Mental Health in India’s Adolescent Girls

At ten years old, at the delicate intersection of childhood and adolescence, I lost my father.

The sudden, swift loss of a loved one left my family with a vacuum that felt insurmountable. Fear, inordinate sadness and hopelessness enveloped our home. Our South Asian family was heavily steeped in cultural norms. Showing one’s wounds to others was viewed negatively.

Crying was looked down upon, and seeking help would be an impermissible acknowledgement of weakness. Therapy was not a word in our vocabulary.

As I was expected to, I placed invisible bandages over my pain and suffering. I walked to school one week later with a forced smile pasted on my face. When asked how I was feeling, I quickly redirected the conversation, replying, “I’m okay.”

This external reticence surrounding my feelings and emotions continued throughout my adolescent years. While I experienced intermittent jolts of sadness and depression – likely as result of all that I had concealed and bottled up – I never once considered the option of therapy.

Now, as a pediatrician, I recognize the need to end the stigma and silence surrounding mental health in South Asian communities.

I have seen again and again the multi-generational consequences of mental illness, particularly depression. I co-founded Girls Health Champions, a non-profit training adolescents as peer-to-peer health educators, because I have seen firsthand that young people have significant unmet needs surrounding mental and physical health.

We know from both anecdotal and empirical evidence that adolescent depression and mental illnesses are on the rise, specifically for young women. Girls are over three times more likely than boys to experience depressive symptoms. The extent and complexity of mental illness among youth in India continues to be understudied, and the support for young people is stagnant.

Our suicide rate is a public health crisis – India accounts for 36.6% of suicides globally. Additionally, among Indian women and teenage girls aged 15–19, suicide has surpassed maternal mortality as the leading cause of death.

We have ample evidence to show that frank discussion and dialogue must start early and occur frequently. However, addressing the mental health of adolescent girls requires a thoughtful, multi-pronged strategy.

We must address cultural attitudes when approaching girls’ mental health education.

We know that South Asians, including young people, share a cultural resistance towards legitimizing mental health as a medical need. According to Dr. Nidhi Kosla, a mental health provider, South Asians “fail to report their [emotional] pain to avoiding burdening others or being seen as weak.” This might explain why many South Asians do not utilize resources such as therapy or psychiatric care, even if they are aware of them.

Additionally, in India, mental illnesses such as depression have often been equated with words such as “pagal”, or crazy. This language intensifies the shame and stigma young people experience. As a result, discussions of mental health must not only focus on awareness raising, but also on addressing and overcoming prevalent stigmas.

Mental health remains an underdeveloped and understaffed field in India’s medical practice. It is time to start building India’s mental health infrastructure.

Out of the 936,000 doctors in India, there are only roughly 4,500 psychiatrists to serve a population of 1.3 billion. In comparison, the USA, with a population a quarter the size of India’s, has 7,000 psychiatrists of Indian origin and 28,000 overall. 

India’s mental health infrastructure is also severely limited, with only 43 government mental health hospitals across all of India to provide services for the estimated 70 million people living with psychosocial disabilities.

In addition, most general practitioners and pediatricians are not adequately trained in identifying or managing mental health illnesses. These are often the people who serve as the first medical ‘touch points’ for young girls. Many providers may even hold negative attitudes towards mental health conditions themselves. Investment in training for frontline health workers is essential.

In both my experiences as a pediatrician and with Girls Health Champions, I have learned that a majority of young girls do not feel they can turn to their parents when it comes to discussing mental health-related issues. 

Parents play a critical role in providing a supportive climate around mental health.

We must educate them to have understanding, empathy, and awareness of mental health-related issues. Parents should develop the capacity to identify potential issues in their children and recognize when it would be appropriate to seek help.

I want our young people to know that it is okay to feel, to reach out for help, or even to say, “I am not okay”.

Day after day, I diagnose young girls with mental illnesses, including depression. During these visits, we often talk about the importance of removing the invisible bandages. We talk about the fact that ultimately, opening up is a sign of strength.

Can the Feminist Body Hair Movement be Intersectional?

For the longest time, I believed that white women had no body hair. How lucky! No waxing, no shaving = no worries.

I was proven wrong when I was 12 years old and shopping for jeans with my father. I went off to the changing room, only to find Sienna Miller plastered on the door. There they were. Thin strands of hair. Visible only because of the lighting in the photograph and the close-up shot. What a revelation!

I had never seen women in the media with body hair.

It is no wonder that South Asia is obsessed with women’s body hair. A colonial hangover and the hairless ideal promoted by the media don’t make for a good combination. This is evident when tracing and reflecting on the history of body hair removal and hearing experiences of Indian women.

In India, waxing is a sacred ritual that starts as young as 12. It is common to hear your neighbourhood aunty snicker that you are due a parlour visit to ‘clean up’. 

Living in the Netherlands has changed my relationship with my body hair.

Long winter months are greeted with tights. Waxing prices are restrictive. The Dutch dress practically thanks to the wind and rain they cycle through daily. When summer comes around, many women shave their legs. Most tend to be more relaxed about their arms, as arm hair is generally lighter and less visible, and hence, not such an ‘issue’.

