Most of my fellow guests worked in the fields of global women’s rights or female health. Yet they were as stunned as I was to hear it.
“I’m not quite sure why we haven’t realised this before,” says Suzanne Petroni, a senior director at ICRW. Suicide has edged into first place “because maternal mortality has come down so much,” she says.
“Which is fantastic. But self-harm was pretty close to being the leading cause of death, even in 2000.”
The picture varies by region.
In Europe, it is the number one killer of teenage girls. In Africa, it’s not even in the top five, “because maternal deaths and HIV are so high,” says Petroni.
But in every region of the world, other than Africa, suicide is one of the top three causes of death for 15 to 19 year old girls. (For boys, the leading killer globally is road injury).
It’s particularly shocking given that suicide is notoriously underreported.
Leading causes of death for teenage girls
- Self-harm
- Maternal conditions
- HIV/AIDS
- Road injury
- Diarrhoeal diseases
Source: WHO
In South East Asia, self-harm kills three times more teenage girls than anything else. (The Eastern Mediterranean, which includes Pakistan and the Middle East, has the second highest rate.)
Professor Vikram Patel, who was recently featured in Time magazine’s 100 Most Influential People for his work in global mental health, is blunt in his diagnosis:
“The most probable reason is gender discrimination. Young women’s lives [in South East Asia] are very different from young men’s lives in almost every way.”
The male suicide rate in this age group is 21.41 per 100,000, compared with 27.82 for girls.
This is the age at which girls may be taken out of school and forced to devote themselves to domestic responsibilities, forgetting all other abilities or ambitions. Hitting puberty can mean no longer being allowed to socialise outside the home. Sometimes it can mean no longer being allowed out of the home at all. And, sometimes, it can mean forced marriage.
Prof Vikram Patel (Roger Dekker for WIRED)
Prof Patel was the founding director of the Centre for Global Mental Health at the London School of Hygiene and Tropical Medicine but now spends much of the year in Delhi, where he works for the Public Health Foundation of India.
“Indian media is filled with aspirational images of romance and love,” he says. “The ability to choose your life partner is an idea that’s championed by Bollywood. But that’s completely not the case in reality for most young women.”
Young brides, says Suzanne Petroni, “are very often taken away from their peers. They’re subjected to early and unwanted sex, and they’re much more likely to experience partner violence than people who marry later. All of these things put them at greater risk of suicide.”
In India, says Prof Patel, “female suicide rates are highest in parts of the country with the best education and economy, probably because women grow up with greater aspirations only to find their social milieu limits them.”
In Prof Patel’s view, “fifty per cent of those attempting suicide in China and India do not have a mental illness. They suffer logical despair.”
The adolescent male suicide rate, though lower, is also extremely high in this region. Prof Patel’s interviews with survivors of suicide attempts have led him to believe that, “for girls, gender issues are usually behind it. For boys, it’s financial insecurities.”
Boys face great pressure to succeed and provide. Which strikes me as a gender issue, too – it’s a different problem from those suffered by women, but it’s still a problem rooted in a rigid gender role.
Leading causes of death for teenage boys
- Road injury
- Interpersonal violence
- Self-harm
- HIV/AIDS
- Drowning
Source: WHO
In the UK, says Joe Fearns, the Samaritans‘ Executive Director of Policy and Research, “all of us in suicide prevention are most concerned by men.”
That’s because almost 80 per cent of all UK suicides are men. But, says Fearns, “the majority of self-harm cases in the UK and presentations at A&E for self-injury are women.”
Part of the reason for the dramatically higher rate of male suicide in the UK (and in most of the western world) is drugs and alcohol; men are more likely to abuse both, leading to more impulsive behaviour.
“Men also tend to use more violent means that are less survivable,” says Fearns. Some of this is circumstance. Fearns tells me there is a higher than average rate of suicide among those working in heavy construction and farming – “because they have the means”.
Far fewer women than men work in these environments.
Concepts/Alamy
Prof Patel sees a similar reason behind the much higher female suicide rate in South East Asia than the UK.
“The suicide attempt rate for young women in the UK is extremely high. But young women are overdosing on paracetamol, which won’t kill you.” Their counterparts in Asia, he says, are more likely to have pesticide to hand than painkillers – “and that will”.
Dr Amy Chandler, a research fellow at Edinburgh University who specialises in self-harm and suicide, agrees. “If you’re upset and you’ve got access to the means, you’re more likely to complete suicide,” she says. According to Prof Patel, “in young people, suicides tend to be impulsive” – making circumstance all the more important. “Most young survivors tell me they’re relieved they’re not dead,” he says. “That’s not the case with older adults.”
Western girls are more likely to self-harm than boys, says Chandler, and “their explanations for doing it are around control: their body being a site where they can exert control. Boys have other routes for expressing anxiety and distress,” such as fighting.
Girls turn to self-harm, she says, “because it’s not acceptable for them culturally to express anger in the same way”.
Bloomberg
Prof Patel believes “sexual pressure” may contribute to the unhappiness of teenage girls in the West, along with experiencing their first bumps against the glass ceiling. Also, in some European countries (and plenty of non-European ones), access to abortion is severely restricted.
Suzanne Petroni of ICRW tells me there’s evidence suggesting this leads “some pregnant girls to feel that suicide is their only option“.
“Gender is a pervasive global issue,” says Prof Patel. “Though it’s clearly far worse in some countries than others”.
“It’s very difficult to identify someone’s motivation when they harm themselves,” says Joe Fearns. But, he says, “groups that have less power” tend to be most vulnerable – suicide rates are consistently higher among the unemployed, and the economically or socially marginalised.
Young women in parts of the Middle East and South East Asia are some of the most disempowered and marginalised people in the world.
And, as we’re somewhat belatedly realising, the consequences can be fatal.
