Suicide has been defined as purposeful and voluntary taking of one’s own life by a person. This self- killing behavior has become a major issue worldwide, with the rate of over 14.5 deaths per 100,000 populations, with the overall prevalence of suicide of one death every 40 seconds. Moreover, it is estimated that if the current trend of suicide deaths continues, then there will be approximately 1.53 million deaths each year, one death every 20 seconds, and one attempt every one to two seconds will occur by 2020.In recent years, incidences of suicide appear to have increased in Chitral and suicide has become a major public health problem. Reports from the local media of Chitral indicate that every month one woman dies due to suicide in the area, and the trend has been increasing since the last five years. From available evidence, it appears that most suicides occur in young people (married women) of the age 20-40 years. Relationship issues and domestic problems are the most common reasons for suicide. Mental illness is rarely mentioned. Lack of resources, poorly established primary and mental health services and weak political processes make suicide prevention a formidable challenge.So far no proper research work has been carried out by any individual or institution in order to explore the causes or reasons behind this issue. They merely count the heads of suicide committers, not the reasons behind it. In addition, due to the close family relations and small population size, the inhabitants of the district avoid stigmatization and they try to conceal suicide incidences. Thus, instead of the massive number of suicide cases, only few cases are reported to local media and police department. The reports in the health department only indicate the number of fatalities in the region, but not the cause of death.
Thus a study (family ethnographic approach) was carried out as the part of study theses by the researcher to discover the factors that contribute to the suicide among married women in Chitral, through exploring the experiences of 24 immediate family members of six women who had committed suicide during the last one year.This study revealed that following factors contributed to the suicide among married women in Chitral:
Poverty is defined as unmet human needs due to the unavailability of money to purchase services and goods needed to sustain life.In rural areas of Pakistan including Chitral, people have suffered with poverty which effects population in different ways. Due to the lack of money people especially women have lack of access to health care, food, and other basic needs. According to this study unemployment, illiteracy, and lack of women empowerment were the main reasons of poverty that led to suicide among women. Research has found that uneducated women were at high risk of suicide because of being financially dependent on others. Moreover, the male partners were also uneducated, which, most probably, increased the chance of suicide among women as men were jobless or labour and were not able to fulfill the needs of their wives and children and instead of fulfilling the needs of their spouse, they show violent behavior which makes women more susceptible for depression and psychological issues which lead to suicide.
2. Domestic Violence
Domestic violence or intimate partner violence (IPV) against women is recognized all over the world for its effects on women’s mental health.Several studies have further found that the prevalence of violence against women is higher in societies where gender roles are unequal in deprived neighborhoods, and among low socio-economic status families, especially where husbands are unemployed. The Pakistani society is male dominated, and the majority of women have to accept arranged marriages; further married women have to accept a certain degree of partner violence to secure the marriage and avoid social stigma. Studies have revealed that prevalence of physical violence was 76 % and psychological violence was>60 %. Physical violence is defined as slapping, throwing things, pushing or shoving, hitting, kicking, dragging, beating or burning. Psychological abuse was defined by four items: insults or making the woman feel bad about her, belittlement or humiliation in front of others, scaring or intimidating her on purpose, and threatening to hurt her or someone she cared about. The research indicated that suicide was considerably higher among women exposed to any form of violence as compared to women not exposed to violence. The category of ‘Feelings of worthlessness’ was also highly prevalent among those subjected to physical and psychological violence. Suicidal thoughts were strongly associated with all forms of violence. Women subjected to any of the forms of violence were as the most important reason for suicidal thoughts. The current study revealed that all married women face some kind of violence in their lives. This again raises question in the mind of the researcher that if the majority of the women are victims of violence, then why do a few commit suicide? The answer might be that the circumstances and intensity of violence may be different or women try their best to apply the learned set norms to cope with the difficulties of life and a majority of them succeed in coping with them. While a few feel exhausted and start to find other means to escape; such as they commit suicide.
3. Imbedded Cultural Norms/Customs
Some of the restrictive norms of the Chitrali culture have restricted women to their homes, because they are considered as the honour of the family and going outside and meeting unknown people might destroy this honour. Due to this lack of autonomy, their decisions were effected; like timely access to health care; proper hygiene and grooming; having a social life to share feelings; visiting or calling parents and friends; and going out when invited, all these were compromised. Research findings showed that some of the suicide victims were even not allowed to talk to their parents on phone or to make a cup of tea for someone without in-laws’ permission. Research participants verbalized that they face these issues on routine basis and face and tolerate them considering as part of married life but some women become more psychologically effected and commit suicide.
4. Infertility or not having a male child
This study identified that the women who were infertile or did not have male child, were been abused physically, psychologically, and through threatens of divorce. Thus, the fear of being divorced, and of violence, had different negative effects on the victims, like stress, anxiety, depression, hopelessness, helplessness, fear of rejection by parents and thus they committed suicide.
