women and mental health

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19/6/2009 1 Maj Dhiraj Raja Women and Mental Health

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19/6/2009 3 INTRODUCTION

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19/6/2009 4 As per Census 2001, The total female population (all ages) is 49.6 Crores which constitute 48.26 % of the country’s total population. Of the 49.6 Crores females, 36.09 Crores live in rural areas. Among the female population, 35.07 % are girl children (<= 14years), 57.10 % are women aged 15-60 years and 7.83 % are elderly women (>= 60 years). Women's mental health: The Facts

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19/6/2009 5 As per the various censuses, The sex ratio has shown, A decrease of 13 points (from 946 in 1951 to 933 in 2001) for all India. A decrease of 19 points (from 965 in 1951 to 946 in 2001) for Rural India. An increase of 40 points (from 860 in 1951to 900 in 2001) for Urban India. Women's mental health: The Facts

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19/6/2009 6 Depressive disorders account for close to 41.9% of the disability from neuropsychiatry disorders among women compared to 29.3% among men. Leading mental health problems of the elderly are depression, organic brain syndromes and dementias. A majority are women. An estimated 80% of 50 million people affected by violent conflicts, civil wars, disasters, and displacement are women and children. Women's mental health: The Facts

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19/6/2009 7 In women age gr 15-44, unipolar depression was the leading cause of disease burden in both developed and developing countries Schizophrenia,BPD and OCD ranked top ten leading cause of burden for women aged 15-44 yrs Women's mental health: The Facts

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19/6/2009 9 Women's mental health: The Facts

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19/6/2009 11 Women's mental health: The Facts

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19/6/2009 12 However, the multiple roles that they fulfill in society render them at greater risk of experiencing mental problems than others in the community. Women bear the burden of responsibility associated with being wives, mothers and careers of others. Increasingly, women are becoming an essential part of the labor force and in one-quarter to one-third of households they are the prime source of income (WHO, 1995). Contd.... INTRODUCTION

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19/6/2009 13 In addition to the many pressures placed on women, they must contend with significant gender discrimination and the associated factors of poverty, hunger, malnutrition and overwork. An extreme but common expression of gender inequality is sexual and domestic violence perpetrated against women. These forms of socio-cultural violence contribute to the high prevalence of mental problems experienced by women. Contd.... INTRODUCTION

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19/6/2009 15 BIOLOGICAL RISKS: Specific Hypotheses Are: 1. Women have greater genetic resistance to infectious diseases and also some rare X-chromosome linked diseases. 2. Women are protected from cardiovascular morbidity by sex hormones until menopause. 3. The reproductive events of pregnancy, child birth and puerperium give women unique morbidity risks not experienced by men. In addition they have female specific disorders such as those related to breast, genital and geniio-urinary areas [ eg: cervicitis, menstrual or menopausal symptoms]. 4. The pathology of some diseases, their symptoms and developmental course may differ for men and women


19/6/2009 16 ACQUIRED RISKS: Women feel more psychological distress (anxiety, depression, guilt, conflicting demands) on a day-today basis and over their life-times than men do, and this may decrease their physiological resistance to acute and chronic conditions. Women tend to be less delighted about life than men and this may make them more vulnerable to stress-related illnesses, but women also buffer the route from stress to disease by reacting to disrupting life events and upsets in more benign ways.


19/6/2009 17 ACQUIRED RISKS Over their lifetime, women maintain stronger emotional ties with more people. Intimate ties with friends, colleagues and neighbors offer social support and deter loneliness. This may act as a buffer for disease - reducing its occurrence, severity and especially, its duration.


19/6/2009 18 ILLNESS BEHAVIOR: Hypotheses of psychological differences proposed are: 1. Perception: Women are more sensitive to bodily discomforts than men are. 2. Evaluation: Women are more likely to label their symptoms as physical illness and after such labeling, assess their illnesses and injuries as more severe and serious than men. 3. Behavior: Women take action by adopting a sick-role. The concept of learned helplessness is more typical of women than men. In addition, bed rest, activity restriction and turning to others/medical attention is believed by them to be helpful

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19/6/2009 19 Behavior: Women take action by adopting a sick-role. This occurs through both their willingness and ability and may have numerous factors, some of which may be that it is more socially acceptable. They also have more dependent and help seeking behavior and have more trust in authority. The concept of learned helplessness is more typical of women than men. In addition, bed rest, activity restriction and turning to others/medical attention is believed by them to be helpful


19/6/2009 20 HEALTH REPORTING BEHAVIOR: Women are more willing to talk about their symptoms to others whether they are friends, employees, interviewers or physicians. Women recall minor health problems and minor health actions better than men do. A presumed reason is that women are more interested in health matters and also more often involved in them as a health helper for children and kin and this greater salience enhances their memory. Vocabulary of illness differs for women and men. They may elaborate more and their presentation includes both somatic and psychological content more often.


