SOS from the homemaker

The quietude at Sumaitri belies the disquieting stories harboured at this crisis intervention centre in New Delhi for the depressed and suicidal. A volunteer clearly remembers the young housewife in her early 30s who visited often. Trapped in an abusive marriage, raped by her husband and his friends, her only outlet proved to be Sumaitri. “She never called, but visited whenever she stayed with her mother,” recalls the volunteer, who wishes to remain anonymous. She had a child to raise and was supported only by a widowed mother. Those at Sumaitri remember her persistent query — “How do I get out of this?” They lent a sympathetic ear, explored the slim options she had, but couldn’t find a way to help her escape her situation. Months later, the mother visited the centre — her daughter had killed herself and the child. The volunteer’s voice is calm. But, she says, there is no hiding the distress the information caused the 30-odd members of the Sumaitri team.

Housewives in distress are making desperate calls to helplines across India. The National Crime Records Bureau (NCRB) says they account for 15.3 per cent of suicides countrywide and 47.4 per cent among female victims. There were 1,31,666 suicides reported in 2014, and marital issues drove twice as many women as men to suicide.

What is pushing this section of society to the edge? Is the silent killer getting the attention it needs? Peter Mayer, an associate professor at the University of Adelaide studying suicide patterns in India, wrote in Economic and Political Weekly last April, “In 2014, 5,650 farmer suicides were recorded in India; in the same year, 20,148 housewives took their own lives, over 250 per cent more in raw numbers. If we were to form our assessment from media coverage it might be one-tenth or less.”

Sumaitri is the sole suicide prevention helpline in the Capital — Delhi reported the most number of suicides among all Union Territories in 2014. Part of Befrienders India/Samaritans, this crisis intervention centre is the only one of its kind in north India. Run entirely by volunteers, the centre on average receives eight distress calls a day.

“About 43-45 per cent is from housewives harbouring strong thoughts of suicide,” says the volunteer.

Physical abuse and harassment for dowry are the major causes of trauma. Alcoholism and unemployment in the family are among the other reasons. However, housewives are all too often failed by the absence of support. Their parents frequently refuse to step in. “Most of the women who call are between 22 and 38 years. They have small children and that often deters them from taking the extreme step. They call because they don’t want to die. It is their last attempt to hear they are important.” Apart from Delhi, there are calls from Kota in Rajasthan and Jalandhar in Punjab.

Volunteers compare their function to that of a pressure cooker nozzle. By allowing callers to vent, they leave them calmer. Volunteers listen, don’t judge, and will even help explore options, but they hardly ever offer suggestions or counsel.

At the Delhi-based Institute of Human Behaviour and Allied Sciences, director Nimesh G Desai talks about the persistent stigma around mental health and the neglect of issues such as suicidal behaviour and depression. “If there is no awareness of the problem, there is no acceptance of it. Friends and family tend not to see even when it [the problem] is right before them,” he adds. And where mental health issues do receive some attention, the housewives happen to occupy the bottom of the priority pyramid. Desai blames society’s inability to care for the paucity of intervention mechanisms that have the potential to save lives. “Volunteer-driven helplines depend on society’s ability to give.” Desai advocates greater coordination between mental health agencies and non-governmental organisations working on women’s issues. “Those organisations are doing a lot of preventive work without being aware of it.”

The tiny Union Territory Puducherry has the highest suicide rate in the country — 40.4 suicides per one lakh population, which is almost thrice the national rate. In his article Thinking Clearly About Suicide in India , Mayer draws attention to the suicide rate among housewives in Puducherry — a whopping 63.6 in 2011, which is more than six times the national rate. Vikas Menon, associate professor of psychiatry at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), and in-charge of Crisis, the JIPMER-run suicide prevention centre, cites the prevalence of drug abuse. “It has broken down interpersonal relationships and led to the abandonment of women in families,” says Menon. Effective intervention and awareness programmes remain elusive. About 1,000 people who attempted suicide have been a part of Crisis since 2010. “The ratio of men to women at the clinic is 55:45. Since this is a central institute, it is possible that men who adopt more lethal methods are brought here. There could also be severe under-reporting when it comes to women,” Menon reasons.

Crisis does not have any exclusive study focusing on housewives. However, Menon says, unlike in the West where 90 per cent of the suicide attempts are associated with psychiatric illness, in Puducherry, 50 per cent of them have been impulsive action. Women at the clinic predominantly belong to the 20-35 age group. A piece co-authored by Menon and his colleagues in The Industrial Psychiatry Journal describes the study sample: out of the 312 cases in the clinic during the period of study, 137 were women, out of which 56.9 per cent were married and 63.4 per cent were unemployed.

Further south, Kerala too has grappled with high suicide rates, often topping the country. However, improved intervention both at the government and community level has helped bring change. Kerala is fifth on the NCRB data for 2014, with its suicide rate (number per lakh) of 23.9 still twice the national average (10.6).

