The Impact of Poverty on Mental Health among Rural Women: A Case of Sadza Community, Zimbabwe

The Impact of Poverty on Mental Health among Rural Women: A Case of Sadza Community, Zimbabwe

Shelly Marandure

MSc Counselling Psychology Department of Psychology Great Zimbabwe University P.O.Box1235, Masvingo, Zimbabwe

DOI: https://dx.doi.org/10.47772/IJRISS.2024.8110181

Received: 15 November 2024; Accepted: 26 November 2024; Published: 16 December 2024

ABSTRACT

This study investigates the impact of poverty on mental health, among rural women. The main objectives are, to assess depression, anxiety and stress levels and to explore their impact among rural women. Data was collected using a quantitative self-administered questionnaire, the Depression, Anxiety and Stress Scale – 21 Items (DASS-21) test tool, and analysis was carried out using the Statistical Package for the Social Sciences (SPSS). A total of 70 respondents took part in the study, with findings indicating that moderate to severe levels of depression are present among the women, which clinically warrants professional help. Contributing factors precluding the respondents from seeking assistance included fear of stigma, or separation from family and loved ones. The study also revealed that poverty affects women differently across varying stages of their lives. Some of the challenges identified ranged from poorly rewarded labour, early marriage, sexual abuse, discrimination, and inequality. Women in the rural community indicated that they live in abject poverty, experiencing lack of basic needs such as food, water, shelter, and poor access to adequate health services. Regardless, the women continue to meet their obligations to their families and community. Solutions suggested included intensive primary health interventions through health education campaigns, self-help initiatives and strengthening community support systems among the women. Through economic-empowerment, and entrepreneurship training and involvement in income generating activities, such as livestock ownership and small-scale agriculture enterprises, women can be freed from the impact of poverty on their mental-health.

Key Words: Poverty, Mental Health, Depression Mental- Illness.

INTRODUCTION

According to Suich (2012), the word poverty is a contested concept; its meaning depends on the “ideological and political context within which it is used”. Suich reiterated that, in its broadest sense poverty is “understood as the lack of, or inability to achieve, a socially acceptable standard of living, or the possession of insufficient resources to meet basic needs”. Poverty is manifested by limited access to education and other basic services, social discrimination and exclusion, as well as lack of participation in decision-making and hunger (United Nations, 2020). It is measured by household income or consumption and expenditure, in terms of each country’s economic status. It is pegged to the level of income of an individual or household, and this can be defined as absolute poverty. The limitation of this definition is that it does not take into consideration the inequalities of income within communities or society and it is difficult to specifically assess the income of informal low resource economies. On many occasions there are substantial differences from what a dollar in one locality can purchase to another.

Poverty can be experienced by an individual, or collectively as a family or a community. This is the state in most rural communities in Zimbabwe, and women are the most vulnerable group. Chronically poor people live in constant poverty, with minimum resources to afford just a few basics for the day. All forms of poverty are present in Zimbabwe and terrorize people (women in this context), leading to depression and other mental conditions. In line with Anyanwu (2010), “an understanding of gendered poverty is a precondition for effective pro-poor development strategies”.

 Studies conducted over the past 20 years indicate a close interaction between poverty and mental ill-health. Common mental disorders such as anxiety and depression are about twice as frequent among the poor, as among the rich (WHO, 2007). Depression is one of the most prevalent mental illnesses, with 3 to 4% of the world’s population suffering from it, at any given time. It is a leading cause of disability worldwide and is a major contributor to the overall global burden of disease according to the WHO (2022). Poverty, at times, can lead to depression and other mental conditions. Mental illness, including depression can exacerbate poverty. WHO (2022) noted that poverty triggers depression in at least 4.4% of the global population (especially women) leading to disability, according to Bodeker (2020). Aslam et al. (2018) affirms that depression “is a severe mental disorder and one that can often go undetected in some people’s lives”. Depression does not always strike all at once; it can be a gradual and unnoticed withdrawal from active life and lack of interest in activities that one used to enjoy. Symptoms can vary from mild to severe, and can include feeling sad, loss of interest or pleasure in activities once enjoyed, and changes in weight and appetite, to mention but only a few. For a diagnosis to be made, ‘symptoms must last at least two weeks’ according to the DSM- 5. WHO Africa (2017) further reported that at least 30 million people are affected by depression, which is the leading cause of disability, and a major contributor to the overall global burden of disease. Depression leads to suicide, which is also the second leading cause of death in 15–29 years old age group globally. Several risk factors have been noted that are possible reasons for the gender differences in depression. It is believed that hormones do contribute to the emotional instability of women between the ages of 25 to 44 years. Hormonal fluctuations, coupled with a stressful life situation, are suggestive of major triggering factors of depression among child-bearing women, regardless of race or socio-economic background. Studies have shown that the ratio of depression between men and women drops gradually with age, confirming the biological and psychological explanation highlighted previously. Most men on the other hand, just try to ‘tough it’ without seeking professional help because depression is viewed as a sign of being weak or unmanly”.

