In my recent fieldwork with girls involved in intergenerational prostitution (prostituted by their husbands and in-laws), I have found it very difficult to find the answers I am looking for. Are these girls being forced to prostitute? Is this something they actually want to do, as they have indicated to me in our discussions? As I walk through the slum where this community resides, I often get the feeling that many of the younger girls don’t want to do this but have several communal, familial, and marital pressures that suffocate their choices. During interviews, I have noticed that the older women speak on behalf of the younger girls who are relatively quiet. Several NGOs have worked on and off with the community, most providing condoms and HIV testing services and some teaching English and the arts to the children. Still, this outreach feels symptomatic and most of these girls no longer utilize these services after marriage, which happens in the early to mid teens and which is when they begin the sex work. Understanding the way the girls actually think on a very internal level may allow NGOs to truly help empower them to have the courage to resist the pressures I’ve mentioned. However, I have yet to hear about or see any groups even begin to ask about mental health.
What is the mental state of these women and girls? How do we move past the surface and understand the deeper psychological struggles that perhaps underlie their acceptance of their situations? Prostitution research shows that women engaged in sex work are often suffering from depression, PTSD, dissociative identity disorders and more. A psychiatric needs assessment would likely uncover heretofore silent needs that these women may likely have. It is very unfortunate that the global mental health gap is so great that mental healthcare service provision is unlikely to be prioritized any time soon in poor communities around the Global South. Aside from the stigma associated with having a mental condition in India, there are very few psychiatrists or mental health professionals relative to the population size. Moreover, the intangible benefits of mental health are often undervalued by funding agencies. The Lancet has published two main series on global mental health in 2007 and 2011, some of the graphs/maps of which I have included above and below.
As you can see in the chart titled “Figure 2,” the change in the number of psychiatrists per 100,000 people has actually been the worst in the lowest income countries where the need is also the least identified and likely to be the highest given that psychiatric conditions tend to develop alongside or in response to trauma and other illnesses. Still, mental healthcare is lagging in high and middle income countries as well. Among the most common psychiatric conditions, depression is one of the leading contributors to global disability and currently less than 25% of those affected receive adequate treatment worldwide. In the community where I’m working, I have a feeling that most of our current interventions will fail without sufficient attention to improving mental health first.