video circulating on the internet showed a nurse maintaining her composure and continuing her duties despite facing sexual harassment from a patient. The healthcare industry, by its very nature, demands trust and vulnerability. However, the video is a testament to the disturbing reality in this noble profession – the prevalence of sexual harassment in the healthcare industry.

On one hand, patients entrust their physical and emotional well-being to medical professionals, seeking solace and care in moments of fragility. On the other hand, this vulnerability extends beyond patients to encompass all healthcare workers. Doctors, nurses, occupational therapists, physicians, and administrative staff are all susceptible to inappropriate behavior during their careers.

Recognizing the pervasiveness of this challenge and the May 2023 Supreme Court directives, the National Medical Commission (NMC) issued directives to all healthcare institutions in India. These directives mandate the formation of committees within each institution to investigate allegations of sexual harassment lodged against any employee. Furthermore, the directives ensure compliance with the provisions of the PoSH Act.

Legislative Mandates: A Framework for Action

Multiple legislative mandates provide the framework for addressing sexual harassment in the Indian healthcare sector:

• The Indian Constitution: Guarantees fundamental rights of equality before the law (Article 14) and protection from discrimination (Article 15) based on gender.
• The Sexual Harassment of Women at Workplace (Prevention, Prohibition and Redressal) Act, 2013 (PoSH Act): Offers a legal framework for addressing sexual harassment at workplaces, explicitly including hospitals and medical institutions.
• The Indian Penal Code, 1860: Criminalizes assault on women with the intent to outrage modesty, under Section 354 and makes sexual harassment punishable under Section 354A.
• The Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002: Regulates conduct of medical professionals and defines certain acts as professional misconduct, including inappropriate behavior towards patients (Chapter 7).

Types of Sexual Harassment in the Healthcare Industry

Quid Pro Quo: This involves a demand or exchange of sexual favors for work benefits, such as promotions or advancements. The Latin term “Quid Pro Quo” translates to “Something for Something” in English.

Hostile Work Environment: This encompasses unwelcome conduct or behavior that creates a hostile or offensive work environment, regardless of promises or demands.

A Statistical Example

In a study spanning 2005-2006, conducted across four hospitals in Kolkata, researchers examined instances of sexual harassment among 135 women healthcare workers. This investigation, encompassing a total of 128 reported incidents, shed light on the diverse forms of harassment experienced by professionals in the healthcare industry, ranging from doctors and nurses to attendants, administrators, and other non-medical staff:

• Verbal harassment: 41 cases
• Psychological harassment: 45 cases
• Sexual gestures and exposure: 15 cases
• Unwanted physical touch: 27 cases

None of the women disclosed incidents of rape, attempted rape, or forced sexual encounters. However, several were aware of fellow women healthcare workers who had endured such traumatic experiences. It's crucial to acknowledge that these reported numbers likely only scratch the surface of the true extent of the problem, as many instances of sexual harassment remain unreported. This reluctance to report is often fueled by concerns about potential retaliation, societal stigma, or a lack of knowledge regarding appropriate reporting channels.

While the scope of this study is limited (pointing to the need for further research and improved reporting systems), it still serves as a valuable indicator of the problem at hand.

Incidents of Sexual Harassment in the Healthcare Industry

Although India currently lacks reliable statistical information on the prevalence of sexual harassment in the healthcare industry, a reading of the following reports paints a despondent picture, highlighting the pervasive nature of sexual harassment in the healthcare industry in India:

• In June 2020, a 25-year-old female patient reportedly faced sexual harassment from her attending doctor over two consecutive days during her hospitalization. The distressing incident occurred in an isolation ward where she was kept during the COVID-19 pandemic. Tragically, just two days after her discharge, she succumbed to excessive bleeding.
• In February 2021, a junior resident doctor at a medical college reported experiencing harassment from a senior resident. Despite the Internal Committee (IC) finding evidence to support the claim, the accused reportedly faced no consequences.
• In May 2021, an ambulance attendant was arrested for sexually harassing a COVID-19 patient. This incident took place when the 38-year-old female patient was being taken to a nearby scanning center in Kerala. The incident came to light when this pneumonia-ridden patient informed the doctors of the harassment, and they further reported it to the Police.
• In June 2021, the wife of a COVID-19 patient in Bihar reported experiencing sexual harassment and alleged negligence at the hospital where her husband and mother were being treated. The lack of appropriate response and actions also led to the woman losing her husband. This incident also went viral on various social media platforms and created an outrage.
• In July 2023, a resident doctor at Nanavati Max Super Specialty Hospital in Mumbai alleged sexual harassment by a senior clinical consultant. When she attempted to report the incident, she reportedly faced threats to her career from the Human Resources department.
• In December 2023, three female employees at a government hospital in Delhi filed a complaint against their manager and supervisor. The complaint alleged sexual harassment and threats of termination if they refused to comply with inappropriate requests.

