Human development

Europeans ruled parts of Sri Lanka from 1505 until the independence from the British Empire in 1948. The country suffered a brutal armed conflict from the early 80s until 2009 which started as an ethnic conflict between the majority Sinhalese and minority Tamils. This later expanded into a war between the Liberation Tigers of Tamil Elam, a separatist militant organisation with international terrorist affiliations, and the Sri Lankan Government (Stanford University, 2015). Since the end of the war, the country has progressed to the high human development (HDI) category, as classified by the United Nations Development Programme (UNDP, 2016). The parameters considered include life expectancy at birth, mean years of schooling and gross national income per capita.

Gender inequality

In contrast to the HDI, the country has failed to progress in the Gender Inequality Index. Sri Lanka is in the 87th position out of 155 countries, but it was in the 75th position out of 148 in 2012 (UNDP, 2013, 2016). Gender inequality is generally assessed by the maternal mortality rate, adolescent birth rate, proportion of females in parliament, secondary education and workforce participation. Sri Lanka has a far better maternal mortality ratio (30 per 100 000 live births) and adolescent birth rate (14.8 per 1000 women) compared to the regional figures for South Asia. However, the proportion of women in parliament is 4.9%, which is far below the regional figure of 17.4%. Sri Lanka ranks highly in terms of secondary education, with 80.2% of females reaching this academic level; South Asian figures are at 36.9%. Finally, Sri Lankan women make up only 30.2% of the workforce, which is on par with regional figures (UNDP, 2016). Even though the degree of gender inequality is less than in neighbouring countries, many Sri Lankan women tend to be engaged in traditionally feminine occupations and earn less than men even in comparable positions. In addition, there is a high concentration of females in low-level positions and males in high-level positions (Gunawardane, Reference Gunawardane2016). Sri Lankan women play a major role in the agricultural industry, but their labour is valued less than that of men (Premarathna, Reference Premarathna2018).

Women and politics

Sri Lankan women obtained voting rights in 1931, just 3 years after women in the UK. Furthermore, when Sirimavo Bandaranaike was elected prime minister in 1960, Sri Lanka was the first country in the modern world to have a female head of state (Kearney, Reference Kearney1981). Despite having a low percentage of female parliamentarians, women have played a significant role in the country's post-colonial political culture. In Sri Lanka's documented history spanning 2600 years, women have held high social and political responsibility. Even today, women are considered the core of Sri Lanka's moral identity (Lynch, Reference Lynch2007).

Poverty and women

Currently poverty is the main contributor of psychosocial vulnerability in adolescent girls in post-conflict settings in northeastern parts of the country (Samuels et al, Reference Samuels, Jones and Abu Hamad2017). In the 1990s, many men were at the war front and the government had to create employment opportunities for young women (Lynch, Reference Lynch2007). Many apparel factories were established in free-trade zones and this industry has remained the country's largest net foreign exchange earner since 1992 (Dheerasinghe, Reference Dheerasinghe2009). Despite families valuing education, a significant number of young women dropped out from secondary education due to poverty, romantic relationships or early marriage (Samuels et al, Reference Samuels, Jones and Abu Hamad2017). Many in this group ended up as garment workers living away from their traditional social networks. These young women are overworked, underpaid and subjected to abuse, highlighting the fact that increased numbers of women in the workforce does not necessarily translate to improved gender equality (Lynch, Reference Lynch2007).

Gender and culture

Young women in Sri Lanka experience stigma associated with gender-based cultural norms. This plays a substantial role when adolescent girls access mental health services. Parents would insist on speaking on behalf of the young person in the context of overprotective parenting in a collectivistic society (Freeman, Reference Freeman1997). Most of these gender-based norms are unrelated to the majority religion, Theravada Buddhism. In fact, Buddhism is known to promote gender equality, where Buddha taught that both men and women could purify their minds and achieve enlightenment to become arahat. The female arahat monk Sanghamitta played a significant role in introducing Buddhism to Sri Lanka in the third century BC (Bartholomeusz, Reference Bartholomeusz1994). In addition, predominantly Buddhist countries have better gender equality compared with those favouring other traditional religions such as Hinduism and Islam (Prewitt-Freilino et al, Reference Prewitt-Freilino, Caswell and Laakso2012).

