A gender and public policy perspective
World Mental Health Day, observed on 10th October, 2026, provided an opportunity to reflect on an issue that affects individuals, families, communities and societies. Although diagnosis and treatment are essential, they do not capture the full meaning of mental health. Mental well-being is also shaped by childhood experiences, relationships, caregiving responsibilities, social expectations and the material conditions in which people live.
Women’s mental health cannot therefore be understood solely as an individual or medical concern. It is closely connected to gender equity, human dignity and public responsibility. A woman may be educated, professionally accomplished and outwardly successful while experiencing profound distress. Another may never receive a formal diagnosis yet feel isolated, exhausted or unable to exercise meaningful control over her life. Equally, a mental-health diagnosis does not diminish a person’s capacity for purpose, connection, recovery or flourishing.
The central question is whether the conditions surrounding women enable them to live with dignity, develop their capabilities, participate in society and access support when they need it.
Understanding Mental Health: More Than the Absence of Illness
The World Health Organisation (WHO) defines mental health in terms of well-being that enables people to cope with life’s stresses, realise their abilities, learn and work well, and contribute to their communities. This understanding places mental health within everyday life rather than restricting it to clinical settings.
Mental well-being does not mean permanent happiness or the absence of sadness, grief, anxiety or uncertainty. These are part of human experience. Distress warrants particular attention when it becomes persistent, overwhelming or disabling, or when a person cannot access the support needed to manage it.
Dr Corey L M Keyes is an American sociologist and Emory University professor known for his research on the mental-health continuum framework, which distinguishes mental illness from positive mental health. The two are related but not identical; the absence of a diagnosed disorder does not necessarily indicate flourishing, while a person living with a mental-health condition may still experience meaning, relationships and personal strengths.
This distinction challenges common misconceptions. Children and adolescents can experience mental-health difficulties, academic achievement does not make a person immune to distress, and mental illness should not automatically be associated with violence or dangerousness. Prevention, treatment, recovery and social support are possible, although each person’s experience is different.
It is equally important not to interpret every difficult emotion as a disorder. Bereavement, illness, relationship breakdown and insecurity can cause genuine suffering. Such experiences deserve recognition and appropriate support, even when they do not meet the criteria for a clinical diagnosis.
The Biopsychosocial Perspective: Linking Mind, Body and Society
Dr George Libman Engel, an American internist and psychiatrist, formulated the biopsychosocial model of health, which provides a useful framework for understanding how biological, psychological and social factors interact. (Engel, 1977).
Biological influences include genetics, physical illness, hormonal changes, sleep, nutrition and medication. Psychological dimensions include emotions, coping strategies, self-esteem, previous experiences and the meanings individuals attach to events. Social influences include family relationships, employment, economic security, culture, discrimination, institutions and access to healthcare.
These dimensions frequently intersect in women’s lives. A reproductive-health concern, for example, may coexist with family pressure, financial insecurity or limited access to specialist care. The resulting distress cannot be understood by examining the body alone, nor can it be reduced to an individual’s thoughts or coping skills.
Cognitive approaches, such as the ABC framework — activating event, beliefs or interpretation, and consequences — can help explain how interpretations influence feelings and behaviour. However, this framework must not imply that suffering is simply the result of negative thinking. A woman experiencing violence, discrimination or material insecurity may be responding to real threats. Psychological support cannot substitute for safety, justice or structural change.
Abraham Maslow, an influential American psychologist associated with humanistic psychology, introduced his theory of human motivation in his 1943 paper, “A Theory of Human Motivation.” His hierarchy of needs offers a broad reminder that safety, belonging, self-respect and opportunities for growth matter to well-being. It should not be treated as a rigid sequence through which every person must progress, because human lives are more complex than a fixed set of stages.
Childhood and Adolescence: Foundations of Emotional Health
Mental health develops across the life course. Early relationships, nutrition, safety, responsive caregiving and opportunities to learn help shape children’s emotional regulation, trust and responses to stress. The WHO–UNICEF Nurturing Care Framework identifies good health, adequate nutrition, responsive caregiving, security and safety, and opportunities for early learning as important foundations for development.
Children learn from what adults do as well as what they say. Being heard, comforted and treated consistently can support trust and emotional security. Repeated exposure to fear, neglect, humiliation or instability may increase vulnerability to later difficulties, but outcomes are not predetermined. Supportive relationships and appropriate services can make a meaningful difference.
