In the Indian state of Kerala, women enjoy a uniquely high status. But depression and suicide rates are high, suggesting the need to look beyond traditional development indicators.
When 33-year-old Hemalatha, wife of a wealthy businessman in Kochi, a port city in the southern Indian state of Kerala, took an overdose of sleeping pills, relatives and friends were puzzled. After all, she had everything a woman could want, they said: a loving husband, two healthy children, a plush waterfront apartment, two housemaids and a chauffeur-driven car.
"But all the time I had the feeling that I was wasting away my life," says Hemalatha, who holds a first-class masters degree in English.
"My husband had forced me to quit my teaching job. He wanted me to stay at home and be the 'ideal' housewife. He could never understand why I wanted to keep my job when he was earning so much."
The once cheerful and fun-loving woman began to suffer from bouts of depression. "Now I can't do without anti-depressants," she says.
Hemalatha is among a growing number of women in Kerala suffering from mental disorders – mainly due to social, economic, cultural and gender-related stresses.
"The number of people with mental disorders due to genetic reasons remains more or less the same. But there is a visible increase in the number of women going to psychiatrists with depression and other mental disorders caused by social and economic reasons," says Dr Chennakkat Joseph John, chief psychiatrist at the Medical Trust Hospital in Kochi.
Ironically this is happening in a state that is considered to be a developing country-role model, particularly for women's development. The literacy rate for women in Kerala stands at 87.86 per cent, compared to the Indian average of 54 per cent. In fact, women's life expectancy, maternal mortality rate, infant mortality rate and fertility rate all compare favourably with those of many wealthy developed countries.
Dr T N Seema, former member of the Planning Board, which oversees the state's development, has an explanation: "Strides in women's literacy, education and health should have a corresponding impact on the status of women. But Kerala is a society where patriarchal values are so deeply rooted that women become more and more frustrated," she says.
With education women become more aware of their potential. But tradition, culture, family, society and state – all patriarchal in structure and ideology – have short-changed women.
The suicide rate among women is reported to be twice the national average. The Deccan Herald newspaper last year quoted Dr C R Soman of Health Action for People, a well-known NGO, as putting the suicide rate of women in Kerala at 27 per 100,000, compared to the national average (for both men and women) of 11.
However, the state registers a high suicide rate for both men and women – about three times the national average, although some experts say this may be because of inadequate suicide reporting in other Indian states.
Many suicides by women in Kerala are linked to depression and distress, according to a study by Dr Krishnapillai Ayyappan Kumar, former director of medical education, who has analysed suicide figures over from 1973-90. Husbands' alcoholism accounted for 18 per cent of suicide attempts and depression for 6 per cent, Kumar's study found.
According to psychiatrists and counsellors, failed marriages, separation, divorce and violence against women are key factors leading to depression.
A typical example is Sunitha, a 23-year-old lab technician who married Anoop, an advertising executive, after a two-year relationship. "We were good friends too," she recalls.
"I used to think he understood me well." But now, she says, "he is so possessive he doesn't even let me go out and meet my friends. He keeps the phone locked when he goes to work."
After a failed suicidal attempt, Sunitha had to be admitted to a private psychiatric clinic.
Statistics at the Crime Record Bureau show that incidence of domestic violence, molestation, abduction and 'eve-teasing' (euphemism for verbal sexual harassment in public places) are on the rise, though there has been a marginal fall in the number of rapes.
"The psychological effects can range from shock, anxiety, fear and humiliation to post-traumatic stress disorders," says Dr Seetha Lakshmi of the Kusumagiri Mental Hospital in Kochi.
But violence against women as a key health issue has yet to be recognised by policymakers.
Acute unemployment among women makes matters worse: while the total work participation has increased in the last decade, in the case of women a reverse trend has set in.
"In a society where around 85 per cent of women are categorised as non-workers, how can you expect them to be psychologically healthy?" asks Dr John.
Another area of concern is women's empowerment, which is related to their decision-making powers within the family and society at large. According to a nation-wide family health survey released in November 2000, Kerala lags behind some of its neighbouring states in this respect.
For example, only 66 per cent of women in Kerala have access to money, compared to 79 per cent in Tamil Nadu. Similarly, while 60 per cent of women in Tamil Nadu do not need permission to visit their friends or relatives, only 40 per cent of women in Kerala enjoy this 'freedom'.
But the state's Mental Health Authority is yet to form policies and programmes that would address the particular problems of women.
This gap is more acutely felt at a time when the globally-praised Kerala health model – essentially a public health and education model that aims at equitable distribution of these services between men and women, between social groups and between regions of the state – has collapsed.
Experts say this is due to the uncontrolled growth of the private health sector and consequent rise in the cost of medical treatment and marginalisation of the poor.
As it is, Kerala's economy has been passing through a severe crisis – largely due to a fall in international prices of agricultural commodities such as coconut, rubber, tea and coffee – which means funds for welfare and health schemes have practically dried up.
"The need of the hour is an intensive gender sensitising programme specially targeting men and policy makers. Non-governmental organisations and women's groups should take the lead," says Mini ukumaran, former director of a state education scheme for rural women.
It's not as if Kerala has slipped beyond repair. But there are paradoxes. Sukumaran notes that the district of Malappuram, which has been declared the first e-literate district in India, is also an economically poor district where teenage marriage and adolescent childbirth among traditional Muslim women are common – which also cause psychological disorders.
"If a little attention is given to women's problems in the district, many women can be easily saved from depression and suicide," she says.
M Suchitra is director of The Quest Features and Footage, a Kerala-based collective of socially-committed Indian journalists.