title: The problem of the pillion rider: India's helmet law and New Delhi's exemption.
abstract: BACKGROUND
  In India, motorized two-wheeler (MTW) road traffic accidents injure or kill 72,000 women annually. Before the Motor Vehicle Act of 1988, which required mandatory helmet use for MTW riders, a study found 0.6% of all MTW pillions (backseat passengers) were helmeted. Citing religious protests to the legislation, Delhi's high court exempted the city's 12 million women from the law. We hypothesize that currently male pillions use helmets more frequently than females, and that overall pillion helmet usage has increased over the last 20 y.
  
  
  METHODS
  Continuous video was recorded in half-hour blocks at four locations in Delhi on separate days, totaling 8 hours of high- and low-volume traffic. Videos were reviewed with at least two reviewers extracting the number of MTW pillions, as well as their gender, approximate age, and helmet usage.
  
  
  RESULTS
  Of 4010 pillions identified, 63.8% were male, 32.4% female, and 3.3% children. Among males, there were significantly more helmeted pillions (88.4%, P < 0.001); among females, there were significantly more unhelmeted pillions (99.4%, P < 0.001). Among unhelmeted pillions, significantly more were female (81.4%) than male (P < 0.001). Current overall pillion helmet use is significantly higher than historical rate (P < 0.001).
  
  
  CONCLUSIONS
  The significantly higher male pillion helmet usage compared with females indicates Delhi's helmet law is associated with increased compliance among those who fall under its jurisdiction. This augments the growing body of evidence that mandatory helmet laws are efficacious, thus repealing the exemption of women is an important step in increasing female pillion helmet usage.
authors: Division of Trauma and Critical Care, Department of Surgery, Northwestern University, Chicago, Illinois. Electronic address: mamta.swaroop@gmail.com.
authors: Mamta
authors: M
authors: Swaroop
authors: Division of Trauma and Critical Care, Department of Surgery, Northwestern University, Chicago, Illinois; Department of Surgery, St. Joseph Hospital, Chicago, Illinois.
authors: Selma
authors: S
authors: Marie Siddiqui
authors: Department of Trauma Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors: Sushma
authors: S
authors: Sagar
authors: Division of Trauma and Critical Care, Department of Surgery, Northwestern University, Chicago, Illinois.
authors: Marie L
authors: ML
authors: Crandall
mesh_terms: D000328:Adult; D002648:Child; D005260:Female; D006260:Head Protective Devices / Q000706:statistics & numerical data*; D006801:Humans; D007194:India; D008297:Male; D009049:Motorcycles / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D012067:Religion; D012737:Sex Factors
keywords: Global surgery; Helmet use; Injury prevention; Motorized two-wheelers; Pillion riders