The Effect of Sexual Harassment in Healthcare Settings

While many are forced to turn a blind eye to the acts of sexual harassment particularly in the healthcare sector, one cannot negate the impact it has on the receiver.

Emotional and psychological trauma: Aggrieved women endure immense emotional and psychological trauma that often manifests into feelings of fear, anger, and helplessness. Physical manifestations such as headaches, sleep disturbances, and difficulty concentrating can compound the challenges faced by the aggrieved, hindering their ability to function optimally.

Career disruption and impact: Incidents of sexual harassment at the workplace can disrupt the careers of healthcare workers. It can lead to decreased job satisfaction, a sense of career stagnation by focusing more on self-preservation, and a hostile work environment that hinders productivity and morale. Ultimately, this can result in increased absenteeism, presenteeism (being physically present but mentally disengaged), and even a complete withdrawal from the healthcare field.

Erosion of public trust: Unreported and under-reported harassment erodes public trust in healthcare institutions, potentially deterring individuals from seeking critical care. This breakdown in trust can have a particularly devastating effect when the perpetrator holds a position of authority over the harassed. A study demonstrates that such a betrayal of trust significantly impacts career commitments, potentially leading employees to abandon a promising future in healthcare. This not only harms the individual but also creates a ripple effect, potentially deterring patients from seeking essential care, especially when they perceive a power imbalance between themselves and the healthcare provider.

Reasons for Lack of Action in Sexual Harassment Incidents in Healthcare Settings

Despite the prevalence of sexual harassment in the Indian healthcare industry, a concerning lack of action often surrounds reported incidents. This complex issue stems from a multitude of factors, including:

• Hierarchical structure : The healthcare industry is inherently hierarchical, fostering power imbalances amongst staff members. This makes women, especially junior staff or patients, hesitant to report harassment due to fear of retaliation, including career repercussions or even termination.
• Fear of losing a job : Due to the demanding nature of the industry, healthcare professionals face immense pressure to prioritize their careers rather than endure the threat of losing their jobs.
• Fear of shame and societal stigma : The fear of being judged, ostracized, or losing credibility within the healthcare community, often deters a woman from raising complaints with the management.
• Inadequate complaint mechanisms : Most healthcare institutions in India lack well-established and accessible Internal Committees (IC) or formal reporting procedures. This leaves aggrieved women without an internal redressal mechanism for addressing their grievances.

Creating a Safer Healthcare Industry in India

While the journey towards creating a safer healthcare industry in India is long, here are our recommendations to pave the way forward:

• Create robust policies and awareness: It is imperative to implement robust anti-sexual harassment policies alongside comprehensive awareness initiatives targeting both staff and patients.
• Empower Internal Committees: It is essential to ensure that ICs are well-trained, sensitized, easily accessible, and equipped with clear guidelines to hear cases of sexual harassment. This fosters a safe environment for reporting incidents and conducting fair investigations.
• Adopt a zero-tolerance approach: Healthcare institutions must embrace and enforce a zero-tolerance policy, ensuring prompt and decisive action against perpetrators of sexual harassment.
• Regular monitoring and evaluation: Regular monitoring and evaluation through ongoing assessments and surveys are instrumental in tracking progress, pinpointing areas for improvement, and enhancing the effectiveness of the system in addressing sexual harassment.

Achieving a safer workplace free from sexual harassment begins with an Employer’s commitment and intentional efforts. Allow Rainmaker to assist you in initiating the path towards a safer workplace. Together, we can build a healthcare industry where everyone feels safe, respected, and empowered.