19/6/2009 21 VIOLENCE AGAINST WOMEN The scope of violence against women is of a stunning magnitude when crimes by intimate perpetrators and strangers are considered. They do not come to public attention because of' cover ups' facilitated by forced secrecy demanded by perpetrators of abuse, or due to closed family boundaries. Family members committed 90% of the physical & sexual assaults recalled by psychiatric patients (Carmen et al, 1984). Thus when psychological variables are ignored in diagnosis, somatic complaints which are the ticket of admission to a medical system may be inaccurately or inappropriately diagnosed as organic in etiology.


19/6/2009 22 GENDER DIFFERENCES IN TREATMENTSRENDERED AND RECEIVED Physicians distinguish the characteristics of 'difficult patients' along gender lines (Schwenk et al, 1989). mainly involve two factors: 1. Medical uncertainty (vague, difficult to describe symptoms - frequently changing symptom picture). 2. Interpersonal difficulty: Difficult physician- patient relationships result in poor health care delivery as well as in patient dissatisfaction.


19/6/2009 23 OCCUPATIONAL STRESS A working woman performs multiple roles in life including that of a wife, mother, employee, maintainer of extended family ties and caretaker of elderly relatives. This trend has raised questions even in the West whether the prevalence of heart disease amongst women would begin to rise as a response to occupational stress and multiple role tensions In an eight year prospective study reported by Eaker (1989) clerical workers who reported having an unsupportive boss were at increased risk of developing coronary artery disease.


19/6/2009 24 STUDIES ON GYNECOLOGICAL PATIENTS Most of the studies on gynecological patients, including ours (Agarwal etal, 1990), show that (a) patients with gynecological disorders had a high rate of emotional disorders, and (b) the highest proportion of emotional disorders were found in patients with uterine bleeding.

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19/6/2009 26 Prevalence rates of depression and anxiety disorders as well as psychological distress are higher for women than for men. These findings are consistent across a range of studies undertaken in different countries and settings (Desjarlais et al, 1995). Women are much more likely to receive a diagnosis of obsessive compulsive disorder, somatization disorder and panic disorder (Russo, 1990). MENTAL DISORDERS AND PROBLEMS EXPERIENCED BY WOMEN

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19/6/2009 27 Only a small part of the 'iceberg of morbidity 'is visible in health statistics or clinical practice ( White etal, 1961). It's gender hue varies, most likely being deeply feminine at the bottom and gradually fading until it is intensely masculine at the very top. The bulk of the iceberg is of a feminine shade. MENTAL DISORDERS AND PROBLEMS EXPERIENCED BY WOMEN

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19/6/2009 28 Action Steps for Improving Women’s Mental Health- U.S Dept of Health and human Services

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19/6/2009 29 During the postpartum period, about 85% of women experience some type of mood disturbance. 10 to 15% of women develop more significant symptoms of depression or anxiety. Postpartum psychiatric illness is typically divided into three categories: (1) postpartum blues (2) postpartum depression and (3) postpartum psychosis. POST-PARTUM PSYCHIATRIC DISORDERS

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19/6/2009 30 Postpartum Blues 50 to 85% of women experience during the first few weeks after delivery. Rather than feelings of sadness, women with the blues more commonly report mood lability, tearfulness, anxiety or irritability. Peak on the fourth or fifth day after delivery and may last for a few hours or a few days, remitting spontaneously within two weeks of delivery. Do not interfere with a woman’s ability to function. No specific treatment is required POST-PARTUM PSYCHIATRIC DISORDERS

