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.

BeMeBeFree: a Campaign to Tackle Teen Anxiety

To no one’s surprise, researchers found a 20% increase in diagnoses of anxietybetween 2007 and 2012. Now in 2018 the rate is even higher. There are a plethora of reasons for this. Many blame social media, while some blame a lack of parenting – the list goes on and on. There’s no shortage of people to blame.

According to the National Institute of Mental Health, 38% of teen girls and 26% of teen boys have anxiety disorders, yet data shows that 40% of students with mental health concerns never seek help.

There are a ton of statistics showing how badly anxiety is affecting our youth and how it’s reaching alarming rates, but what I don’t see a lot of is thorough examinations of the culture that young people live in today. There are many countries worldwide where doctors don’t have to medicate children as young as 8. There are numerous other countries where the suicide rate and incidents of eating disorders in young people haven’t reached epidemic proportions.

Why is this happening at this rate in America?

I created the BeMeBeFree Campaign to take a look at how anxiety affects our youth, but instead of hearing about it from academics, I wanted teens to share their story with us on our website www.bemebefree.org. Storytelling is a creative form that teens really gravitate to, so I decided to create a story sharing campaign where teens could share their story and encourage others to do the same.

Research has shown that if someone with anxiety writes about how they’re feeling and share it with others, it reduces their angst.

Carolyn Costin, a leading anxiety therapist working on the BeMeBeFree Campaign told me that “with little down time, less sleep and constant social media vigilance, our modern technology, cultural pressures and instant image access create an anxious suffering in our youth in ways that we are just beginning to fully understand.”

I’m reaching out to 20,000 high schools, 3,000 universities and 800 mental health organizations asking them to invite students to submit stories of how they’ve dealt with anxiety. We’ll be posting them on the story community page of our website so others can read them and hopefully become empowered to share their story. This will start the process of teens building a community and creating something that’s important to them – a sense of belonging to something.

Credit: Be Me Be Free

One of the unique things about this campaign is that Lifetime have agree to turn a story that we select from the submissions into a movie to air next year. During the process of making the movie I plan to implement various initiatives to keep engaging with our audience to keep the discussion going.

Shukree Tilghman, a writer/producer of the hit NBC show ‘This is Us’ has come aboard the BeMeBeFree Campaign/movie as an Executive Producer.

Ultimately, our campaign goal is to improve the culture of mental health in America and connect our youth. Submissions are open until 5 October 2018. 

Fight For Girls, Not Against Them

It feels like just yesterday I was huddled outside my school classroom with five other pigtailed girls, swapping cards or singing along to good old Gwen Stefani. (Shoutout to Gwen for being my fashion inspiration and role model for pretty much my entire childhood.)

Female friendships start off as innocent, symbiotic relationships. As little girls, we seemingly have no worries and – if your childhood was anything like mine – days are filled with endless dress-up parties, goofy sing-alongs and formidable-fort-building. But at what point do we blur the lines and turn these innocent relationships into carnivorous competitions?

Welcome to the world of female competitiveness, where beneath the sisterly front runs an undercurrent of tough rivalry.

I think one of the reasons some of us fight so hard for women’s empowerment among women is because of personal experience of competition and backlash from fellow women. Unfortunately, it is all too easy to be sucked in – especially for young women. You may not even realize it’s happening, as it begins very subtly throughout teenage years. Whether it’s someone degrading you in front of others, talking about you negatively behind your back, trying to delay your success in order to accelerate their own, or doing something to make you look bad on purpose – you are a victim. It’s like a competition you never signed up for and didn’t agree to take part in – but the good news is, you don’t have to be part of it.

RULE NUMBER ONE: Don’t let negativity take over your teenage years – I can’t stress this enough! There are far more important issues that need your valuable time and attention. People who want to succeed by seeing you fail just have selfish motives – it’s their problem – not yours. It’s easier said than done, but try to focus your attention on yourself rather than worry too much about what others are doing.

RULE NUMBER TWO: Whether or not you’ve ever been guilty of any of the above (most of us have, even if we weren’t aware of it at the time), it’s the responsibility of all women and girls to focus on empowering & uplifting each other. It’s such an important skill to be able to admit to our own mistakes and then actively try to change our behaviour. Don’t let pride prevent you from growing.

One question I’ve been thinking a lot about is whether we are actually competing with other women or, ultimately, with ourselves – with how we think of and perceive ourselves. For many of us, we look at other women and see a ‘better’, smarter or prettier version of ourselves. Do we even acknowledge the other woman as an individual? It’s like a mirror that reflects an inaccurate version of who we are, but we turn on the mirror itself because it’s easier than exploring the real insecurities behind the reflection we see. And so…

RULE NUMBER 3: You are enough. Don’t let anything or anyone make you believe otherwise. You don’t need recognition from others to believe it. You don’t need to pull other women down to believe it either. When we each focus on being the dominant force in our own universe, rather than invading other universes, we all win.

