Throughout history and in every civilization, the central role of women in society has ensured the stability and progression of nations. A woman has been granted the position of the goddess because not only is she responsible for giving birth to new life and thereby facilitating continuity of life, but also because she is the primary caretaker of children, sick, weak, injured and elderly. While in the past women stayed home as nurturers, in the present day she is also a breadwinner for the family. Present-day women have multiple roles in the family: nurturer of children, caretaker of the elderly, and also a contributor to the family income.
Historically, there is clear evidence of inequality, oppression and dominance over women. Women were considered weaker sex requiring protection from men. In many countries, they weren’t allowed to go out to work and did not have voting rights for long. Even in the modern era, until very recently, middle-class women were expected to be involved in domestic tasks emphasizing child care, with exception of women from lower economic strata, as poverty compelled them to seek work outside the home, but these occupations were lower in pay than those available to men leading to exploitation.
In recent years, there has been a change in the availability of jobs to more respectable professional jobs where more education is demanded. However, even though women from all socioeconomic backgrounds are working full time; it does not relieve them from domestic duties or change their social position. In several places, women tend to receive lower wages than their male counterparts. Another attitude that women have to deal with on a daily basis is sexism in which men assume superiority over women and maintain it through domination, further underestimating the role of a woman. In some families, women are allowed to work provided they are solely responsible for household chores and child care. It should therefore be no surprise that women are at higher risk for common mental disorders.
Studies report that symptoms of depression, anxiety, and unspecified psychological distress are 2–3 times more common among women than among men; whereas addictions, substance use disorders and antisocial personality disorders are more common among men. Unfortunately, men with substance use or personality disorders may further victimise women.
Possible reasons that make women vulnerable to common mental disorders include social factors such as the imposition of rigid traditional roles on women which restricts her personal liberty and grants low autonomy in decision making. Women are also repeatedly exposed to domestic and sexual violence. According to WHO report, lifetime prevalence rate of violence against women ranges from 16% to 50%, and at least one in five women suffers rape or attempted rape in their lifetime. In India, domestic violence is a common problem experienced by women. A household survey by Jain et al., in 2004 reported that 23% of women had been beaten in the last six months. The husbands of 12% of these women had explicitly threatened to pour kerosene on them and set them alight. Another study found that sexual coercion was experienced by 30% of women. Such gender-based violence can cause huge emotional distress, posttraumatic stress disorder, and other mental health issues.
Women quite often come across situations that are of gender disadvantage. These include misogyny and gender discrimination, especially at the workplace. Educated and qualified women are subject to workplace bullying. Workplace bullying refers to systematic negative treatment of an individual over an extended time. Researchers have frequently reported that women are more likely to be bullied at the workplace than men. A study by Hoel et al. found that almost 16% of women senior managers reported having been bullied compared to around 6% for male senior managers. As recently as 2018, a survey reported that a higher proportion of women compared to men reported hearing demeaning remarks about them, having their work contributions ignored, being mistaken for someone at a much lower position, being addressed in a less than professional way, needing to provide more evidence of their competence, and having their judgement questioned in their area of expertise. A possible explanation for this was given by Sidanius et al., who attributed bullying to women having lower social power. Most of the industries are dominated by males, and women are in a minority position, therefore they become more salient and vulnerable. In such an unequal situation, the one in power may try to maintain the inequality by more or less openly discriminating and using various negative acts against the less powerful. Workplace bullying is a strong social stressor, and it can have negative consequences on mental health.
Women are also at higher risk for suicide in India. In contrast to many other countries, Indian women outnumber men in completed suicides. The reason why a high number of women are attempting and completing suicide may be because of many sociocultural factors. Common mental disorders which is higher among women, exposure to violence, difficulties in interpersonal relationships, dowry-related harassment, etc., have been commonly reported to be associated with suicidal attempts among women. In the West, marriage is generally protective against suicide, but it appears marriage is a stressor for women in India. A study by Srivastava and Kumar found that among suicide attempters, men were more likely to be single and women, married. A married woman is expected to leave her parents and live with her husband and his family, who are often strangers to her in an arranged marriage setting. She is left alone at their mercy, as her parents distance themselves post marriage. Arranged marriages put social and family pressure on the woman to stay married even if she is abused or harassed for dowry, wherein women may find suicide as the only way out because divorce is highly stigmatised.
It is tragic to note that despite women having a higher incidence of common mental disorders, they are under-represented when it comes to service utilisation. Apart from disregard for a woman’s mental health, lack of awareness, and lack of resources, women may not seek help because of the stigma associated with mental illness. Further, women’s mental health may be attributable to external factors which put her at a disadvantage. In this context, a qualitative study was conducted in rural Maharashtra where a group of women were interviewed to determine the characteristics of women mental health. Almost every participant mentioned that a mentally healthy woman has a harmonious home life, and freedom to move around and make her own decisions without having to defer to her husband, suggesting that these women viewed deficits in a harmonious relationship and lack of freedom to mental health issues. As noted by S Malhotra (2015), women’s mental health cannot be considered in isolation from social, political, and economic issues. While a clinician may prescribe drugs, women’s mental health is dependent on the social, cultural, and family environment she lives in, and should therefore be addressed.
A woman’s mental health requires more than a medical prescription. It requires collective and effective mental health promotion, involving societal changes which can be brought about through policies that support gender empowerment, economic access and equity, and offer protection against discrimination, exploitation and harassment. There may be many barriers to why a woman may not seek help. Quite often women may fail to report abuse because of the possible repercussions. Sometimes, domestic violence is accepted as a private family matter. Sexual assault may be treated as a stain on a woman’s character. All of which calls for interventions at various levels. It is unfair that women’s welfare is clubbed with that of children, which often dilutes the cause, and reduces it to maternity care. Women need a separate government body or ministry that is devoted to addressing their needs and fighting against social injustice. The need of the hour is to create awareness and equal opportunity for women, to fight gender disparity, and to protect women from not just violence, but from harassment and bullying. Although the criminal justice system has stringent laws against dowry, sexual assault, etc quite often, the oppressions are subtle and difficult to report. Women may need support groups who are empowered, aware of rights and resources, and capable of fighting exploitation and injustice. Women must also join the cause, for they need to speak for themselves and for others around them and fight against all social evils while offering empathic support to other women. As the saying goes, behind every successful man, there is a woman; but behind every successful woman is a tribe of other successful women who have her back.