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19/6/2009 31 POSTPARTUM DEPRESSION 1 in 10 post-natal women experience clinical depression (Pitt in 1968) Several prospective studies have found that post-partum period is a time of greater risk for depression than pregnancy (Kumar & Robson, 1984). Post-partum depression ,when it does occur, interferes with the developing mother-infant relationship and causes disruption of family life (Cox et al, 1984). POST-PARTUM PSYCHIATRIC DISORDERS

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19/6/2009 32 The incidence of post partum psychosis has been reported as 1-2/1000 deliveries. Kendell and colleagues (1987) have noted that for primipara, the relative risk in the first month for psychotic breakdown is very high. Those with a past history of bipolar depressive illness arc at greater risk of post partum breakdown than unipolar depressive illness. POST-PARTUM PSYCHIATRIC DISORDERS

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19/6/2009 33 More than a century ago, investigators were already trying to identify an association between depression and menopause Initially, women were described as suffering from a “climacteric melancholia” or “nervous irritability” Depression and the Menopausal Transition

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19/6/2009 34 It has been speculated that some women might be particularly vulnerable during periods of intense hormonal fluctuations comparative recent evidence suggesting that major mood symptoms may be linked to decrease in serotonin measure From psychosocial point of view, “empty-nest syndrome” was proposed as a psychosocial cause of psychological symptoms manifesting during the menopausal transition. Depression and the Menopausal Transition

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19/6/2009 35 During their lifetimes, women are twice as likely as men to have panic disorder (5.0% versus 2.0%), agoraphobia (7.0% versus 3.5%), PTSD (10.4% versus 5.0%), or GAD (6.6% versus 3.6%).1,5 Social anxiety disorder (15.5% versus 11.1%) and OCD (3.1% versus 2.0%) ANXIETY DISORDERS

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19/6/2009 36 Women who were sexually abused as children appear to be at increased risk of adult onset PTSD and panic disorder. ANXIETY DISORDERS

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19/6/2009 37 Compared with men, panic disorder in women tends to be more severe and associated with higher rates of significant comorbidity, such as agoraphobia, GAD, and somatization disorder. OCD exhibit sex differences, with females being more likely to exhibit cleaning/contamination or aggression/ checking compulsions, comorbid depression or an eating disorder, and a less severe clinical course. ANXIETY DISORDERS

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19/6/2009 38 Male to Female ratio is1:10 or 1:20 Life time prevalence among women is 0.5-3 %(Anorexia Nervosa),2%-5% (Bulimia Nervosa) Onset is usually between the ages of 10-30 yrs Eating disorders frequently are associated with other psychiatric disorders, such as depression, substance abuse, obsessive-compulsive disorder, and social phobia. EATING DISORDER

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19/6/2009 39 Approximately 2:1 ratio of depression in women compared with men took this difference in prevalence to be indicative of a biologically based sex difference in women’s proneness or vulnerability to depression compared with men. Explanations invoking genetic, neurotransmitter and endocrinological differences related to reproductive hormones have all been advanced Gender differences in rates of depression are maintained across the life span with prevalences among elderly women generally higher than those among men (Vazquez- Barquero et al., 1992; Beekman, Kriegsman & Deeg, 1995; Zunzunegui et al., 1998 DEPRESSION IN WOMEN

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19/6/2009 40 Brown and Harris (1978) identified four vulnerability factors that increased the chances of a woman developing depression in the presence of a stressful life event. These factors were parental loss before the age of 17, particularly the loss of one’s mother before the age of 11, the presence at home of three or more children younger than 14, a poor, non confiding marriage and the lack of full or part time employment. DEPRESSION IN WOMEN

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19/6/2009 41 current severe event with a pronounced ongoing difficulty has also been found to be critical (Brown, Andrews & Harris, 1986; Brown, Bifulco & Andrews, 1990; Brown, 1998).Such experiences include the death of a child of any age, death of a husband or partner, two or more abortions, sexual abuse, and physical violence in the marriage or relationship. DEPRESSION IN WOMEN

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19/6/2009 42 Brown, Harris and Eales (1996) argue that: ‘The losses and abuses would be expected to have acted adversely not only on the availability of support, but also to have increased the negative elements of her self-evaluation DEPRESSION IN WOMEN

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19/6/2009 43 Women are three times more likely than men to engage in non-fatal suicidal behavior (e.g., taking an excessive dose of sleeping pills), though less likely to use a lethal method (e.g., firearm) and die by suicide. Girls from nuclear family and women married at very young age, to be at higher risk for attempted suicide and self harm-Biswas et al.(SP Agarwal) SUICIDE

