A shocking statistic has emerged, which reveals suicide has overtaken maternal mortality as the biggest killer of young women in the world. Nisha Lilia Diu asks the experts why this is happening – and how we failed to notice
Towards the end of last year, a shocking statistic appeared deep in the pages of a World Health Organisation report. It was this: suicide has become the leading killer of teenage girls, worldwide.
More girls aged between 15 and 19 die from self-harm than from road accidents, diseases or complications of pregnancy.
For years, child-bearing was thought to cause the most deaths in this age group. But at some point in the last decade or so – statistics were last collected on this scale in 2000 – suicide took over. And, according to the WHO’s revised data for 2000, it had already just inched its way ahead of maternal mortality at the turn of the millennium.
Yet, somehow, we didn’t notice.
I heard the statistic from Sarah Degnan Kambou, President of the International Centre for Research on Women (ICRW), at a Gates Foundation breakfast last month.
Most of my fellow guests worked in the fields of global women’s rights or female health. Yet they were as stunned as I was to hear it.
“I’m not quite sure why we haven’t realised this before,” says Suzanne Petroni, a senior director at ICRW. “Maternal mortality has come down so much, which is fantastic,” she says.
That’s a major factor behind the fall in the overall death rate for 15-19 year old girls from 137.4 deaths per 100,000 girls in 2000 to 112.6 today. It’s an amazing achievement.
And it has allowed the spotlight to fall, finally, on what has actually been the biggest killer all along: suicide.
The report looks at six global regions. In Europe, it is the number one killer of teenage girls. In Africa, it’s not even in the top five, “because maternal deaths and HIV are so high,” says Petroni.
But in every region of the world, other than Africa, suicide is one of the top three causes of death for 15 to 19 year old girls. (For boys, the leading killer globally is road injury).
It’s particularly shocking given that suicide is notoriously underreported.
Leading causes of death for teenage girls
“We don’t really know the extent of the problem,” says Roseanne Pearce, a Senior Supervisor at Childline in the UK. “Because the coroner often won’t record it as suicide. Sometimes that’s at the family’s request, and sometimes it’s simply to protect the family’s feelings.”
In countries where stigma is particularly high, suicides are even less likely to be recorded than they are in the UK. And the poorest countries in the WHO’s report have very patchy data on births and deaths at all, let alone reliable detail on what caused those deaths.
In South East Asia, the problem is acute: self-harm kills three times more teenage girls than anything else. (The Eastern Mediterranean, which includes Pakistan and the Middle East, has the second highest rate.)
Professor Vikram Patel, a psychiatrist who was recently featured in Time magazine’s 100 Most Influential People for his work in global mental health, is blunt in his diagnosis:
“The most probable reason is gender discrimination. Young women’s lives [in South East Asia] are very different from young men’s lives in almost every way.”
The male suicide rate in this age group is 21.41 per 100,000, compared with 27.82 for girls.
This is the age at which girls may be taken out of school and forced to devote themselves to domestic responsibilities, forgetting all other abilities or ambitions. Hitting puberty can mean no longer being allowed to socialise outside the home. Sometimes it can mean no longer being allowed out of the home at all. And, sometimes, it can mean forced marriage.
Prof Patel was the founding director of the Centre for Global Mental Health at the London School of Hygiene and Tropical Medicine but now spends much of the year in Delhi, where he works for the Public Health Foundation of India.
“Indian media is filled with aspirational images of romance and love,” he says. “The ability to choose your life partner is an idea that’s championed by Bollywood. But that’s completely not the case in reality for most young women.”
Young brides, says Suzanne Petroni, “are very often taken away from their peers. They’re subjected to early and unwanted sex, and they’re much more likely to experience partner violence than people who marry later. All of these things put them at greater risk of suicide.”
In India, says Prof Patel, “female suicide rates are highest in parts of the country with the best education and economy, probably because women grow up with greater aspirations only to find their social milieu limits them.”
In Prof Patel’s view, “fifty per cent of those attempting suicide in China and India do not have a mental illness. They suffer logical despair.”
The adolescent male suicide rate, though lower, is also extremely high in this region. Prof Patel’s interviews with survivors of suicide attempts have led him to believe that, “for girls, gender issues are usually behind it. For boys, it’s financial insecurities.”
Boys face great pressure to succeed and provide. Which strikes me as a gender issue, too – it’s a different problem from those suffered by women, but it’s still a problem rooted in a rigid gender role.
Leading causes of death for teenage boys
In the UK, says Joe Fearns, the Samaritans’ Executive Director of Policy and Research, “all of us in suicide prevention are most concerned by men.”
That’s because almost 80 per cent of all UK suicides are men. But, says Fearns, “the majority of self-harm cases in the UK and presentations at A&E for self-injury are women.”
