• 221/58.6% faced WSH at some point, suggestive looks (50.3%), sexual jokes (42.7%), sexual remarks (34.7%), inappropriate touching (69/18.3%), attempted rape (8/2.1%), rape (5/1.32%), secretly being watched (30/7.9%)  
• Settings include wards (133/60.1%), operating theatres (65/29.4%), docs’ quarters/on-call rooms (30/7.9%) 
• Some feel sexual harassment is part of the female experience while others uncertain whether certain comments/remarks/gestures constituted ‘harassment’ due to commonality/other female colleagues tolerating it 
• Perpetrators include males including patients, six (2.71%) reported being additionally harassed by females 
• Increased awareness/edu, empowerment workshops, strengthening victim-friendly reporting pathways (non-punitive, confidential), recommended  

A study of the sexual harassment of female doctors in healthcare related workplaces, found that 221 (58.6%) out of a representative sample of 377, faced such at some point in the form of suggestive looks (50.3%), sexual jokes (42.7%), sexual remarks (34.7%), inappropriate touching (69/18.3%), attempted rape (8/2.1%), rape (5/1.32%), and secretly being watched (30/7.9%) in the settings of wards (133/60.1%), operating theatres (65/29.4%), and doctors’ quarters and on-call rooms (30/7.9%). The perpetrators including patients were male, with a minority (six/2.71%) reporting that they were also harassed by females. 

Workplace sexual harassment (WSH) is a common problem in Sri Lankan medicine and therefore, there needs to be increased awareness and education on the matter, inclusive of workshops for female doctors aimed at empowerment, and the strengthening of victim-friendly reporting pathways that are non-punitive and help to preserve confidentiality. 

These findings, observations and recommendations were made in a commentary on ‘Us too: Sexual harassment of female doctors in Sri Lanka’ which was authored by M. Vidanapathirana (attached to the National Hospital, Colombo), K. Kulathilaka (attached to the District General Hospital, Negombo) and S. Fernando (attached to the Colombo University's Medical Faculty's Medical Humanities Department), and published in The Lancet Regional Health Southeast Asia's 36th Volume, this year (2025).

The widely publicised workplace rape and murder of a female Indian doctor in August of last year (2024) and the workplace rape of a female Sri Lankan doctor last month (in March), brought to light, as mentioned in The Lancet's "The structural roots of violence against female health workers", the structural failures that enabled such depravity. While sexual harassment in medicine is increasingly reported, its prevalence and enablers in South Asian healthcare have not been, as noted in S. Nelson, B. Ayaz, A.L. Baumann and G. Dozois's ‘A gender-based review of workplace violence amongst the global health workforce — A scoping review of the literature’, adequately assessed. 

Hence, Vidanapathirana et al. conducted a cross-sectional study to assess the prevalence and consequences of sexual harassment among female doctors in Sri Lanka, employing both a questionnaire-based method, and a qualitative exploration. This study was conducted from September to October 2024, among female doctors registered with the Sri Lanka Medical Council, employed in Sri Lankan healthcare for at least six months. Female doctors employed for less than six months and those who were not working in the preceding six months at the point of data collection were excluded. Female doctors were invited to take part regardless of whether or not they had been victims of or witnesses to workplace sexual harassment. The female doctors were selected to represent all age groups, medical hierarchies (different career strata) and work settings (including different specialties). The study sample approximately represented only 3% of female doctors in Sri Lanka (Central Bank, Number of doctors. Census and Economic Information Centre Data). The response rate was 377/98.2%. 

The mean age of the participants was 37.35 years (standard deviation - 6.65 years), and the majority worked in a clinical environment (75.3%). In terms of the professional status, 5% were junior doctors, 62.5% were Medical Officers (Senior House Officers), 19.8% were postgraduate trainees, and 12.8% were consultants. 

The preliminary findings of the study raise serious concerns. 

Of the study participants, 221/58.6% reported sexual harassment in the workplace at some point in their career. The three commonest forms of harassment were suggestive looks (50.3%), sexual jokes (42.7%), and sexual remarks (34.7%). Some participants felt that sexual harassment is part of the female experience. Some were uncertain as to whether certain comments, remarks and gestures warranted classification as ‘harassment’ due to how common they were, and because ‘other female colleagues tolerated it’.