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19/6/2009 44 The earlier appearance of symptoms in men than women. Goldstein et al (1989) studied the age of onset and found that the mean age was 24.3 for males, and 27.9 for females. Onset at age forty occurred in 8% of females and only 1% of males. SCHIZOPHRENIA

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19/6/2009 45 Takei et al (1992), found that schizophrenic females, first admission with a peak of July. In contrast, schizophrenic men showed an admission peak in January. A winter peak was most pronounced for males with early onset schizophrenia [ first admission before the age of 25]. SCHIZOPHRENIA

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19/6/2009 46 Almost all studies found the outcome of Schizophrenia to be better in females, at varying lengths of follow-up. Thara & Rajkumar (1992), have also reported a better outcome in females. Mc Glashan & Bardenstein (1990) found that the gender differences in outcome were more pronounced in schizophrenia than schizo-affective and affective disorders. Part of the better outcome in females in the short and mid-term may be explained by a better response to both drug treatment and family interventions (Seeman & Lang, 1990; Haas, 1990 SCHIZOPHRENIA

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19/6/2009 47 PHENOMENOLOGY: Several studies & reviews (Goldstein & Link, 1988; Bardenstein & McGlashan, 1990; Castle & Murray, 1991) have concluded that there are differences symptoms of schizophrenia between the two sexes. Overall, men are more prone to express negative symptoms such as social withdrawal and blunted affect. Females are more likely to present with dysphoria and depressive symptoms. SCHIZOPHRENIA

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19/6/2009 48 In the Chestnut Lodge Follow-up Study (McGlashan & Bardenstein, 1990), The study found higher prevalence, older age of onset and greater suicidal tendencies in women. SCHIZOAFFECTIVE DISORDER

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19/6/2009 49 The rates of bipolar disorder are nearly equal for women and men (1.4 and 1.3 percent, respectively) the onset tends to occur later in women, and they are more likely than men to experience a seasonal pattern of the mood disturbance, depressive episodes, mixed mania, or rapid cycling. Women with bipolar disorders also are more likely than men to experience co morbidity, particularly thyroid disease, migraine, obesity, and anxiety disorders, whereas men are more likely to experience a co-occurrence of substance use disorders. Bipolar Disorder

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19/6/2009 50 By the time they are hospitalized, female patients have had more episodes and less precipitating factors. The outcome scenario is somewhat equivocal and even contradictory. Bipolar women are re hospitalized less frequently, healthier at last contact, and less episodic post discharge. They also control drug and alcohol abuse better then their male counterparts. At outcome, bipolar women function better with respect to occupation, living situation, and global recovery. Bipolar Disorder

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19/6/2009 51 Recent research is increasingly investigating the correlation between the co-occurring mental health and substance use disorders in women with a history of sexual or physical trauma. Studies on this issue find that from 55 to 99 percent of women in substance use treatment report a history of trauma, as do 85 to 95 percent of women in the public mental health system, with the abuse most commonly having occurred in childhood. Having a history of violence, trauma, or abuse is associated with increased risk of behaviors, such as smoking, binge drinking, cocaine use. SUBSTANCE ABUSE

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19/6/2009 52 Considering that about one-third of American women report regular alcohol consumption and 2.3 percent, or 2.5 million women, meet the criteria for alcohol dependence, The meta-analysis by Reddy and Chandrashekar (1998) revealed an overall prevalence of 6.9/1000 for India with urban and rural rates of 5.8 and 7.3/1000 population. The rates among men and women were 11.9 and 1.7, respectively An estimate by Anand (2000). The prevalence of alcohol use among women was estimated to be 0.5%. SUBSTANCE ABUSE

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19/6/2009 53 Alcohol is consumed in lesser quantities by women in our country as compared to Western. Prescription drugs and over the counter drugs are consumed more by women. Two thirds of prescriptions for psychotropic drugs such as Diazepam and Alprazolam are for women. Multi centered sample surveys in colleges carried out by Dr.Mohan Issac and others have, over the last two decades, found similar trends. SUBSTANCE ABUSE

