The number of cases of burns among women is unusually higher in India with the proportion being undisputedly more in women married for less than 10 years, a latest study has shown.
The pattern of burns in India is unusual in two senses. First, deaths from burning are more common among women than men, and second, burns are a well-known means of female suicide or homicide, the study suggests, describing burns as a result of violence against women.
Estimates suggest that every year 1.5 to 2 lakh people die of burns in India and the number of such cases is almost double that number, but still grossly underestimated. The study revealed that 1.1 to 1.6 times more women suffer burn injuries and die of it than men. It is also the only unnatural cause of death from which women die more than men.
Although most burns among women are said to have been caused by accidents, there is a general feeling that a large proportion is not, an investigation of burns cases in Delhi and Mumbai has suggested.
The study, led by SNEHA, a non-governmental organisation working on women’s health, addressed the ‘realities’ faced by women who suffer serious burns and are admitted to hospital.
The most common reason that women suffer burns is kitchen fires, and severe injuries are often related to use of kerosene, according to the study. The researchers, led by Dr. Nayreen Daruwalla of SNEHA, Dr. Jyoti Belur of the Department of Security and Crime Science, and Dr. David Osrin of the Institute for Global Health (both at University College London), interviewed women, their families, doctors, nurses and police officers about the stories behind burns and the medico-legal procedures involved in the cases.
The pilot study, as part of UCL Grand Challenge of Global Health award, was done in Lokmanya Tilak Hospital in Mumbai and Safdarjung Hospital in New Delhi for two months during which 33 women who sustained burn injuries were interviewed.
Of these, 22 were supposedly accidental burns, 5 suicidal cases and 6 homicidal. “But we don’t know exactly the causes. Grossly 40-80 per cent were not accidental cases,” said Dr. Osrin.
Although most burns were said to have been accidents, there was a general feeling that a large proportion was not. It is well known that burns have been associated with dowry deaths, but the story is more complicated because women do not want to complain against their husbands or in-laws.
The other reasons given are cramped living conditions, substandard stoves, rubber LPG gas pipes gnawed by rats and even road accidents, in addition to suicides.
“Globally the proportion of men sustaining burns is more, if not equal than women as men to the risky jobs,” Dr. Osrin explained.
According to Dr. Daruwalla, stringent laws are in place and all burns — especially of women in the first seven years of marriage — require medico-legal investigation. Hospitals and the police are in close communication about women admitted with burns and action is swift. It is quite possible that this, along with improving home conditions and knowledge of the risks and consequences, has improved the situation.
But the picture is complicated. Circumstantial evidence is often not felt to be convincing enough for a case to be filed, and unless there is a clear allegation, the process may grind to a halt, Dr. Daruwalla explained.
One can imagine the pressure on women who have suffered the profound effects of burns: physical, mental and in terms of the precariousness of their future lives. It is no surprise that most say that the burns were the result of accidents. What are women to do when faced with the reality of going back home, looking after their children and living with their families?
Doctors see their primary duties as saving lives and achieving the best possible outcome for such victimised women, often through years of follow-up and support. Given the risks of both accidental and non-accidental burns, the police find it challenging to get past the story they are told if there is no clear allegation and women and their families are unwilling to go down the lengthy road to justice.
One welcome development is the institution of fast-track courts, which are cutting down the time that cases take to come to trial. Another is communication between hospitals and the police, which can help to make sure that medico-legal records are as clear as possible. A third possibility is to involve counsellors with access to social and legal services to help create a space in which women who have experienced burns feel safe and supported.
Finally, the researchers found that many people do not appreciate the risks. They may be using inferior stoves and fuel sources, or may not fully understand the effects of kerosene and flames.