The researchers compared survival rates for women post-assault and women who were injured accidentally, and the figures suggested something more sinister was at play. Photo: AFP

London: Women who are assaulted in India are 40 times more likely to die from their injuries than their US counterparts, with social factors mostly to blame for the gaping disparity, according to research released on Thursday.

The researchers at the University Of Washington said they compared survival rates for women post-assault and women who were injured accidentally, and the figures suggested something more sinister was at play.

“We looked and I don’t believe the women (assaulted) in India were worse injured — the clinical injury scores were not that high. That led me to hypothesise about social factors,” Mohini Dasari, a surgeon and researcher at University of Washington, told the Thomson Reuters Foundation.

The research compared more than 25,000 trauma cases and was published in the British Medical Journal’s prestigious BMJ Global Health.

It found that women in the United States had more than five times better odds of surviving a simple fall or road accident than their counterparts in India — largely due to better medical care.

But the gap in survival rates jumped to 40 when it came to intentional attacks, prompting suspicions that neglect and a code of silence around domestic violence in India was to blame.

Women in India are nearly 40 times more likely to die after being assaulted than are their female peers in the US, finds a comparative analysis of trauma data from both countries, published in the online journal BMJ Global Health.

The researchers drew on information submitted to Indian (11,670 cases) and US (14,155 cases) trauma databases for 2013 to 2015 for the top three causes of injury: falls; road traffic accidents; and assaults.

The Indian database comprised patients at four hospitals in Kolkata, Mumbai, and Delhi–‘megacities’ with more than 10 million inhabitants. The US database included patients treated at three level 1 trauma centres in the medium sized city of Pittsburgh, Pennsylvania.

After rail transport and burn injuries had been excluded, and the cases matched for trauma type/severity, age, and gender, the final analysis included 7505 Indian and 9448 US cases.

Comparative analysis showed that Indian men were more likely to die after sustaining any one of the three categories of injury than either Indian women or US men and women.

And US men were three times as likely to die after sustaining a fall than were US women.

But the greatest disparity in risk of death emerged for Indian and US women who had been assaulted–a difference the researchers describe as “unparallelled.”

Women in India who had been assaulted were nearly 40 times as likely to die of their injuries as were their US counterparts.

Both men and women in the US had between five and seven times lower odds of dying after a fall or a road traffic accident than did their counterparts in India.

In a bid to explain the findings, the researchers point to previous studies showing that men tend to be more badly affected than women after sustaining trauma, but it’s not clear whether this is due to differences in injury type or in recovery.

As to the wide discrepancy in death risk following assault among women, the researchers suggest that women in India who have been assaulted may not seek medical attention promptly.

They point to reliable evidence suggesting that only one in four female victims of assault in India actively seek care after experiencing intimate partner violence.

Pre-hospital care services are also not likely to be as well developed as they are in the US, added to which women from low income households may not be able to afford the treatment they need, they suggest.

The researchers accept that the two sets of data were not standardised, and that some of the trauma cases might have been miscoded as falls or road traffic accidents when they were in fact assault, both of which would have affected the findings.

“The higher odds of death for Indian females compared with US females suggest that there are other injury and systemic factors that contribute to this discrepancy in mortality odds,” they write.

Code of silence

Violence by partners makes up a significant percentage of assaults on women in both countries, said the researchers.

But previous studies that show only one in four Indian women who are assaulted seek health care after an attack led the researchers to ask how social barriers might prevent Indian women reaching hospitals quickly.

“I’m imagining a woman whose significant other has assaulted her, and they’re not necessarily going to let them call for help. We know violence is sometimes condoned by in-laws and the woman might not be able to go and ask for help,” said Dasari.

“There is clearly something that leads to that high odds of death,” she added.

The study analysed patients at four hospitals in Kolkata, Mumbai and Delhi, and compared them to three trauma centres in Pittsburgh, Pennsylvania.

Juan Carlos Puyana, Professor of Surgery at University of Pittsburgh, told the Thomson Reuters Foundation that researchers will struggle to make definite conclusions until the records of trauma better document the causes of injuries.

Even in this study, some assaults may have been mis-registered as falls or road traffic accidents, which could have affected their findings, said Puyana.

“Not every woman is going to go to a hospital to say: ‘I have just been beaten’ or ‘I have just been assaulted’. Probably the real level is actually higher than we’ve seen in these results,” he added. Reuters