Women suffer. Good or bad times, rain or shine, heaven or hell. Even the epics, myths and religious scriptures don't spare woman. From Eve's banishment from paradise to disrobing of Draupadi. Thankfully, there are exceptions in recent works of literature, arts and movies. Still, we have a long way to go when it comes to women's liberation.
While typing this out Bob Marley's No, woman, no cry plays out in my mind. But that's a man's perspective. This story is about women, the violence and sexual abuse she faces on a daily basis and the mental trauma she undergoes as a result of such violence and societal pressures.
To begin with, sexual violence has serious and numerous repercussions on a woman’s mental and physical health.
Here are a few cases that encapsules the plight of a woman even in a so-called "civilized" and "modern" society.
'My abusive partner'
“My partner was abusive whenever we had sex. He used to hit me and be very rude. It worsened to such an extent at times that I felt like I wanted to rip off my private parts”, says 25-year-old Pallavi (name changed for anonymity), who hails from Kerala.
Eventually she started hating her own body even long after she left that abusive relationship. She even began self-harming, and it took her a long time and ample effort to cope with the trauma and veer towards the path to recovery.
Why kurta makes her shudder
23-year-old Riya (name changed for anonymity), was attending a church festival with her friend. They were at one of the many crowded stalls looking at bangles when a guy tried to lift her kurta from the back and almost succeeded. She screamed...But he got away in the crowd. It might seem like she got lucky and safe, but even today, every time she picks up a kurta to wear, she remembers this incident and silently shudders. It's a trauma she has to deal with.
Sexual violence and mental health
According to a research paper -- Sexual violence and poor mental health of women, by Rashmi Rai and Ambarish Kumar Rai, mental health issues linked to sexual violence affects more than 50% of women across the globe and has a significant impact on their health and well-being.
Psychologically, it has a long-lasting detrimental effect on how the victim views herself, other people, and events.
According to this hospital-based research, women who have experienced sexual abuse suffer from mental illnesses such as anxiety, insomnia, obsessive behaviors, and acute stress disorder, among others. Surprisingly, those facing mental health issues due to sexual violence are often subjected to further incidents of sexual violence.
The World Health Organization (WHO) reported that sexual violence is a significant factor contributing to poor mental health among women in various countries, including India.
As of October 2021, women accounted for the highest proportion of mental health disorders in India, with 39 percent experiencing stress disorders and 30 percent suffering from anxiety disorders. In comparison, 33 percent of men were diagnosed with depression, while 31 percent of women experienced the same during that time period.
During a job interview...
Another instance shared by a 22-year-old job aspirant was truly shocking. During a job interview in a metropolitan city, a male interviewer—an educated 40-year-old corporate executive—unexpectedly grabbed and kissed her while showing her around the office. She immediately stepped back, firmly said no, and asked if he had sought her consent. He simply responded that he thought she might be open to it.
To play devil's advocate, it was a job interview, and she wasn’t wearing anything that might have suggested she was okay with inappropriate advances. Surprisingly, when she shared her horrific experience with her loved ones, they called her dumb and questioned why she went there alone. After the incident, she had a panic attack, but no one cared enough to ask if she was okay.
The depressed woman continues to feel unsafe around others, haunted by a fear of meeting new people and sharing her experiences, worried about being victim-blamed.
"In my observation, survivors may experience a range of psychological and emotional challenges, and the impact can vary from individual to individual," says Megha, a practicing nurse at a reputed mental health hospital in Bangalore.
"I have observed that survivors can suffer profound, long-lasting effects. Post-traumatic stress can lead to nightmares, flashbacks, intrusive thoughts, and a detachment from reality as they cope with overwhelming feelings. Survivors often lose interest in activities they once enjoyed and experience changes in sleep and appetite, resulting in a loss of identity and self-esteem," Megha explains.
What experts have to say
“Indian women do not receive the medical attention they deserve, particularly regarding mental health," says Dr. Shaji KS, a psychiatrist and former Dean of Research at Kerala University of Health Sciences, Kerala.
"Depression is the most common mental health issue globally, with women—especially those of reproductive age—being more susceptible. Distressing experiences significantly contribute to this vulnerability," he notes.
"Women in their reproductive years undergo hormonal changes that can make them more vulnerable to mental illnesses. Both stress and biology play a role," Dr. Shaji adds.
Dr. Shaji also points out that women with depression often do not seek help from mental health professionals for two main reasons. First, there is widespread ignorance about depression as a clinical condition; many people confuse it with unhappiness or reasonable worry about persistent situations. Consequently, healthcare professionals, particularly those who are not psychiatrists, often fail to identify depression in women. Second, due to a lack of awareness about depression as a clinical issue, many women do not seek help, leading to a significant treatment gap—particularly concerning women in their reproductive years.