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19/6/2009 54 A recent study of dementia in urban Mumbai population reported Alzheimer’s disease was the most common type of dementia, followed by vascular dementia and its prevalence was higher in women than man.-Pinto et al(2001) In an elderly rural population of WB,61% were found to have psychiatric illness with female having significantly higher rate than male.-Nandi et al(1997) Mental health of women senior citizens

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19/6/2009 56 In March 1999, at the 43rd session of the UN Commission on the Status of Women, a Resolution Was adopted that recognized that violence against women is escalating in all cultures, societies and socio-economic groups and as a consequence the prevalence of mental disorders in women, throughout their life cycle, is also on the rise. Violence has been taken to include any act of verbal or physical force, life-threatening deprivation, directed at any individual woman or girl that causes physical or psychological harm, humiliation or arbitrary deprivation of liberty and that perpetuates female subordination - (Heise, Pitanguy, & Germain, 1994). VIOLENCE AGAINST WOMEN

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19/6/2009 57 Physical, sexual and psychological violence occurring in the family, including battering, sexual abuse of female children in the household, dowry- related violence, marital rape, female genital mutilation and other traditional practices harmful to women, non-spousal violence and violence related to exploitation; Physical, sexual and psychological violence occurring within the general community, including rape, sexual abuse, sexual harassment and intimidation at work, in educational institutions and elsewhere, trafficking in women and forced prostitution; Acts of violence against women also include forced sterilization and forced abortion, coercive/forced use of contraceptive, female infanticide and prenatal sex selection VIOLENCE AGAINST WOMEN

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19/6/2009 60 VIOLENCE AGAINST WOMEN Womb to Tomb

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Legal definition of DV : 

19/6/2009 67 Legal definition of DV Domestic Violence Act 2005 defines DV Any act, omission or commission or conduct of the respondent shall constitute domestic violence in case it - Harms or injures or endangers the health, safety, life, limb or well-being, whether mental or physical, of the aggrieved person or tends to do so and includes causing physical abuse, sexual abuse, verbal and emotional abuse and economic abuse; Harasses, harms, injures or endangers the aggrieved person with a view to coerce her or any other person related to her to meet any unlawful demand for any dowry or other property or valuable security;

Legal definition of DV : 

19/6/2009 68 Has the effect of threatening the aggrieved person or any person related to her by any conduct mentioned in clause (a) or clause (b); Legal definition of DV Otherwise injures or causes harm, whether physical or mental, to the aggrieved person.

Types of domestic violence: : 

19/6/2009 69 Types of domestic violence: "physical abuse" "sexual abuse“ "verbal and emotional abuse“ "economic abuse“ “Social abuse”

Mental Health Problems : 

19/6/2009 70 Mental Health Problems Lifetime experiences of abuse and violence are common among women seen in mental health settings. 30-90% of women in domestic violence programs have identifiable mental health problems It is also noted that the stress of domestic violence may aggravate the already existing or co morbid psychiatric disorders.

Mental Health Problems : 

19/6/2009 71 Mental Health Problems Battered women develop substance abuse problems (7-36%) as a way of coping with violence Women suffering domestic violence are five times more likely to attempt suicide. Frequently exhibit marked anxiety, confusion, multiple somatic complaints and frequently visit the emergency. Depression is common(60%).

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19/6/2009 72 While studies have shown that dowry-related violence against women occurs among all subgroups of the population, the rates are higher among the poor and the lower castes. (Rao and Bloch, 1993). The most media-sensationalized type of violence against women in India is dowry death. A dowry death is defined as the unnatural death of a woman caused by burns or bodily injury occurring within the first 7 years of marriage, if it can be shown that the woman was subjected to cruelty by her husband or her husband’s relatives shortly before death in connection with a demand for dowry (Johnson, 1996; Prasad, 1996) DOWRY DEATH

Laws in India : 

19/6/2009 73 Laws in India During the 1980’s, far-reaching changes were introduced in our criminal laws to deal with DV In 1983, DV :as a specific criminal offence by the introduction of section 498-a into the Indian penal code. Section 498-a of the Indian penal code covers dowry-related harassment Also addresses dowry deaths in section 304-b. Section 306 should be invoked when a woman commits suicide because of dowry-related harassment.