Depression in rural women is worsened by high rural poverty rates, with more than 20% earning incomes at or below the poverty line (Simmons et al., 2008). Coupled with the poor access to mental health care facilities in rural areas versus in urban communities, exacerbates the issue. In Zimbabwe there are only four mental health facilities: Inguthseni Central Hospital, Harare Psychiatric Unit, Ngomahuru Hospital and Parirenyatwa Hospital Annex, with psychiatric units at Gweru General Hospital and in Mutare General Hospital. All are in urban areas except for Ngomahuru. Probst et al (2006) also established that receiving care from a specialist is more problematic in rural areas, given the population size and distribution of health-care providers. Mental health has not been considered as a priority by many policy-makers; hence the budgets do not take into account mental-illness and mental health as an important part of health, though 14% of lives lost to disability globally are known to be caused by depression and other common mental illnesses.

This study investigates the impact of poverty on mental health, particularly on depression.

The Aim of the study

The study aims to examine the impact of poverty on depression among rural women. The study also aims to solicit ways to promote mental health among this group of women.

The Objectives

To assess depression levels among rural women

To explore the impact of poverty on mental health among the women

To solicit strategies to mitigate the impact of poverty on mental health

To solicit ways of promoting mental health among rural women

RESEARCH METHODOLOGY

Quantitative approach was used in this study. Quantitative research focuses on the exploration of numerical patterns. According to Bell (2005), quantitative research involves collecting and analyzing numerical data concerned with the relationship of one set of facts to another. He reiterated that quantitative approach embraces the assumption that individuals inhabit a relatively stable, uniform, that can be measured, understood, and also generalized by striving to establish relationships between two or more variables. Thus, results from one community can be inferred to another community. A questionnaire was used to collect data in this research. A survey provides a quantitative numerical description of trends, attitudes, or opinions of a population by studying a sample of that population (Creswell, 2009).A survey was carried out on a selected group from the population identified by the researcher. The sample involved women from a community, who answered a self-administered questionnaire. This  method is cost-effective and caters for a  large sample  size.

Population and Sampling

The study grouped women into four different groups for proper analysis, and to see how each group might be impacted by poverty on mental health. The different groups are school children (upper- primary and secondary school girls), youth, married and widowed/lone mothers. To select the target population the researcher used a short questionnaire to assess their social status. The women who were invited to participate in the research survey completed the questionnaire that was provided, as a screening tool. The researcher had 150 subjects, but 70 questionnaires were returned. Non-response rate might reduce a probability sample to a convenience sample and as a result the conclusion may be weaker. Nonetheless if a, sample is too large it may incur high costs and time in data collection.  The researcher used the stratified random sampling technique. This is a type of sampling in which the total population is divided into smaller groups or strata according to common attributes, such as age, gender, and marital status. In this study all participants were women, who were stratified according to age, marital, status and unemployed, in a rural setup.  The researcher divided the sample according to table 3.1 below, and a total of 70 women were picked.

Figure 4.1 Number of expected respondents.

The researcher conducted the primary data collection technique to find out the depression level of the women .The researcher administered questionnaires in collecting data. All women were equally represented in the groups, as illustrated above. In this study, the DASS-21 item was used ‘as it is a structured approach that will produce data that is easily quantifiable. According to studies worldwide, its reliability and validity have been well established. It measures symptoms of depression and anxiety as well as stress in both clinical and non-clinical samples, Daza et al., 2002.

