Reprinted with permission from the Thomson Reuters Foundation
As an advocate working in a research institute, I rely on evidence to understand and underscore the importance of issues. Over the years, when arguing for expanded sexual and reproductive health information and services for youth worldwide, I’ve often cited the fact that maternal mortality was the leading cause of death for adolescent girls aged 15 to 19.
It was a compelling case: Girls who become pregnant young are at higher risk of dying in pregnancy and childbirth than those whose bodies are more mature. For far too long, poor or nonexistent access to sexuality education and youth-friendly health services, as well as the perpetuation of harmful societal expectations and gender norms that compelled girls to marry and give birth young, led to high numbers of maternal deaths.
Recently, I learned that the evidence has changed. Largely as a result of improvements in maternal health worldwide, maternal mortality—while still a leading cause of death—is no longer the number one killer of adolescent girls. That’s the good news.
The bad news? Suicide now tops the list.
Suicide kills more girls between the ages of 15 and 19 than any other cause—more than pregnancy, HIV/AIDS, road injury and diarrhoeal diseases. In every part of the world but Africa, suicide is among the top three killers of girls in this age group. The suicide rate in South and East Asia is particularly shocking; in this region, it is five times higher than in Europe or the Americas.
The World Health Organization (WHO) released a landmark report this month called Preventing Suicide: A Global Imperative. The report offers insights into global rates and causes of suicide, stressing the need to make suicide prevention a higher priority on the global health agenda. It sheds light on some of the key risk factors for suicide, including, among others, discrimination, trauma, abuse, relationship conflict, social isolation and barriers to accessing health care. The evidence also suggests that adolescents who are socially and economically marginalized have the highest risks for suicide. While WHO’s report does not focus on how suicide affects adolescent girls specifically, we know that these particular risk factors are all part and parcel of the daily lived experiences of marginalized girls around the world.
The limited evidence we have about married adolescent girls, for example, suggests that they are more likely to experience intimate partner violence than their peers who marry later, and that they often face feelings of hopelessness, helplessness and depression. A study conducted by the International Center for Research on Women in India, for example, found that girls who married before 18 were twice as likely to report being beaten, slapped or threatened by their husbands than girls who married later. Child brides face social isolation, are subject to early and unwanted sex and typically don’t have the skills or agency needed to succeed in a relationship.
The evidence also demonstrates links between unwanted pregnancy and suicide. Particularly in contexts where girls have little or no access to sexuality education, contraception or safe abortion, and where they are expected to abstain from sexual activity before marriage, some pregnant girls may feel that suicide is their only option.
As educational attainment improves and mass communication expands across the globe, adolescent girls are given ever greater glimpses of the world in which they could live. They may dream of becoming pilots, teachers, doctors and politicians, but if societal norms and economic realities force them to become only submissive wives and fecund mothers, what happens to their mental health?
If a girl does have the opportunity to study or to work outside the home, but faces the daily threat of being attacked by acid or bullets, how can she possibly retain her mental health?
It’s important to note that harmful gender norms also contribute to suicide among boys. In 2012, as many boys as girls in this age group died as a result of self-harm. As ICRW’s research about masculinity in the Balkans, as well as fantastic work from organizations like Instituto Promundo and the MenEngage Alliance have shown, strict interpretations of what “makes a man” can also lead to self-harm by boys and young men.
WHO’s recent report provides a good perspective on the significance of suicide as a global health issue, as well as some recommendations for preventive action. Understanding the drivers of self-harm are critical in determining how best to act. In particular, we need far more evidence about the harms that “traditional” gender norms pose to the mental health of both adolescent girls and boys. Moving forward, the global health and development communities must continue to prioritize sexual and reproductive health, but must also increasingly address the drivers of suicide in order to make significant improvements in adolescent health and mortality.