THE World Health Organisation (WHO) has reported that over one million people die by suicide every year, with a global suicide rate of 16 per 100,000 persons. On average, one person dies by suicide every 40 seconds. Overall, suicide deaths constitute 1.8pc of worldwide deaths. In the last 45 years there has been a 60pc increase in suicide cases. India and China alone constitute about 30pc of suicide mortalities worldwide.
Clearly, these figures show the widespread prevalence of suicide. Mental health problems are the most obvious cause. As a result, governments across the world are treating the rising swell of suicide rates as a public health issue and increasingly focusing on detection and preventative measures. In Pakistan, however, suicide still remains a ‘hush-hush’ affair — despite it being a major public health issue in recent decades.
Many reasons can be advanced for this neglect. The act of suicide is frowned upon in religion, as are social norms surrounding the issue of suicide. Furthermore, the discovery of suicide can also get you into legal cross hairs if the law is followed in letter and spirit. For these two reasons, families hesitate to highlight or report suicide deaths. Governmental policy has moved in tandem with these societal trends. This is why Pakistan neither maintains data on suicide, nor does the government share any information with WHO — making it difficult to gather reliable statistics.
Suicide is a rising public health issue.
Hence, there is no way to estimate the exact extent of the problem and promulgation of an ameliorative policy solution. Only media reports or data gathered by NGOs offer a snapshot of this growing problem. A handful of available academic studies shed some light on the pattern and reasons for the pervasiveness of suicide. Such studies, where available, are focused on limited settings.
One study, based on research conducted in six Pakistani cities, reported a high rate of 7.6 per 100,000 in Larkana, followed by 2.8 in Rawalpindi. Another study, published in the British Journal of Psychiatry, showed a higher rate of attempted suicide, at 39pc, among women in Bara tehsil, in comparison to 21pc among men. This finding has been confirmed in other studies as well.
These meticulous studies, however, also show that reported figures are, likely, grossly underestimated. Nonetheless, reported figures reflect a progressive increase, in line with global trends emerging from WHO-reported suicide figures. The Human Rights Commission of Pakistan reported that, in 2011, there were 1,153 attempted suicides and 2,131 suicides across the nation.
Suicide data in India is better organised and analysed. One study, conducted in India in 2007, put the number of annual suicides at 100,000. The suicide rate was found to be higher in southern states than in northern states. Unlike in Pakistan, Indian researchers have devoted considerable energy to the issue of suicide. There are a number of trends visible in these studies; the result of which has been a candid discussion on India’s suicide rates and possible prevention strategies.
Suicide rates are higher among men than women. However, the rate of attempted suicides is higher among women than men. The rising suicide rates are attributed to a number of factors, with family and financial reasons being the two most prevalent factors. Financial reasons are by far the top-ranked cause. In recent studies, the rate of suicide in Greece is shown to be linked to the prolonged financial crisis that has hit the country. In Cyprus, the financial crisis also forced people into committing suicide. Similarly in India, the rising suicide rate among farmers due to crop failures has also been reported.
Based on media reports, many modes of committing suicide can be identified in Pakistan. Hanging by rope, self-immolation, or ingesting an overdose of medicine seem to be the most common methods. In Japan, the act of committing ritual suicide is considered noble; preserving honour and warding off shame and stigma.
Suicide is a complex phenomenon. The fact that suicide is considered a very personal act diminishes the efficacy of simplified prevention strategies. Considering suicide’s multidimensional roots, any preventative measure should encompass a multidimensional strategy to address the issue. WHO’s suicide prevention Multisite Intervention Study on Suicidal Behaviours has demonstrated that suicide mortality can be reduced by instituting brief low-cost interventions in developing countries.
However, for any plan to be effective in Pakistan, it is important that the subject be discussed openly, with a robust data reporting and collection system in place. There is a big role for public health officials in all of this, since Pakistan has not addressed this public health issue with the seriousness it requires. Preventing suicide can only succeed if efforts from all agencies are unified.
The writer is a development consultant and policy analyst.
Published in Dawn, June 26th, 2016