Schools also have an important role. Teachers should not be expected to diagnose or treat conditions beyond their training, but they can recognise changes in behaviour, respond to bullying, create respectful classrooms and refer students to appropriate services.
Adolescence brings physical, emotional and social changes. Puberty, menstruation, body image, peer relationships, academic pressure, online experiences and changing family expectations can all affect well-being. The WHO estimates that one in seven people aged 10–19 globally experiences a mental disorder. This is a global estimate for adolescents of all genders, not a statistic specific to girls or India.
For girls, mental health should be considered alongside menstrual health, nutrition, safety and equal access to education. When girls are expected to combine schoolwork with substantial household responsibilities, they may face pressures not equally imposed on boys. School participation alone does not guarantee a supportive childhood.
Women’s Mental Health Across the Life Course
Women’s mental health may be influenced by menstruation, pregnancy, childbirth, infertility, reproductive-health conditions, menopause and ageing. These transitions occur alongside changes in relationships, responsibilities and social expectations. They do not inevitably lead to mental illness; their significance depends on individual health, previous experiences, living conditions and access to support.
Menstrual health matters for physical and emotional well-being. Some women experience premenstrual symptoms that affect daily life, while premenstrual dysphoric disorder (PMDD) can involve severe mood symptoms and functional impairment. Persistent or severe symptoms warrant clinical assessment rather than dismissal as ordinary mood changes.
Taking a menstrual history may help clinicians identify patterns in mood, sleep, energy and other symptoms. The purpose is not to attribute every emotional difficulty to hormones, but to consider possible interactions between physical and mental health.
Pregnancy and the postnatal period: Pregnancy and childbirth can bring physiological changes, sleep disruption, uncertainty and new responsibilities. Some women experience perinatal depression or anxiety and need professional care. Others face distress intensified by isolation, financial pressure, relationship difficulties or expectations that motherhood should always be joyful.
Maternal mental health should therefore be understood as both a healthcare concern and a social issue. Appropriate care includes respectful maternity services, support from family and community, and recognition of the demands of caregiving. Stress during pregnancy should not be used to blame women for later outcomes in children; development is complex and not predetermined.
Menopause and later life. Menopause is generally identified after 12 consecutive months without menstruation when there is no other cause. The transition may involve changes in menstrual patterns, sleep, mood, concentration and physical comfort, but experiences vary widely. Symptoms may intersect with work demands, caregiving and changes in family life.
Clinical assessment is important when symptoms are severe or persistent. Treatment should be individualised; hormone therapy may be appropriate for some symptoms and some women, but it is not a universal solution to every emotional or cognitive concern.
Across these stages, menstrual, perinatal and menopausal histories may be relevant to mental-health assessment, but they must be considered alongside psychological, social and other medical factors.
Reproductive Health, Relationships and Emotional Security
Some of the most difficult questions about women’s mental health emerge where physical illness, reproductive experiences and intimate relationships intersect. Two experiences shared with me illustrate why emotional well-being cannot be separated from dignity, safety and the quality of relationships.
The first concerned a woman who married in her teens and spent decades raising her children and caring for her husband’s family. After approximately 15 to 18 years of marriage, her husband entered into a second marriage, which remained undisclosed for a considerable period. His family did not accept the arrangement. She continued to fulfil her responsibilities within the household and care for her children and in-laws.
As her children grew and established their own lives, she was diagnosed with breast cancer and underwent treatment, including chemotherapy. On medical advice, she subsequently underwent a hysterectomy. Her husband cared for her during cancer treatment, and their life together continued through these circumstances.
Within three months of her mother-in-law’s death, however, her husband divorced her. When she later shared her experience with me, she described emotional distress as she tried to comprehend the end of a long marriage while dealing with the consequences of illness. Her account does not establish the reasons for the divorce or show that illness or surgery caused the marital breakdown. It does, however, raise important questions about emotional security and the need for support during serious illness and major relationship changes.
The second experience concerned a couple who were both medical practitioners and moved to a city to pursue professional opportunities. During their five-year marriage, they were unable to conceive. The woman was repeatedly blamed for the infertility despite there being no established basis for holding her solely responsible. She endured prolonged psychological stress, compounded by the suppression of her concerns and verbal and physical abuse. She later encountered information suggesting that the infertility might have involved her husband. The marriage eventually ended in divorce.
Throughout this difficult period, her parents provided emotional support. She subsequently remarried and had two children. Her later experience should not be interpreted as evidence that motherhood was necessary to restore her well-being or establish her worth. Her dignity was never contingent on whether she could conceive.
