Earlier this month, two sisters, aged 25 and 23, ended their lives at their home in a Rajasthan village, hours before their families had arranged their weddings. They were teachers at the local primary school. The two seem to have followed the footsteps of a long line of young people, especially women, who have ended their lives when faced with being married off against their wishes. Could there be a more tragic or cruel example of the waste of a human life?

Suicidal behaviour is shaped by social and economic conditions, in particular related to poverty, violence and exclusion, rather than individual psychopathology alone. Yet, this knowledge overlooks a major driver of youth suicide in India — the abyss between what young people aspire to and what society permits them to achieve. This may well be the reason for the paradox that the highest suicide rates are observed in the most developed states, notably Tamil Nadu and Kerala, while the lowest rates are reported at the other end of the development spectrum, in Bihar.

Our work in the Million Death Study and data from the National Crime Research Bureau reveal that death by suicide is a leading cause of mortality in young people, and two-thirds of all such female deaths occur before the age of 25. Youth is a phase of life particularly vulnerable to self-harm behaviours that intersect with the dramatic life transitions.

In India, this collides with dramatic social change, which pits the dreams of young people against unbending social norms. Several laws across the country limit the ability of young people to love a person of their choice.

Emile Durkheim, the French sociologist, argued that suicide is a social phenomenon. How well individuals are integrated into society and are regulated by its norms influence suicidal behaviour. Two types of deaths by suicide that he described over a century ago are particularly resonant in India today: Anomic suicides, which occur during periods of rapid social or economic change, when norms are disrupted, and desires become unbounded or frustrated. And, fatalistic suicides which occur in situations of oppressive discipline where individuals see no hope of changing their circumstances.

What does this mean for policies that aim to reduce youth suicides? We can look across our border for a clue. Across multiple analyses, the dramatic fall in China’s suicide rate since the 1990s is explained not by mental health services but by large-scale structural changes — economic development, urbanisation and social transformation in rural areas — which collectively reduced exposure to intense social strain, particularly for women. In short, death by suicide among youths will not be prevented by investing only in mental-health care, as important as this is for people struggling with mental-health problems, but by building a society where young people’s aspirations — for high-quality education, a secure occupation with adequate income, the opportunity to love and live with the person of their choice — are respected.

These are as much societal and political choices as family and personal choices. Across history, deaths by suicide have a political context, as evidenced by deaths by suicide in colleges, in particular among Dalit youth. Oppressive social norms are driving our youth to choose death when faced with a life which is not of their choice. Preventing such deaths will need societal transformation, where social class, caste, gender and religious identities do not become drivers of othering.

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Today, laws seek to prohibit live-in relationships, restrict interfaith and inter-caste marriages, and do not offer enough space for same-sex relationships. It is important to mobilise diverse voices in our communities, from faith leaders to politicians, from young people to mental-health professionals, to turn these tragic deaths into a catalyst for initiatives for social change.

To choose to die because of oppression by one’s family or community constitutes a form of honour suicide — it’s as morally abhorrent as honour killings. We must raise our voices against this travesty, which goes against not only the dreams of our young people but also the spirit of the Constitution.

The writer is Paul Farmer professor at Harvard Medical School

© Indian Express