However, this is not necessarily the case for Dutch minority women. And this is the exact reason why the feminist body hair movement spearheaded by celebrities like Miley Cyrus have come under fire for lack of representation.

Although I still occasionally remove my hair, the pragmatic culture I’ve found myself living in has rubbed off on me for the better.

I suppose getting older (and wiser) also has something to do with it. I don’t remove hair as often, nor do I let my hair removal calendar dictate when I can or can’t wear a skirt.

Of course, I am not advocating that we must all stop removing body hair. We navigate and negotiate our ‘choice’ in the issue. When I return to India, I slip back into old patterns – albeit consciously. To avoid uncomfortable stares, I choose to wax. This is the reality for many with poly-cystic ovary syndrome (PCOS), and for minorities with coarser hair, for whom the costs of rebelling against societal norms are too high.

How do we move away from the idea that hair is ‘dirty’ and create an intersectional feminist body hair movement that all South Asians can own?

Reframe and contextualise body hair in sex education.

Sex education should go beyond mentioning pubic and armpit hair. Discuss the options of body hair removal so that young women can be informed, without encouraging it as an inevitability. Talk about why it has become common, and place it in your country’s context. Frame body hair within changing fashion trends. And parents, support your kids to develop self-confidence.

Get the boys on board.

If you are lucky enough to have received sex education, you will know that there is often very little dialogue between girls and boys during puberty. As a result, many boys and men in India have disappointing attitudes to hair on women. Boys must not only learn about their own body hair, but also that of women, so that they understand what is natural and normal.

Let hair be seen.

Even adverts for razors in India are afraid to show actual body hair! Deepika Padukone, a famous Bollywood actress, shaves an already hairless leg in this one to show the wonders of her Gilette razor. I think a serious makeover of Indian school uniforms is needed, too. Mandatory skirts don’t allow girls to show their hair on their own terms.

Let us change the way women are represented. Have images in school textbooks that depict women with body hair. Check out illustrator Aqya Khan for inspiring examples.


Let’s take control of the narrative of body hair and allow it to be seen – for all those 12 year-old girls across South Asia.

In Conversation with Tasneem Kakal

Tasneem Kakal is an advocate for sexual and reproductive health and rights. Born and raised in Mumbai, she spent 5 years taking a daily train to and from university. In this interview with Girls’ Globe, Tasneem tells us what the experience taught her about navigating public space as a young woman.

“I would walk up the stairs and go to my platform in this huge crowd of people. And I realized I was doing something that I didn’t know I was doing…”

We all have the right to move through the world without fear. Public space should be accessible to all, regardless of gender. By raising her voice and bringing attention to the everyday nature of inequality, Tasneem stands in solidarity with other women and girls.

“I had to push the boundaries, little by little.”

This video was made possible through a generous grant from SayItForward.org to support women’s advocacy messages.

If you liked this post, we think you’ll love our interviews with Kinga, Winfred, Scarlett and Natasha, too! 

Will Education Alone Suffice?

In a not-so-small village in India, where people earn their livelihood by farming, education is booming. In the last decade, this village has seen the birth and development of a government school and several private schools. A couple of these are even elite ‘English medium’ schools.

The village has also seen the opening of a pre-university college. But to pursue any vocational or professional course afterwards, an individual must travel to the next town. With no frequent bus connectivity, this higher education remains a distant dream for many. But the people of the village are still ecstatic.

Their children can now say a few words in English. They can identify the English alphabet. They can – sometimes stutteringly – say a sentence in English too. Their children are educated – a word whose purpose and worth many of us fail to comprehend.

In a real-life scenario, each family enrolls their child/children in school dutifully. Fees are low, midday meals are provided and children are taken care of while the parents work in the fields as daily wage labourers. By the time the children are back, parents are back at home too.

When boys reach 5th or 6th standard, they drop out of school to work alongside their parents. Another breadwinner for the family is more important than learning English – which ‘they will never use anyway’.

The girl child, however, is sent to school to complete her education up to the 10th standard. Some progressive families will even allow their daughters to study up to the 12th. All because it increases their demand in marriage.

A boy educated up to 4th standard will work from the age of 9 till 24, manage to buy an acre of farm land with the joint earnings of his family, and then approach the family of a well-educated girl with a marriage proposal.

If all goes well, the proposal is accepted and a marriage is celebrated by the families. The daughter-in-law dutifully takes up her responsibility of cleaning the house, cooking three meals, tending to the cattle and bearing children – often before she herself is even 20 years old.

This is the story of young adults in most villages here.

Is there any need for change? Who is to blame? Does something have to be done, or is this something to be left alone?

Schools and colleges were, at some point, new to many living in villages across India. Yet most people accepted them with open arms. My question, though, is if this education does not translate into a good job and decent pay, is it of any use to poor farming communities?

Ensuring we don’t just stop with providing schools, but focus on creating livelihoods through relevant vocational training is a major need for our people.

Making opportunities for working and earning available to girls and boys equally is the responsibility of every government.

What use is a 12th standard education if a girl is unable to support herself financially? After all, financial independence is very closely linked to security and safety.

I believe that societies change and adapt to the opportunities presented to them. Law makers, influencers and policy makers must understand the needs of a population with a view to future growth, rather than simply providing dead-end educations!