Paper short abstract:

Synthesising primary and secondary data from a rapidly urbanising district in Sri Lanka, we establish the gendered, cumulative, and transformative nature of surviving and deceased women's trajectories through self-harming experiences, culminating in a conceptual framework relevant beyond Sri Lanka.

Paper long abstract:

Women disproportionately experience self-directed violence (SDV), particularly those residing in South Asia and engaging in non-lethal behaviours, yet discourse remains informed by excessively male data. Limited research explores South Asian women's experiences to understand how, why and with what consequences they engage in SDV. Calls persist for targeted research on women of reproductive age to inform gender-sensitive prevention efforts. This paper contributes to theory building by developing an emic conceptual framework to understand women's pathways through SDV in urbanising Sri Lanka.

Applying an innovative psychosocial autopsy approach to gather primary and secondary data in 2016, we interviewed 17 surviving self-harming women and analysed narratives from 20 suicide inquest files of reproductive age women in Gampaha District using Interpretative Phenomenological Analysis.

Informed by living and suicided women's stories, seven interrelated, dynamic and cumulative dimensions formed a conceptual framework highlighting women's exposure to vulnerabilities particular to their socially constructed identity as inferior members of patriarchal societies. The ways in which women's gendered position limits their ability to manage impacts and access support, and the unsuitability of the language of impulsivity to describe women's SDV emerges. Women's selection of SDV in this context offers both transformative potential and unforeseen consequences.

Our framework presents women's SDV as one consequence of structural and interpersonal gender-based violence, enacted at all levels and over women's life courses. It is likely relevant in other contexts where traditional patriarchal structures persist. We advocate for a human rights-based approach to advance the prevention and postvention agenda for women's self-directed violence.