5.13 Discussion
5.13.2 Prevalence of Mental Health Challenges among the Kayayei
According to the WHO (2012), mental health is an essential part of an individual’s ability to lead a fulfilling life, such as the ability to form and maintain a relationship, study, work, and make other important decisions in life. As such, anything that will compromise this capability to make any of these choices leads to malfunctioning, not only at the individual level, but also at the family and societal levels (WHO, 2012). It is further indicated that a person’s innate and learned ability to deal with feelings and the social world can influence the individual’s mental state.
The findings of the qualitative study indicated that the participants experienced issues of stress, anxiety, and depression. This finding was corroborated by the quantitative study which indicated the prevalence of anxiety to be extremely high (94.4%), followed by depression (86.6%), and stress (42.3%). The findings of this present study showed a comparatively lower prevalence of stress in comparison to the extremely high prevalence of anxiety and depression among the Kayayei, that seems to contradict previous findings which shows a higher prevalence of stress rather than anxiety among the migrants (Hovey, & Magaña, 2000; Mirzaei,
127 Ardekani, Mirzaei, & Dehghani, 2019). The deviation of the present study is likely to be attributable to the background contexts of the Kayayei. The opinion of stress as declared by the Kayayei is quite different from other groups since their whole life consists of challenges.
Poverty rates in the three northern regions are extremely high, and these women do all sorts of menial jobs mostly on the farm to make ends meet while taking care of their domestic duties as well (Britwum & Akorsu, 2016). These Kayayei are therefore used to working under challenging conditions which might account for the low levels of stress recorded in the present study.
The findings of the present study, where depression and anxiety were found to be extremely high is consistent with the study by Chen (2011) in that there is a high prevalence of psychological distress among rural to urban migrants. In another study, Pannetier et al. (2017) found the incidence of anxiety and depression among female migrants to be 24 per cent which is far lower than the present study. Their study was, however, among international migrants whilst the present study was on internal migrants. The present study also combined moderate to extremely high levels of depression and anxiety as psychologically distressed which accounted for the high prevalence of anxiety and depression.
Studies have shown that migrants’ psychological adaptation occurs in phases with mental health declining over time (Delara, 2016). Migration predisposes migrants to mental health issues due to the change in socio-cultural settings (Bhugra & Jones, 2001; Meyer, Lasater, &
Tol, 2017; Mulcahy & Kollamparambil, 2016). Migration to a different location may lead to loss of cultural identity and inability to comprehend the new social norms and to navigate the local environment, that could result in an increase in mental health distress (Kumar & Diaz, 2019; Syse, Dzamarija, Kumar, & Diaz, 2018) as observed among the Kayayei in the current study. The disruptions to the normal social roles and networks, may according to Kirmayer et al. (2011) have a profound effect on the mental health of the Kayayei. However, it is difficult to imagine and measure the loss of friends, family, social networks, and to establish new relationships in places where the societal norms are very different (Kumar & Diaz, 2019; Syse, Dzamarija, Kumar, & Diaz, 2018). The movement from rural to urban areas is often associated with adverse lifestyle changes, including changes in dietary intake and social interaction (Kumar & Diaz, 2019).
128 The high mental health challenges among the Kayayei may also be due to discrimination and perceived social inequity (Wang et al., 2010). In a male-dominated society, women are assigned subordinate positions (Delara, 2016), rendering them powerless to defend themselves against discrimination and other injustice in society. Further, Ghana as a country has no national policy protecting the rights of individuals who are self-employed (Amponsah- Tawiah
& Dartey-Baah, 2011). These women are subjected to physical and mental abuse by their clients and the people around them (Ahlvin, 2012). Income generated from their business is not enough to rent decent accommodation since their income is largely based on the generosity of their clients and not always on a negotiated price between them and their clients (Awumbila et al., 2008). They are also expected to support their families at home as well as pay those people who brought them from the north to the capital city, causing lots of frustration and stress with a consequent negative impact on their mental health.
Previous studies have found that the Kayayei, upon their arrival in the city, do not get any decent and affordable accommodation (Ahlvin, 2012; Kwankye et al., 2009; Opare, 2003).
They, therefore, have no choice other than to sleep in front of Kiosks where there is little or no security. Consequently, they are sometimes attacked by armed robbers who deprive them of their savings and this situation also exposes them to sexual abuse or even abduction by sexual predators. This could explain the high prevalence of depression, anxiety and stress found among the Kayayei. This confirms the conceptual framework that the context in which the Kayayei operates has a direct influence on mental health challenges. Nevertheless, the present study found that some of the Kayayei have suicidal tendencies. The mental distress because of the daily lived experiences without any protection causes some of them to lose hope and think that their lives on earth are of no importance, therefore, death will be the best option to end their suffering as indicated in the qualitative study. This implies that Kayayei need social and psychological support to deal with their daily lived experiences as suggested by Demetry and Dalal (2014).
The tenets of the conceptual framework surrounding environment will have an influence on the psychological and mental status of migrants (Lazarus & Folkman, 1984). For example, the qualitative aspect of this study found daily experiences of the Kayayei such as sexual abuse and exploitation, verbal, physical abuse, and sometimes abduction impacted on their mental health negatively. In Ghana, there is no law protecting this venerable group and so even when they report a crime, most of the time, the perpetrators are not persecuted. The lack of protection
129 and the perceived neglect of society is of concern to these Kayayei who often think about the social injustice against them. This is in line with the argument by Infante, Idrovo, Sánchez- Domínguez, Vinhas, and González-Vázquez (2012) which indicated that migrants in their transitional or the final host destination are submitted to physical, verbal, and even sexual violence but have no form of security from agencies and the state at large.
It is further worth noting that economic hardships among the Kayayei might also be a reason for the high prevalence of physical and mental health challenges. This present study found that the average daily income of the Kayayei is GHS 14.63 (about three ($3) US dollars when the data was collected in 2018). The main reason for the Kayayei migrating to Accra is to earn more income to take back home for various purposes such as acquisition of capital for starting a business, and income to go back to school. Realising that these expectations are not being met is likely to be a source of mental health distress for the Kayayei. Before migrating to Accra, the capital city, most of the Kayayei have unrealistic pre-migration expectations that they will earn enough income within the shortest possible time due to stories they have been told by other families of remittances they received from their children as found by Awumbila et al.
(2014).