‘Hospitals offer a critical window of opportunity for supporting survivors’: Making the PWDVA work in health systems

THE PROTECTION OF WOMEN FROM DOMESTIC VIOLENCE ACT, 2005 (‘PWDVA’) is one of the first civil legislations to integrate the role of Healthcare Providers (‘HCPs’) in identifying and responding to domestic violence in India. Despite extensive global evidence on health impacts of domestic violence, there was hardly any policy engagement with health systems to respond to violence. One of the earliest efforts in India was Dilaasa, a public hospital-based crisis intervention department in Mumbai. It was set up in 2000 as a joint initiative between the Centre for Enquiry into Health and Allied Themes (‘CEHAT’), a non-governmental research organisation, and the Brihanmumbai Municipal Corporation (‘BMC’). 

Health system interventions are premised on the recognition that violence has many overt and covert health consequences. Healthcare encounters provide a critical window of opportunity to identify and support survivors, particularly when abuse restricts women’s mobility and access to other forms of support. This makes hospitals strategic sites for early identification and timely intervention to disrupt the cycle of violence. The Dilaasa model was the first of its kind to train health professionals to identify survivors during routine clinical care, provide first-line support and information, and refer them to hospital-based counsellors for psychosocial support, crisis intervention, and coordinated linkages to relevant services.

As conversations around the need for a civil law for domestic violence gained momentum in the early 2000s, evidence from models like Dilaasa strengthened the case for recognising domestic violence not just as a social and legal issue but also a critical public health concern. A retrospective review of counselling records between 2001 to 2004 found that among 923 women who sought Dilaasa services, 40 percent were between 15 to 25 years, while 35 percent were 26 to 35 years. One-third of these women presented with physical assault-related injuries, 20 percent were admitted for ‘accidental poisoning’ (most commonly suicide attempts), and 16 percent sought care for reproductive health concerns, including unwanted pregnancies, vaginal discharge, and sexually transmitted infections. These insights highlighted the diverse health manifestations of domestic violence and reinforced the need to integrate the role of health professionals’ within the statutory framework.