Why a sensitive healthcare system is key to addressing the high suicide rate among India’s women

The number of deaths by suicide in 2021 registered an increase of 7.2% from the previous year according to the National Crime Records Bureau’s Accidental Death and Suicides in India report released in August.

Of these, 27% of the total suicides – 45,026 – were among women. Almost 52% of the women (23,179) who died by suicide were housewives. This is more than double the number of suicides by farmers (10,881) that year.

This is not surprising. India has one of the highest suicide rates among women: it accounts for more than one-third of the total number suicides among women globally. The relationship between domestic violence and mental health consequences such as anxiety, depression, suicidal thoughts is well-established.

Women facing domestic violence grapple with additional challenges due to the stigma in reporting abuse and expressing suicidal thoughts.

The mental health concerns of women who land up in hospitals following attempts at suicide are ignored. These attempts are not recognised by healthcare providers as a cry for help.

Every day, there are at least two cases of female patients who attempted suicide being admitted to a public hospital in Mumbai.

The Centre for Enquiry into Health and Allied Themes or Cehat, which has worked with the health sector for the past two decades, has found that when cases of attempted suicide by women reach the hospital, they are invariably documented as “accidental consumption of poison or accidental overdose of pills” by healthcare providers. Neither the underlying factors that triggered the attempt nor the mental health aftermath of suicide attempts are addressed by the healthcare system.

What does NCRB data say

Data on the cause of suicides provides insights about linkages between domestic violence and suicide among women. According to the report, 7,903 suicides were reported among women under the cause of “marriage related issues” and 15,769 under “family problems”, which together accounts to more than half of the suicides among women. The National Crime Records Bureau defines “family problems” as problems other than “marriage related issues”.

Further, the bureau’s data on Crime in India-2021 showed that nearly one-third (1,32,580) of crimes against women were categorised under “cruelty by husband or his relatives”.

Healthcare system’s role

Healthcare facilities offer unique sites for interventions to address domestic violence as they may be among the first places where women may report such abuse. A woman facing domestic violence may not go to a police station to seek action against abuse, but she will invariably reach a hospital to seek treatment for health complications resulting from violence.

Healthcare providers, however, are fearful of the law and prefer avoiding issues that are medico-legal – such as road accidents that are medical as well as legal cases. Further, medical education and in-service training fails to equip healthcare providers to recognise the effects of violence on a woman’s health.

Women who attempt suicide, thus, are provided only medical treatment and miss out an opportunity to receive psychosocial care from healthcare providers to prevent future attempts. The situation is compounded when a mandatory assessment of every such case is carried out by the hospital’s psychiatry department and terminology such as “deliberate self-harm and attention seeking behaviour” are used in different diagnoses.

The data of Dilaasa, a hospital-based crisis department for survivors of violence, shows that out of 3,435 cases in the past 19 years, one in five survivors of domestic violence had attempted suicide while almost one in four had suicidal ideation.

The healthcare system needs to acknowledge that domestic violence is an underlying cause for suicide attempts among women.

The capacity of healthcare providers must be built up to recognise the physical and emotional health consequences of violence against women. The evidence from Cehat’s work suggests that training of healthcare providers to identify domestic violence as a risk factor for the physical and mental health of women results in providing comprehensive care.

Trained healthcare providers proactively ask women about violence and provide support if they suspect that their health concerns are a result of abuse. Thus, the role of health system cannot therefore be overemphasised in responding to immediate psychological needs of women facing domestic violence and preventing suicides.

The healthcare system can also play an important role in improving the quality of data on suicides. Though the National Crime Records Bureau data is the only national-level data available on suicides in the country, it is highly underreported since it is based on first information reports.

There is low reporting of suicides due to gaps in the investigation of cases of unnatural deaths across states, the absence of a health facility-based registry, social stigma and legal complications. In a further indication of the underreporting of suicides, a paper published in The Lancet titled Gender Differentials and State Variations in Suicide Deaths in India said there were 2.5 lakh suicides in India in 2016 while the National Crime Records Bureau pegged cases of death by suicide at 1.3 lakh the same year.

The statistics of the National Crime Records Bureau are likely to be the tip of the iceberg. There is a need to strengthen the health facility-based reporting of suicide attempts and suicides by developing a standardised registry and reporting mechanism.

Sanjida Arora is a research officer at Cehat. Sangeeta Rege is coordinator at Cehat.

Also read: Rural hospitals in Gujarat become support centres for domestic violence survivors