Trigger Warning: Mention of sexual violence
Introduction
Healthcare systems globally are embedded with gender inequalities, discrimination and exclusion. Worldwide, one in every four nurses faces sexual harassment. Many Gender-based violence (GBV) cases have preceded the R G Kar case, which involved nurses, community health workers and other women healthcare staff appointed in other allied healthcare services. It points to an urgent need for greater dialogue about the kind of mistreatment, abuse and violence women in the healthcare workforce, cutting across ranks, status or standing, have to face. In this blog, I try to deal with the nature of GBV that women healthcare workers face, the power structure and hierarchy over them, as well as the need to address unheard voices that have raised issues related to cases of violence. These and more are herein being taken into account.
GBV in healthcare settings, including the experiences of women healthcare workers and the entrenched power structures and hierarchical dynamics that perpetuate these harassments, is ignored, minimized and under-studied. Global estimates indicate that 8 to 38 per cent of health workers have experienced violence at some point in their careers. Among them, women healthcare workers (nurses, community health workers – CHWs, public health nurses, doctors) — who constitute 75% of the global health workforce— face a disproportionate burden. However, it is often inadequately analyzed and when courageous voices are silenced, it increases risk of women healthcare workers. This exacerbates their plight and trivializes their workspace issues, and GBV often remains unrecognized.
For example, in September of this year, a 31-year-old junior doctor was raped and murdered at the RG Kar Medical College and Hospital in Kolkata, India, highlighting the urgency of addressing GBV in healthcare. Yet, this is not the first case of GBV in healthcare. In 2021, at a workshop in Delhi, nursing students shared their experience of violence in pre-service training (before formally entering the profession of nursing), including verbal, physical, sexual, mental, ethnic and caste-based abuse. These stories represent only the “tip of the iceberg,” as many cases remain unreported and shrouded in silence.
Women in the Health sector
Women healthcare workers endure harassment, intimidation, assault and abuse from multiple sources in their workplace: co-workers, supervisors, administrative personnel, contractors besides patients, and patients’ relatives. Contractual or informal employment exacerbates their vulnerability, as fear of losing jobs often silences victims of harassment or assault. The nature of employment (permanent/contractual/daily wage earner) shapes their experience of sexual harassment, gender bias, and occupational gender segregation and related hazards. For example, in 2014, nurses across states in India like Jammu and Kashmir, Jharkhand and Rajasthan, protested in front of the Union Ministry of Health, seeking intervention in various cases of sexual harassment. During COVID-19, media reports described how nurses and CHWs were violently treated within and outside the workplace. This takes on a different dimension for Community Health Workers, primarily women who work at the intersection of the community and the health system, face unique risks. Their “workplace” extends beyond the hospital walls into homes and communities, where threats of violence and harassment are common.
Caste and Ethnicity
Caste and ethnic discrimination intersect with GBV, compounding the violence faced by women healthcare workers in India. The tragic case of Dr Payal Tadvi, who faced relentless caste-based harassment in her medical training, revealed the deep-seated systemic discrimination in healthcare institutions. Such oppression is routine, perpetuated by hierarchical structures within medical education and practice.
Similarly, nurses from north-east India experienced racial discrimination and around 185 nurses quit work from the nursing homes in Kolkata during the pandemic. They faced racism and violence from coworkers and patients. There is a pervasive culture of casteism, racism, and discrimination and it starts to appear as early as in nursing training. The hierarchical structure within healthcare service, research, training and administration encourages a strict compliance culture, which impacts power relations based on gender, caste, ethnicity and medical/non-medical profession. Such a culture can traumatize the nurses, midwives, ayahs (informal non-clinical care providers to women, infants and elderlies in hospitals), and CHWs, taking the form of unjustified and irrational reverence for doctors, further entrenching systemic inequalities. In medical practice and training, perpetrators of violence view violence against young nurses as a method to build resilience. This is deeply rooted in patriarchy, sexism, and elitism in the workplace.
Culture of Bullying and Normalizing GBV
Workplace GBV within the healthcare settings cannot be separated from the broader culture of bullying, and harassment ingrained in medical institutions. Media reports and shows, such as the Bangla series Bijoya, reveal how toxic masculinity, and the normalization of bullying thrive within medical education and practice.
This impacts medical students’ learning experience, leading to fear and perpetuating a culture of violence and complete disregard for wellbeing. These practices not only harm individual workers but also shape the overall culture of healthcare. Bullying impacts learning environments, peer interactions, and professional hierarchies, perpetuating cycles of violence and creating a hostile working climate for women across cadres. The starting point for addressing workplace GBV lies in recognizing and critically examining bullying as a gateway through which violence infiltrates the medical system. Understanding its presence in medical education and clinical practice is essential to uncovering how such behaviors evolve and shape healthcare professionals’ daily experiences and interactions.
Interventions – Breaking the Silences and Building Solutions
Silence accompanied by forgetting and ad-hoc remembrance is not an option. Addressing this pervasive violence requires a shift toward acknowledgement, evidence-based dialogue, and actionable change. Violence against women in the workforce in healthcare is rooted in power dynamics that favor domination and subordination. Addressing these issues requires both systemic change and targeted interventions:
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Data Collection and Evidence Building
Comprehensive data on GBV in healthcare settings is crucial for understanding the problem’s scope and designing effective interventions. For instance, during COVID-19, rapid gender assessments across 13 countries highlighted the potential for safe and innovative data collection. However, healthcare systems need standardized administrative data on GBV to inform sustained programmatic responses.
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Strengthening Institutional Mechanisms
Internal Complaints Committees and employee grievance cells play a critical role in addressing workplace violence. However, their functioning within the healthcare sector remains understudied. Strengthening these mechanisms and ensuring their accountability can create safer environments for women health workers.
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Capacity Building and Training
Targeted training for healthcare providers on GBV awareness, prevention, and reporting is essential. Empowering workers with the tools to recognize and report violence can drive cultural change within healthcare institutions.
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Policy and Advocacy
Both state and non-state actors must proactively address workplace GBV. This includes implementing zero-tolerance policies, providing support for survivors, and fostering collaboration between healthcare institutions, policymakers, and advocacy groups to create inclusive workspaces.
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Community Engagement
For community health workers, addressing workplace violence requires redefining their “workspace.” This involves building community-level awareness and strengthening protections for CHWs working in vulnerable settings.
The author would like to thank the reviewer for the helpful comments.
Dr Bijoya Roy
Assistant Professor
Centre for Women’s Development Studies, New Delhi