DOMESTIC VIOLENCE ACT 2005Strengths of the act : 

19/6/2009 74 DOMESTIC VIOLENCE ACT 2005Strengths of the act A new dimension to the word abuse ………. includes actual abuse or threat of abuse (harassment by way of dowry demands) All crimes in the Domestic Violence Act are non-bail able The Act has also defined Physical Violence very comprehensively, as: Any kind of bodily harm or injury, A threat of bodily harm, Beating, slapping and hitting. For the first time, the law has expanded the definition to include sexual, verbal and economic violence.

DOMESTIC VIOLENCE ACT 2005Strengths of the act : 

19/6/2009 75 DOMESTIC VIOLENCE ACT 2005Strengths of the act The new law is also tough on men who subject women to name calling or verbal abuse. Another significant step has been to recognize Economic Violence. Under the Act, Economic Violence is: Not providing money, food, clothes, medicines,# Causing hindrance to employment opportunities # Forcing a woman to vacate her house. In short, a husband cannot take away her jewellery or money, or throw her out of the house while they are having a dispute.


19/6/2009 76 RAPE SECTION 375 IPC Lifetime prevalence rates of rape for women were 9.2% and rates for molestation were 12.3%. 20% and 30% of adult women have experienced sexual abuse and assault during their lifetimes PUNISHMENT FOR RAPE Imprisonment of either description > 7 years. May be for life or a term of 10 years ± fine Wife / not < 12 years 2 years or fine or both. Special reasons 7 years

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19/6/2009 77 Leventhal (1990) found a wide variation in reported prevalence rates, ranging from 6% to 62%. one woman in three has experienced unwanted sexual experiences before the age of 16 years (Beitchman et al.,1992; Anderson et al., 1993 Depression and anxiety are the primary psychological outcomes. It has been suggested that CSA may also be implicated in postpartum depression (Buist & Barnett, 1995; Buist, 1998 ). Psychiatric comorbidity is common. Child sexual abuse

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19/6/2009 78 Women who have been victims of child sexual assault are two to four times more likely to be raped in adulthood than non-victims, and are at heightened risk of experiencing other forms of victimisation (Russell, 1986; Simons & Whitbeck, 1991; four times more likely to report partner abuse-Friedman, 1997). Revictimisation

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19/6/2009 79 In 1987, The Indecent Representation of Women (Prohibition) Act was passed to prohibit indecent representation of women through advertisements or in publications, writings, paintings, figures or in any other manner. In 1997, in a landmark judgement, the Supreme Court of India took a strong stand against sexual harassment of women in the workplace. The Court also laid down detailed guidelines for prevention and redressal of grievances. The National Commission for Women subsequently elaborated these guidelines into a Code of Conduct for employers Sexual harassment


19/6/2009 80 INDECENT ASSAULT – Section 354 IPC Sec 354 IPC punishment – imprisonment 2 years ± fine or both. Sec 509 IPC Insulting the modesty of a woman. Pnishment: Simple imprisonment 1 year ± fine

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19/6/2009 81 The Immoral Traffic (Prevention) Act was passed in 1956. However many cases of trafficking of young girls and women have been reported. These women are either forced into prostitution, domestic work or child labor. TRAFFICKING

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19/6/2009 83 KIDNAPPING 1. OF MINOR GIRL – SEC 366A IPC Whoever by any means induces any minor girl < 18 year age. To go from any place To do any act with intent Forced or seduced to Illicit intercourse Punishment: 10 years imprisonment ± fine 2. Sec 366 B IPC - Import into India from any country - Outside India or from Jammu & Kashmir - Under the age of 21 years


19/6/2009 84 PROSTITUTION: Sec 372 IPC Prostitution: Female < 18 years Sold, let for hire or otherwise to prostitute or brothel held responsible until contrary proved Intent for - prostitution - illicit intercourse Unlawful / immoral purpose Punishment of either description 10 year ± fine Sec373 IPC:Buying girls for prostitution

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19/6/2009 85 The Hindu personal laws of mid-1956s (applied to Hindus, Buddhists, Sikhs and Jains) gave women rights to inheritance. However, the sons had an independent share in the ancestral property, while the daughters' shares were based on the share received by their father. Hence, a father could effectively disinherit a daughter by renouncing his share of the ancestral property, but the son will continue to have a share in his own right. Additionally, married daughters, even those facing marital harassment, had no residential rights in the ancestral home After amendment of Hindu laws in 2005, now women in have been provided the same status as that of men The Hindu Succession (Amendment) Act, 2005

The Hindu Succession (Amendment) Act, 2005 : 

19/6/2009 86 The Hindu Succession (Amendment) Act, 2005 The Hindu Succession (Amendment) Act, 2005 amended Section 6 of the Hindu Succession Act, 1956, allowing daughters of the deceased equal rights as sons. In the case of coparcenary property, or a case in which two people inherent property equally between them, the daughter and son are subject to the same liabilities and disabilities. The amendment essentially furthers equal right between males and females in the legal system.

