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In just about any country, data shows men die by suicide more frequently than women – nearly three times higher.
In India, too, the focus on death by suicide has largely been on men and farmers.
Neck-deep in debt, hounded by private landlords and banks, the country has witnessed countless sordid tales of distressed farmers often killing themselves by drinking pesticide.
There's no doubt that India has some of the highest farmer suicide rates in the world.
But here's the thing – suicide is everywhere. We see the headlines, watch the news. How often do you hear about female suicides? We know the facts, but it's only part of the story.
India features at the top of global suicide rates among women - nearly 37 percent or a third of the world's annual female suicides.
These are alarming numbers.
Why does India have such a huge burden? What is driving these deaths? Why are these figures underrepresented?
Suicides in India: The Hidden Victims
A study published in the journal Lancet Public Health in 2018 looked at suicide rates across Indian states and genders from 1990 to 2016 based on multiple sources.
The research was part of the 2016 Global Burden of Diseases, Injuries and Risk Factors (GBD 2016).
It found that India’s contribution to global suicide deaths increased from 25.3 percent in 1990 to 36.6 percent in 2016 among women, and from 18·7 percent to 24·3 percent among men.
This is even though India had 17.8 percent of the global population in 2016.
"What was shocking was that the death rate among women in India was double that of the average global rate for women, which was the biggest finding of this paper," says Rakhi Dandona, a public health expert at the Public Health Foundation of India and a lead author of the study.
The age-standardised suicide death rate (SDR) among women in India has dropped since 1990, but it has not fallen as fast as elsewhere in the world. It has also not been able to lower the suicide rate among men, the data shows.
The Age Factor
It turns out young adults are taking their own lives in alarmingly high numbers in India.
Suicide ranks first as the cause of death in India in both the age groups of 15-29 years and 15-39 years, as compared with its second and third rank globally in these age groups, respectively.
The highest age-specific rates of suicide for men were among elderly men aged 75 years or older, while among women it was for young women aged 15-29.
Variations Across States
The other expectation that most people have for suicide is that as women get more empowered financially and more educated, you would have less suicide deaths.
The study found wide variations in suicide death rate across states in India.
If you look at the state level data, we had higher suicide death rate in women in southern states as compared to northern states. This was also counterintuitive. Southern states are more educated, more empowered for women.Rakhi Dandona, Public health expert & lead author of the study
The southern states of Andhra Pradesh, Karnataka, Tamil Nadu, and Telangana consistently had high suicide death rates for both men and women.
The central and western states show mid-level rates, with the exception of Chhattisgarh that had a high suicide death rate among men.
Suicide death rate in the north and north-western states were generally low.
A mixed pattern was seen for the eastern states, with West Bengal having higher rates than the other states.
In the north-eastern states, Tripura had among the highest suicide death rate and the other states had a mix of high and low suicide death rates.
But why do the so-called more educated, more empowered states have more suicide deaths rates compared to the others?
Is it because these states report these cases more? We don't know. Is it because women want to do more, but the society doesn’t allow them? We don’t know.
"We do not unfortunately have those answers," Rakhi says.
"Maybe there is a mismatch between what women expect when they are empowered than what the society is actually able to provide to them. It's more of a theory and we really don’t have a good handle on why this is happening. We do not unfortunately have those answers," Rakhi adds.
'Marriage Not a Protective Factor'
We now know that suicide is shockingly the most common cause of death in young people, and that women are significantly more vulnerable than men.
Would you be surprised to know that clear structural reasons like patriarchy is killing these women?
The Lancet study clearly states that married women account for the high proportion of suicide deaths in India.
Marriage is known to be less protective against suicide for women.
These are not isolated data. The National Crime Records Bureau (NCRB) also states that in 2018, around 63 housewives killed themselves every day, on average, making up 17.1 percent of all the suicides in India.
Housewives form the second-largest group killing themselves, according to NCRB data.
Thus, data shows that women in the age group – 15 to 49 – who are married and in the child-bearing age have a high suicide death rate.
"When we look at this, we could ask – How does the life of women in India look like?" says Priti Sridhar, CEO at Mariwala Health Initiative.
"Due to early marriage, she could have dropped out of school early, becoming financially dependent on her husband and in-laws – which implies that her ability to participate in decision making – whether it is financial, sexual or reproductive rights reduces," Priti says.
Young mothers are prone to perinatal depression due to limited support system around.
“You have early marriage, you may not have a partner of your choice, maybe move to a different location, and there is the pressure of bearing a child,” Priti says.
Domestic violence – physical, emotional – is a fairly well known risk factor, Rakhi says.
"Then there is poverty, relationship with partner, limited support from families, because of the way culturally women are looked at post their marriage, etc.," Priti says.
All these factors could lead to a lot of stress and therefore lead to death by suicide.
But this kind of data is not readily available, experts say.
We Need Better Ways To Collect Data
Unfortunately, there aren't many studies that tell you the reason for these suicides, other than NCRB, experts say.
The NCRB data also doesn't have a lot of parameters to look at to collect accurate data.
"Which is why one of the areas of suicide prevention is better data collection – to move away from NCRB collecting data to the ministry collecting data," Priti says.
Reporting to a police station is not the way to go. "This way the numbers are not accurate and are not collected in all instances," she adds.
Lack of Social Support
"You cant break stigma and talk about suicide prevention without having services that support the individuals going through stress." Priti says.
Social support for both men and women is where we need to work more. If something goes wrong in a person's life, he or she should have the option of people or the system on whom they can depend on.
"For example, if you lose a job, you should have a social security system where you’re taken care of. You shouldn't be wondering how to eat food the next day," Rakhi says.
"That kind of system is not readily available in India."
India does not even have a suicide prevention policy and it is not part of any ministry's agenda because it is so intersectoral, and the data collection is with the police, Priti says.
So, Where Do We Go From Here?
We need to work on our laws.
"There are laws around domestic violence in India. But it’s the implementation of those laws which is a problem," Rakhi says.
We need to step back and think – how can we have a system that is more supportive?
"Not just in terms of health, but the economic, the societal – how are we patient with each other? How are we able to offer more support so that people don’t tip off?" Rakhi says.
For stigma to go away you need to provide quality accessible services - family support, peer support, policy level changes, intervention programmes at grassroots level.
"I think today in India, suicide is seen like a personal choice that somebody has made. It’s not seen as a social issue that needs to be addressed by the government, health systems, not-for-profit or workplaces...we need to start seeing it as a public health issue," Priti says.
The gist is this: To get to the right story we need data-driven, gender-specific strategy. We need to talk about mental health, institutional structures and deconstruct marriage. We need to get to the bottom of this.
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