The questionnaires were handed over to the respondents in person and were handed back immediately after completion, however, some of the questionnaires were not returned. The major problem that was encountered was that some of the respondents were reluctant to handle the papers due to the Covid-19 pandemic. This led to a reduction in the targeted number of participants.

Demographic characteristics: The frequency distribution and percentages generated are presented in tabular form below to give added visual meaning and understanding of the information collected.

Figure 4.2: Profile of respondents (n =70)

Age:  According to figure 4.2, 14.3% of the respondents were young women, aged between 14 and 19 years. This represented the early teens, still in primary or secondary school. This group experienced a lack of basic needs such as sanitary wear and other basic needs such as underwear, decent housing, and basic food. Over 28.6% of the respondents were between 20 to 35 years old, and 36-55-year-olds. The group represented the young to middle-aged adults, who are still productive and are mothers. The hardships experienced by this group affected their children as well. The last group was the 46–55-year-olds, which was 21.4% of the participants. Only 7.1 % of the widowed or lone women participated in the study. This shows that there is a representation of all age groups, which allows generalization in other communities.

Profile of the respondents concerning marital status

Table 4.1: Marital status

Marital Status:

Of the respondents, over 64% were married, slightly over 28% were single and 7% were widowed women. Among the married were very young girls as well, who had been given into marriage due to religious or cultural beliefs. The single women included some who were mothers as well. Each of these categories of women faced the impact of poverty on their mental health in unique ways.

Figure 4.3

As shown in Table 4.2 shows all participants had symptoms of depression

Table 4.2; Depression status * Poverty Cross- tabulation

Table 5 showed the cross-tabulation of depression and poverty which indicated that about 85% of the participants had moderate to severe depression.

Table 4:3: Depression * Marital status Cross-tabulation

Table 4.6 indicated the cross-tabulation of depression and marital status. The results showed that about 73% of the participants across all marital strata exhibited moderate to extremely severe depression. The most affected group was the married women who accounted for more than 50% of participants with depression. Single women also had the highest number of participants with severe depression.

Table 4.4: Depression status * Age Cross-tabulation

Table 4.4 showed data cross-tabulating depression with age. The data showed that the 36-55 years age group was the most affected by depression accounting for about 51%. The data also showed the age group least affected was the 14-19 years age group.

Perception of Poverty According to Marital Status, Among Participants

The study found that 73% of the participants experienced the effects of poverty differently according to their marital status. The young unemployed women, who were still in the childbearing age group, seem to experience economic hardships more than their urban counterparts, with more than 50% exhibiting signs and symptoms of depression and dependent on their parents/guardians for upkeep and sustenance. However cultural and religious beliefs still have a profound influence on the way they are treated in the community. The study revealed that the girl child is disadvantaged from an early age as she is expected to provide unpaid labour in the home. She may drop out of school to get married or to give the boy child an opportunity to continue with school if the resources are not sufficient for both of them. Early marriage is a common norm among some communities where religious practices openly promote this practice.

In some societies it was found that young widows cannot inherit land from their deceased spouses if they have no son. A study in Zimbabwe by Demographic Health Survey (DHS) as cited in Manjengwa et al, (2012) established that: “widows between the ages of 20 and 29 represented the highest proportion of women who were dispossessed of their property when husbands died, with rural widows (47 percent) almost twice more likely to be dispossessed than urban widows (26 percent)”. The scenario relegates the widow into abject poverty and severe depression.

 Married women are also negatively affected by poverty when husbands fail to provide for the family (Belle, 2012). In a study in America, Belle found this interesting as the study revealed women living below the datum were considered unhappy compared with those above the poverty line. Additionally, poverty is perceived differently by married women when their expectations of a happy marriage are thwarted by a lack of financial freedom. This is confirmed by the prevalence of depression among married women of the rural community. It emerged that married women suffer from income poverty which is caused by dependency on husbands who earn very little from casual jobs (Manyange, 2017). Gupta, et.al, (2000), thought that women’s role in most developing countries is relegated to the home as mother and caretaker, while men’s role is being responsible for productive activities. This however promotes a dependency syndrome in women, who in the event of the loss of their husband fail to cope. This supports the idea that poverty predisposes individuals to depression.

