# An Empirical Study of Informed Refusal by Sexual Assault Survivors Under the Protection of Children from Sexual Offences (POCSO) Act at a Tertiary Care Center in Northeast India

## TL;DR

This study examines why sexual assault survivors in India refuse medical exams under the POCSO Act, finding that fear, social stigma, and relationships with the assaulter are key factors.

## Contribution

The study provides empirical insights into the reasons for informed refusal among sexual assault survivors under the POCSO Act in Northeast India.

## Key findings

- Romantic involvements and child marriage were the most common reasons for survivors' refusal of medical examination.
- Fear of the medical procedure and social stigma were significant factors in both survivor and parental refusals.
- Age and education level were significantly associated with reasons for refusal among survivors and their guardians.

## Abstract

Introduction

In India, the Protection of Children from Sexual Offences (POCSO) Act is a comprehensive legislative framework designed to protect children from sexual abuse, emphasizing child-friendly processes and mandatory reporting to ensure justice and protection. This study aims to evaluate the prevalence, demographic patterns, and various factors that lead to the refusal of medical examinations by sexual assault survivors despite appropriate counseling.

Methods

This hospital-based cross-sectional study was conducted at Gauhati Medical College and Hospital (GMCH) in Guwahati, Assam, from January 6, 2019, to January 6, 2021. The study included all sexual assault survivors under the POCSO Act who refused medical examination at the Department of Forensic Medicine. Survivors brought under the POCSO Act who consented to the examination were excluded.

Results

A total of 350 survivors under the POCSO Act were presented to the examination center for examination by the law enforcement agency (police), of which only two were male survivors. One hundred and two cases refused examination, representing 29.14% of the total cases. Of these 102 cases, 67 (65.7%) survivors declined examination. At the same time, parents of minors refused on behalf of their wards in 35 (34.3%) cases. Romantic involvements (53.7%, n=36), involvement in child marriage (19.4%, n=13), social stigma (4.5%, n=3), and fear of examination procedure (14.9%, n=10) were the most reported causes of refusal by the survivors. The age of the survivor and the reason for refusal were found to be associated (chi-square value: 10.3, p-value < 0.05). Meanwhile, parents or guardians mostly refused examination due to fear of the procedure (45.7%, n = 16) and social stigma (31.4%, n = 11). Parents' reasons for refusal were found to be significantly associated with the age (chi-square value: 23.7, p-value < 0.001) and education level (chi-square value: 15.0, p-value = 0.005) of the survivor.

Conclusion

Romantic relationships with the alleged assaulter, child marriage, and fear of medical procedures were the noted reasons for refusal among the survivors. Parents of toddlers mostly refused a medical examination of their child, fearing the possible physical or psychological side effects of the procedure. Social stigma and fear also contributed to parental refusal. The reasons for refusal significantly differed with the age of the survivors. Identification and assessment of reasons for informed refusals to medical examination among sexual assault survivors is critical in determining the underlying factors of such refusals. Proper counseling may reduce refusal rates due to fear of the procedure.