India attempts to lower maternal mortality but ignores a major contributing factor: suicide

According to a study published in The Lancet, the rate of self-inflicted deaths among Indian women and girls is double the global norm. Experts claim that a major factor is domestic violence.

India attempts to lower maternal mortality but ignores a major contributing factor: suicide.

A pregnancy is frequently reason for joy because it means a new life and a new member of the family. However, this is not the case for the women who visit Garima Malik's clinic in New Delhi. Others cry. Others seem irritated, agitated, or angry. Domestic violence is typically the core cause; pregnancy is a particularly sensitive period for it, and Malik is trained as an experienced counselor to detect the indicators.

"They discuss suicide. Then they become tranquil. We discuss risk management, safe planning, and recommendations. So they manage to go on," he says. According to Malik, many of the women who visit the clinic managed by the non-profit organization Doctors Without Borders (MSF) had experienced physical and psychological abuse while pregnant. They may not want to have intimate relations with a partner in the beginning of their pregnancy or right after giving birth.


Others claim it's because they had a daughter, which some people think is less attractive. Women may experience loneliness as a result of this, along with frustration. They believe that she suffers since the family and he [the spouse] both thought the family needed a man, she claims.


The women who visit Malik's clinic are the fortunate ones, she notes, as the majority of Indian women who experience suicide thoughts during or after pregnancy will not seek or receive assistance.


In southern India, a study of low-income pregnant women found that 7.6% were at risk of suicide, compared to 0.4% in the US.


In India, suicide has historically been one of the main causes of mortality for women of reproductive age. The suicide rate among Indian women and girls is twice as high as the global average, according to a new study that was published in the medical journal The Lancet.


The nation has achieved significant progress since the turn of the millennium in lowering overall maternal mortality, slashing deaths by more than half. Compared to 254 in 2004, there were 103 maternal deaths per 100,000 live births in 2019. The UN has set a target of bringing down maternal mortality worldwide to 70 deaths per 100,000 people by 2030.


High suicide rates in the perinatal period, which encompasses pregnancy and the first several weeks after giving birth, have been made more widely known as a result of this success. In southern India, a 2016 study of 462 low-income pregnant women found that 7.6% of them were at risk of suicide, compared to 0.4% in the United States.


Administration inactivity

According to the health professionals contacted, the government has not done anything to address this issue, and the 2018 action plan for the prevention of suicide has never been implemented. Lakshmi Vijayakumar, a psychiatrist and member of the World Health Organization's (WHO) International Network for Research and Prevention of Suicide, criticizes India for losing "an enormous number" of young women and claims that there is no efficient mechanism, plan, or strategy to address this issue.


Data are scarce. India does not break down the data by cause of death; instead, it extrapolates national figures on maternal mortality from a representative sample survey. Police retain records of recorded suicides, but they don't note if the person was expecting a child. Furthermore, suicides are frequently underreported.

India attempts to lower maternal mortality but ignores a major contributing factor: suicide.

Psychiatrist Vijayakumar adds that while perinatal suicides are frequently associated with a history of mental illness, this does not seem to be the case in India. Instead, social variables including early marriage, violence against intimate partners, peer pressure to have a boy, and the lack of economic freedom for women are what matter.


An instructive success tale

India has achieved exceptional achievement in reducing the physical causes of maternal fatalities, which is mostly attributable to the rise in the number of births that occur in free public health facilities as opposed to at home. According to official statistics, these increased from 31.1% in 2005–2006 to 88.6% in 2019–2021 as a result of awareness programs and modest financial incentives for both women and health services.


One of the states in southern India that has done the best at lowering maternal deaths is Kerala. It is the safest place to give birth in the nation, with a maternal death rate of 43 per 100,000 live births. Additionally, it is the only State to have examined information on perinatal suicide, looking at the 1,076 maternal fatalities registered between 2010 and 2020. Mortality decreased from 66 to 43 over that time, while the rate of suicide rose from 2.6% in 2010 to 6.6% five years later and to 18.6% in the years 2019–2020.


The relatively low maternal death rates in Kerala are the result of the small sample size, so this results should be interpreted with some caution. But when combined with the southern India data from 2016, it shows a trend, according to doctor and Center for Mental Health Law and Policy head Soumitra Pathare. We now have reliable statistics demonstrating that suicide is a serious issue among young women, especially those who are pregnant or have recently given birth, she says. "Interventions have been made to attain maternal mortality, which has significantly decreased. Therefore, what this really demonstrates is that we haven't taken any action to stop suicides, she says.


He cautions that the data only shows a portion of the issue. Up to 20 people try suicide for every suicide that occurs, according to estimates. “So the number of suicide attempts [in India] fluctuates from 0.6 million to six million,” says Pathare. She adds, "We don't even gather data about it.


Essential is early intervention

Although the Kerala study highlighted psychiatric disease, youth, singleness, and domestic abuse as risk factors, little research has been done on the causes of perinatal suicide in India.


According to government statistics, close to one in three Indian women between the ages of 15 and 49 who have ever been married have experienced intimate partner abuse. 3.1% of the women in this group reported having experienced physical abuse when they were pregnant. Despite legal challenges, marital rape is not recognized by the law.


According to government statistics, close to one in three Indian women between the ages of 15 and 49 who have ever been married have experienced intimate partner abuse.


According to Nayreen Daruwalla, who oversees a program at the Mumbai-based NGO Society for Nutrition, Education and Health Action (SNEHA) aimed at preventing violence against women and children, suicide during pregnancy typically falls into one of two categories. One is when a married woman is pregnant and the family wants a son, she adds. He claims that the large number of single mothers is primarily caused by a lack of social support and, occasionally, a partner's lack of support, who may be reluctant to get married when they learn that the woman is pregnant. she.


The Indian network of health workers, which can reach all pregnant women, is mentioned by Shaji KS, dean of research at Kerala University of Health Sciences and a member of the team that investigated perinatal suicides in Kerala. from the nation. He claims that including a psychological component to promote their mental health would aid in averting many fatalities.


More professional training, according to MSF's Malik, is required to help Indian women become economically independent, which would make it simpler for them to leave abusive situations. This has been shown to be successful in lowering suicide rates, according to an Australian study. Women's labor market participation in India has been continuously reducing, falling from about 30.4% in 2000 to 19% in 2021. "When we talk to those patients, when we talk about getting out of that type of relationship and leaving their husbands and such a poisonous atmosphere, they want to do it. Because they are not financially independent, they cannot, she claims. According to studies, limiting access to pesticides, which are frequently used in suicides in India, may help avert certain fatalities.


Lakshmi, a psychiatrist and WHO advisor, was a member of a task force formed by the Indian government in 2018 to recommend strategies to lower suicide rates generally, but her suggestions were not followed through on. The government unveiled plans for a national telemedicine program for mental health in February in response to questions about funding for suicide prevention. She did not, however, make a commitment to follow the working group's suggestions. The proposal has been provided, Lakshmi asserts. I hope it will someday see the light of day, but it's still lying there," she adds.

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