Culturally, widows suffer a double tragedy when the husband dies, without leaving a son to take over the estate, which is the loss of a spouse and assets. Pondai (2014) refers to it as “social exclusion”, where women are left destitute and mentally traumatized after the death of a spouse. In cultures where the judicial system fails to protect vulnerable women, the grieving process takes longer, predisposing them to depression. In a study, Manjeya, et, al. (2012), established that widows between 20-29 years of age represented a large percentage of those whose assets were taken, after the loss of their husbands. Fortunately, the judicial system of Zimbabwe provides support and protection to widows, in the event that family members decide to disinherit them.

Poverty affects individuals differently throughout the life span. Each stage has its own challenges, which warrant unique interventions. The youth might worry over where to market their produce. They may lack marketing strategies on how to run small enterprises and end up making losses. A SIDA report reiterated this notion of lack of information and marketing strategies among the youth.

RESULTS AND DISCUSSION

Prevalence of depression among participants

The study found that the majority of women in the community were experiencing moderate to severe depression, according to the DASS-21 tool 85% of the women confirmed the constant stress or worry that they went through due to the scarcity of basic needs. The women exhibited moderate to severe depression due to scarcity of food. Majority of the population, in Zimbabwe lives in rural communities, according to WHO (2016), of these 70.4 % live in poverty and 20 percent in extreme poverty. This affirms the findings of this study that the majority of participants had symptoms of depression, severe enough to be clinically diagnosed and to warrant intervention.

The study found that there is a strong association between poverty and depression among women the community. More than 70% of the women exhibited moderate to severe depression. The most affected age groups were between 35-55 years. Of these 21% indicated shortage or lack of food and other basic needs. The constant anxiety and stress of not having food reserves for their families led to depression.  This is in line with findings from South African study in an informal settlement, of Khayelitsha Township on the outskirts of Cape Town, which revealed that constant exposure to scarcity of basic needs leads to common mental illnesses such as depression and anxiety, (Lund, 2016).

Strategies to Mitigate Poverty

Research across the globe confirms that there is a link between poverty and depression, and that deprived groups are prone to mental ill-health due to constant scarcity of basic needs. Based on this premise, when determinants of poverty are resolved, mental health improves. Strategies to alleviate the needs of rural women require a multi-dimensional approach to manage the gaps and deficits identified as indicated.

The following are some of the identified determinants of poverty in the village.

• food scarcity and water,
• lack of financial assistance,
• Land tenure, and poor standards of living.
• Early marriages are also of concern in village.

Currently mental health services, including counseling is not available at tertiary level, in public institutions. If there are any such services, it is provided by NGOs, and the community elders.

Poverty reduction is about involving the affected individuals in the planning and implementation of ways to change their status quo. It is about ‘owning their capacity to be agents of change’. The women identify the challenges they are facing and together with mentors, and prioritize what it is that should be addressed first. Training of rural women on basic skills equipping them to start income generating projects was one of the first initiatives that were chosen as the first step to be taken towards poverty reduction.

Activities identified required minimum capital to generate income in the shortest possible time. All women should be involved to avoid social exclusion and to create a sense of ownership among all participants.

The young girls experience a type of deprivation that requires attention as well. Identified among the problems was repeated absenteeism from school, which is related to the menstrual cycles. Donor agents in partnership with well-wishers to assist in providing sanitary wear. This may improve self-esteem and school performance as well.

CONCLUSION

The purpose of this study was to find out the relationship between poverty and depression among rural women. The results have shown that over 70%, exhibited some form of depression, at different stages of their lives. Study also reveals that there is scarcity of food, and water and other basic needs in the rural community. Over 21% indicated a shortage of food reserves and lack of assistance from NGOs or relatives. Constant worry over lack of adequate food may have contributed to the high levels of depression, as reflected by data analysis.

 Nonetheless the women were willing to participate in basic mental health assessment and counseling as an alternative to conventional treatment. At present counseling is offered by respected community elders, clergyman and village health workers, (vana mbuya utano).The presence of psychologist at tertiary level would help women in the rural community.

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