2. What sort of discriminatory gender norms lead to mental ill-health and psychosocial distress?

A range of social and environmental factors including rapid social change, migration, social isolation, conflict/post-conflict environments, unemployment and poverty, individual and family crises, changes in traditional values and conflict with parents, have been recognised by a range of scholars as being key drivers of mental ill-health and psychosocial distress amongst young people (e.g. Patel et al., 2007; Stavropoulou and Samuels, 2015; WHO, 2010). However, there remains relatively little in-depth discussion around the role of norms and specifically gender norms as underlying causes of mental ill-health and psychosocial distress. This is not to say that there is no awareness of gender norms as critical influencing factors. A recent and welcome report by Kapungu and Petroni (2017) does address this to some extent as does a recent newspaper article which explores the linkages between mental health of Indian women and patriarchy; often norms framed in terms of ‘culture and context’ are cited when discussing mental health and psychosocial needs of displaced persons or refugees in humanitarian contexts (see e.g.  Hassan et al, 2015); and a range of innovative tools also dealing with issues of culture and context have been developed largely to be used in humanitarian contexts (see Stavropoulou and Samuels, 2015 as well websites for the Mental Health and Psychosocial Support {MHPSS} network and the Reference Centre for Psychosocial Support of the IFRC). Nevertheless, further study is needed to unpack and explore the pathways between context-specific gender norms and outcomes in terms of broader well-being, and particularly in relation to mental health and psychosocial well-being, and something which this piece starts to do.   

Exploring the intersection of gender norms and mental health and psychosocial well-being during adolescence is particularly pertinent (though this is not to say that these issues are not also critical /play out during other stages of the life course) because this period is a decisive time in the life course when girls and boys start undergoing a range of changes as they transition from childhood to adulthood. It is during this period that developmental changes occur and key skills are acquired such as those that relate to: health, physical and neurological development; social behaviours and attitudes; and education and employment. Bodily changes are also heighted at this stage, e.g. the start of menstruation and the development of breasts for girls and deepening voice and hair growth for boys. But perhaps more critically, the environment in which adolescents reside and, in particular, the norms which are embedded into the communities and which implicitly guide behaviour, attitudes and social interactions, start playing a pivotal role in their lives, also creating potential for mental ill-health and psychosocial distress (Gilligan, 1982). 

Girls in particular during adolescence begin to encounter/confront the constraining role and influence of gender norms in a range of domains, from education and marriage to mobility and career aspirations outside the home. Often these gender norms translate as a decline in freedom for girls, i.e. freedoms that girls once experienced become severely restricted – while a younger girl could go out of the home relatively easily in a context such as Nepal, as she reaches adolescence she is no longer able to, or no longer able to do so on her own. Similarly, in Afghanistan and Pakistan, strict rules that enforce purdah are aimed to curtails girls’ mobility in the public domain (Kabeer et. al., 2011). This is largely because at that age in these settings the girl is considered ‘marriageable’ and if she moves around on her own her ‘honour’ is at risk. This also often coincides with her being taken out of school, as of paramount concern for her parents is marrying her to a good family. As a result of all of this, the girl is likely to feel powerless or disempowered with an inability to control her own destiny and future; she can lose hope and she can also become anxious and fearful particularly if she is being married to an older man (still very common in many contexts) (see e.g. Ghimire and Samuels, 2014).  

Post marriage, a young bride can also face psychosocial distress as she is often living away from her natal home in an area where she knows no one. As an outsider, she can easily become isolated with no opportunities for social interaction and therefore also no one in whom to confide. One young married women interviewed in Viet Nam poignantly told me that if it were not for her children, she would have taken her life a long time ago. She was depressed at having married young (in her case it was an elopement marriage), completely isolated and it seemed that her husband was abusing her (Samuels et al, forthcoming). China, which accounts for 26% of global suicides, is the only country where suicide rates among women are higher than among men, with between 25% and 40% more woman than men committing suicide each year. This is largely attributed to woman marrying young, being isolated, taking on a disproportionate burden of household work, facing large amounts of pressure to produce a male heir and being denied the same level of education as boys. 

Norms also include largely implicit rules on how men should treat women, based often on contrasting and opposing notions of masculinity and femininity.  Men, in short, should be seen to control women and particularly their wives, who in contrast are seen as inferior and subservient. In many contexts this male control can take the form of violence towards their spouse, both physical and psychological. This violence is accepted by many people, including the spouse, also because of a range of additional or intersecting norms that restrict the spouse from speaking about it. Such intersecting norms include a perception that violence between a husband and wife is a private matter, that it is perceived as a husband showing ‘love’ for his wife, and that leaving a husband or divorcing him would bring such shame and stigma to both the woman and her family that staying in an abusive relationship is preferable (see e.g. Naved et. al., 2017). While these notions are changing, and there are examples of positive role models and champions in all contexts, not only do these notions persist, but new forms of e.g. online violence are emerging, e.g. online or cyber violence (see Samuels et al, 2017). All of these behaviours affect the mental health and psychosocial well-being of girls and women.  They feel undervalued, face isolation, fear, pain and also hopelessness, as they are usually unable to see a way out. 

Syrian refugee girls
Syrian and Lebanese girls in a pyschosocial support project, Lebanon, Credit Russell Watkins DFID CC BY 2.0