Medico-legal issues related to child sexual abuse cases in India: A qualitative review

Abstract

Background: The Protection of Children from Sexual Offences (POCSO) Act, 2012, is a pivotal legal framework in India aimed at protecting children from sexual abuse. Despite its comprehensive scope, the medico-legal implementation of the Act presents several challenges for healthcare providers, law enforcement, and the judiciary, especially in ensuring sensitive yet legally sound handling of child survivors. Objectives were to analyze key medico-legal challenges in the implementation of POCSO, with a focus on forensic examination, evidence collection, consent, mandatory reporting, and the role of medical professionals in legal proceedings. Method: A qualitative review of secondary data was conducted using statutory provisions of the POCSO Act, government-issued medico-legal guidelines, peer-reviewed journals, judicial decisions, and policy reports from organizations such as Ministry of Health and Family Welfare of Govt. of India, National Commission for Protection of Child Rights (NCPCR), United Nations Children's Fund (UNICEF), and HAQ: Centre for Child Rights during January to June 2024. Thematic analysis was used to identify core issues. Results: Five major themes emerged from the analysis: Training Deficiencies – Medical professionals often lacked formal training in child-sensitive forensic procedures under POCSO. Consent and Confidentiality Challenges – Ethical dilemmas were frequent regarding assent, parental consent, and mandatory reporting. Documentation and Evidence Integrity – Poor-quality medico-legal documentation compromised evidentiary value in court. Infrastructure Gaps – Most facilities lacked child-friendly spaces and essential forensic equipment. Legal Preparedness – Doctors were inadequately oriented for courtroom roles, affecting the quality of expert testimony. Conclusion: Effective implementation of POCSO’s medico-legal provisions requires improved training, intersectoral coordination, standardized protocols, and infrastructure development. Bridging the gap between medical ethics and legal obligations is essential to ensure justice while preserving the dignity and rights of child survivors.