A day in the field always begins with the ASHAs-the vital link between the health system and the community. Even before entering the community, I often find myself reflecting on a recurring question: Why is it so difficult to talk about mental health? Why is emotional well-being to be explained in simpler, more familiar words for people to understand and relate to it? Often, we avoid using the term “Mental Health” altogether because it carries deep stigma. Sometimes, the word itself becomes a barrier. The term “Mental Health” can evoke a range of associations with fear, labeling, judgment, or misunderstanding, where the word “Mental” is heard first and “health” is overshadowed. Before identifying, counselling or intervention, the foremost challenges start with linguistic barriers which create immediate resistance, obscuring the real emotional burdens people experience in their daily lives.
Globally, the burden of mental health conditions is steadily rising. Conversations are gradually shifting toward more focused approaches, starting to consider vulnerable populations, particularly pregnant women and mothers of infants under one year of age. Emotional well-being does not affect individuals alone as it extends to families and communities, ultimately shaping society as a whole. Reduced quality of life, impaired functioning, and social exclusion are common consequences. The World Health Organization estimates that mental health conditions cost the global economy nearly one trillion USD annually, with depression among the leading causes of ill health and disability. Social determinants such as stigma, discrimination, gender inequality, poverty, rapid urbanization, and cultural beliefs surrounding mental illness further compound these challenges.
Why Women?
Gender is a critical determinant shaping mental health outcomes. Socially defined roles, expectations, and inequalities influence both the prevalence and lived experience of mental health conditions among women. According to the India State-Level Disease Burden Initiative, depressive and anxiety disorders are more prevalent among women (3.9%) than men (2.7%). Despite this disparity, maternal emotional well-being remains insufficiently addressed within many national maternal and mental health programs, where the primary focus often remains on physical indicators alone. Initiatives under MANSI 2.0 illustrate efforts to bridge this gap. In districts Haridwar, the programme has strengthened community awareness around maternal and child health, contributed to reductions in infant and neonatal mortality risks, and supported the identification of high-risk pregnancies. At the same time, field experience revealed an important missing element: the need to integrate women’s emotional well-being into maternal and child health services. This realization has informed emerging efforts to design more holistic community-based approaches that address both physical and emotional dimensions of care.
But what does this look like on the ground? Let me take you along on a day in the field.
With hope (आशा ) and alongside ASHAs, we visited a village household with a joint family. We asked to meet a pregnant woman to screen her well-being. When she arrived, she appeared more like a girl than a woman. She was around 19 years old. Early marriage is common in this community, and she had been married only ten months. She was now two months pregnant.
She sat quietly, responding only briefly when asked questions. Her husband, about 20 years old, answered most of them whether she was eating properly, whether she was taken for checkups, or whether anything was bothering her. Observing this dynamic, I suggested to the counsellor that it might help to speak with them privately. Once they stepped aside along with her husband, the counsellor learned that the young woman said she “couldn’t feel anything “ मेरे को माँ बन्ने वाली feel नहीं हो रही” about her pregnancy. She seemed unaware of the changes happening in her body. The counsellor gently explained how her body would change, how hormones could affect mood, and why antenatal checkups were important.
While they were talking privately, I spoke with other girls in the household and learned that most of them did not attend formal school. There was no dramatic reason offered, no single incident, no visible conflict. It was simply “how things are.” Girls study a little, then they stay home. Some prepare for marriage. Some take on household responsibilities. Education, beyond a certain point, quietly fades from the picture. Instead, they studied at a Islamic school (madrasa) until about grade five and did not continue beyond that. This raised an important question for me: if girls are not exposed to basic education about their bodies, health, menstruation, or reproductive health, how can they be expected to understand the physical and emotional changes they experience? How do they interpret discomfort, fear, or confusion without the language to describe it? Limited education can be one of the reasons why this young woman struggled to recognize or interpret what was happening within her.
In that case at the beneficiary home, I could realize that her struggle to recognize what was happening within her was not simply an individual gap in knowledge. It reflected something larger, it would be limited access to information, limited spaces for open discussion, and limited continuation of formal education. When education stops early, awareness often stops with it. This made me reflect further: to truly understand a community, we must understand why girls discontinue education, what influences those decisions, and how change can be encouraged. Would engaging community/religious leaders or families help emphasize the importance of education and its role in awareness, confidence, and overall well-being?
That day reinforced something I have increasingly come to understand in the field: nothing exists in isolation. Education, gender norms, age at marriage, family decision-making, and cultural context intertwine to shape health outcomes. Social determinants are not abstract concepts found only in textbooks; they are lived realities, visible in everyday routines and silent compromises.
Change in such settings rarely arrives with announcements or immediate transformation. It begins quietly in shared stories, in reflective questions, in moments when someone feels heard without judgement. Sometimes it begins with sitting in a courtyard, listening.
As I left that day, I carried more questions than answers. But perhaps that is where meaningful work begins, not with assumptions, but with curiosity. I hope to continue exploring, listening, and understanding this community more deeply, so that any future plans are not imposed from outside, but rooted in the realities of the lives within.
References- World Health Organization. (2025, September 2). Over a billion people living with mental health conditions – services require urgent scale-up
Sagar R, Dandona R, Gururaj G, et al. The burden of mental disorders across the states of India: the Global Burden of Disease Study 1990–2017. Lancet Psychiatry. 2020. https://doi.org/10.1016/S2215-0366(19)30475-4.
