International women’s day blog
Name: Emily Bebbington
Background: Medical doctor specialising in Emergency Medicine
Role in SASHI: Burns Lead
It’s an honour to be showcased as part of the SASHI team for International Women’s Day. This day was founded over 100 years ago to fight for the equality of women in the USA, a country we now recognise as being one of the most developed in the world (1). The success and privileges I have had in my life are built on the hard work of others, and for that I am extremely grateful. It is important the we remember this and use the opportunity of International Women’s Day to highlight the inequities underpinning gender dominated problems globally to continue to achieve social justice.
Burns are a particularly gendered problem. In the UK and USA burns more often affect boys and men, thought to be due to risk taking behaviour and occupational exposure (2). In South East Asia and Eastern Mediterranean regions burns are seen far more frequently in women, with higher rates of attempted suicide by burning, known as self-immolation, than is seen anywhere else in the world. This has led to the term ‘geographical belt of self-immolation’ to encompass the countries where the highest rates of self-immolation are reported amongst women (Iraq, Iran, Afghanistan. Pakistan, India, Sri Lanka, Bangladesh)(3).
National Civil Registration and Vital Statistics data is lacking in many low and middle income countries such that subcategories about cause of death is not available (4). For example, nationally representative data about number of fire related deaths may be available, but not the reported cause of the fire injury (accidental, suicidal, or homicidal). India is estimated to have 160,000 burns deaths per year, 100,000 of which are in women (5). This is the same number of deaths as from maternal causes - a research and policy area that rightly receives a significant amount of funding and exposure. Women are three times more likely to die from fire related injuries in India than men. The reasons for this difference are multifactorial and an area of research need.
Local studies have shown intentional burns injuries (suicidal and homicidal) are more often reported by women (6). But it is likely this is not the full picture. Interviews conducted with burns survivors and healthcare professional reveal a culture in which women may be put under pressure to conceal the true cause of their injuries; where healthcare professionals are restricted in their ability to probe inconceivable sounding histories due fear of medicolegal retribution and inability to offer safeguarding; and police may not investigate thoroughly due to fear of partiality (7). This is underpinned by poverty. Poverty creates an inescapable increased risk of burns death for women in India. Difficult home circumstances make accidents more common from poor quality cooking equipment, unsafe gas canisters, and lack of space (7). When this is combined with the role of women, the acceptance of abuse, and traditional depictions of fire associated with purity (e.g. Sati), the structural factors that may lead to accidental burns injuries may be just as likely to lead to suicidal and homicidal ones.
I lead the workstream on burns in the SASHI project working in close collaboration with Professor Mohan, the Head of Department of Plastic Surgery at Mysore Medical College and Research Institute. We aim to strengthen the evidence base on misclassification of accidental, suicidal, and homicidal burns to improve burns classification for clinical and surveillance purposes. This will form the work for my PhD at Bangor University.
References
1. History of International Women's Day: International Womens Day; 2021 [Available from: https://www.internationalwomensday.com/Activity/15586/The-history-of-IWD.
2. Peck MD. Epidemiology of burns throughout the world. Part I: Distribution and risk factors. Burns. 2011;37(7):1087-100.
3. Rezaeian M. The geographical belt of self-immolation. Burns. 2017;43(5):896-7.
4. Cobos Muñoz D, de Savigny D, Sorchik R, Bo KS, Hart J, Kwa V, et al. Better data for better outcomes: the importance of process mapping and management in CRVS systems. BMC Medicine. 2020;18(1):67.
5. Sanghavi P, Bhalla K, Das V. Fire-related deaths in India in 2001: a retrospective analysis of data. Lancet. 2009;373(9671):1282-8.
6. Natarajan M. Differences between intentional and non-intentional burns in India: Implications for prevention. Burns. 2014;40(5):1033-9.
7. Daruwalla N, Belur J, Kumar M, Tiwari V, Sarabahi S, Tilley N, et al. A qualitative study of the background and in-hospital medicolegal response to female burn injuries in India. BMC Womens Health. 2014;14:142.
Publication date: 2 March 2021