Discriminatory gender norms, mental ill-health and psychosocial distress

A range of social and environmental factors have been recognised by researchers such as Patel et al. (2007), Stavropoulou and Samuels (2015) and WHO (2010), as being key drivers of mental ill-health and psychosocial distress among young people. These factors include rapid social change, migration, social isolation, conflict/post-conflict environments, unemployment and poverty, individual and family crises, changes in traditional values and conflict with parents.  

Yet there has been little in-depth discussion around the role of gender norms in particular as underlying causes of mental ill-health and psychosocial distress. This is not to say that there is no awareness of the importance of gender norms as an influence. A welcome report by Kapungu and Petroni (2017) addresses this to some extent as does an article by Prateek Sharma on the links between patriarchy and the mental health of women in India. Norms that are framed in terms of ‘culture and context’ are often cited when discussing the mental health and psychosocial needs of displaced persons or refugees in humanitarian contexts, as shown by Hassan et al. (2015). In addition, a range of innovative tools have been developed to deal with issues of culture and context, primarily for use in humanitarian contexts (see Stavropoulou and Samuels, 2015, as well as websites for the Mental Health and Psychosocial Support {MHPSS} network and the Reference Centre for Psychosocial Support of the IFRC). 

Nevertheless, further study is needed to unpack and explore the pathways between context-specific gender norms and outcomes in terms of broader well-being. This is particularly true in relation to mental health and psychosocial well-being. While gender norms wield enormous influence at every stage of life, it is critical to explore the intersection of such norms and mental health and psychosocial well-being during adolescence because this is such a decisive moment. Girls and boys start to go through many developmental changes as they make the transition from childhood to adulthood. 

It is during this period that developmental changes occur (including bodily changes such as the start of menstruation for girls and deepening of the voice for boys) and key skills are acquired such as those that relate to: health and physical development; social behaviours and attitudes; and education and employment. More critically perhaps, the environment in which adolescents live and, in particular, the norms embedded in their communities that guide their behaviour, attitudes and social interactions, start to play a pivotal role in their lives. 

Adolescent girls, in particular, begin to feel the constraining role and influence of gender norms across their lives, from education and marriage to mobility and career aspirations outside the home. These gender norms often curtail the freedoms they once enjoyed: while a younger girl may be able to go out of the home relatively easily in a context such as Nepal, she is no longer able to do so once she reaches adolescence – or no longer able to do so on her own. Similarly, in Afghanistan and Pakistan, strict rules that enforce purdah aim to limit girls’ mobility in the public domain, as shown by Kabeer et al. (2011). 

Such restrictions are imposed because an adolescent girl in these settings is considered ‘marriageable’ and her honour (and that of her family) could be at risk if she moves around on her own. This loss of freedom often coincides with her being taken out of school, as her parents may see her marriage into a good family as a greater priority. As a result of all of this, the girl is likely to feel powerless or disempowered, unable to control her own destiny and future. Ghimire and Samuels (2014) find that she may lose hope and become anxious and fearful, particularly if she is being married to an older man (still a common practice in many contexts).  

Once she is married, a young bride can face psychosocial distress, as she is often living away from her natal home in an area where she knows no one. As an outsider, she can easily become isolated with no opportunities for social interaction and, therefore, no one in whom she can confide. 

One young married women interviewed in Viet Nam told the author that if it were not for her children, she would have taken her own life a long time ago. She was depressed at having married young (in an elopement marriage in her case), completely isolated and said that her husband was abusing her, a story captured in Samuels et al. (2018). 

China, which accounts for 26% of global suicides, is the only country where suicide rates among women are higher than among men, with between 25% and 40% more woman than men committing suicide each year. This is attributed largely to women marrying young, being isolated, taking on a disproportionate burden of household work, facing great pressure to produce a male heir and being denied the same level of education as boys. 

Norms also include implicit rules on how men should treat women, often based on contrasting and opposing notions of masculinity and femininity. Men, in short, should be seen to control women and particularly their wives, who are seen as inferior and subservient. In many contexts this male control can turn into violent abuse of wives, both physical and psychological. Such violence may be seen as acceptable by many people, including the wives themselves, because tolerance of violence is reinforced by a range of additional or intersecting norms that stop women speaking about it. 

Such intersecting norms include a perception that violence between a husband and wife is a private matter, that it is perceived as a husband showing ‘love’ for his wife. It also plays into beliefs that leaving a husband or divorcing him would bring such shame and stigma to both the woman and her family, and that staying in an abusive relationship is preferable (see Naved et al., 2017, for example). 

While such notions are changing, and there are examples of positive role models and champions in all contexts, they still persist. What’s more, new forms of violence are emerging, such as online or cyber violence as outlined by Samuels et al. (2017). All of these behaviours affect the mental health and psychosocial well-being of girls and women.