Mental Health of Women Affected by Gender-based Violence: A Neglected Public Health Domain

Abstract

Gender-based violence or violence against women is a global pandemic affecting 736 million women across the world. India is considered quite ahead in terms of women empowerment, but data about violence against Indian women point out that we are still leaps behind. When health impacts of gender-based violence against women are considered, mental health impacts are often overlooked. This article aims to highlight a hidden pandemic of mental health impact of gender-based violence on women and to come up with long-term solutions to tackle it. PubMed and Google Scholar were searched for articles on “gender-based violence ” AND “mental health.” Various documents were also searched to look for strategies to tackle mental health impact of violence on women. There is still a long way to go as far as mental health consequences of abuse on women are concerned. We are still just focussing on the physical injuries when the majority of medical help is considered. Counseling sessions and psychotherapy sessions along with screening of women at all OPDs are the long-term solutions.

BACKGROUND

Gender-based violence refers to any nature of damage, which is performed against a person or group of people because of their factual or perceived sex, gender, sexual orientation, and/or gender identity. Gender-based violence against women implies violence that is directed against a woman because she is a woman or that concerns women disproportionately.[1]

Violence directed against women is an age-old pandemic and currently affects 1 in 3 women worldwide.[2] Abuse can be in any form, and it could be physical, sexual, emotional, economic, or psychological actions or even threats of these acts. This even includes behaviors that frighten, intimidate, terrorize, manipulate, hurt, humiliate, blame, injure, or wound the other person, here women. It can be caused by anyone: a current life partner, any family member, colleagues, schoolmates, friends, and an unknown person.[1] Women empowerment just looks like a mirage when globally 30% of women agree that they have experienced violence. That is 736 million women around the world.[3] This viewpoint highlights the burden causes and lacunae in giving health care to women affected by gender-based violence.

METHODOLOGY

From September 1, 2023, to September 30, 2023, PubMed and Google Scholar were explored using keywords gender-based violence AND mental health. A filter of articles published in the past ten years was applied, and of total 19000 articles, relevant articles were included.

Burden of gender-based violence against women

When we consider Southeast Asia, it has been reported that 33% of partnered women aged 15-49 years experienced physical and/or sexual violence from a current or former husband or male partner at least once in their lifetime.[4]

In India, according to National Family Health Survey-5 (NFHS-5; 2019-21),[5] 29.3% of ever-married females aged 18-49 years have faced spousal violence, whereas 3.1% of women experienced physical violence during pregnancy. Approximately 24% of women reported physical/sexual intimate partner violence in the past twelve months.[6] In the Women, Peace, and Security Index in 2021, India ranked 148 of 170 countries,[7] showing that 147 countries are treating their women better than our country in which goddess form of deity is commonly prayed.

The prevalence of gender-based violence against women from their spouses showed a mild decline from 31.2% according to NFHS-4 to 29.3% in NFHS-5.[5] The highest prevalence of gender-based violence was seen among women of Karnataka (44.4%) and the lowest (1.3%) among females of Lakshadweep overall and Nagaland (6.4%) among states. NFHS-5 reported prevalence of gender-based violence against women as more than 25.0% in 14 states of the country, showing that in almost half of the country, 1 in 4 women is affected by violence just because she is a woman.

Determinants of violence against women

Gender-based violence, as with any type of violence, is a problem, which involves involving relations of power. Its basis is feeling of superiority and an intention to assert that superiority in the family, at school, at work, in the community, or in society as a whole.[1]

General reasons for gender-based violence against women are patriarchy and structural racism;[8] large age difference between couples, polygamous marriage (allowed in Islamic religion), low level of education in females, and economic dependence in females accepting nonbrutal violence especially emotional violence as an expression of love have been reported as causes of domestic violence.[9] Taking emotional violence and one or two slaps is generally considered right over one’s partner and is even shown in widely celebrated and blockbuster movies.[10] The movie was a success highlighting how deeply rooted this thought of owning a woman is instilled in people. Females in India are instilled with the mindset since childhood that their real life will start after marriage, and they are “Paraya Dhan,” i.e. someone else’s money/property.[11]

Cultural aspect of GBV in India

The gender dynamic in India was found to be paradoxical as women are respected and protected but also expected to take more responsibilities in taking care of others apart from fulfilling their professional duties. Males are celebrated for their personal achievements such as salary hike in job, whereas females even when earning more/equal than their male counterparts are appreciated more for taking care of their families or younger ones.[12] This creates a traditional and more orthodox way to live in a society, and it has been reported that men who adhere to traditional, rigid, and misogynistic views on gender norms are more likely to use violence toward women. New generation is developing a flexible attitude,[13] but data show that there is still a long way to go.