Part of the reason for the dramatically higher rate of male suicide in the UK (and in most of the western world) is drugs and alcohol; men are more likely to abuse both, leading to more impulsive behaviour.
“Men also tend to use more violent means that are less survivable,” says Fearns.
Roseanne Pearce at Childline tells me 75% of the girls who contact the service with suicidal feelings are either planning or have attempted an overdose, compared with just over half of boys.
Boys are much more likely to be planning or have attempted to hang themselves – a method with a far lower chance of survival.
Some of the disparity between the male and female rate is also down to circumstance, says Fearns. He tells me there is a higher than average rate of suicide among those working in heavy construction and farming – “because they have the means”.
Far fewer women than men work in these environments.
Rhea (not her real name) is 17 and has attempted suicide twice. “Porn was everywhere in my school,” she says. Her boyfriend Andy became “obsessed with it”.
She’d “made it clear,” she says, that she “wasn’t ready to have sex,” but one evening he sexually assaulted her in a park. The assaults became routine. Rhea did nothing.
“The constant talk about porn had made me feel like what was happening was normal,” she says. She uses that word repeatedly to describe her attitude towards Andy’s assaults: normal.
“I felt trapped, like everyone thought it was normal and I had to go along with it if I wanted to be accepted.”
The pressure to conform to these perceived expectations was so great that, eventually, Rhea says, “I felt like there was no way out.” She tried to kill herself.
“The suicide attempt rate for young women in the UK is extremely high,” says Prof Patel. He believes “sexual pressure” is a significant factor in their unhappiness.
Roseanne Pearce agrees, adding that “sexting is another big issue among our callers. Girls become desperate, even suicidal, because they’ve sent a picture and it’s been posted online.”
There is also relentless pressure on Western girls look a certain way: to be thin and sexy. The boys at Rhea’s school constantly compared the girls’ bodies to women they saw in porn films, almost always negatively.
But, says Rhea, the strongest pressure comes from online media.
“Kim Kardashian, for example, and all of her waist-training stuff at the moment.” The Kardashian sisters have been posting endless selfies on social media wearing waist-slimming corsets.
“Loads of girls at my college are talking about it and they’re unhappy because it makes them feel insecure in themselves and like they have to try to look like that.”
Rosie Whitaker had been spending a lot of time on social media when she took her own life in 2012, aged just 15. She wasn’t looking at pictures of celebrities, though.
Her aunt, Nancy Whitaker, tells me about the dark TUMBLR accounts dedicated to self-harm that Rosie was introduced to by a friend, who was already a self-harmer, and that Rosie became immersed in herself.
“They’re very dark images of girls that are just skin and bones, cutting themselves. It’s like they’re competing to see who can be the most shocking.”
She says, “you may have people who are not fitting in, for whatever reasons, who have body image issues or are being bullied – children who are vulnerable – and when they discover these websites they think, ‘Oh people understand me, they know how I feel.’ All of a sudden they join the self-harm thing and they feel like they belong.”
“But,” she continues, “when you write something like, ‘I’m fat, I’m ugly, I want to die,’” – as Whitaker’s niece Rosie did – “instead of someone saying ‘Oh, don’t be silly, you’re beautiful,’ they say, ‘Yeah, why don’t you just go kill yourself.’”
“And when they’re in such a vulnerable mindset anyway, a complete stranger’s words like that…” Whitaker trails off.
Pearce is familiar with what she describes as “self-harm websites dominated by girls encouraging each other, trying to shock each other, trying, probably, just to get some attention.”
Dr Amy Chandler, a research fellow at Edinburgh University who specialises in self-harm and suicide, tells me Western girls are more likely to self-harm than boys and, in her experience, “their explanations for doing it are around control: their body being a site where they can exert control.”
“Boys have other routes for expressing anxiety and distress,” such as fighting. Girls turn to self-harm, she says, “because it’s not acceptable for them culturally to express anger in the same way”.
Whitaker thinks there’s truth in this. “Boys will shout or punch a wall. Their aggression can come out in other ways. They don’t necessarily turn it on themselves in the same numbers as girls do.”
“It’s very difficult to identify someone’s motivation when they harm themselves,” says Joe Fearns of the Samaritans.
But, he says, “groups that have less power” tend to be most vulnerable – suicide rates are consistently higher among the unemployed, and the economically or socially marginalised.
Young women in parts of the Middle East and South East Asia are some of the most disempowered and marginalised people in the world.
Even in the West, adolescence is a time when girls feel their choices become restricted: that they must look and behave in certain ways to be accepted.
“Gender is a pervasive global issue,” says Prof Patel. And, as we’re somewhat belatedly realising, the consequences can be fatal.
Invoke Article 33 of the ILO constitution
against the military junta in Myanmar
to carry out the 2021 ILO Commission of Inquiry recommendations
against serious violations of Forced Labour and Freedom of Association protocols.
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