These accounts are not intended to represent every woman’s experience. They illustrate how illness, reproductive stigma, gendered blame, violence and the loss of emotional security can intersect. They also show why support should include appropriate healthcare, counselling, protection from abuse and the social and economic resources that enable women to make informed choices.
The Hidden Psychological Cost of Social Expectations
Women’s mental health is shaped not only by biological and individual factors but also by gendered social expectations. Pressure to fulfil prescribed roles as daughters, wives, mothers and caregivers can affect self-worth, emotional security and social belonging, particularly when women’s lives diverge from prevailing norms.
Research from Kashmir published in the International Journal of Sociology and Social Policy examined women’s experiences of infertility and documented stigma, marital strain, social isolation and emotional distress. The findings illustrate how reproductive challenges may become a wider social burden when motherhood is treated as a defining measure of womanhood. As a qualitative study, it illuminates lived experiences rather than establishing the prevalence of these experiences across the region.
A 2026 secondary analysis of National Family Health Survey-5 data found substantial state-level variation in estimates of primary and secondary infertility. Its estimates differed according to the type of infertility measured, with comparatively high estimates of secondary infertility reported in Mizoram, Meghalaya and other areas (Perumal et al., 2026). These figures must be interpreted in light of the study’s definitions and methods; they do not justify generalisations about every Northeastern state or community.
Marital conflict, infidelity, abandonment and domestic violence may further compromise psychological well-being, but their prevalence and consequences must be established through reliable, context-specific evidence rather than assumptions about particular communities. A gender-responsive policy approach should integrate psychosocial counselling into reproductive and primary healthcare, strengthen confidential support and referral systems, and challenge discriminatory attitudes that disproportionately blame women for infertility.
Infertility can involve male factors, female factors, both partners or unexplained causes. Appropriate assessment and counselling should therefore include both partners where possible, while ensuring that women have confidential access to support and protection from abuse.
The policy imperative extends beyond promoting individual resilience to addressing the social conditions that produce preventable distress. Dignity, freedom from violence, access to care and equitable social support are essential to women’s psychological well-being.
Afiyah: Spiritual and Mental Well-Being
In Islam, the Prophetic supplication, “O Allah, I ask You for ‘Afiyah in this world and the Hereafter,” expresses an aspiration towards holistic well-being, encompassing health, protection and peace. For many women, faith can provide meaning, hope and strength during adversity.
Yet psychological distress should never be construed as a weakness of faith or a reason to endure suffering in silence. Spiritual resources and compassionate communities can complement professional mental healthcare, enabling women to seek support without stigma while preserving their dignity.
A culturally responsive approach to mental health can respect spiritual beliefs while recognising the importance of evidence-based treatment, social support and timely intervention.
Work, Unpaid Care and the Gendered Burden of Resilience
Women’s mental health is also shaped by the distribution of time, labour and responsibility. Many combine paid employment with childcare, care for relatives, household management and the emotional work of sustaining relationships. These demands are often treated as private family matters rather than concerns for public policy.
India’s Time Use Survey 2024 provides an important perspective. Among people aged 15–59, approximately 41 per cent of women and 21.4 per cent of men participated in unpaid caregiving for household members. Among participants, women spent an average of about 140 minutes a day on such caregiving, compared with approximately 74 minutes for men. These figures concern unpaid caregiving, not all domestic work, and should be interpreted within that distinction (Ministry of Statistics and Programme Implementation, 2025).
Unequal care responsibilities can restrict rest, sleep, learning, paid employment and time to seek healthcare or counselling. When women experience exhaustion, their difficulties may be dismissed as a failure to manage responsibilities, while the unequal distribution of those responsibilities remains unexamined.
Workplaces may add pressure when inflexible schedules, limited leave, stigma or inadequate facilities make it difficult to manage menstrual disorders, pregnancy, menopause or other health conditions. The aim is not to assume that every woman needs the same adjustment, but to establish fair workplaces that respond to health needs while protecting privacy and preventing discrimination.
Resilience cannot mean expecting women to absorb ever-increasing demands. It must be supported by fairer care arrangements, safe workplaces, reasonable flexibility, accessible healthcare and economic security.
From Individual Well-Being to Public Policy
If mental health is shaped by psychological and social conditions, the response must extend beyond clinical treatment. India’s National Mental Health Policy of 2014 and the Mental Healthcare Act of 2017 provide important foundations for mental-health services and rights-based care. The continuing challenge is to translate these commitments into coordinated, accessible and gender-responsive support.