Health problems related to violence against women

When discussing health impacts of violence on women, the physical injuries are usually the center of attention, but studies have reported gynecological, central nervous system, and even stress-related health problems, in women who are abused sexually or physically.[14] Research evidence now clearly shows a direct link between women’s experiences of domestic violence and heightened rates of depression, trauma symptoms, and self-harm.[15] There are also reports of marital violence and increased predisposition to suicide among married adolescents.[16] Female victims of exploitation can have serious neuropsychological sequelae such as problems with attention and memory affecting daily lives of women.[17] Abused women, when compared with nonabused women, perform worse in tasks of alternating attention, short-term memory, and direct and indirect visual memory.[17] Besides Indian women account for 36% suicide rates globally, and experts have opined that domestic violence is its one of the major causes.[18] Moreover, psychological abuse has now been established as a significant risk factor for mild and major depressive illnesses in women and even causes preterm delivery if a pregnant female is exposed to domestic violence.[19] So much data are available on mental health impact of violence against women, yet we are failing our females by not taking any action to first of all prevent it, second of all diagnose it at earliest, and third of all treating it. It would not be wrong if it is pointed out that a major neglect is happening on this front. To overcome this, we suggest a comprehensive approach toward mental health issues pertaining because of gender-based violence against women, which are as follows:

1. Rising above and beyond mental health helplines: Mental health helplines do not help with diagnosing the issue and its impact at the earliest. To include mental health problems because of violence against women, screening and counseling sessions should be performed at all the levels already in place such as Adolescent Reproductive Sexual Health (ARSH) clinics for adolescents, obstetrics, and gynecology outpatient department clinics and monthly meetings at workplace of females

2. Creating standard mental health scoring systems to screen for deranged mental health because of gender-based violence: To help women at the earliest, researchers and clinicians should come up with standard mental health scoring systems to screen the females at every opportunity available as discussed in point 1. E.g., Every female coming for their immunization during pregnancy should be screened.

3. Lifecycle approach to institution of marriage: The concept of marriage and importance of respecting one’s partner should be ingrained in children from early years of life. This could be included through informal education in Integrated Child Development Services (ICDS) in anganwadis and Adolescent Reproductive Sexual Health (ARSH) Clinics.

4. Taking “Me Too” approach in creating awareness against gender-based violence: Females at reputed positions should take this initiative and come forward with their experiences of gender-based violence, so that women from lower socioeconomic status do not hesitate from talking about it. Welfare committees for females in workplace should include female workers from lowest to highest ranking, and monthly meetings should be held discussing their experiences and screening, so that help could be provided before major mental health blow.

5. Premarital counseling: This type of counseling, although prevalent in Western countries, is not seen as commonly in India. These sessions can make partners aware about topics such as finances, household chores, and seeing marriage as a union of family instead of two people. It will help partners to know about views of their future spouse on difficult topics and their responses too. These sessions must be strengthened with screening tests for bipolar and borderline personality disorder and other screening tests to check for anger management issues or violent personalities.

6. Planned parenthood: Partners should be promoted to go for planned parenthood instead of conceiving a child just as a next step after marriage. Future parents should be educated that children are also “responsibility” and not only God’s gift. As a parent, one has to plan finances for their children at least until they become adults. Unplanned pregnancies lead to undue stress and financial burden, eventually leading to a stressful environment in family.

7. Engaging men against domestic abuse from childhood: This huge battle cannot be won without sensitizing men from a young age against domestic violence. Children especially boys should be taught in schools about the importance of equal rights for women and problems associated with domestic violence.

Is not it weird that a female who has never experienced gender-based violence, particularly from their partners, takes it as a sign of blessing instead of taking it as an equal sign of respect in a partnership. This just brings us to conclude that this deep-rooted evil will need more forces that it is taking to curb maternal mortality rates in our country because females themselves are instilled with the idea that “it is common, hence it is not an issue.”

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.