BY Methmalie Dissanayake
When Sri Lanka began to experience severe fuel shortages, gas shortages, and long lines at filling stations in 2022, many rural villagers like Shanthi* initially felt a slight difference in their daily lives. Living in a remote village in Anamaduwa, Shanthi’s life had long been marked by
scarcity of essentials. She had never used domestic gas for cooking, relying on firewood instead. The fuel queues that dominated the news seemed distant and irrelevant; without a vehicle, Shanthi had always walked everywhere to save money. Her son rode a bicycle to school, a few kilometres away, a routine that remained unchanged as the crisis began to unfold.
“When I saw those queues on TV, I didn’t feel what was happening at all. For most of us in villages, we have always survived without gas,” Shanthi remarked.
However, as the crisis deepened, even the most self-sufficient villagers began to feel an impact. The soaring prices of food, school supplies, and public transportation soon became inescapable burdens. For Shanthi, these escalating costs were not just financial pressures but a slow and silent assault on her mental well-being—a reality she neither understood nor could articulate.
The 2022 Economic Crisis: A Catalyst for Mental Health Struggles
The 2022 economic crisis was one of the most severe crises in the country’s history, with inflation reaching record levels and essential goods becoming unaffordable for many. The crisis was marked by a dramatic shortage of foreign reserves, which led to the government’s inability to import crucial supplies such as fuel, cooking gas, and medicine. As these shortages worsened, the prices of basic commodities skyrocketed, plunging millions into poverty and uncertainty.
For women in rural areas, like Shanthi, the crisis exacerbated an already difficult life. These women often bear the brunt of economic hardships, managing household budgets that are stretched thin, ensuring their families have enough to eat, and caring for children with minimal resources. As the crisis unfolded, the mental toll on women became increasingly apparent, though largely unrecognized.
Shanthi is one of many who did not recognize these feelings as mental health issues. Women’s mental health in crisis
Shanthi began to notice changes in her own behavior and emotions. She felt constantly on edge, overwhelmed by the pressures of providing for her family in an economy that seemed to be collapsing around her. Sleep became elusive, and she found herself worrying incessantly about the future— continuously thinking whether she would be able to afford her son’s education, whether they would have enough food and whether life would ever return to normal.
But for Shanthi, these feelings were just another part of life. She didn’t understand that her persistent anxiety and sleeplessness were symptoms of a mental health struggle. In her village, the concept of mental health was virtually non-existent; there were no words to describe what she was going through, no framework to understand it.
“I actually didn’t even know what mental health was. To be honest, I doubt whether I have enough knowledge about it even now. It’s just a strange concept. We women were always taught to be strong no matter what. So, feeling like that is just a sign of weakness, and it can’t go on, because for us, there is no time for worrying,” she said.
This lack of awareness and the absence of mental health resources in rural areas meant that Shanthi, like many other women, suffered in silence. Mental health services in Sri Lanka, particularly in rural regions, are sparse and often inaccessible. Even when services are available, cultural stigmas prevent many women from seeking help.
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While Shanthi’s story is one of resilience in the face of adversity, it is also a story of untold suffering—suffering that could have been mitigated with the right support and awareness. Across Sri Lanka, women like Shanthi have shouldered the heaviest burdens of the economic crisis, often at the expense of their mental health.
Rani*, another woman from a nearby village, also found herself struggling under the weight of the crisis. As prices soared, Rani took on additional work, laboring in fields and doing odd jobs to make ends meet. Until then, it had always been her husband who managed the majority of their finances. Rani maintained a small chena in the backyard of their modest house, cultivating peanuts, corn, mung beans, and other crops. When the harvest was ready, they would take it to the town fair, and sometimes intermediaries would come to the village to buy the produce directly from them. However, she noticed that the money was no longer enough. They had never earned a satisfactory income before, but this time it felt as though all the money they earned was vanishing into thin air, without being able to do anything substantial with it.
But the relentless pressure took its toll. “I started having headaches all the time, and I couldn’t concentrate on anything,” she shared. “I thought it was just because I was tired, but it felt like something more.”
Desperate to find a solution to her problems, Rani turned to soothsayers, hoping that they could offer guidance or a remedy for her worsening situation. She felt that no matter how hard she worked, her efforts to improve her family’s life seemed futile. The visits to soothsayers became a regular part of her routine, a way to seek answers in a world that felt increasingly out of control. Yet, these visits provided little relief; the underlying issues remained unaddressed.
Like Shanthi, Rani did not realize that her symptoms were related to mental health. The constant stress and worry manifested physically, but without the knowledge or resources to
address it, both women continued to push through—and they still do. Neither of them has sought mental health assistance at a hospital, nor do they want to. Even to this day, they don’t feel the need to seek help.
Not only Shanthi and Rani, but many women interviewed for this article also reported feeling distressed, experiencing a lack of sleep, and suffering from constant headaches. Yet, none of them sought mental health support.
One of the women interviewed found herself trapped in microfinance debt, a burden that only added to her stress and anxiety. The high-interest loans, initially taken out with the hope of improving her family’s financial situation, instead became a source of constant worry, further compounding her mental and emotional struggles.
Despite the overwhelming pressure, she, like the others, did not consider seeking mental health assistance, as the concept itself remained unfamiliar and stigmatized.
