A total of 77% of suicide deaths worldwide occur in lower and middle-income countries. The highest mortality rate due to suicide was recorded among South Asian Women in 2016 and 2019. Women are known to make more suicide attempts as compared to men. Despite these statistics, very little is known about the theoretical understanding behind the origination of women’s suicidality in South Asia.
Western theories rely on individual and mental illness factors to understand suicide. However, South Asian cultures marked by collectivism and an inter-dependent culture bring forward unique stressors. For instance, patriarchy affects women across the globe, but also differently in South Asia. For example, dowry which is a prevalent custom in South Asia is one such unique factor. In many cases, this leads to less power and autonomy for women as compared to their male counterparts. Moreover, specific sociocultural factors like marriage and the burden of childcare, which women have to bear across the globe but more acutely in parts of South Asia, have also been known to put South Asian women at risk of suicide.
To address this gap and further the understanding behind women’s suicidality, Pakistani feminist scholars studied the intersectional identities of Pakistani women with a history of suicidality. This means they looked at “women’s multiple identities as mothers, daughters, wives, and daughters-in-law, as well as women’s struggles within Pakistani’s socio-cultural and religious context,”. Their research sheds light on factors that bring feelings of suicidality among women.
The researchers conducted in-depth interviews with twelve Pakistani women with a history of suicidality. All the women were married; however, some had separated from their husbands. All of them had children. Except for one who was Christian, everyone else was Muslim. Some lived in joint families whereas others lived in an extended family system. Through the interviews, four major themes emerged that help in understanding the suicidality of women.
“The susraal (in-laws’ home) creates an intolerable and lonely ecosystem where women are actively excluded and diminished”
The women interviewed in the study shared experiences of suffering violence, abuse, and abandonment at the hands of their in-laws. Many women shared how they underwent chronic stress due to torture by their mothers-in-law as well as husbands. A woman in the study shared,
“We don’t get along. When I came to my mother’s house, [my husband] used to hit me. Then I would return to his house. I would stay there 3–4 days, then he would hit me so I would leave. He would always make some excuse, sometimes about clothes, sometimes about work. My husband always finds some deficiency in me. Sometimes he hits me with his hand and sometimes with a stick, blood would come out. He would lock me in the dining room and hit me.”
Unfulfilled dowry expectations led to continuous shaming of the women within their homes. Women felt helpless, unvalued, and replaceable. They longed for the peace that they had in their parent’s homes. To escape this unbearable suffering, they thought of suicide. A participant shared,
“If you are pareshan (worried), if you have no aasara (support) then what would you do?! You would wish to die to jaan choot jaye (get rid of the problems).”
The stories shared by women show a troubling pattern of violence that goes beyond the relationship of husband and wife. There is abuse and violence within households causing severe physical and emotional distress to women.
“Women struggle negotiating the morality of motherhood vis-à-vis psychological and social suffering”
Women having children prioritized their children’s well-being over their personal suffering. Their moral responsibility and obligation towards their children stopped them from attempting suicide. Responsibility in this case acted as a protective factor against suicide. Similar findings have been reported in India where migrant workers felt their own healing and well-being as defined by others around them, such as providing for their children and family in the village. Given the patriarchal setup that they live in, they shared how the burden of taking care of children falls on mothers. They understand that no one will look after their children once they are gone. A mother having a son shared,
“I think about [suicide] but then when I see my son then I stay quiet, I say that when he grows up then I will do what I need to do [suicide]. I have my son right now, who will I leave him with, no one provide for him, can’t give him anything to eat or drink.”
Their children also seem to understand the dynamic between their mothers and in-laws. They understand that they might have to face violence at the hands of their family if their mother is not there to protect them. A mother describing her conversation with her daughter said,
“When I lie down, my daughter comes and lies down next to me. I tell her, it’s better to die than live this type of life. Then she says why do you say such things. I responded, ‘does your chacha [paternal uncle] not say enough terrible things to me?’ Then she said, mother if you die, chacha won’t let us live in peace.”
