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As a country with extremely high perceived gender inequality, India has one of the highest rates of gender-based violence in the world, particularly towards women. Even within India, rates of gender-based violence vary between different states. A state-level study conducted by the Symbiosis Statistical Institute found that Delhi had the highest rates of violence and domestic violence against women in India, followed by Uttar Pradesh. On the other hand, Nagaland has reported the lowest rates of violence and domestic violence towards women in India. In a six-state study conducted by the World Health Organisation (WHO), it was found that 40% of women experienced physical assault by a male partner. This statistic is for reported incidents; the real number could be higher due to a lack of reporting. The lack of government intervention to help tackle gender-based violence contributes to this. However, this is not a recent development.
History of the Patriarchy in India
India has historically been a predominantly patriarchal society for generations, and the importance and emphasis on traditional values and customs may have contributed to the continuation of patriarchy in the country. The high rates of gender-based violence (particularly towards women) in India are maintained, and in some states, continue to rise due to the patriarchal social norms established over thousands of years. Historically, the role of women in society has undergone a series of changes with perceptions varying between castes. During the Vedic period in India (c. 1500 BC – c. 500 BC), women were given equal rights to men to participate in rituals and to uphold the dharma (referring to leading a righteous life). This allowed women to fight alongside men in wars, engage in festivals and philosophical discussions. The status of women gradually decreased, particularly around c. 200 BC – c. 200 AD. It is worth noting that the role women were expected to play in society varied hugely between castes (a discriminatory system still prevalent in India). For example, upper-caste women around this time were expected to stay at home and were prohibited from working outside the household.
One might argue that it is the caste system which has resulted in the continuation of patriarchy in India: while discrimination based upon the caste system is prohibited by the government, it still survives.
The discrimination against women continued, especially with the advent of the Mughal invasions in the eleventh century, where women were imprisoned as slaves or forcibly married. This led to further restrictions placed upon women, including restricting their education. It is important to mention that globally throughout history, wars have worsened the gap between the social status of men and women, and these results are not limited to this invasion. The British colonisation of India was a significant factor which contributed to the continuation of patriarchy in India. From the eighteenth century until India’s independence in 1947, British laws and customs were forced into Indian society. This included the reduction in economic freedom women had— particularly women of lower castes— as food-crops that were cultivated to ensure villages could remain self-sufficient were replaced by cash-crops such as cotton and indigo. The main loss for women as a result of this deindustrialisation catalysed by the British meant that indigenous industries were destroyed and replaced by machine-made cultivation systems by the British. By destroying industries which women were active participants in, such as textile, embroidery, silk manufacture and the selling of milk and produce, the economic self-reliability of women was reduced. The social and political freedoms of women were also eroded due to the implementation of British reforms.
Marriage in India
Historically, there has always been an expectation of women to be married and to raise a family. The traditional roles of women meant that they were expected to maintain the domestic aspect of the household, while their husbands were expected to ensure financial stability and govern the family. The aim of marriage was to provide security, stability and companionship and to be the core of the family. However, this led to the social mandate requiring most women to get married, thereby establishing high rates of child marriages. Within marriage itself, women (often young women who had married older men) were expected to be completely obedient to their husbands and were seen as inferior individuals (not just in India – this is a global trend). This image led to a rise in female infanticide, as the social pressures of women to bear sons were so high. Many mothers preferred to kill their daughters over subjecting them to a life where they would not be respected. This practice is a direct consequence of female devaluation in society. In marriage, the perception of men being superior to their wives has translated into gender-based violence against women, which includes assault and harassment.
Despite this, it is important to emphasise culture cannot be blamed for the prevalence of patriarchy in India – numerous other factors have contributed to this and pinpointing the blame towards cultural factors would be incorrect.
A misconception surrounding the devaluation of women is that it is a cultural norm, when in fact contemporary factors and systems (which are not consequences of culture) uphold these systems. These may include social and economic policies, as well as a lack of access to education and healthcare.