Physically invasive forms of sexual harassment were reported in the form of inappropriate touching (69/18.3%), attempted rape (eight/2.1%), and rape (five/1.32%). Furthermore, 30/7.9% disclosed being secretly watched while in doctors’ quarters or in on-call rooms. 

All possible healthcare settings were reported as places of sexual harassment. However, the commonest places where sexual harassment took place were the wards (133/60.1%) and operating theatres (65/29.4%). 

All strata of men, including patients, were identified as the perpetrators, albeit at different frequencies. All were harassed by males, while six/2.71%, in addition, reported being harassed by females. 

Other regional studies report varying figures of sexual harassment in medicine. In P. Chaudhuri's ‘Experiences of sexual harassment of female health workers in four hospitals in Kolkata, India’, 10% of both male and female doctors reported sexual harassment. In B.S. Nayanar, N. Fareed, H. Battur and J. Praveena's ‘A study on the nature of violence against doctors in tertiary care centres in Karnataka, India: A cross-sectional study’, 57% of female healthcare workers, not limited to doctors, reported experiences of workplace sexual harassment. 

Differences in personal perception of sexual harassment, as elaborated in E. Frank, D. Brogan and M. Schiffman's ‘Prevalence and correlates of harassment among United States female physicians’, may affect responses, thereby explaining the wide variation in the reported prevalence. 

In Vidanapathirana et al.'s analysis, even in this group of educated women, the perception of sexual harassment appeared to be conflicting as there was confusion as to whether a certain behaviour constituted harassment if it is common or if other females seemingly tolerated it. Women often look to other women’s responses to determine whether a certain behaviour is inappropriate, and in certain settings where sexual harassment is rampant, it may be trivialised, so that women no longer identify it as harassment (C.T. Begeny, H. Arshad, T. Cuming, D.K. Dhariwal, R.A. Fisher, M.D. Franklin, P.M. Jackson, G.M. McLachlan, R.H. Searle and C. Newlands' ‘Sexual harassment, sexual assault and rape by colleagues in the surgical workforce, and how women and men are living different realities: Observational study using National Health Service population-derived weights’ and M. Birks, H. Harrison, L. Zhao, H. Wright, Y.C. Tie and N. Rathnayaka's ‘Nursing students’ experience of bullying and/or harassment during clinical placement’). This, per Vidanapathirana et al., may reflect some cognitive reframing even among educated females, due to the pseudo-normalisation of unacceptable behaviour.

While it is also possible that the reported prevalence may be overinflated due to selection bias, Vidanapathirana et al. however postulate that underreporting may be more likely due to the highlighted variabilities of perception where the respondents who felt that certain forms of harassment were part of the ‘female experience’ may not have identified these behaviours as ‘harassment’, and past incidents which were trivialised in the participants’ minds may have been lost to recall bias. Additionally, female doctors, who were psychologically traumatised from sexual harassment, may have been less likely to participate in the study at all.

The roots of sexual harassment, as observed in O.O. Kheir, H.M. Khair, B. Mapayi and Y.H. Patwa's ‘Prevalence of sexual harassment among female medical staff in four Khartoum State (Sudan) tertiary hospitals’, lie in cultures with hierarchical structures and gender inequality. According to D.S. Vithanage's ‘Understanding the nature and scope of patriarchy in Sri Lanka: How does it operate in the institution of marriage?’, South Asian communities, which are predominantly patriarchal, have an omnipresent male-female power imbalance, which perpetuates sexual harassment. 

Vidanapathirana et al.'s findings that show that sexual harassment is pervasive in Sri Lankan healthcare are a testament to this power imbalance. The results show that in spite of being ‘doctors’, their ‘femaleness’ renders female doctors vulnerable to sexual harassment anytime, anywhere and by anyone in the workplace (S.P. Phillips and M.S. Schneider's ‘Sexual harassment of female doctors by patients’).

This is an opportune moment for change, as a call to action for female physician safety has been recently instigated in several medical fora (G. Arakeri, V. Rao and S. Patil's ‘A crisis of safety: Female health-care workers in India need reforms’). There is sufficient evidence to prompt much needed reformation. “It is also important for institutions to prioritise empathy for the victim and recognise that sexual harassment is a result of power inequality rather than a response provoked by the victim”. It is high time for Sri Lanka to look at the alarming data that speaks for itself and take action so that fear and shame can finally change sides, Vidanapathirana et al. concluded.