The number of housewives committing suicide has always exceeded that of farmers in Kerala, says PN Suresh Kumar, professor of psychiatry at KMCT Medical College and chairperson of Thanal, a unit of Befrienders India/Samaritans in Kozhikode. For a small State, Kerala has better preventive mechanisms in place. Befrienders India/Samaritans alone helps run at least five suicide prevention helplines across the State, including one in a small town such as Kodungallur.

“In the first three-four years of Thanal, we would receive 25-30 calls a day. Now, it is usually less than five,” says Kumar. Among housewives, the issues mainly involved family problems and the husband’s alcoholism.

“Women’s empowerment initiatives such as Kudumbasree and ayalpakkavedi (neighbourhood projects) have helped,” adds Kumar. If suicide rates in Kerala haven’t spiked in recent years, Kumar credits it to a multi-pronged approach. “Even religious groups organise counselling and women’s self-help groups have brought in economic independence in small towns.”

Nupur Dhingra Paiva, a Delhi-based clinical child psychologist who teaches at Ambedkar University, peels away the layers around women and depression. If a significant chunk of women committing suicide are housewives, Dhingra blames it on the systemic neglect meted out to them. As a child psychologist, her first encounter with a woman in crisis is through the child. “A closer look at post-natal depression shows it merely isn’t about childbirth. It has a history,” says Dhingra.

Epidemiologically, women are more susceptible to depression, and Dhingra faults the social construct — one where women have few avenues to express their anger — for this. “Depression is a reaction. It is anger turned inward. Women are finding themselves increasingly stuck,” she explains.

Status quo — keeping women uneducated and neglected — stokes problems. But so does change. A society in transition and changes in lifestyle have heightened conflict. “When you educate a woman, you create dreams. And when they are rebutted, it creates anger. The women seem to say, ‘First you send me to school. Now when I have an opinion, my mind is not valued.’ That creates greater conflict,” argues Dhingra. She uses this rationale to explain the higher rates of suicide among the southern States.

Mayer believes it is imperative to make a distinction between the number of housewives committing suicide and the rate per lakh. “The increasing number is mostly due, I think, to the growth in population. The rate is relatively steady, and might even have been falling slightly in recent years,” Mayer says in an e-mail. After a spike in 2011, when the suicide rate among housewives hovered close to 20, it dipped and stabilised around 15 in the subsequent years. The rates, however, consistently remained above the national average and the farmer suicide rates.

Except for farmer suicides, says Mayer, India’s overall suicide ‘crisis’ remains woefully neglected. Marriage, which implies a sense of “protection” from suicide in industrialised societies, works differently here. Except for Chhattisgarh (a puzzle!), the highest rates for suicide by housewives are in the South and West Bengal, says Mayer. By contrast, dowry deaths are most prevalent in Haryana, Delhi, Uttar Pradesh, Bihar, Rajasthan and Madhya Pradesh. This seeming dichotomy leads him to hypothesise that “higher rates of literacy and female empowerment have a role to play. There is, quite probably, much in the traditional explanation that greater individualisation (being able to imagine a different life-course for oneself) makes a small number of women consider that their married lives are unsupportable”.

Mayer has also documented nuances, particularly transitions in the nature of marriages. In Kerala, suicides among women were more prevalent in rural areas, while in UP, it was higher in the cities. “The transition to more ‘companionate’ marriages has become almost normal in cities in Kerala; the most acute tensions which arise in the period of transition now seem to have moved to the mofussil. In UP, the transition is just beginning, and the tensions are felt first in the cities.”

Effective interventions continue to be scarce. The lack of supportive NGOs is noticeable in the North, he admits. While the South may be better off in this aspect, he insists that even these are not nearly enough. “Access to help, treatment for depression, and education in schools and for parents and friends about the warning signs, are all measures which seem to help a bit.”

At the Delhi Commission for Women (DCW), chairperson Swati Maliwal Jaihind intends to provide despairing housewives the help they seek. This includes offering suicide prevention counselling under 181 — the DCW helpline — wherein “a housewife in distress is immediately connected to the right counsellor.” Jaihind knows helplines are not the only solution. Now that the DCW has been sanctioned an enhanced budget, Jaihind wants to set up empowered mahila panchayats in the community. “When housewives become a part of campaigns, approaching someone for help becomes easier. Helplines are the last resort. We need interventions on the ground,” she says.

Working with Ratnaboli Ray at Anjali, an institution in Kolkata that rehabilitates people with mental health issues, are several housewives who once found themselves on the brink. “Suicide goes beyond the territories of caste and class,” Ray says on the phone from Kolkata. Economic dependency can be debilitating. “Domesticity takes a toll. It is a burden to be the accommodating housewife. However, there isn’t enough cogent research on the vulnerability of housewives.”

Part of Ray’s team is Shamoli Das (name changed), a housewife who is now also a trained primary health worker. She also happens to be a “suicide survivor”.

“She was married early. Her husband never stood up for her and the in-laws treated her badly. The burden of being a housewife, a mother, a young wife and daughter-in-law was daunting. She felt alone and attempted suicide,” says Ray. Anjali reached out to her, rehabilitated her and, finally, trained her. Das today takes care of one of Anjali’s kiosks and spreads awareness about mental health. Das had a second chance. Others were not so lucky.

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