Background
Indian women’s mental health, gender inequality, and access to care
Theoretical framework: CMH competence
Psychosocial support group (PSSG) interventions
Study objective
Methods
Setting and intervention
Indicator | National - India | State-Uttarakhand | District-Dehradun |
---|---|---|---|
Population (millions) | 1210 | 10.1 | 1.7 |
Rural Population | 68.8% | 69.5% | 44.5% |
Under Age 15 Population | 28.6% | 28.9% | 25.3% |
Sex Ratio at Birth (females: males) | 919: 1000 | 888: 1000 | 886: 1000 |
Female Literacy Rate | 68.4% | 76.5% | 81.5% |
Male Literacy Rate | 85.7% | 90.7% | 91.8% |
Sampling and inclusion
Data collection
Data analysis
Results
FGD Location and Number* | Caregiver/PPSD | Months Since Group Start | Meetings/ Month | Members | Age Range | Average Age | Education Level | |||
---|---|---|---|---|---|---|---|---|---|---|
No School | Completed Primary | Completed Secondary | Completed Bachelors or Masters | |||||||
DEH 1 | Caregiver | 2 | 2 | 11 | 18–45 | 31.0 | 2 | 3 | 6 | 0 |
DEH 2 | Caregiver | 8 | 2 | 13 | 19–65 | 34.4 | 3 | 1 | 3 | 6 |
MUS 1 | Mixed | 5–6 | 2–4 | 6 | 24–52 | 39.2 | 3 | 1 | 2 | 0 |
MUS 2 | PPSD | 8–9 | 2 | 5 | 26–49 | 34.8 | 1 | 3 | 1 | 0 |
MUS 3 | PPSD | 6–7 | 2 | 5 | 42–60 | 45.8 | 2 | 1 | 2 | 0 |
SAH 1 | Mixed | 7–8 | 1 | 9 | 25–65 | 35.8 | 4 | 4 | 0 | 1 |
SAH 2 | Caregiver | 5–6 | 2–3 | 10 | 16–36 | 23.4 | 2 | 6 | 2 | 0 |
Education Level Totals | 17 No school | 19 Primary | 16 Secondary | 7 Bachelor's/Masters | ||||||
Totals
|
59
|
16–65
|
33.6
|
29% No School
|
32% Primary
|
27% Secondary
|
12% Bachelors/Masters
|
Community level factors
Community attitudes to freedom of movement
Group Member (GM): “First we will have to seek permission from our husband, if he allows us to go.”
Community Health Worker (CHW): “People feel bad and do not like it. They say that women used to stay at home and now these people are taking her out (Logon ko accha nahi lagta hai. Pehle auratein ghar pe hi rehti thi. Ab yeh log unko ghar se bahar le jathe hai).” [Here, when the CHW says “these people are taking her out,” she is referring to the Burans staff members and their encouragement of women to participate in the community’s PSSGs, despite other community members’ disapproval.]
GM: “Even if we go to temple, from there they follow us. That’s why we feel scared in coming out. This is how it is in our community.”
Facilitator: “Who are the ones stopping women from coming out of the home?”CHW: “In my opinion they are the father and mother-in-law. They are old and in that age, they think that if another person’s daughter-in-law doesn’t go, then how come our daughter in law can go out to purchase goods? They always compare with others in their life.”
Community mental health awareness
CHW: “They only think that it is something to 'pass the time' because they want some support for their family if the woman goes out of the house.” [Here, “support” refers to financial support]
Household level factors
Attendance conditional on family support
GM: “My own sister couldn’t come because her husband was not allowing her to.”
GM4/GM5 together: “Our family always has problems. They really wish that we would not go to the meetings.”GM4: “They tell us not to go.”GM5: “We like it, so we come.”
Individual level factors
Employment and income contribution
Education
Seeing the benefits
CHW: “The main thing is when the woman comes to the group, she should know the truth about the support group as to what is the purpose of the group. The woman should know the benefits of the group, what she can achieve and where she can take herself through the support group. I believe that women can speak with their parent in laws once they understand all these things about the group.”
Distance
Interviewer: "Are women allowed to go to Dehradun [a nearby city], or are their movements restricted to the village?
CHW: Many women do go to the hospital or the market. Some of them need someone to accompany them as they cannot go out on their own. Now that they are a part of the support group, they think they need to come out of their homes. The families' mentality is changing (parivar ki mansikta badal rahi hai), but it is difficult as knowledge is limited."
Personal determination
GM: “It depends on us. If we make a decision to do something, then not just family, even an outsider cannot say anything. First our spirits should be high (apne hausle buland hone chahiye). If we keep thinking ourselves that they will not allow us, they will interfere. But, if we said once that, we have to go, then we have to go. We have to strengthen ourselves first.”
Discussion
Women’s freedom of movement
Community mental health awareness
Women’s education and employment
Implications
Starting with communities: policy support for CMH competence
Gender relations: forefront of CMH programs
GM: “How will we share [what we have learned] with anyone when we don’t go out?”