Women at receiving end as Covid-induced mental health crisis looms large

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Another Mental Health Day (MHD) has just passed off. The life-shattering impacts of the pandemic has catapulted the number of mental health cases in an unprecedented manner, while the critical mental health services in 93% countries remain disrupted (WHO). In such a gloomy scenario, the President, World Federation for Mental Health (WFMF), Ingrid Daniels, expressed concern that ‘women are reporting greater levels of anxiety and depression’.

 
As the world struggles through illnesses, bereavements, social isolation, income and job losses et al, the predictors of poor mental health like fear, anxiety and emotional distresses grip the troubled humanity. A global analysis of data (January 01, 2020-January 29, 2021, Lancet) in 204 countries and territories, revealed an additional case load of 76.2 million in major mental disorders (MDD) and 53.2 million in anxiety disorders, out of which, 35 million cases for MDD and 52 million for anxiety disorders were of women, as compared to 2019. While, according to CARE’s Rapid Gender Analysis across 38 countries this year, the number of women, who suffered from COVID-19 related mental health impacts, was found to be threefold more than that of men. Nevertheless, a  Lancet study observed that ‘the gender difference is on the expected lines, as women are already more susceptible to depression and anxiety disorders due to pre-existing socio-economic and cultural disadvantages’.

While, a first of its kind review and meta-analysis of information gathered from 32-countries and more than four lakh participants in 2021, reported that the ‘high prevalence rates among women are the direct effects of the fear of the contagion and perception of danger from the COVID-19, and indirect effects of the adverse economic fall out, particularly in countries with larger domestic outbreaks, low health system preparedness, and high economic vulnerability’(Nature). A survey by a global mental health network to gauge stress levels in the Indian population during the pandemic, showed that 66% of women being stressed, compared to 34% of men. While, marginalised women like sex workers or trans women endured extreme emotional and physical vulnerabilities in the absence of any financial relief or support system, said the Mariwala Health Foundation, which works for making mental health services accessible to them. 

 
While the UNWomen has unequivocally declared that the ‘pandemic is not just a health issue, but, a profound shock to societies, exposing the inherent deficiencies which compel women to play multiple  and underpaid roles’. In the past, many research studies linked women’s greater psychological, psychiatric risks to their subservient socio-economic and cultural status, and underscored the imperativeness of looking into them through ‘lifestyle’ factors, instead of from the ‘individual angle’. Yet, the gendered aspect, which determines a woman’s standing in society, her control and power in a family, and, consequently, her ability to retain mental equanimity in the face of stressful life events like poverty, hunger, malnutrition, unremitting responsibility of caring, stressful reproductive cycles, violence, and sexual abuse et al, so far, received  scant attention. 

 
In this pandemic, the fatality rate among women may be lesser, yet, they, as frontline workers and at home, became the victims of ‘shadow pandemic’. A global study estimated that ‘a prolonged lockdown for six months is likely to result in 31 million additional cases of gender-based violence’. In India, the National Commission of Women recorded a 2.5 times increase in domestic violence cases (February and May 2020). A field survey in August, 2020 in six States in North India reported that ’more than 30% of the female respondents complained about feelings of depression, exhaustion, anxiety, and worsened perception of safety, as they lived through food insecurity and income losses’. Further, women with daughters experienced a greater sense of anxiety and reduced feeling of safety, it said. India witnessed a 50% spike in incidents of child marriage within the first few months of pandemic in 2020 (NCRB) and trafficking, while, 13% of girls faced sexual abuse during the pandemic, said a field survey (May-July 2020) by a group of NGOs in Delhi, Haryana, Jharkhand, Uttarakhand, Odisha and Chattisgarh. In high-income urban settings, working mothers with young children experienced tremendous mental stress due to the lack of childcare facilities and pressures of home schooling.

 
Nevertheless, even in the pre-pandemic era, mental disorders constituted one among the leading causes of the global health burden, and two most disabling mental disorders like depression and anxiety ranked among the top 25 leading causes of the disease burden.(GBD, 2019) About,13% of the world’s population have been affected by the mental health and substance use disorders, 12.6 percent of males and 13.3 percent of females. 

 
While mental disorders are now on the rise in every country, a UN policy brief cautioned against ‘the historic underinvestment in mental health needs’. A Lancet study indicated that the countries spend even less than 2% of their health budgets on mental health. In India, it is less than 0.5% of the total health budget, which itself is marginally above 1% of GDP. Researchers (Lancet Psychiatry,July) have also cautioned that ‘the huge psychological toll of COVID-19, will create enormous demands on the health systems’, while, some rued that ‘most national surveys tend to report aggregated findings, without stratifying by gender, which gives limited insight on women’, even when a large number of women put up with post-traumatic stress disorder, anxiety, and depression across nations (Johnson, 2021).

 
The COVID-19 pandemic is a wake up call for the nations to ensure the mental well-being, as a priority health issue, and go for a more integrated, holistic and multidisciplinary approach for a stronger, healthier and inclusive world.

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The author is Former Director-General, Doordarshan, & All India Radio, and Former Press Secretary to the President of India.



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