How a sensitive healthcare system is the first place to start


The number of deaths from suicide in 2021 saw a 7.2% increase from the previous year, according to the National Crime Records Bureau’s report on accidental deaths and suicides in India released in August.

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

This is not surprising. India has one of the highest suicide rates among women: it is responsible for more than a third of all female suicides worldwide. The connection between domestic violence and psychological consequences such as anxiety, depression and suicidal thoughts is well documented.

Women subjected to domestic violence face additional challenges as they are stigmatized for reporting abuse and expressing suicidal thoughts.

The mental health concerns of women who end up in hospitals after attempting suicide are ignored. These attempts are not recognized as a call for help by healthcare providers.

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

The Center for Inquiry into Health and Allied Themes, or Cehat, which has worked with the health sector for two decades, has found that cases of attempted suicide by women who do reach the hospital are invariably reported as “accidental use of poison or accidental overdose of pills.” Health care provider. Neither the underlying factors that triggered the suicide attempt nor the psychological consequences of suicide attempts are addressed by the healthcare system.

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What does NCRB data say?

Data on the causes of suicide shed light on associations between domestic violence and suicide among women. According to the report, 7,903 suicides among women were reported under the cause of “marital problems” and 15,769 under “family problems,” which together account for more than half of suicides among women. The National Crime Records Bureau defines “family problems” as problems other than “marital problems.”

Number of female suicides in 2021, by age and domestic violence. Credit: NCRB data.

In addition, Bureau of Crime India 2021 data showed that almost a third (1,32,580) of crimes against women were categorized under “cruelty committed by the husband or his relatives”.

The role of the health system

Healthcare facilities offer unique venues for domestic violence interventions as they may be among the first places women can report such abuse. A woman who has been subjected to domestic violence may not go to a police station to take action against abuse, but she will invariably go to a hospital to seek treatment for health complications resulting from violence.

However, healthcare providers fear the law and prefer to avoid medico-legal matters – such as B. Traffic accidents, which are both medical and legal cases. Additionally, medical undergraduate and in-service training do not equip healthcare providers to recognize the impact of violence on a woman’s health.

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As a result, women who attempt suicide are only treated medically and miss out on the opportunity to receive psychosocial support from healthcare providers to prevent future attempts. The situation is made worse when the hospital’s psychiatric department conducts a mandatory assessment in each of these cases, and terms such as “deliberate self-harm and attention-grabbing behavior” are used in various diagnoses.

Data from Dilaasa, a hospital crisis unit for violence survivors, shows that out of 3,435 cases over the past 19 years, one in five domestic violence survivors had attempted suicide, while almost one in four had suicidal thoughts.

The health system needs to recognize that domestic violence is a fundamental cause of suicide attempts among women.

The capacity of health care providers needs to be built to recognize the physical and emotional health consequences of violence against women. The evidence from Cehat’s work suggests that training health care providers to identify domestic violence as a risk factor for women’s physical and mental health leads to comprehensive care.

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Trained health care providers are proactive in asking women about violence and supporting them when they suspect abuse is causing their health problems. Therefore, the role of the health system in responding to the immediate psychological needs of women exposed to domestic violence and in preventing suicide cannot be overemphasized.

The healthcare system can also play an important role in improving data quality on suicide. Although the National Crime Records Bureau data is the only nationally available data on suicides in the country, it is grossly underestimated because it is based on initial intelligence reports.

Few suicides are reported due to gaps in the state’s investigation of cases of unnatural deaths, lack of a health facility-based registry, social stigma, and legal complications. Another clue to the underreporting of suicides is an article published in The lancet entitled Gender Differentials and State Variations in Suicide Deaths in India stated that there were 2.5 lakh suicides in India in 2016, while the National Crime Records Bureau put the number of suicide deaths in the same year at 1.3 lakh.

Statistics from the National Crime Records Bureau may be the tip of the iceberg. There is a need to strengthen the reporting of suicide attempts and suicides in healthcare settings by developing a standardized register and reporting mechanism.

Sanjida Arora is a Research Associate at Cehat. Sangeeta Rege is a coordinator at Cehat.

Also Read: Rural Hospitals in Gujarat Become Support Centers for Domestic Violence Survivors





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