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19/6/2009 87 The Government of India declared 2001 as the Year of Women's Empowerment (Swashakti). The National Policy For The Empowerment Of Women came was passed in 2001 The principle of gender equality is enshrined in the Indian Constitution in its Preamble, Fundamental Rights, Fundamental Duties and Directive Principles. The Constitution not only grants equality to women, but also empowers the State to adopt measures of positive discrimination in favour of women NATIONAL POLICY FOR THE EMPOWERMENT OF WOMEN (2001)

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19/6/2009 88 From the Fifth Five Year Plan (1974-78) onwards marked shift in the approach to women’s issues from welfare to development. In recent years, the empowerment of women has been recognized as the central issue in determining the status of women. The National Commission for Women was set up by an Act of Parliament in 1990 to safeguard the rights and legal entitlements of women. The 73rd and 74th Amendments (1993) to the Constitution of India have provided for reservation of seats in the local bodies of Panchayats and Municipalities for women, laying a strong foundation for their participation in decision making at the local levels. INTRODUCTION NATIONAL POLICY FOR THE EMPOWERMENT OF WOMEN (2001)

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19/6/2009 89 India has also ratified various international conventions and human rights instruments committing to secure equal of women like Convention on Elimination of All Forms of Discrimination Against Women (CEDAW) in 1993 The Mexico Plan of Action (1975), the Nairobi Forward Looking Strategies (1985), the Beijing Declaration as well as the Platform for Action (1995) INTRODUCTION NATIONAL POLICY FOR THE EMPOWERMENT OF WOMEN (2001)

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19/6/2009 90 There still exists a wide gap between the goals mentioned in the Constitution, legislation, policies, plans, programmes, and related mechanisms on the one hand and the situational reality of the status of women in India, on the other. This has been analyzed extensively in the Report of the Committee on the Status of Women in India, "Towards Equality", 1974 and highlighted in the National Perspective Plan for Women,1988-2000, the Shramshakti Report,1988 and the Platform for Action, Five Years After- An assessment" INTRODUCTION NATIONAL POLICY FOR THE EMPOWERMENT OF WOMEN (2001)

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19/6/2009 91 Creating an environment through positive economic and social policies for full development of women to enable them to realize their full potential Enjoyment of all human rights and fundamental freedom by women on equal basis with men in all spheres – political, economic, social, cultural and civil Equal access to participation and decision making of women in social, political and economic life of the nation Equal access to women to health care, quality education at all levels, career and vocational guidance, employment, equal remuneration, occupational health and safety, social security and public office etc. Strengthening legal systems aimed at elimination of all forms of discrimination against women Goal and Objectives

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19/6/2009 92 Changing society attitudes and community practices by active participation and involvement of both men and women. Mainstreaming a gender perspective in the development process. Elimination of discrimination and all forms of violence against women and the girl child; and Building and strengthening partnerships with civil society, particularly women’s organizations Goal and Objectives

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19/6/2009 93 Decision Making Women’s equality in power sharing and active participation in decision making, including decision making in political process at all levels will be ensured for the achievement of the goals of empowerment Mainstreaming a Gender Perspective in the Development Process Policies, programmes and systems will be established to ensure mainstreaming of women’s perspectives in all developmental processes, as catalysts, participants and recipients. Wherever there are gaps in policies and programmes, women specific interventions would be undertaken to bridge these. Policy Prescriptions Judicial Legal Systems

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19/6/2009 95 Economic Empowerment of women and Poverty Eradication Social Empowerment of Women Education Health A holistic approach to women’s health which includes both nutrition and health services will be adopted and special attention will be given to the needs of women and the girl at all stages of the life cycle Nutrition Housing and Shelter Environment Policy Prescriptions Judicial Legal Systems

