Implementation gaps in the two-finger test ban in medico-legal evidence collection on rape: a qualitative study in three districts of Bangladesh

The use of the two-finger test (TFT) for collecting medico-legal evidence on rape has been recognised as a public health concern. It has been banned in many countries around the world. However, the scant evidence available on the implementation of this ban suggests its poor implementation. Continued use of TFT directly threatens the achievement of SDG 5 by compromising the quality of healthcare for rape survivors, negatively impacting their psychological health, bodily integrity, and chances of reporting and convicting the perpetrator(s). The current study assesses the implementation of the ban in Bangladesh, identifies gaps and suggests ways to improve the implementation of the ban. The qualitative study was conducted between September 2023 and January 2024 in three districts of Bangladesh: Dhaka, Dinajpur and Rangpur. Eight healthcare facilities at the primary, secondary and tertiary levels were included. We conducted 35 key informant interviews with stakeholders from the health, legal and NGO sectors; two focus group discussions with NGO staff; and five in-depth interviews with rape survivors or their parents. Data were coded via Atlas.ti 7 and analysed using the grounded theory. The findings revealed widespread practice of TFT by healthcare providers outside of capital. Healthcare providers’ conviction regarding the usefulness of TFT in proving rape combined with judicial acceptance of TFT-based findings were contributing factors that hindered implementation of the ban in Dinajpur and Rangpur. The implementation of the ban in Dhaka was linked to awareness of the healthcare providers about the ban, their knowledge of the ineffectiveness of TFT in proving rape and rejection of the TFT-based findings at the court. Awareness must be promoted about the ban and ineffectiveness of TFT in proving rape not only in the health sector, but also in the legal sector. In addition, measures must be taken to ensure compliance to the ban. The findings have implications for programmes and policies not only in Bangladesh but also in other low- and middle-income countries grappling with TFT ban implementation to ensure dignified healthcare to rape survivors.