Perinatal Depression in India: Rural Rajasthan
The expectation of women to bear children soon after marriage continues to affect women in India today. The mental strain of raising a family on women (who are expected to establish domestic security in the house) has been historically ignored and misunderstood. Only recently is the prevalence and impact of perinatal depression among women being explored and combatted. The Mata Jai Kaur Maternal and Child Health Centre (MJK centre) is at the forefront of supporting women before, during and after pregnancy by providing quality healthcare. Situated in the rural and remote areas of Sri Ganganagar, Rajasthan, the centre has helped provide care to thousands of vulnerable women and children. One of the key programmes established by the centre is the Khushee Mamta Program, which aims to deliver basic psychosocial interventions and training counsellors to provide care for women with pre- and perinatal depression. This is the first programme of its kind in Rajasthan, where 20% of women are married by the age of 15 and 20% of women aged 15-19 have children. Pre- and perinatal depression among women can lead to higher incidences of poor pregnancy outcomes so tackling this issue is key in helping vulnerable women experiencing depression. A pilot study that tested the extent to which a community-based lay counsellor could deliver maternal mental health interventions was sustainably implemented across rural Rajasthan. This was done by monitoring and evaluating the Khushee Mamta Program over an intervention period of 18 months. 1290 women were screened, and the study included 155 rural towns and villages. 161 women had enrolled in the study, of which 19 had moderately severe or severe depression. The number of counselling sessions delivered to participants varied depending on the individual needs of the women. Using a PHQ-9 (a questionnaire designed to monitor the severity of depression and response to treatment), it was found that 86% of the patients improved. Despite the programme being in its pilot stages, the initial results are promising. Through volunteers and donations, the MJK centre is able to expand and scale up its amazing work.
Perinatal depression in India
In India, estimates of the prevalence of perinatal depression range between 6 – 48%, which has led to the acknowledgement of risk factors for perinatal depression which include domains such as economic status, child gender preferences and family and marital pressures. The age group most at risk of perinatal depression is 18-22 years. The lack of family support for vulnerable women and the prevalence of patriarchal systems in India have contributed to the prevalence of depression among these women. Postpartum psychiatric disorders (occurring after giving birth) can be classified into three broad categories: postpartum blues, postpartum psychosis and postpartum depression. Postpartum blues are relatively transient and may resolve soon after giving birth. It usually requires reassurance to dissipate. Postpartum psychosis is much more severe, requiring hospitalisation and often involving hallucinations, delusions and restlessness. Postpartum depression needs treatment, with studies indicating that children who have mothers with postpartum depression have higher rates of cognitive and behavioural abnormalities and have higher risks of being underweight than the children of non-depressed mothers. Management includes both non-pharmacological and pharmacological treatments. Non-pharmacological treatments include psycho-education and group psychotherapy. Involving the patient and family members can help mothers handle the responsibilities of motherhood better. Pharmacological treatments include medication management. The integration of diagnosis and treatment systems in healthcare is crucial in the early detection and treatment of perinatal depression. Implementation has been developed in high-income countries such as the UK and much of Europe. This is key in low and middle income countries, and can be achieved by implementing a stepped-care approach.
Through government support and funding, establishing systems for diagnosis and treatment of perinatal depression can help women who are vulnerable in India.
This is key throughout India, but especially in rural parts with lower access to healthcare and professionals.
Overall, the implementation of systems to help women at risk of suffering from perinatal depression requires support from larger bodies and organisations. Practically, this can translate into improved healthcare, social protection and more education etc. requiring the assistance of politicians, voters and policymakers to establish changes to existing outdated systems. However, another crucial step to supporting women is to improve gender equality and abolish the ancient and outdated systems which have historically oppressed women, preventing them from being perceived as equal to men and have led to obscene rates of gender-based violence towards women and children.
The stigma surrounding marriage, childbirth and upholding status is preventing women from accessing help, even though many are severely in need of it.
Through the reduction of social pressures placed on women, it is possible to improve the rates of perinatal depression in India, but this is a battle that needs to be fought globally if we are to make a meaningful difference.