Women's suicide in low-, middle-, and high-income countries: Do laws discriminating against women matter?

Background: Women's suicide is a serious public health issue in low- and middle-income countries (LMIC). This study explored whether institutional discrimination against women, as manifested in formal and informal laws, is relevant to country's income-level variability in women's suicide mortality. It also examined which discriminatory laws are associated with LMIC women's suicides.

Methods: Scores on laws discriminating against women, across 176 countries, were obtained from the Gender, Institutions and Development Database. Male-to-female (M/F) 2017 suicide ratios were the index of women's propensity for suicide. The mediating role of laws discriminating against women on the association between country's income level and M/F suicide ratio was analysed by bootstrapping method. Regression analyses examined which discriminatory laws were associated with LMIC women's suicide rates.

Results: LMIC had significantly smaller M/F suicide ratios than high-income countries. Institutional discrimination mediated the association between country's income-level and M/F suicide ratio (total effect: β = -0.13, 95% CI [ -0.26, -0.01]; direct effect: β = -0.06, 95% CI [ -0.20, 0.08]; indirect effect: β = -0.07, 95% CI [ -0.15, -0.02]). In LMIC, higher levels of discrimination against women in laws about access to productive and financial resources (β = -0.69, p < 0.001), civil liberties (β = -0.60, p < 0.001), and in family law (β = -0.57, p < 0.001) were associated with smaller M/F suicide ratios after controlling for male suicide rates and sex ratios at birth.

Conclusions: The relatively high suicide rates recorded among women in LMIC might be related to the higher level of institutional discrimination women experience in these countries. In LMIC, where, by law, women had restricted access to productive and financial assets and to justice, and/or unequal rights with regard to citizenship, household-responsibilities, divorce, and inheritance, M/F suicide ratios were lower-that is, women's suicide rates were higher. Suicide theory, research, and prevention targeting women should incorporate social-context and social-justice perspectives.