First, integrate mental-health support into healthcare. Primary healthcare, adolescent health programmes, reproductive-health services and maternal care should offer opportunities to discuss emotional distress alongside physical symptoms, without fear of dismissal or stigma.
Second, strengthen emotional support in schools. Schools need age-appropriate social and emotional learning, safe reporting mechanisms, anti-bullying measures and clear referral pathways. Teachers should be equipped to recognise distress while respecting the limits of their professional role. Adolescents’ needs should be addressed alongside nutrition, menstrual health, safety and continued access to education.
Third, improve gender-responsive healthcare. Healthcare providers should recognise connections between physical and mental health. Menstrual history, perinatal experiences and menopausal symptoms may be relevant to assessment, but should be considered sensitively and without assuming that hormones explain every difficulty. Reproductive-health services should provide infertility counselling, psychosocial support and appropriate assessment of both partners.
Fourth, strengthen responses to violence and abuse. Services for women experiencing violence, coercion or abuse must include confidential, trauma-informed support, effective referral pathways, legal assistance and practical options for safety. Mental-health treatment cannot compensate for unsafe living conditions; protection and accountability must accompany care.
Fifth, recognise unpaid care as a public-policy concern. Affordable childcare, support for caregivers, accessible community services and fair workplace practices can reduce pressures on women. Economic opportunity and mental well-being are connected when women have meaningful control over resources and decisions affecting their lives.
Finally, improve evidence and accountability. Policy should be evaluated through women’s experiences. National averages can conceal differences by region, income, disability, age and social circumstances. Rural women, women facing social exclusion, women with disabilities and those living in conflict-affected areas may encounter distinct barriers. Programmes must respond to these realities rather than assume a single intervention will meet every need. Research should account for gender, life stage, social conditions and access to services, and women’s experiences should inform programme design and evaluation.
Resilience, Dignity and the Conditions for Flourishing
Resilience is often described as the capacity to recover from adversity. An exclusively individual understanding, however, risks placing the burden of recovery on the person experiencing distress and implying that continued suffering reflects a failure of strength.
A more useful approach recognises resilience as both personal and social. Individual capacities, supportive relationships, healthcare, financial security, safe environments and responsive institutions can all contribute to recovery. Some women draw strength from family and community; others need professional care, practical assistance or protection from harmful relationships. There is no single pathway.
The Global Flourishing Study offers a broader, multidimensional perspective on well-being, examining outcomes beyond a single measure such as income or happiness. Its framework encourages consideration of life satisfaction, relationships, meaning and other dimensions of a life going well (VanderWeele et al., 2025).
For women’s mental health, this perspective directs attention not only to symptoms but also to agency, connection and the conditions that enable participation in life. Women’s well-being should not be judged simply by whether they continue to fulfil their responsibilities. We must also ask whether they are safe, have time to rest, are listened to, can make decisions that matter to them and can access help when they need it.
The objective is not to produce women who can endure everything without complaint, but to build families, communities, workplaces and public institutions in which preventable distress is reduced and seeking help is recognised as a legitimate exercise of agency.
Mental Health: A Shared Responsibility
Women’s mental health is more than the absence of illness. It concerns how women grow, learn, work, care, form relationships and navigate changes in their bodies and lives. It emerges through the interaction of biological, psychological and social conditions.
The experiences discussed here show that distress may be associated with illness, infertility stigma, violence, unequal care responsibilities or the loss of emotional security. These experiences are not identical, and women respond to them differently. They nevertheless underline the importance of dignity, support, safety and meaningful choice.
Schools should foster not only academic learning but also emotional understanding and respect. Healthcare systems must recognise the relationship between physical and mental health. Families and communities should offer support rather than blame, while workplaces and public institutions should address the conditions that undermine well-being.
Strength should not be an obligation imposed on women. It should be enabled by supportive relationships, accessible care, economic agency and institutions that recognise women as people with rights, aspirations and lives of their own.
Progress should be measured not by how much hardship women can endure, but by whether they can live with dignity, seek help without judgement and participate fully in society. Mental health is therefore not solely a matter for clinicians. It is also a question of gender equity, social justice and the public conditions that allow people to recover, participate and flourish throughout their lives.
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Dr Shabistan Gaffar is Chairperson of the All India Confederation for Women’s Empowerment and former chairperson of the women’s cell of the National Commission for Minority Educational Institutions (NCMEI). She can be reached at [email protected]