As women, we experience enough unfair competition, backlash and discrimination in our lives. We certainly should not experience it from fellow women, too. We are here to support, appreciate and encourage each other.

Our fight should be for, not against one another.

What Would You Say to Your 19-Year-Old Self?

There are moments in life when you simply need to remind yourself that you are enough. In order to do that, you have to have enough self confidence to come up with the words that are both comforting and inspiring.

I’ve been told that nothing is impossible, but also that certain things aren’t meant for me. I’ve been told to follow my heart, but also to always be mindful of others. I’ve been told to say what I really want and to move in that direction, but also to move with caution.

I’ve been told many conflicting things, but I am finding out that the most important words come from within. What do I tell myself when I am not sure of the next step, or when I am scared to articulate my thoughts and turn them into actions? I tell myself to move. Just move. Take a step, and move. Be bold.

Forget your failures and mistakes because they are over. Sometimes we have to fail over and over until our failures are no longer setbacks; they simply push us closer to our goals.

Ask yourself…what are my goals and for how long am I willing to pursue them?

It took me many years to invest in myself and to appreciate my own value. But once I knew my own worth there were no more excuses. I don’t have many profound words of wisdom or a wonderful magic toolbox to fix every unforeseeable problem. But if I could sit down with my 19-year-old self, I would tell her how special she is and that there is no need to be so unsure. I would tell her to just be selfish.

Be selfish, know your worth and love yourself. Wait for no one to validate you, just make sure you have your own stamp of approval.  Stop hesitating and move boldly towards your goals. The world is your drawing board so dream big, hold on tight to those dreams and pursue your passions with unwavering focus and perseverance.

Most importantly, I would tell her: “Some things aren’t that serious. Just smile!”

If you could sit down with your 19-year-old self today what advice would you give?

Cover photo credit: Wynter Oshiberu 

Involving Men and Boys in Efforts to Achieve a #BetterLife4Girls

One may wonder why men and boys involvement in matters like teenage pregnancies and child marriages is important. Well, it is clearly because behind every teenage pregnancy or child marriage, there is a male involved.

In the wake of the movement to end child marriage and teenage pregnancy, young people, parents, religious, cultural  and community leaders have to be called to action. Because these are issues that affect girls directly, it is of peculiar interest how pivotal the male voice has to be to make sure that the plight of a better life for girls is heard.

The fight for gender equality remains incomplete without male involvement as we stated earlier this year here on Girls Globe and we won’t repeat the statistics.

One part of of our agenda, from our recently concluded community dialogues in the eastern part of Uganda on ending under-age marriages and teenage pregnancies by Reach A Hand, Uganda supported by UNFPA Uganda, was to capture voices of men and boys as a way to continue involving them in anti child marriage and teenage pregnancy advocacy efforts.

Men and boys from the three Eastern region districts of Mayuge, Butaleja and Iganga, where the dialogues were conducted, showed keen interest in the topics, voicing similar concerns when it came to the causes of child marriages and teenage pregnancies. These included parental negligence, poverty, radical religious practices, minimal law enforcement, child labor, peer groups, western influence among others.

Mr. Muyagu Benard, the cultural leaders’ representative in Butaleja district noted that parents have shunned their responsibilities. “Parents do not spare time for their children, while others are too busy talk about sex education with their children,” he said, before condemning some for still believing in gaining riches through marrying them off, even at tender ages.

Mr. Gidudu Emmanuel, Officer in Charge Criminal Intelligence Butaleja district, warned that child marriages and teenage pregnancies lead to fatal damages like obstetric fistula, and in extreme cases, loss of their lives. He explained that these young girls’ bodies have not matured enough to carry the baby, let alone deliver it. This could lead to torn body tissues, a lot of blood loss and the possibility of death. He added that these girls get pregnant when they don’t even have enough food to feed neither themselves nor their babies and some of the children end up dying of hunger. He called upon everyone in the district to fight for change.

The Khadhi (Islamic leader) of Butaleja district, Sheikh Hajji Swaib Hussein Mukama, highlighted the fact that this is an era where girls should be taken to school because they are the mothers and leaders of tomorrow. He urged parents and fathers in particular, to support their children under the umbrella of religion to avoid teenage pregnancies.

The men in Mayuge pledged to stop individualizing children and vowed to make them a community responsibility so that there is joint effort in taking care of the girls and fighting against teenage pregnancies and child marriages.

