Have you ever wondered why certain groups of vulnerable women are absent from literature, policy, legal documents and other formal instruments? You never read or think about them, one could actually think they do not exist at all!  These are the forgotten women, women who occupy the space beyond the margins, women on the margins of the margins!  Given the state of the war against women, with the rising numbers of femicide cases, sexual assault and rape, it can be argued that all women are vulnerable. True as this may be, this instalment, focuses on women with mental disabilities – the often-ignored and ostracized. Given the many forms of violence against women in general, and women with mental disabilities in particular, this article horns into the issue of sexual violence against women with mental disabilities (WMD). A note: it is not debatable that women with mental health challenges have sexual reproductive health rights, the debate is often on the extent to which they can consent to the act of sex and understand the implications. Do WMD understand the issues of child bearing? Are WMD making an informed choice? Do WMD understand the concept of safe sex? What of HIV and STIs? 

For most parts of Southern Africa, mental health care is virtually non-existent as the health sector has failed to cater for the mental health needs of citizens. It is, therefore, not uncommon to see women with mental disabilities wandering on the streets of Malawi, Mozambique, Zambia and Zimbabwe, among many others in the region. Often times these women are asking for alms, staying under a bridge or merely sitting on the street. In most cases, the women are pregnant, sometimes with another child strapped on their backs. It is a familiar picture.  

Although there are cases where the women actually consent to acts of sex, more often than not, the story is one of sexual exploitation, violence and abuse.  Unfortunately, when raped or sexually abused WMD have no comprehension of the gravity of the act. Those who understand the concept of rape are likely to not report such cases because they have already been ostracised by society and fear their reports will be dismissed as hallucinations of a “mad woman”. The few that find courage to report such incidents are often not believed, and indeed, are routinely dismissed! In fact, any person with a mental disability walking into a police station is likely to be dismissed. In other cases, they are apprehended and detained before their complaint is even heard, let alone recorded. Law enforcement agents, institutions and systems in the majority of Southern African countries do not only lack the capacity to cater for the needs of WMD, but these institutions also immensely contribute to the prejudice and the systemic violations suffered by WMD. 

In some cases, women with mental health challenges are locked up in homes. On a recent trip to Madagascar, I learnt about people with mental disabilities who are chained to poles, and this practice is not unique to that country. The practice of chaining or locking persons with mental disabilities is itself a brutal act of violence (but that’s a story for another day). WMD put under chain, lock and key are raped and impregnated by uncles, close family friends, house helpers and so on. In some cases, the family takes care of the babies, yet in other cases, a back street abortion is provided as a solution with little or no regard to the individual’s position on the matter. The acts of sexual abuse and molestation are never reported, they are swept under the carpet and no one is ever held accountable! “– you will bring shame onto the family they say, you will expose the fact that we have a family member with mental health issues, she wanted it, she asked for it, she enjoyed it” they say!” And just like that, the issue is buried, never to be discussed. 

For WMDs, the act of sexual assault or rape sparks a chain of complex issues.  If they do not report the assault they cannot access health care, and consequently HIV post exposure prophylaxis, for example. Many have contracted HIV this way and have not had access to life saving treatment. The few who may get access to Anti-Retroviral Therapy (ART) encounter adherence challenges.  The current ART regimen, for example, requires strict commitment to treatment, good nutrition and an understanding of the operations of health systems, including appointments. It is almost impossible for a woman with critical levels of mental health disabilities to meet these ‘pre-requisites’ due to, among other things, the nature of their disability and their living conditions, which are often–times below the poverty line. On the reproductive health front, many women end up pregnant with no antenatal support. Many lives have been lost in childbirth due to lack of maternal care and birth attendants. Many other WMD have lost their children before the age of 1 due to nutritional deficiencies and poor child care.  

On the occasion of the 2019 ‘16 days of activism against gender based violence’, I am especially encouraged by Malawi’s theme – “Leave No One Behind”. As we chant this mantra, which many countries beyond Malawi subscribe to, I find myself wondering the extent to which our joint–actions as countries, and as a block of SADC Member States ensure no one is left behind in the fight against GBV. Are we including women with mental health challenges in the fight against GBV?  What are individuals and communities doing to protect women with mental health issues from GBV? What are we as women, women rights activists and Women Human Rights Defenders (WHRDs) doing to ensure the rights of women with mental health challenges do not fall onto the margins of the developmental agenda, but remain at the centre of Agenda 2030? Are we including networks of women with lived mental health experiences in our discussions and planning sessions on ending GBV? 

What are the laws and policies that countries have in place to protect women with mental health challenges? What are the SADC, African Union (AU) and United Nations (UN) instruments addressing this issue?  To what extent are these instruments implemented? Beyond the laws and policies, what interventions are championed by the various line ministries to ensure that WMD are protected as bonafide citizens of the respective countries? Are ministries of health, education gender social welfare and finance caucusing to find a sustainable solution to violence against women with mental health challenges? 

Data is also a big issue – there is practically little to no data on this subject matter. What are research institutions and the academia doing to generate reliable research data to support policy formulation and implementation?   

What resources are available for this work? Are states, donors’, donor foundations allocating adequate resources towards the inclusion of WMD into this agenda? Yes, a bagful of questions, but questions that need to be asked if we need to remember the forgotten ones, the ones that society should be caring about.  

Cynthia Ngwalo Lungu is the Health Rights Programme Manager at OSISA.