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19/6/2009 97 Health is more than not being sick. Health is influenced by important factors such as the physical environment, health practices and coping skill, biology, health care service and the social and economic environment in which people live their daily lives. Some effective strategies for addressing social and economic determinants of health include the following: 1. Develop and promote education, literacy and employment policies that contribute to employment status. mfc bulletin/October 2008-January 2009 PROMOTION OF WOMEN'S MENTAL HEALTH

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19/6/2009 98 2. Improve community environments that promote physical activity, mental well-being and quality of life. 3. Providing quality and affordable housing. 4. Addressing issues of unequal access to affordable and nutritious food. (Sheridan, 2008) PROMOTION OF WOMEN'S MENTAL HEALTH

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19/6/2009 99 There is a need to formulate developmental plans that enable women to access greater and better educational, economic and health opportunities. It also calls for changing the deeply embedded cultural norms that put women at a disadvantage through a suitable program of social change: specific strategies are listed below. 1 Promotion of gender equity and equality within the family and society is required so that women are not bound by prescribed gender norms and gender roles. The findings of this study underscore the significance of empowerment programs for women aimed towards developing self-worth that is not solely defined by the cultural stereotypes of successful performance of gender roles and responsibilities. PROMOTION OF WOMEN'S MENTAL HEALTH

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19/6/2009 100 2 .It is important to introduce measures that will strengthen self-esteem, enhance problem solving abilities, and reinforce autonomy and assertiveness skills among women. 3. It is equally important that clinicians are trained to be sensitive to Mental Health Care and Human Rights the mental health impact that various disorders and their interventions can produce. Stigma and misconceptions about mental illness can be tackled only by extensive and intense public education efforts. While NGOs can do this in their limited catchment areas, it warrants a national effort by the government to initiate a suitable programme.

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19/6/2009 101 4. Spaces need to be created for women where they can express their tensions, anxieties and feel validated and understood, to prevent escalation into severe mental illness. 5. Sensitization of the community towards mental illness, its causes and modes of treatment is of utmost importance. 6. Economic empowerment of women will greatly reduce their financial dependence on their families.

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19/6/2009 102 7. Policy planners also play a critical role, since any comprehensive strategy to improve the mental health of women necessitates coordinated action. This involves the improvement of policies and legislation, better access and availability of healthcare facilities, better health education and determination of safety at the places where women live and work. Enhanced gender sensitivity in all walks of life will certainly augur a better future for the mental health of women.

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19/6/2009 103 8. Sensitisation of the police and law makers, legal reform, community based facilities and support for homeless mentally ill women in the governmental and non-governmental sector, greater participation of the private sector in the care of women with mental problems, access to benefits under the PWD Act for women with mental illness, special attention to childcare, inclusion for pension and disability allowance are specific needs.

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19/6/2009 104 9. There needs to be effective co-ordination between the Ministries of Health and Family Welfare, Social Justice and Empowerment, Women and Child Welfare, Law, Labour and Education. Stringent action needs to be taken against any human rights violation of women, particularly those with mental illness. 10.The role of civil society in bringing about attitudinal change and the crucial role of the media in ethical reporting and giving due priority to the subject is also very critical in the efforts to address mental health care issues for women.

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19/6/2009 105

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19/6/2009 106 Build evidence on the prevalence and causes of mental health problems in women as well as on the mediating and protective factors. Promote the formulation and implementation of health policies that address women's needs and concerns from childhood to old age. Enhance the competence of primary health care providers to recognize and treat mental health consequences of domestic violence, sexual abuse, and acute and chronic stress in women. Women’s mental health touches the lives of almost everyone, either directly or through the women we love. CONCLUSION

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19/6/2009 107 Women’s Mental Health:An Evidence Based Review-World Health OrganizationGeneva-2000 Ahuja and Vyas-Pstgraduate Psychiatry SP Agarwal-Mental Health in India Action Steps for Improving Women’s Mental Health-U.S Dept of Health and human Services The National Policy For The Empowerment Of Women NCRB Report Mental, neurological and substance abuse disorders: Strategies towards a systems approach-GURURAJ G.*, GIRISH N.*, ISAAC M.K. REFRENCES

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19/6/2009 108 THANK YOU

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