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Trajectories of self-directed violence amongst women of reproductive age in Sri Lanka

Palfreyman, Alexis Danielle (2019) Trajectories of self-directed violence amongst women of reproductive age in Sri Lanka. PhD thesis, London School of Economics and Political Science.

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This thesis contributes to an understanding of the scale of different dimensions of selfdirected violence (SDV) amongst women of reproductive age and the trajectories through which women engage in them, by presenting findings of primary and secondary data collected through extensive mixed-methods fieldwork in Sri Lanka. It responds to the marginalisation of the female experience and the fuller spectrum of SDV, as research has disproportionately invested in understanding the extreme outcome of suicide through a male lens. Focused in one western district, it capitalised on women’s attendance at antenatal services to isolate the prevalence of SDV amongst reproductive age women both before and during pregnancy and its potential correlates using innovative screening measures (n = 1000). Complementing this sub-focus on perinatal women, women’s core health service provider – Public Health Midwives (n = 11) – shared in-depth accounts of their experiences of and responses to managing women’s SDV. Establishment of a prospective surveillance system in Sri Lanka’s second largest public hospital yielded data on trends in women’s non-fatal self-harm and first-person accounts of women’s pathways to a medically serious event (n = 210); analyses of in-depth interviews with 17 women are presented. Active case finding of known suicides in the district allowed for reflection on the current medicolegal system generating suicide data in this context as well as the insights of 32 women’s deaths based on these archival data. The findings of this thesis highlight high levels of mental distress, (intimate partner) violence and lifetime prevalence of SDV in Sri Lankan women. The particularities of women’s gendered position in Sri Lankan society observed throughout this thesis such as sexual and reproductive health and rights, exposure to violence and expectations to embody respectable womanhood, emphasise the value of employing a gendered perspective to assess women’s risk of self-directed violence and inform future policy and prevention efforts.

Item Type: Thesis (PhD)
Additional Information: © 2019 Alexis Danielle Palfreyman
Library of Congress subject classification: H Social Sciences > HQ The family. Marriage. Woman
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Sets: Departments > Social Policy
Supervisor: Gjonça, Arjan and Coast, Ernestina

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