Guwahati: Nearly 29% of child sexual assault survivors brought to Gauhati Medical College and Hospital under the Protection of Children from Sexual Offences (POCSO) Act refused medical examination, despite mandatory counseling. This startling figure comes from a two-year empirical study that raises important questions about gaps in communication, survivor autonomy, and institutional trust.
The study—titled “An Empirical Study of Informed Refusal by Sexual Assault Survivors Under the POCSO Act at a Tertiary Care Center in Northeast India“—was conducted by doctors from various medical institutions in Assam and published in the peer-reviewed journal Cureus.
The POCSO Act is India’s comprehensive legal framework for protecting children from sexual offences. It mandates child-friendly procedures, compulsory reporting, and medical examinations within 24 hours of reporting an offence. These examinations are to be conducted by female doctors in safe environments. However, consent remains a crucial part of the process—children above 12 can legally refuse examination, and for those below 12 or with disabilities, guardians can do so on their behalf.
The study, conducted at GMCH between January 2019 and January 2021, focused on survivors who declined the examination. Of the 350 survivors brought for medico-legal assessment, only two were boys, reflecting the broader challenge of underreporting of male child sexual abuse in India. Among all survivors, 102 (29.14%) refused examination, either personally or through a guardian.
Of these, 67 survivors (65.7%) refused on their own—primarily adolescents aged 12 to 18. The remaining 35 refusals (34.3%) were made by parents or guardians, mostly for younger children or those with mental disabilities.
Among those who declined examination themselves, several clear patterns emerged. Romantic involvement with the accused was the leading reason, cited by 53.7% of survivors. Many adolescents were in consensual relationships and feared that cooperation with authorities could lead to the arrest or punishment of their partners. Child marriage accounted for 19.4% of refusals. These young girls, often already mothers, were reluctant to initiate a legal process that could destabilize their family life. Fear of the medical examination was another major factor, cited by 14.9% of survivors, who described anxiety about pain, exposure, and retraumatization. Shame and social stigma influenced a smaller portion—7.5% and 4.5%, respectively—but remained powerful deterrents, especially in rural settings.
The study found a statistically significant correlation between the age of the survivor and the reason for refusal, suggesting that adolescents are more likely to exercise personal agency based on emotional or relational factors.
Among the 35 cases of parental or guardian refusal, 45.7% of parents declined due to fear of the medical procedure, especially for very young children. Some feared the examination would cause further physical damage. A further 31.4% cited social stigma—worries about community judgment, future marriage prospects, or school expulsion. Another 17.1% feared the child might be expelled from school if the abuse became known. In 5.7% of cases, the refusal was related to the child’s mental disability.
Again, statistically significant links were found: parents of toddlers were more likely to refuse due to fear, while those with older or school-going children were more concerned about stigma and institutional backlash. Parents of children with lower levels of education were also more likely to refuse examination.
“The autonomy of child sexual assault survivors to refuse a medical examination needs to be respected,” the study notes. “However, such refusals can severely weaken legal proceedings, offering the accused the benefit of the doubt due to the absence of forensic evidence.”
The report underscores that forensic and medical examinations are critical not only for legal outcomes but for timely health interventions. Yet, many families are driven by fear—of pain, of shame, of social consequences.
The study stresses that informed refusal must not be dismissed, but rather understood in context. It highlights the urgent need for trauma-informed counseling tailored to both children and caregivers, early sex education, and community-level awareness campaigns on consent, rights, and legal recourse. Greater inter-sectoral collaboration between medical, legal, and social services is also essential.
“Survivors must be informed of their rights and the role of medical examination in preserving justice,” the authors urge. They also emphasize the importance of sensitivity—particularly in cases of adolescent romantic relationships—to avoid retraumatization or unjust criminalization.
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