Towards the end of last year, a shocking statistic appeared deep in the pages of a World Health Organisation report. It was this: suicide has become the leading killer of teenage girls, worldwide.
More girls aged between 15 and 19 die from self-harm than from road accidents, diseases or complications of pregnancy.
For years, child-bearing was thought to cause the most deaths in this age group. But at some point in the last decade or so – statistics were last collected on this scale in 2000 – suicide took over. And, according to the WHO’s revised data for 2000, it had already just inched its way ahead of maternal mortality at the turn of the millennium.
Yet, somehow, we didn’t notice.
In South East Asia, the problem is acute: self-harm kills three times more teenage girls than anything else. (The Eastern Mediterranean, which includes Pakistan and the Middle East, has the second highest rate.)
Professor Vikram Patel, a psychiatrist who was recently featured in Time magazine’s 100 Most Influential People for his work in global mental health, is blunt in his diagnosis:
“The most probable reason is gender discrimination. Young women’s lives [in South East Asia] are very different from young men’s lives in almost every way.”
The male suicide rate in this age group is 21.41 per 100,000, compared with 27.82 for girls.
This is the age at which girls may be taken out of school and forced to devote themselves to domestic responsibilities, forgetting all other abilities or ambitions. Hitting puberty can mean no longer being allowed to socialise outside the home. Sometimes it can mean no longer being allowed out of the home at all. And, sometimes, it can mean forced marriage.
Prof Patel was the founding director of the Centre for Global Mental Health at the London School of Hygiene and Tropical Medicine but now spends much of the year in Delhi, where he works for the Public Health Foundation of India.
“Indian media is filled with aspirational images of romance and love,” he says. “The ability to choose your life partner is an idea that’s championed by Bollywood. But that’s completely not the case in reality for most young women.”
Young brides, says Suzanne Petroni, “are very often taken away from their peers. They’re subjected to early and unwanted sex, and they’re much more likely to experience partner violence than people who marry later. All of these things put them at greater risk of suicide.”
In the UK, says Joe Fearns, the Samaritans’ Executive Director of Policy and Research, “all of us in suicide prevention are most concerned by men.”
That’s because almost 80 per cent of all UK suicides are men. But, says Fearns, “the majority of self-harm cases in the UK and presentations at A&E for self-injury are women.”
Part of the reason for the dramatically higher rate of male suicide in the UK (and in most of the western world) is drugs and alcohol; men are more likely to abuse both, leading to more impulsive behaviour.
“Men also tend to use more violent means that are less survivable,” says Fearns.
Roseanne Pearce at Childline tells me 75% of the girls who contact the service with suicidal feelings are either planning or have attempted an overdose, compared with just over half of boys.
Boys are much more likely to be planning or have attempted to hang themselves – a method with a far lower chance of survival.
Some of the disparity between the male and female rate is also down to circumstance, says Fearns. He tells me there is a higher than average rate of suicide among those working in heavy construction and farming – “because they have the means”.
Far fewer women than men work in these environments.
Rhea (not her real name) is 17 and has attempted suicide twice. “Porn was everywhere in my school,” she says. Her boyfriend Andy became “obsessed with it”.
She’d “made it clear,” she says, that she “wasn’t ready to have sex,” but one evening he sexually assaulted her in a park. The assaults became routine. Rhea did nothing.
“The constant talk about porn had made me feel like what was happening was normal,” she says. She uses that word repeatedly to describe her attitude towards Andy’s assaults: normal.
“I felt trapped, like everyone thought it was normal and I had to go along with it if I wanted to be accepted.” The pressure to conform to these perceived expectations was so great that, eventually, Rhea says, “I felt like there was no way out.” She tried to kill herself.
“The suicide attempt rate for young women in the UK is extremely high,” says Prof Patel. He believes “sexual pressure” is a significant factor in their unhappiness.
Roseanne Pearce agrees, adding that “sexting is another big issue among our callers. Girls become desperate, even suicidal, because they’ve sent a picture and it’s been posted online.”
There is also relentless pressure on Western girls look a certain way: to be thin and sexy. The boys at Rhea’s school constantly compared the girls’ bodies to women they saw in porn films, almost always negatively.