On the other hand the young men advised their sisters to stay in school, avoid moving alone at night which can lead to being exposed to risks like rape and defilement. They further implored them to abstain, use condoms when old enough to have sex and to stand up for their rights in cases where they are forced into child marriages.

One of the young men, Desmond Ali, the chairperson Uganda National Students Association (UNSA) in Iganga district mentioned how he has already started contributing to bettering girls’ lives, by carrying a pad wherever he goes incase any of his female classmates need assistance. He also pledged to include child marriages and teenage pregnancy as an item agenda during the Annual Iganga UNSA meeting in February yext year.

Men and boys are often untapped-yet critical- resource in the fight against issues affecting society, especially under-age and child marriages. By not engaging them, we are stirring the pot deeper. Placing them at the forefront of this agenda, will transform respect for women and girls.

Featured Image: International Youth Foundation

A Letter to the 15-Year-Old Me

As we celebrate women’s month in South Africa, I took a moment to reflect on of all the mistakes I made and the right things I did to prepare myself for womanhood.

I am a 26-year-old young woman, who doesn’t have it all together. But, I am glad I am working towards a goal. Looking back to when I was young, there are certain things I wish someone could have told me, lessons that I should have learned a lot earlier. Although I am happy with the life I am leading, I have made my own fair share of mistakes. I made enemies that could have become valuable friends, spent money that I should have saved and wasted time that could have been better used.

On the note, I decided to write a letter with advice to my 15-year-old self, with the hope that it will be useful to someone who is in their journey to womanhood:

  1. You are beautiful. The world may have its definition of beauty, but you are allowed to create your own. You are your greatest asset, and no one can love you or value you more than you. Tell yourself how beautiful you are every day. You know yourself best.
  2. The world owes you nothing. In fact you are the one who owes your government tax, if you’re religious you probably owe your church tithe, and maybe even your time towards community service. You have to consistently work hard to stay alive.
  3. Standout. It may seem cool to be part of the most popular group of friends where you study or live. But you need to strive for individuality, if you are blending in you may be giving up a lot of who you are just so you can fit it. Remember, you are so special – you cannot afford to be anyone else.
  4. Educate yourself. Get formal education, study society, your history, history of your country, continent and the world. Remember you are a product of your parents’ past. Don’t only depend on the education you get at school, it forms a small part of the life you will live in future. Learn something new every day. Read about financial reports, sports, politics and stay well informed. An educated mind is an empowered mind.
  5. Humility is key. Do not look down on other people just because they are not like you. They may not be of the same religion, race, class, speak the same language or gender. That does not give you the right to look down on them. Learn about your differences, learn about their religion and accept them as they are.
  6. Travel whenever you can. Never miss an opportunity to meet new people and learn about where they live, their beliefs and what they like. The best lessons are learned in a place of discomfort.
  7. Stay healthy. Having a healthy mind and body is essential. Exercise and eat right while feeding your mind with positive thoughts. Skinny is not always healthy. Exercise for health, not only weight–loss.
  8. Marriage is not everything. Women are mostly groomed to get married, so much that you start thinking of marriage at 15. Marriage is good, but remember that your success should not be tied to a man. Work on making yourself a masterpiece. Marriage can be an addition to the masterpiece. You can be happy without being married.
  9. Find your passion. Find out what makes you tick and what you are willing to do without remuneration. Your passion will be a place of mental refuge when days are dark, friends are few and finances are dry.
  10. Spend wisely. Teach yourself to manage finances as early as you can in life. The skills you acquire will come in handy when you earn your first salary. Know how to differentiate between needs, wants and luxuries. It’s not bad to spend your money on anything you want, but know when the right time is to spend on each of the three. Remember to save money wherever you can.
  11. Have fun. Try to have as much fun as possible in everything you do, including exam preparations and writing assignments. It’s the best way to excel. Allow yourself to make mistakes, laugh at yourself and do not walk away without learning from them.
  12. Life is a journey not a destination. You are a work in progress. You need to improve yourself to be a better person in all you do. There are so many talented people in the world that average will not be enough. Strive for excellence in your studies, career and extra-mural activities. An undergraduate degree is nice, but a master degree is more competitive.
  13. Run your own race. Never mind how fast or how far other people your age are progressing. What matters is that you have started and are determined to achieve your goals. However long it takes, you will get to where you want to be. Do not compete, it is bad for your confidence.

What would you tell yourself at age 15 if you could go back? Perhaps to be more gentle to yourself – and to recognize the uniqueness you possess. Maybe you should write this letter too – and remember that it’s never too late to listen to your own advice!

Featured image: Rebecca / Flickr (Creative Commons)