5. Relationship issues
Different relationship issues such as lack in parental support, in-laws’ interference, mis matched marriage, and extramarital affairs were the relationship factors that contributed to the suicide among women.This study also revealed that poor parental support, being rejected and neglected by parents in childhood or young age, death or divorce of mother in early age, and authoritative parenting style were related factors with higher rates of distant behaviour, anxiety, depression, actual violence or fear of violence were been observed among women who committed suicide.
6. In-laws Interference
Interference of in-laws in the couples’ life, results in an unsatisfactory marriage life, gap in the relationships among couples, and husbands’ failure to fulfill the basic needs of their wives. Moreover, there are some stereo type cultural values and beliefs, such as showing affection towards wives and caring for wives is considered as a weakness of the husbands and it is called zanmureedi in Chitrali proverb which means (being servants of wives). Due to the fear of this stigmatization, in spite of having love and respect, husbands cannot show it to their wives. Moreover, husbands cannot buy anything for their wives as individuals; they have to buy the same thing for everyone in the house. This interference in the married life of couples led to lack of access to physical, psychological, social, and sexual needs, which further added to the women’s the feelings of rejection, inferiority, worthlessness, hopelessness loneliness, dependency, fear of being abused and divorced, depression, and stress which are strong predictors for suicide.
7. Lack of support from family/community/society
Almost all women who committed were victims of violence. Majority of the victims had tried to raise their voice against the abusers. First of all they informed their parents, family members, community and some local organizations such local council, but instead of helping them, they blamed the women for being the reasons of issues. This shows that women arewith lack of support from family, community, society, and even country level which increases the risk for self-harm to get rid of the bitter life.
8. High expectations from women
In our culture women will be considered good if: they are not selfish, tolerate criticism, are empathetic with all, reliable, able to organize everything’s or tasks, always compromise in difficult situations, and respect and keep good relationships with everyone in the family. Not only this, women are considered passive, hesitant, and weak in making decisions. Thus, they have been delegated with the household and agricultural roles and responsibilities. Women are expected to plough and furrow like a farmer, graze animals as a shapered, harvest crops like a tractor, rear children as they are mothers, and care for husbands and in-laws as they are daughter’s in-law. In simple word, in Chitral women to be lived just like an angel that they are not allowed for any mistake. These expectations make the women overburdened which puts negative effect on their physical and psychological health and make them susceptible for suicide.
9. Social stigmas
Being stigmatized after divorce is major reason of suicide among women in Chitral. Participants of this study shared a famous prayer, which all Chitrali parents recite before and after their daughters’ marriage “Khudaixurmodiar, kidoyan e nasibo sum diar”, ‘ May God not give one a daughter, if He does, she should have only one marriage.’ The background is that, in Chitral, divorce is considered a big dishonor for women as well as for the family. Therefore, parents are more conscious about their honor rather than the lives of their daughters. This behavior of parents makes women more prone to violence and suicide. Moreover, daughters also witness when their mothers compromise for every challenge and they either adopt the same or commit suicide to get rid of the difficult life.
10. Lack of legislative support
The unsatisfactory role of the policy in women related issues is another reason of suicide among women.Although, article 25 of Pakistan’s constitution says: “all citizens are equal before the law and are entitled to equal protection of law” but, unfortunately, the women who are victims of violence have no access to report to the police, since there is no women police station in the district. Moreover, the majority of the women are not aware of their rights to complain. A few of them know about but they do not consider going to the police because of the fear of being stigmatized for going to a male police station. The findings revealed that the victims who try to access the police station are ignored, because of the male dominant society and political interference. Moreover, if women want to go to inform the police about the bad treatment by in-laws, the parents do not allow them, and if they insist, the parents also abuse them, because the parents fear the abusive behaviors of the police in the police stations.
The current study, most probably the first ethnographic research in the context of Pakistan, conducted with the aim of exploring the root causes of suicide among women in the Chitrali culture. The results of the study found poverty and violence against women as two main themes for suicide among married women. This research has provided basic information for researchers, policy makers, and health care providers for use in planning interventional research and suicide prevention programs in the future. The findings of the study revealed that women in Chitral face a number of issues in their life, such as lack of autonomy, burden of work, financial dependency, lack of husbands’ support due to the interference of in-laws, and lack of parental support, which has caught the women in a web and escape has become difficult for them. Thus, they lose heart, suffer from depression, feel helpless and hopeless, and end their lives. Moreover, neither the government health department nor the other health care organizations in Chitral have provided the people the facility of counseling or opportunity to verbalize their feelings at times when they have feelings of depression, helplessness, hopelessness, and inferiority. The findings of the study affirmed that women who had committed suicide wanted to share their feelings but there was no one to hear and provide support to them. This study provides an opportunity to the health department and legislative department of KPK, and the NGOs to offer poverty alleviation, proper implementation of legislation to punish the culprit who shows violence towards women, and suicide prevention programs in order to manage the burden of high-rising suicide in Chitral.