By Aashika Ravi
Would it surprise anyone to know that marriage, just like every other institution in this glorious patriarchy that we live in, is harder on a woman’s mental health than on a man’s?
Some alarming statistics were recently reported from a study published in The Lancet Public Health journal. The study found that four of every 10 women who commit suicide in the world are Indians. Most of these Indian women who kill themselves are under 40, and most are married. In fact, married women account for the highest proportion of suicide deaths among Indian women.
These are not isolated data. According to the National Crime Record Bureau data (2013), out of 1.3 lakh suicides women comprised 51.4 percent – of which again 76 percent were married. We spoke to psychiatrists, sociologists and other mental health professionals to uncover the multiple factors that inform such a high incidence of suicides among married women in India.
Dr Rathna Isaac, a clinical psychologist based in Bangalore, clarifies that the gender tilt to suicide is a worldwide phenomenon and not restricted to India. “When it comes to mental health, gender itself is a negative in that women generally have poorer mental health than men, and that has been linked to their gendered position [and also] associated with their reproductive time. Marriage on the whole places a higher burden on the wife. Women have a slightly harder time while men have a better time – their mental health gets better while women’s gets worse.”
Worse, the Lancet paper also states that India’s contribution to global suicide deaths increased from 25.3 percent in 1990 to 36.6 percent in 2016 among women – data that singles India out as a caustic place for women’s mental health.
Psychiatrist and founder of Sneha suicide prevention centre, and a collaborator on the Lancet study, Dr Lakshmi Vijayakumar wrote recently about marriage’s impact on mental health: “In India and other such low-income countries, marriage isn’t a protective measure. It acts as an aggravating factor. The inability to adjust to a new environment and solve interpersonal issues plays a major role in pushing under-30 women to commit suicide.”
Sociologist, feminist researcher and activist Manjima Bhattacharjya also believes that mental health is informed by social pressures. “Increasingly, research is telling us that mental wellbeing is not just a medical issue or a pathological issue. It’s not only about mental illness per se. It is strongly related to lived experiences of social life, especially to gendered norms. Strict gender roles or gender norms keep women and girls under high levels of surveillance, restrict their mobility, leave them with high burdens of domestic labour as well as leading to gender-based violence. For married women, these gender roles are usually compounded (of caring, child-bearing, household labour, tight webs of familial control). Additionally, there are so many taboos around sexuality and lack of information on contraception, and so women have little control over their own bodies or choices around child bearing.”
Bhattacharjya also points to a study by SAMA, a resource group for women and health, that found young women in early marriages in rural India had an increased risk of mental health issues due to a disproportionate burden of household labour and lack of companionship, among other reasons.
While SAMA’s study tackles questions of class variations in the mental health of married Indian women, Bhattacharjya shares an insight on the link between caste and suicide. “Marginalization is certainly a cause of distress. Both caste and age are structural factors that compound marginalization – being Dalit or being younger means another kind of powerlessness that is bound to have an impact on mental wellbeing. Pune-based MASUM did a study (2015) on young people committing suicide in the area they work in and found that many of the deaths were due to inter-caste relationships, which were taboo. The lack of space to talk about desire, love, romance and strong taboos around sexuality and caste, along with very little space to dialogue with parents, were behind many of these youth suicides.”
In contrast, in urban areas the pressure to perform multiple roles can also cause a deterioration of women’s mental health. Isaac suggests a role conflict that comes from the idea of ‘having it all’ projected onto working women these days. “Some parts of women’s lives are changing, but some are not. In a certain way this has piled on expectations. More women are working and earning now than 30 years ago. They’re also expected to have a life, look nice, etc. But the traditional expectations that you look after the home, your partner, be the primary caregiver for children – that hasn’t changed. They have to do both and that becomes a bit of a strain.”
This vulnerability is further exacerbated by age. Incidentally, the Lancet study found that 71.2 percent of suicide deaths among women in India were in the 15-39 age group.
“Physically and physiologically they are at a vulnerable time, especially if they are pregnant or going through a post-natal period,” says perinatal psychiatrist Dr Ashlesha Bagadia. “If [a woman is] going to become mentally unwell or be at her lowest, emotional strength-wise, it’s going to be during this period. Hormonally, biologically and physiologically, women are more at risk. And culturally, we are very far from an environment where they can seek help which is validated, and are not blamed for it.”
As Bagadia points out, access to mental health support services remains particularly difficult for married women in India. “I go to a maternity centre to work with obstetricians who will identify if a patient needs to go to a psychiatrist. Then the woman will be like ‘No no, if I see someone here, what will everyone in the hospital think?’ And these are all educated women. So the stigma is there everywhere.”
When asked about possible family opposition to seeking help, she says, “There’s opposition, and there’s also ‘Can’t we help you?’ Let’s say the woman is in a position to talk about what she’s feeling and there is a supportive environment at home. Sometimes in their eagerness to be supportive, the family tend to be invalidating in saying ‘Just talk to us, we’ll help you out of it.’”
Isaac adds that “time is also an issue. Finding time to go for therapy and to look after yourself is not easy. Even if attitudes in the family are pro seeking mental health help, there is a section of people whose husbands or husband’s family are not keen on you getting help because they fear either that they’ll be exposed [and shamed] or that the woman might ‘get ideas’ and someone might encourage her to seek something that is for herself and not them.”
As expected, seeking help for mental health issues is even harder in rural areas. “In SAMA’s study, the researchers found that women’s health-seeking trajectories are determined by their families or husbands, not by themselves,” Bhattacharjya explains. “They have little say in when they get to go to a doctor usually, unless in extreme circumstances. In most places I visit in rural India, women only go to the hospital for childbirth. It is rare that they access health services for other reasons, so to think they would go and seek help for mental ill health – already a taboo with so much stigma attached to it – seems improbable.”
Vivek Varma, a Bangalore based psychotherapist, sees these statistics differently. “Stressors build up at earlier ages, mostly at puberty. So if there’s a high chance of mental illness that leads you to suicide, you start catching it at a much earlier age. In rural areas, marriage happens at a much earlier age, like before they hit 20. So if people have been pushed to the limit of suicide, they are usually already married. The chances of them being unmarried is much lower due to cultural expectations.”
In terms of solutions for tackling this suicide epidemic among young married Indian women, how do we go beyond just knee-jerk calls for more awareness and sensitization?
Manoj Chandran, CEO of White Swan Foundation, an organization that offers knowledge services in the area of mental health, provides an interesting perspective. “For every person who dies of suicide, there are at least 10 attempts made, and 100 people who carry the thought of suicide. We very rarely talk about attempts and thoughts of suicide. That is where the focus must be.”
In his opinion, efforts to create awareness shouldn’t stop there. “Very rarely do we find communication and aids for the rest of the population – those around suicidal people who have a much larger role to play in the prevention of suicide.”
When asked about women-centric suicide prevention strategies, Bagadia suggests that public reporting should not give out graphic details of suicide deaths. “Just reading up about how it [suicide] can be done can give a woman ideas on what she can do it at home with what she has around.” She adds that, specifically, folks to whom women present themselves commonly – obstetricians, pediatricians or even “quasi-psychologists” like hairdressers and bartenders – should be sensitized and be able to talk about mental illness in a mature way.
In the long term, Chandran believes that “suicide prevention should become integral to health and community services elements. If I have a women-centric community initiative, I must include suicidality in my work. If I’m running geriatric-related work, then suicide among geriatrics is something I should look at.”
Co-published with Firstpost.