Pooja Chauhan's is perhaps a classic example of what domestic violence could do to your health. When the housewife from Rajkot, Gujarat in western India, in her early twenties, decided to walk almost naked on the streets protesting the government's indifference to her complaint against her husband's family, she hit the headlines.
Some hailed it as a courageous move; others called it her key to the hall of fifteen minutes fame. Pooja was largely called mad. Still the incident helped throw focus on the mental health of the women who suffered from domestic violence.
In fact studies conducted by several organizations have found that victims of domestic violence are also more likely than others to suffer from chronic health conditions and participate in risky behaviors.
The first-ever World Health Organization (WHO) study on domestic violence, conducted in 2005, revealed that intimate partner violence was the most common form of violence in women's lives - much more so than assault or rape by strangers or acquaintances.
The study reported on the enormous toll physical and sexual violence by husbands and partners had on the health and well being of women around the world and the extent to which partner violence was largely hidden.
Agrees Dr Shalini, Chennai based psychiatrist in southern India: 'At least physical violence is noticed and people sympathise with the victim. But when the woman is mentally affected, it goes unnoticed. Only when things get serious, like in the case of Pooja Chauhan, some attention is paid to her.'
Shalini says several women coming to her for counseling have suffered from partner neglect. 'They feel they are treated as objects and this leads to depression and sometimes more serious problems.'
One quarter to one half of all women who had been physically assaulted by their partners said that they had suffered physical injuries as a direct result. The abused women were also twice as likely as non-abused women to have poor health and physical and mental problems, even if the violence occurred years before. This includes suicidal thoughts and attempts, mental distress, and physical symptoms like pain, dizziness and vaginal discharge.
Domestic violence is known to affect women's sexual and reproductive health and may contribute to increased risk of sexually transmitted infections, including HIV. In the WHO study, women who were in physically or sexually abusive relationships were more likely to report that their partner had multiple sexual partners and had refused to use a condom than women in non violent relationships. Women who reported physical or sexual violence by a partner were also more likely to report having had at least one induced abortion or miscarriage than those who did not report violence.
Says B Usha, a women's rights activist: 'In all my visits to districts, I have found women subjected to sexual violence suffering from problems like miscarriage. This would also have a lasting impact on their mental health."
Although pregnancy is often thought of as a time when women should be protected, in most study locations, between 4% and 12% of women who had been pregnant reported being beaten during pregnancy. More than 90% of these women had been abused by the father of the unborn child and between one quarter and one half of them had been kicked or punched in the abdomen.
In various developing and industrialized countries, between 16 and 52 percent of women reported that they had been assaulted by an intimate partner. In the United States, 28 percent of women reported at least one episode of physical violence from their partner. In Nicaragua, 52 percent of women aged 15 - 49 in the city of Leon reported having been physically abused by a partner at least once. Many cultures condone or legally sanction domestic violence. In Northern Nigeria, for example, Section 55 of the Penal Code allows a husband to discipline his wife so long as the action does not amount to the 'infliction of grievous hurt.'
For policy makers, the greatest challenge is that the abuse remains hidden. At least 20% of women reporting physical violence in the study had never told anyone before being interviewed.
B S Ajitha, noted lawyer and activist, says the far-reaching Domestic Violence Act of 2006 had not been put to full use in the country. 'Lack of infrastructure, lack of training and sensitization to service providers, police and the judiciary has made this law very underused. Only forty cases would have been filed in Tamilnadu in southern India under this law since its promulgation an year and half back' she says.
Ajitha says though the law has a provision for medical facility, the providers have no clue about it. 'The law clearly states that the woman should be given medical help, if she needs it. It is the duty of the protection officer to take her to a psychiatrist or a doctor. But neither the protection officers seem to be aware of it nor the Tamilnadu government has enlisted the hospitals that could be used for this provision. Not even the victims are aware of this provision.'
Despite the health consequences, very few women reported seeking help from formal services like health and police, or from individuals in positions of authority, preferring instead to seek out friends, neighbors and family members. Those who did seek formal support tended to be the most severely abused.
Violence against women and girls is a major public health and human rights issue that has for too long been denied the attention and concern of international organizations, national governments, traditional human rights groups and the press. Only recently have governments and the international community acknowledged the prevalence and scope of violence against women and girls. Meanwhile, hundreds of millions of girls and women around the globe continue to endure debilitating and often fatal human rights abuses.
From genital mutilation to burning of the daughter-in-law who does not bring in enough dowry to honor killings when someone marries out of the community to acid attacks by frustrated lovers or husbands, the list of outrages suffered by women anywhere in the world is almost endless.
Indeed the World Health Organization estimates that domestic violence is a greater cause of death among women aged 15 to 44 than cancer, malaria and traffic accidents combined.
Not to forget the horrendous crime of trafficking in women. According to the United Nations Population Fund, an estimated 4 million women and girls around the world are bought and sold either into marriage, prostitution or slavery. Trafficking is an international multi-billion dollar industry. Traffickers operating across international borders procure their victims in many ways. Some women and girls are abducted; some are deceived by offers of legitimate work in another country; some are sold by their own poverty-stricken parents or are themselves driven by poverty into the lure of traffickers who profit from their desperation. These women and girls suffer unspeakable human rights violations as commodities of the trade in human beings.
Such an appalling situation can be fought back only by sustained awareness campaign, making women realize that they have got every right to lead the life the way they please, on an equal footing with men.