It is their moral and future-oriented commitment towards their children that protects them against suicidality. However, such a moral dilemma of choosing between children’s well-being and ending one’s own suffering further increases feelings of despair within women.
“Diminished sabr (patience), unresolved grief, and longing for sukoon (peace)”
Patience and peace protected women against suicidality by helping them fight against unjust circumstances. However, due to increasing distress, they find their patience decreasing. Moreover, in handling multiple identities of being mothers, wives, and daughters-in-law while facing abuse and violence, there is no space left for peace. A woman shared,
“I cry a lot; I cry in private. I ask when will I find sukoon (peace), when will I get rid of these worries? When will everything be normal?”
Such lack of patience and peace significantly contributed to them feeling suicidal. A participant shared,
“I cannot tolerate more suffering, my sabr runs out. I was in such an ordeal that I wished zameen jagah dy aur main iss main utar jaon (the ground would open and swallow me whole) …”
Sabr and Sukoon allow women to become resilient in the face of hardships. But, their absence leads them to think more about suicide.
“Religious faith anchored women’s value for her life and afterlife”
Women’s belief in a higher power gave them the strength to endure difficulties. They reported that Tawakkul (the act of seeking refuge in Allah’s plan) provided them with patience. A woman shared,
“I have yakeen (faith). Whenever there is mushkil waqt (difficult time), Allah will support me. I will remember Allah, so there will be support, you know.”
Religious beliefs have been found to be important for women’s mental health. The study reported that women’s religious beliefs prevented suicide attempts. However, it did not contribute to decreasing suicidal ideation. Women shared that despite knowing that suicide is considered a sin, their distress pushes them to thoughts of ending their lives in order to escape the unbearable suffering. A participant shared,
“I say that Allah will give me death. Then, I think khudkushi (suicide) is haram … One time I tried [suicide] but then I asked Allah for forgiveness. This is a gunnah (sin).”
In some cases, these religious beliefs also led to a sense of shame, guilt, and worthlessness in women as they felt that they had betrayed and failed Allah by thinking of suicide.
Women’s Intersectional Identities in a Patriarchal World
The study revealed through women’s stories that marriage leaves them deprived of autonomy as well as safety. Stepping into the violent homes of their in-laws, their helplessness and isolation push them towards suicide. At the same time, it is their moral obligation towards their children that keeps them alive. The disproportionate burden of caregiving, especially childcare, acts as a protective factor against suicide. Women navigate and negotiate within their multiple identities while thinking of suicide. The researchers mention,
Women’s multiple identities underscore the interconnected nature of their internal struggles in the context of familial and societal expectations, offering a more comprehensive understanding of the factors influencing suicidal behavior in this population.
The study presents multiple insights in the context of understanding Pakistani women’s suicidal behavior; it is not without limitations. The study mentions that the participants faced constraints in terms of time and autonomy influencing the depth of the insights gathered from them. Moreover, they recommend that future studies should explore the views of other family members like husbands, in-laws, and children.
Research Article Citation (APA Style): Saeed, G., Mumtaz, S., Tanveer, J., Hamid, E., Jehan, S., Atiq, M., … & Hagaman, A. (2024). Maternal suicidality in Pakistan: Developing a critical feminist grounded theory to inform suicide prevention programs. SSM-Mental Health, 6, 100356.
https://www.sciencedirect.com/science/article/pii/S2666560324000616
Researcher Contact Info: G. Saeed [[email protected]]
Neha Jain
Neha Jain is a doctoral scholar at the Department of Humanities and Social Sciences, IIT Kanpur. In her doctoral work, she is exploring institutionalized and de-institutionalized mental healthcare settings in India to understand the nature of care and recovery in mental health through the experiences of various stakeholders. She is also a counseling psychologist trained in trauma-informed therapy and works through an attachment lens with people in their early adulthood years. Apart from therapy and research, she loves reading personal newsletters and listening to Desi rap music.