Proxy war against head injury: Myriads of conflicting laws and gender-based discrimination
Correspondence Address: Source of Support: None, Conflict of Interest: None DOI: 10.4103/0028-3886.258042
Source of Support: None, Conflict of Interest: None
Keywords: Gender, head injury, legislation, safety restraint
The story of the modern rider has followed the same path in a host of developing countries, reflecting the contemporary socioeconomic strata. While the anecdote here is about the Indian scene, nearly the same story can be told of countries like China, Indonesia, Philippines, and Brazil. Between 2000 and 2016, the per capita income in India rose a whopping 1,388%. The result is a visible increase in vehicles even among middle- and lower-class households. While the population has grown only 1.4% between 2000 and 2009, the number of vehicles has grown by 28.3%, and the number of deaths due to accidents by 32.4%. Fourteen deaths per hour in India are attributable to road traffic accidents (RTA) with the majority occurring among vulnerable road users.,,,,
The profile of the two-wheeler rider has changed significantly with the country's development. While they were once synonymous with the image of an affordable personal mobility device for the middle-aged family men, two-wheelers have now become the step-ladder of the young. Women now occupy more than a third of the two-wheeler market in India (highlighted in commercials with the tag line: “Why should boys have all the fun!”). This change in profile has placed the brave naivety of youth at odds with the road safety laws.
Bombarded by the media, young drivers are more self-conscious than ever before. They believe in their blind invincibility or an immature nihilism, adopting statements such as “this will never happen to me,” “who cares,” “I am too good a driver to crash,” and “It is better to burn out than to fade away.” To many, their appearance matters more than their safety. A news covered by a prominent daily newspaper showed that even while holding boards to create awareness about the essentiality of helmet use among women, none of the girls were wearing a helmet. Watching their heroes in films perform daredevil stunts without helmets and emerging scratchless has its effect on the everyday rider's psyche. This has given rise to the “rescue” driver-individuals who consciously refuse to follow the helmet regulation. This rejection cuts across the lines demarcating cultural beliefs, education, economic status, and region.
Another aspect, particularly in smaller cities, is the distance of the ride. There are many riders who believe that while traversing short distances, a helmet is not needed. They do not realize that wearing a helmet is akin to wearing barrier contraception. It does not matter how long or short the sexual activity is, one needs to wear it every single time. The world over, people are in a rush to get things done, and are pressured for time. A young girl heading toward college may forget her helmet while coming down to the parking and would more commonly decide to brave the possibility of an accident than the punishment for being late to class. Nowhere in the world is conscience a sustainably strong motivator for discipline.
Road traffic laws are not given the importance, they deserve. No country believes that road traffic safety should be a human right, not just for the rider but also for the vulnerable road users. This attitude is demonstrable in the Indian scenario. The Indian motor vehicles act of 1988 (third modification) was created at a time when two-wheelers were few and personal cars even fewer. With genuine foresight, the legislature created section 129, which made helmet-wearing compulsory for all two-wheeler riders except turban wearing Sikhs.
But in the 1990s, despite criticism from scientific bodies and state judiciary, the local legislature of Chandigarh, India, amended the law to exempt all women from wearing helmets, under the pressure of populist politics. In 2004, the honorable Supreme Court of India further added to the controversy by declaring helmets compulsory for all, but with a clause that local legislative bodies may make exemption for safety restraints in matters of local governance. Even when lawmakers debate who should wear a helmet and who should not, there is absence of safety specifications in the helmet design. Head injury studies have proven that only helmets with jaw guards and fastened chinstraps provide protection against head injury. In price conscious developing nations, it is not uncommon to witness any headgear in the name of helmet to avoid a fine from the traffic police viz. a sports helmet, an utensil, or a mining helmet.
The efficacy of a proper head protection has been proven beyond doubt in numerous studies. For example, a study conducted by Tripathi et al., reported that out of 1,346 patients received in 9 months from two-wheeler accidents, 231 were women with most of them being pillion riders, who were not wearing a helmet at the time of the RTA. Severe head injury was reported in only 4.3% of helmeted patients, whereas in non-helmeted patients, this value was raised almost six times. The real problem, therefore, has been compliance. Studies performed regarding the incidence of head injury after a strict implementation of legislation for mandatory compliance (Italy and Taiwan) of helmets have shown a significantly decreased incidence of severe head injury rates. On the other hand, the effect of repeal of legislation was studied in multiple states in the United States, which highlighted that compliance decreased by 50% despite the awareness programs being well in place.,
In 2007, K. Ganpathy, a respected Neurosurgeon in Chennai, India, submitted an affidavit to the Honorable High Court. He recommended that helmet use should be made compulsory for all and the court agreed. This action probably saved more lives than he had saved in his long practice as a surgeon. In many regions, lawyers opposing the legislation quoted the opinions of doctors casually and without evidence. Arguments are flown around, such as “Helmets do not provide sufficient protection,” “Helmet law will lead to decreased growth of the auto industry,” and even “Helmet wearing leads to an increase in the incidence of cervical spine injury.”
A law intended to save life should not discriminate based on gender or the person's position on the vehicle. Gender-based discrimination in safety restraints is akin to telling a lady that it is safe to jump off a plane without a parachute. The only thing worse than injustice for those who witness it is to do nothing. Neurosurgeons need to work with the police in creating awareness programs so that the police understand the importance of stricter enforcement of the already existing laws. The law should force noncompliant riders to provide community services in the hospitals taking care of victims of RTAs. The community, and most importantly, doctors must demand stronger legislations, that surpass populist politics and gender-based discrimination in safety regulations.
Among the adrenaline seeking and image conscious youth, conscience is sidelined in every action. We need to be their conscience. In fact, we need to reactivate the conscience within them, because we have seen their future in our wards, and it is up to us to prevent it.
We are grateful to Dr. Awdhesh K Tripathi, Pediatrician, ESI Hospital, Gwalior (Madhya Pradesh), India, for his thoughtful inputs related to the article.
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Conflicts of interest
There are no conflicts of interest.