Suicide is a major cause of death around the world. Are developing countries of South Asia equipped to handle this challenge?
The World Suicide Prevention Day is held on September 10th every year since its creation in 2003. The event, organised by the International Association for Suicide Prevention (IASP) revolves around issues such as improving education about suicide, disseminating information, decreasing stigmatisation and, most importantly, raising awareness that suicide is preventable. The event is being co-sponsored by the World Health Organisation (WHO). To highlight the importance of keeping cultural context in view when devising strategies for suicide prevention, the chosen theme for 2009 is "Suicide Prevention in Different Cultures.”
The magnitude of this problem is highlighted by the statistics provided by the WHO. Suicide has been noted as the leading cause of death in individuals under 35 - an estimated 10 million people attempt suicide while one million actually succeed in ending their lives every year - that's one death every two minutes. By 2010, the WHO estimates the number will climb to 1.5 million.
South Asia is home to a major part of the world's population and is estimated to account for up to 60% of all suicides. Though the WHO warns of rising suicide trends worldwide, the Dutch suicidologist, Diekstra fears that the most dramatic increase in suicide mortality in the next decades will be observed not in the developed world but rather in the developing countries. Statistics from the WHO on suicide in some South Asian countries seem to support Deikstra's trend predictions:
• In Bangladesh, the number of suicides between 1972 and 1988 averaged at 600 suicides per month, while 1992-1993 saw an increase of 984 suicides per month. The total number of suicides reported to the Forensic Medicine Department of Dhaka Medical College indicates that suicides have increased from 12 per month in 1989 to 18 per month in 1998.
• Suicide rates in India average at 11 suicides per 100,000 persons per year, an increase from 6 per 100,000 persons during the 1980s. While 89,000 persons committed suicide in 1995; the number increased to 96,000 in 1997 and to 104,000 in 1998, an increase of 25%. During 1988-1998, suicides increased by 33.7%.
• In Sri Lanka, it is estimated that nearly 50,000 persons have been killed in the last 15 years due to war. Deaths due to suicide, in the same period, are estimated to be 106,000 twice the number due to war. One study estimated the real extent of the problem was estimated to be at 44-50 suicides per 100,000 people. Significantly, the proportion of youth committing suicide increased from 33% in 1960 to 44% in 1980.
The trend of increased suicides in developing countries is further highlighted by other sources:
• The HRCP (Human Rights Commission of Pakistan) report for 2005-6 declares that total suicide and attempted suicide cases increased from 2,712 in 2005 to 3,919 in 2006. There were around 200 women suicide cases reported within the first six months of 2006 along with 181 cases of attempted suicide, most of the victims being under 30 years of age.
• While quoting The Khatmandu Post in the November 2008 issue, The Gulf Times reported that in Nepal, “the number of suicides reported by police rose by 40% in the past four years. Official statistics showed 2,789 suicides in 2007, up from 1,992 in 2004. The newspaper said 659 cases were reported during the first three months of 2008, keeping pace with the record 2007 total.”
• The BBC in July 2009 reported that according to official figures, Bhutan experienced its highest number of suicides in 2001 when 58 people killed themselves.With a population of just 682,000, the issue is of high concern in the country.
Suicide has become a grave concern for many South Asian countries, many of which are struggling with problems of massive corruption and mismanagement at every level. These alongside issues of poverty, unemployment, illiteracy, lack of civic facilities, poor access to health facilities, and disproportionate population growth are preventing the governments to adequately focus to solving the suicide crises. Governments spend only a small fraction of their national budget on social and health sectors which in turn enhances the frustration experienced by citizens on social and cultural pressures and thus drives many individuals towards self-destructive behaviour by inducing in them feelings of guilt, desperation, anxiety, and even serious mental health problems. Stigma and discrimination by society allows many of these health problems to go unchecked, with devastating results for the whole community.
Women in the South Asian countries remain particularly vulnerable to suicide because of numerous factors including social and cultural pressures, domestic and sexual violence, and undiagnosed or untreated mental illnesses. A World Bank study that focused on disability from neuropsychiatry disorders among women found that up to 30% women were affected in the developing countries as compared to 12.6% men. In Pakistan, a 2007 trend analysis report by the HRCP found young married women to be at highest risk. In Bangladesh, a 1996-97 survey on injury-related deaths among women found that suicides have a major effect on mortality among young married women and almost 50% women reported having suffered verbal, physical and sexual abuse at the hands of their husbands. Many women in patriarchal societies blame the effects of gender inequality to be a major cause of their low status and consequent distress.
According to WHO, preferred methods of suicide vary from culture to culture as do motivations: Of the suicide related attempts, suicide by hanging is chosen by 26% in India and 45% in Bangladesh while self-burning (immolation) is commonly adopted in India by 11% individuals indulging in Deliberate Self Harm (DSH). Ingesting household products is the commonest method adopted by 70% of suicide seekers in Sri Lanka and 37% in India. Reports suggest that this problem is particularly significant in rural areas. The rising costs of seeds, pesticides and fertilizers have resulted in heavy debts for farmers and have pushed them to commit suicide by ingesting the same pesticides because of their easy availability. Pesticide ingestion results in approx. 250,000 deaths each year globally.
There also exists a serious issue of underreporting in some South Asian countries that hinders effective management of the issue. Attempted and successful suicide is underreported because of social stigma and also because committing suicide is a criminal offence in some countries such as Pakistan. Hence, many suicides are reported as accidents and actual figures elude statistical collection, posing a constant challenge to prevention strategies. Effective data gathering is also important in order to identify high-risk groups and establish timely preventive measures.
For developing countries, suicide prevention is a challenge that has devastating consequences for the society as a whole. Fewer resources and inadequate social services offer a tough test that many of these nations are trying to overcome with help from local social activists and international humanitarian agencies like WHO and the IASP.
Initiatives are conducted to emphasise support for people under stress, addressing issues like domestic violence for women, restricting access to common methods of suicide etc. More focus on media education about responsible reporting, and public awareness campaigns for mental health de-stigmatisation is needed in order to change cultural attitudes. Healthcare professionals also need to be trained to identify risk groups and provide sustained help and support. In short, there has to be a committed, sustained effort by communities, world humanitarian agencies and governments if suicide prevention goals are to meet any success.
Published Sept, 09. Escapism from Life - Suicide in SouthAsia SouthAsia Magazine