Dr. Hema Tharoor, a psychiatrist at Apollo Hospital, Chennai, highlights the difficulty many women face in setting boundaries due to cultural upbringing. "A large majority of women are conditioned to tolerate intimate partner violence or sexual harassment in the workplace, often to keep the family together or due to financial constraints."
"When a woman silently endures this, society praises her strength and resilience, but in reality, she is breaking inside. Mental trauma can manifest as psychosomatic illness. A patient might enter your clinic with chronic pain and multiple ailments, having consulted several doctors without finding a solution. Often, she cannot speak about the abuse but continues to endure physical pain, leading to significant psychological stress," she explains.
The average Indian working woman faces various forms of sexual harassment, from subtle inappropriate behaviors to overt actions in the workplace. This harassment can come not just from men but also from female bosses. Many women feel compelled not to report workplace harassment due to financial constraints and societal expectations. As a result, they may experience anxiety and post-traumatic stress, depending on the severity of the abuse.
Severe maltreatment at work can lead to burnout, which may manifest as musculoskeletal issues or even blood sugar problems. Some women resort to food as an emotional crutch, leading to abrupt weight gain, eating disorders, and obesity-related health problems. At the core of these issues is the abuse they endure, trapping them in a harmful cycle, according to Dr. Hema.
Maternal mental health
Another major concern for women's mental health is maternal mental health. Disorders in this area are significant for mother-infant dyads in India but have not received the attention they deserve. Depression and anxiety affect an estimated 10 to 20% of pregnant women worldwide, with even higher prevalence among mothers from low- and middle-income countries.
A study from Government Medical College Thrissur, Kerala, found that the prevalence of depression during pregnancy was as high as 53%. Unrecognized and untreated antepartum and postpartum depression are significant risk factors for suicide.
In cases of abortion and miscarriage, the social stigma surrounding these events can be overwhelming. Despite the legality of medical termination of pregnancy (MTP) in India and court rulings upholding women's bodily autonomy, society often views women who undergo these procedures as outcasts, regardless of their circumstances.
In the landmark Supreme Court case of KS Puttaswamy vs. Union of India, the right to bodily autonomy was recognised as part of the right to privacy. Similarly, in the High Court on its own motion vs. State of Maharashtra, it was ruled that forcing a woman to continue an unwanted pregnancy violates her bodily autonomy and adversely affects her mental health.
This position was also supported in the 2009 case of Suchita Srivastava & Another vs. Chandigarh Administration, where the Supreme Court asserted that reproductive choices fall under the right to privacy, dignity, and bodily integrity.
Dr. Shaji explains that an abortion triggers hormonal changes similar to those experienced during pregnancy. Thus, the post-abortion period can resemble the post-delivery period in terms of vulnerability to depression. The risk of depression peaks in women following delivery or a loss of pregnancy, making any abortion a precarious situation.
The study "Perinatal Mental Health Around the World: Priorities for Research and Service Development in India" by Sundarnag Ganjekar, Anilkumar Viswananthan, and Prabha S. Chandra outlines alarming case studies. In one instance, a 19-year-old who underwent an abortion at an undisclosed location was found dead a month later after consuming poison.
In another case, a 21-year-old, 26 weeks pregnant and known to have frequent arguments with her husband, took her life by hanging. Factors like intimate partner violence, emotional abuse, loneliness, lack of social support, and unwanted pregnancies heighten these women's vulnerability. Issues like dowry demands, substance abuse, and a dysphoric temperament further contribute to the risk of suicidal attempts. Early antenatal screening could have identified these mental health issues and potentially averted these tragedies.
"The solution lies in increasing public awareness—especially among women—about postnatal depression and mental health during the reproductive age, including teenage pregnancy and perimenopause. Additionally, we must equip healthcare providers to identify and treat mental disorders like depression," says Dr. Shaji.
Dr. Hema emphasises the importance of understanding and nonjudgmental support from healthcare professionals. "The stigma surrounding single women seeking MTP or having sex is pervasive. It's crucial for these women to find gynecologists and other professionals who will offer compassionate care without judgment."
Initiatives by the Gynecological Association and organisations like MeHelp are taking steps to spread awareness. There is an urgent need for increased access to mental health services and the development of women-specific mental health programs. Recognising that women's mental health is not just a personal or family issue but a pressing public health concern is vital for ensuring immediate attention and action.