Published on Investing in Health

Mental Health: An opportunity to achieve gender parity

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Why are there so many missed opportunities for women to be healthy, productive, and valued members of society, speaking purely from a development perspective?
Last week at Out of the Shadows: Making Global Mental Health a Development Challenge, co-hosted by World Bank and World Health Organization, a discussion on women’s mental health playing a central role for the functioning of families and societies addressed an uncomfortable reality: in many places around the world, women are more vulnerable to mental health challenges and unable to access the care and services they need.
The power that women have to access employment, income, healthcare, and legal resources can differ significantly compared to men. Although mental health has largely gone unaddressed for both men and women, issues of social perception, discrimination and stigma further complicate the ability of women to access mental health care services.
While less is known about the gendered differences in mental health, evidence is emerging. Depression, anxiety, and somatic complaints in particular, affect approximately 1 in 3 people, predominantly women. Depressive disorders account for roughly 42% of the disability from neuropsychiatric disorders among women (compared to around 29% among men), with depression as a leading cause of disease burden for women in all countries, regardless of income. Unipolar depression, predicted to be the second leading cause of global disability burden by 2020, is twice as common in women.
In Fragile and Conflict-Affected Settings (FCS), these issues are compounded by exposure to violence, which is often embedded in a larger context of adversity. An estimated 80% of 50 million people affected by violent conflicts, civil wars, disasters, and displacement are women and children, who are faced with chronic stressors such as the loss of livelihood, displacement, exclusion, persistent insecurity, or the stress of regularly seeing perpetrators of violence in one’s community.
Further research on FCS suggests that the high prevalence of sexual violence that women are exposed to, and the correspondingly high rate of Post-Traumatic Stress Disorder (PTSD) that can follow, has the largest impact on women.  Conditions of adversity in FCS further exacerbate these negative mental health impacts of direct exposure to violence, at least in part by increasing stress levels and draining coping resources. Last but not least, mental health issues related to conflict and violence are underreported. Women are less likely to disclose histories of abuse, violence, or victimization, unless asked directly by a primary care physician - a rare resource in FCS settings.
Understanding the debilitating impact of poor mental health on women, and men too, across diverse settings is a critical first step. But what can we do next?
We can work to increase access to vital resources like employment opportunities, healthcare, education, water, and sanitation for men and women with mental illnesses. We must bear in mind that women’s help-seeking behaviors and attitudes are different as a product of many factors, including stigma, and will inform how they access services.
We can focus on delivering integrated services. Increasingly, development agencies are looking for ways to be more inclusive. One avenue is through health system strengthening and reform, which includes integrating mental health care and services into the primary healthcare system and creating access to available interventions and proven therapies. Another is by integrating development interventions with psychosocial support. For example, we can equip the education sector with the tools to deliver psychosocial support as primary prevention mechanisms for school-aged children.
Strengthening institutions and communities is critical. Governing bodies and affected populations, especially in FCS, have often been equally exposed to conflict and violence and vulnerable to mental distress. Capacity building at the national and municipal level can help protect local economic growth, in particular the social capital and income acquired by women, and develop better systems, frameworks, and policies.
Last but certainly not least, we can foster and encourage environments where women have the autonomy to not only exercise control, but also access resources for coping and resilience, such as psychosocial support from friends, families, and communities.
Let us build off last week’s momentum to bring mental health out of the shadows. We can do our part as a development community by improving the conditions of adversity that strain mental well-being and limit women from achieving their potential. Improving access to and quality of mental health care in established economies, middle and low-income countries, and FCS settings is a key opportunity that should not be squandered.


Samhita Kumar

Mental Health and Development Specialist

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