A study conducted by the department of community health at the Christian Medical College, Vellore, made the alarming finding that suicide accounts for one-half to three-quarters of all deaths in young women and a quarter of deaths in young men in southern India.
Also read: South India: World's Suicide Capital
Dr Anuradha Bose, associate professor in paediatrics who also works for the CMC's department of community health, was one of the members of the group that conducted this study.
In a telephone interview with Contributing Special Correspondent Shobha Warrier, Dr Bose discussed the impact of the study.
What was the reason for conducting such a study?
In the department of community health, data has been collected on a regular basis for the last 18 years or so on causes of death. We have all this information available to us. We looked at the causes of death in children between the ages of 1 and 10, and contrary to what we expected, the single largest cause of death among them was drowning. It took us by surprise because we were under the impression that it was infectious diseases like diarrhoea that caused most deaths.
Was this study conducted all over India?
No. The department of community health, CMC, works in the Kaniyambadi block of Vellore district which has a population of one lakh. This village is situated right next to Vellore. We have information on a lot of things in the block as the department has been working here for many years. In this block, the single largest cause of death among children aged 1 to 10 was drowning.
That made us wonder what the cause of death in the next higher age groups, that is, 10 to 14 and 15 to 19, would be. We pulled out the information from our health information system. When we looked at the causes of death in the age group 15 to 19 from 1992 to 2001, we found that suicide was the largest cause of death.
Let me tell you about the words injury and accident. Accident implies that you can do nothing to prevent it. When you use the word injury, it is understood that you can do something to prevent it. Injury is classified as unintentional injury and intentional injury. Intentional injury is suicide, homicide, and acts of war in any form. Everything else comes under unintentional injury.
If you look at the causes of death in the age group 10 to 14, unintentional injury was the single largest cause of death. In the 15 to 19 age group, intentional injury, that is, suicide was the largest cause of death.
Did this also come as a shock to you?
It did not come too much as a shock. But when we compared the figures elsewhere in the world, we were shocked to see that it was so much higher than what was reported elsewhere previously in India or in other countries; not just in high income countries, but even in countries like Sri Lanka.
The rate for boys was 58 per 100,000, and for girls it was 150 per 100,000. The rates are so high that if this happened with a disease, you would actually conclude that something has to be done immediately.
Once you had this information, did you try to find out the reasons for this high rate of suicide among girls in south India?
My own thinking is that girls commit suicide more frequently because this is a manifestation of what we call the gender bias against the girl child in Indian culture and Indian society. They are driven to it when families fight, or they fail in the exams, or if they cannot fulfil their love life, or sometimes when the girls feel they are a financial burden. But our study did not exactly touch upon why this happens... We do not know why they took suicide as an option.
We are continuing our study, but we need a fairly large amount of information before we can say anything with certainty.
It was reported that a similar study found higher rates of suicide among girls in China, Singapore, etc. But the situation is different in the so-called developed countries. Has Asian culture got anything to do with this?
In most high-income countries, boys do not talk about suicide, but kill themselves more often. The methods they choose are such that they cannot be saved. On the other hand, girls may talk about killing themselves more often, but usually the methods they choose are such that they can be saved.
In India, they [suicidal girls] use hanging or take pesticide. In a remote village, if they take pesticide it is impossible to save them. The girls also burn themselves. In India, they use more effective methods.
China and Singapore have reported higher suicide rates in women of a slightly older age group, but the rate is not as high as what we have in India. If it is 25 per 100,000 for men in China, it is 30 per 100,000 for women. It is higher, but it is not as dramatically high as it is here. At the time the Chinese data was published, it took the world by surprise because most of them thought men committed suicide more often.
It might have something to do with the Eastern culture. Definitely in our society, it is because there is so much bias against girls. Maybe the girls feel less in control of their lives.
The results of the study are alarming...
It is terribly sad. Every time there is a death, the health worker in the village tells the story behind the death to us. It is written on the back of the death report. Some of the stories are quite sad.
One of the girls wanted to marry a boy who belonged to a different subsect from the same caste. But there was opposition from the family. So she killed herself.
Have the rates increased over the years? Has society become more rigid?
The rates are not going up. We looked at the data from 1992-2001. There was not much variation in the rates; it is almost the same. We haven't looked at earlier years though.
Do you feel Indians as a race are more vulnerable or hypersensitive?
I don't think we are racially any different in terms of our emotions. Obviously there is something in our culture that says suicide is an option. But exactly what factor, we don't know.
Why do you think the incidents of suicide are more in southern India?
It is more here because I think it is properly monitored. We have health workers who live in the villages and they know what is happening there. This kind of system is difficult to duplicate. We have an excellent system of surveillance.
You mean, there won't be much difference between southern India and the rest of India?
I think so. I don't know that for a fact. I think if you could put this kind of system in place, you may find similar high rates elsewhere in India. I don't know much about the culture in the North, I am afraid.
Now that you have come out with such a finding, would you be looking at educating society to prevent these incidents?
Our department feels this is something that needs to be urgently addressed. We have started family counselling work. It has been there for a few years now. The department carries out what is called family life education among high-school students. We talk to them about sex, relationships, etc, and we think that might help.
We have made a small start. We are very much aware that we need to do much more.
Image: Uday Kuckian