(December 2014) More than 1 million adolescents die around the world every year. Some trends have remained steady since 2000: Boys have higher rates of death during adolescence (ages 10 to 19) than girls because they have a high number of road traffic accidents, and older adolescents (ages 15 to 19) have higher rates than younger ages. But for the first time ever, according to the World Health Organization, suicide is the #1 cause of death for adolescent girls ages 15 to 19.
A new report by WHO, Health for the World's Adolescents: A Second Chance in the Second Decade, shows that in every region except Africa, suicide was among the top three causes of death. The report links to interactive graphics on adolescent mortality by age, sex, and region.
Part of the shifting trend is due to important declines in maternal mortality, previously the cause of death affecting the most girls: Maternal mortality has been cut almost in half between 1990 and 2013. Suicide is the leading cause of death for both male and female 15-to-19-year-olds in the Southeast Asia region, with slightly higher rates for girls (28 per 100,000 population) than boys (21 per 100,000 population). The rate for girls in this region is more than twice the global rate.
Suicide Rooted in Social Isolation
WHO also released Preventing Suicide: A Global Imperative that reviews risk factors for suicide across all ages, which include barriers to health care access, discrimination, trauma, abuse, violence, relationship conflict, and social isolation. According to Suzanne Petroni, gender expert at the International Center for Research on Women, adolescents who are socially and economically marginalized have the highest risks for suicide.1
"It should come as no surprise to anyone that we are now seeing the 'feminization of adolescent suicide'," says Charlotte Feldman-Jacobs, program director for gender at the Population Reference Bureau. "If you look at all the risk factors for suicide listed in the WHO report, the group that would have the least power to overcome these barriers is adolescent girls."
Suicide is linked to mental health issues, which are in turn related to stigma and social isolation. Adolescents are especially vulnerable to mental health problems. Research on brain development in adolescence shows how reward-seeking regions of the brain develop before the regions responsible for planning and emotional control. Adolescence is the time when unhealthy behaviors like tobacco and alcohol use, poor diet and exercise patterns, overweight and obesity, and risky sexual activity generally begin. The WHO report notes that depression is the top cause of illness and disability in adolescence.
Violence against women can be a big cause of mental health issues. Poverty and social isolation of girls is prevalent in Southeast Asia, where the suicide rates are high. There, girls suffer from high rates of violence in many forms: female infanticide, child marriage, intimate partner violence, dowry violence, trafficking, and honor crimes. Violence against girls and women in India has gotten worse, with an increase of 70 percent in the past decade.2 Research in urban poor neighborhoods of Bangalore, India, found that among women ages 16 to 25, nearly 80 percent had experienced physical, psychological, or sexual domestic violence by their husbands or members of their extended family.
Child brides especially face social isolation, are subject to early and unwanted sex, and lack the skills or power to succeed in a relationship. Petroni cites a potential relationship between unwanted pregnancy and suicide. Especially where girls have no access to sexual education, contraception, or safe abortion, they may feel suicide is their only option. Other evidence from Southeast Asia shows a link between violence and self-immolation and suicidal thoughts among married adolescents, and an elevated risk of self-destructive behaviors.3
Much work remains to be done to change attitudes about violence against women. Even among girls in Southeast Asia, acceptance of violence in certain circumstances is high: Thirty percent of women and 26 percent of men in India reported that wife-beating was acceptable if a wife argues with her husband.4
The WHO report offers a comprehensive response plan for countries that urges strengthened suicide prevention efforts and encourages countries that follow WHO's Mental Health Action Plan 2013-2020 to aim for a 10 percent reduction in the suicide rate. WHO offers successful strategies like restricting access to the means for suicide (pesticides, firearms, medications) and incorporating suicide prevention into health care services. Keeping girls in schools is especially important during the adolescent years.
Heidi Worley is senior writer/editor at the Population Reference Bureau.
- Suzanne Petroni, "Suicide, Not Maternal Mortality, Now Leading Killer of Adolescent Girls," accessed at www.trust.org/item/ETC, on Sept. 23, 2014.
- Suneeta Krishnan, "Moving From Research to Practice: Responses to Domestic Violence In Urban India," presentation to Interagency Gender Working Group, Population Reference Bureau's Sixteen Days of Violence, March 10, 2014.
- Jennifer L. Solotaroff and Rohini Prabha Pande, Violence Against Women and Girls: Lessons From South Asia (Washington, DC: World Bank, 2014); and Shireen J. Jejeebhoy and Sarah Bott, Non-consensual Sexual Experiences of Young People: A Review of the Evidence From Developing Countries (New York: Population Council, 2003).
- Donna Clifton and Ashley Frost, The World's Women and Girls 2011 Data Sheet (Washington, DC: Population Reference Bureau, 2011).