LITTLE is known about mental health status of apparel workers. Attention has largely been on their basic safety measures, especially fire or building safety. When physical health is reported, it is largely about their musculoskeletal conditions like body or joint pain or at most their lung capacity. This is unsurprising as mental illness is mostly an ignored or under-diagnosed condition in most developing countries where awareness in ordinary people and diagnostic skills of health professionals on this is quite low and limited. Poor mental health does impact apparel workers’ quality of life, well-being, family relations and social engagement. Depending on the prevalence, duration, type and severity of a mental illness, this may compromise their working ability leading to diminished efficiency in this highly manual labour-intensive sector, which runs in a fierce global competition.
Depression as a health condition is more acknowledged in high-income countries. Rampant social inequalities, income disparities, widespread poverty, chronic pain, and common medical conditions are reported to be associated with depression. Young women of lower socio-economic status in developing countries are at a particular risk as economic insecurity, disease burden, early marriage, multiple pregnancies and high rates of child mortality are more common among them. All this can lead to depression. Young women in Bangladesh may be exposed to family and workplace discrimination and violence and have little social and economic protection. This increases their risk of developing a mental health condition. Research shows that people with depression, anxiety, or other mental health disorders have higher unemployment rates, greater job turnover, less productivity and more absenteeism.
Only a handful of published research work have reported on the mental health condition of Bangladesh apparel workers. A recent research of mine shows the prevalence of moderate-to-severe depression to be 20.9 per cent among apparel workers. In the workers surveyed, who earn less, work part-time, suffer from chronic pain, have urinary problems, or have experienced traumatic events in life reported higher rates of depression. This study shows a clear association of depression with low earning. These estimates may have underestimated the real prevalence rates of depression as workers may not always be comfortable to disclose their true state of mind and mental health conditions are generally almost always under-reported.
A fifth of Bangladeshi apparel workers suffering from depression deserve attention from all stakeholders who greatly benefit from their labour. The job is monotonous, high-paced, physically draining and mentally exhausting. Depression’s impact on reduced employee morale, sense of well-being and workplace productivity is well studied in high income economies. The effect is probably higher in a country such as Bangladesh with few operational social and economic safeguards in place.
Poverty-level wage labour is high and rising in Bangladesh and other low- and middle-income countries as western corporations have sourced out for cheaper and abundant labour as high production costs, worker rights activism and regulatory enforcements drove out jobs from their countries of origin. The workplace health, safety and well-being of these workers in destination countries are often not an important consideration and their mental health is unequivocally discounted, almost always. The overall unfamiliarity at the population level, lack of training among healthcare providers and the scarcity of healthcare resources may conceal the real burden of depression and other mental health conditions in a country such as Bangladesh. More studies on the prevalence and risk factors of these conditions are urgently needed. A general attitude of ignoring the importance of mental health does not help either. In Bangladesh, when depression is even diagnosed, appropriate health care is often not available.
Workplace environment with exposure to hazards and unsupportive managerial staff are identified as risk factors of depression. Other studies suggest that lower income or poverty level wages and financial strain lead to an increase in depressive symptoms that may continue. Interventions for mental health conditions can be multi-pronged and factory management can initiate some measures such as addressing their economic insecurity, to improve work environment and work life that may somewhat help to improve workers’ mental health. Safer and healthy workplace, better wages and benefits, higher job security, and frequent and friendly managerial interaction may somewhat help to reduce the prevalence of depression.
Young working women in Bangladesh are a vulnerable social and demographic group. A vast majority of them are exposed to daily adversities at home, work and outside. There are about 10,000 annual suicides reported in Bangladesh with younger females found to be the most vulnerable. About 65 per cent of Bangladeshi women still get married before they are 18; the infant mortality rate is 27 per 1,000 live births and the total fertility rate is 2.1 (births per woman). Things are much worse for women from lower socio-economic backgrounds.
The government, international and local non-governmental organisation, healthcare providers, foreign buyers, rights activists, advocacy groups and factory owners should appreciate the importance of mental health in this working age young female population and plan more resources and support to care for such treatable conditions. With only a few tertiary-level mental health care institutions and less than 1 mental health provider per 100,000 people, Bangladesh is poorly prepared to provide mental health care.
Depression is a multidimensional health issue with personal, social, economic and health determinants and consequences. Denying depression’s high prevalence is not going to help anyone.
Dr Hasnat M Alamgir is a professor of pharmacy at the East West University.
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