Women and sexuality

Premarital sex is culturally not accepted, but more than 10% of school children and more than 20% of out of school adolescents are found to be sexually active (Thalagala et al, Reference Thalagala, Rajapakse and Yakandawala2004). Additionally, the use of barrier contraceptives is low in the country compared with others (Premadasa et al, Reference Premadasa, Vidanapathirana, Wijegoonewardene and Disanayake2016). This has potentially made young women vulnerable to sexually transmitted diseases and unwanted pregnancies. Abortion is a criminal offence in Sri Lanka unless performed to save the life of the mother. Therefore, young women who are pregnant due to premarital sex would face substantial social pressure to seek illegal and unsafe abortions by unqualified practitioners, leading to physical and psychological trauma (Abeyesekera, Reference Abeyesekera1997).

Unlike many other Asian nations, the Sri Lankan population does not show a significant preference to sons, probably due to absent disadvantages for females in health and education (Fikree & Pasha, Reference Fikree and Pasha2004). Studies have found more than a third of women had experienced intimate partner violence in their lifetimes and young women are more vulnerable. In contrast, Sri Lanka has fewer issues relating to dowries and child marriages, which is a positive difference to other Asian nations (Jayasuriya et al, Reference Jayasuriya, Wijewardena and Axemo2011). In 2005, specific legislation was made against domestic violence which was a landmark for women's rights. Unfortunately, marital rape is not a criminal offence unless the spouse is judicially separated (Jayatilleke et al, Reference Jayatilleke, Poudel and Yasuoka2010). Furthermore, young Sri Lankan women are known to be harassed and discriminated against due to their clothing and a recent survey by the United Nations Population Fund found that 90% of women using public transport reported being sexually harassed (UNFPA, 2017). Motherhood is considered an essential component of a woman's social identity. In Sri Lankan couples suffering from infertility, pressure from the extended family, myths about the responsibility of infertility and poor marital communication could lead to significant psychological distress in young women (Lansakara et al, Reference Lansakara, Wickramasinghe and Seneviratne2011).

The next generation of women

Although an equal proportion of men and women obtain secondary education, there are higher numbers of women in tertiary education. In the 2015/2016 academic year, 63% of all state university entrants were females; women made up a majority in undergraduate medicine (59%) and law (86%) (UGC, 2016). This has been the trend for the past few years, and a significant majority of the graduates are now females, making it appear that women are more educated than men. The educational capabilities and employment of Sri Lankan women influence their power and control in their families (Malhotra & Mather, Reference Malhotra and Mather1997).

Mental health of women

The female suicide rate in Sri Lanka is one of the highest in the world and there are high rates of self-harm in young women living in rural, disadvantaged groups. These acts are mostly made impulsively against perceived wrongful treatment, often related to family disputes and conflicts with intimate partners (Marecek, Reference Marecek2006). In the aftermath of the 2004 tsunami, it was found that depressive psychopathology among adolescents was significantly associated with depression in their mothers. Furthermore, positive mother–child relations directly related to better adolescent psychological health (Wickrama & Kaspar, Reference Wickrama and Kaspar2007). This is understandable in the Sri Lankan context where family cohesiveness is highly regarded and motherhood is valued and attributed with serious responsibility, which is highly beneficial to the children. However, it could be challenging for a young women to fulfil the social role of a traditional mother when they are more likely to be educated and employed than the women of the past, who were mostly homemakers. This role change of the Sri Lankan mother could induce rifts between married partners and in-laws, where grandparents are expected to be significantly involved in childrearing. This could be an issue for the grandparents because, in this Buddhist-majority country, elderly people engage in deeply religious activities in their preparation for a noble birth after their death, and temples are flocked by senior citizens learning and practising meditation.

The future

It appears that young Sri Lankan women of the future will be more educated than men. However, they are likely to face a changing patriarchal society and are likely to develop psychological issues that would require greater support from health professionals. The mental health services tackle a heavy load of major psychiatric disorders and the subspecialties are not well developed (Chandradasa & Champika, Reference Chandradasa and Champika2018). Nevertheless, with the end of armed conflict and improved living conditions, a substantial proportion of Sri Lankan psychiatrists who trained in high-income countries are returning to their home country. This foreign exposure is a compulsory advanced training component of the Sri Lankan postgraduate psychiatry programme (Chandradasa & Kuruppuarachchi, Reference Chandradasa and Kuruppuarachchi2017). Their experience in more gender-sensitive services in high-income countries such as the UK and Australia as well as their local training could be employed to develop more structured and culturally appropriate mental health services for Sri Lankan women. Collaborative work between mental health specialists, professional organisations, health administrators and policymakers is essential to make this a reality.