Mental health : A double burden for women
In 2022, Sri Lanka faced its worst economic crisis in history. The country experienced severe shortages of fuel, food, and medicine, leaving millions of people struggling to meet their basic needs. While both urban and rural areas felt the impact of these shortages, the effects were particularly harsh on rural communities, where resources were already scarce. Among those most deeply affected were women, who faced not only the external pressures of the crisis but also the internal burden of managing their families’ struggles.
Traditionally, women in Sri Lankan society are viewed as the backbone of the family. While men have historically taken on the role of economic providers, it is women who shoulder the responsibility of keeping the household running, ensuring that their children are fed, sent to school, and cared for. The economic crisis intensified this burden. For many rural women, the rising costs of food and transportation meant that they had to stretch their already meager household budgets even further. They faced the impossible task of filling empty stomachs with dwindling resources.
Women not only bore their own mental and emotional struggles but also took on the weight of their families’ distress. They had to keep everyone afloat—physically, emotionally, and financially—while dealing with their own anxieties about an uncertain future. In rural communities, where support systems for mental health are virtually non-existent, women were often left to manage these immense pressures in isolation.
The traditional mindset that women must remain strong, no matter the hardship, contributed to their silent suffering. The societal expectation that women should keep the family together while the men contribute economically created a “double burden” for women during the crisis. They were expected to manage the household and provide emotional support to their children, all while dealing with their own fears and uncertainties. The relentless pressure to maintain a
normalcy in their families’ lives, despite the crumbling economy, led to a profound but unspoken mental toll on many rural women.
While men, who primarily dealt with financial aspects, faced economic stress, women were left grappling with the more complex emotional and practical demands of survival. The crisis highlighted the invisible, unpaid labor women perform daily—labor that becomes even more taxing in times of crisis. Their role as caregivers, decision-makers, and emotional anchors became a source of unacknowledged mental strain. Many of these women, already juggling countless responsibilities, found themselves overwhelmed by the magnitude of the crisis, yet unable to seek help due to cultural stigmas surrounding mental health.
In rural Sri Lanka, mental health services remain limited, and for most women, seeking support is not seen as an option. Mental health is often misunderstood and stigmatized, leaving many women to struggle in silence, unaware that their persistent anxiety, sleeplessness, and stress are symptoms of deeper mental health issues. For these women, taking care of their families came first, even at the expense of their own well-being.
Mental health situation in rural Sri Lanka
“With the economic crisis, transport costs tripled, exacerbating an already difficult situation for rural women,” said Dr. Samanmalee Jayasinghe, Psychiatrist at Colombo North Teaching Hospital, Ragama. “In many rural areas, there are no proper public transport facilities, and often women have to travel several kilometres to reach a hospital without the convenience of a public bus. Many are forced to rely on their own transport, which has prevented numerous women from seeking mental health support.”
Dr. Jayasinghe also highlighted that the lack of transportation not only costs money but consumes a significant amount of time. “To attend a clinic at a state hospital, they have to travel for hours. While mental health clinics are available at these hospitals, the absence of reliable transport facilities has led to many women opting out of seeking help,” she added.
However, she noted that there has been some progress in mental health awareness among rural women, particularly regarding conditions like postpartum depression. This awareness has been largely driven by the efforts of midwives working in villages. “Thanks to the awareness campaigns conducted by midwives, the stigma surrounding postpartum depression has significantly reduced, and many rural women are now seeking help for this condition,” Dr. Jayasinghe explained. “Yet, when it comes to other mental health issues, there is still a pressing need for greater awareness.”
“Unlike their counterparts in urban areas, rural women are unable to seek help from private hospitals. The costs are prohibitively high, and there are no private hospitals within easy reach in most rural regions,” Dr. Jayasinghe noted. “Moreover, the mass exodus of doctors, driven by the economic crisis and the IMF-backed high income taxes on their salaries, has severely impacted the entire state health sector.”
She further explained how this situation has taken a toll on mental health services in particular. “The mental health sector has been disproportionately affected because many psychiatrists have either permanently migrated or left temporarily for higher studies. The shortage of specialists has created a significant void, especially in rural areas where services were already limited,” she said, emphasizing that addressing this issue is crucial for the future of mental health care in Sri Lanka.
“Not only do rural women lack awareness about mental health, but their families, particularly their husbands, are also often unaware of the mental health struggles their partners face,” Dr. Jayasinghe pointed out. “Men, too, experience mental health issues, especially due to economic pressures, and this has led to an increase in domestic violence against women. In turn, this further exacerbates the mental health challenges faced by rural women.”
She stressed that the mental health crisis following the economic downturn has affected rural women on multiple levels. “The compounding pressures from economic hardship, lack of awareness, and domestic violence create a vicious cycle that takes a severe toll on women’s mental well-being. Unfortunately, this often goes unaddressed. What’s more concerning is that children are also affected by the ripple effects, as they may face physical or emotional violence from mothers struggling with mental health issues.”
Dr. Jayasinghe concluded by emphasizing the broader implications of ignoring mental health in rural women. “At the end of the day, failing to address mental health concerns in rural women affects not just the individual but the entire community. This is an urgent issue that requires immediate attention and action,” she added.
*Names with held on conditions of anonymity
This story was produced with the support of Internews