Postpartum depression (PPD) is a socially stigmatised, mental health condition that is primarily related to pregnancy and childbirth. It can be observed within a few weeks of delivery and could last up to several years in all parents.
However, PPD is found to have a higher global and national prevalence among women belonging to the child-bearing cohort as certain bio-physiological and socio-cultural risk factors predispose them to it.
PPD is classified as a globally prevalent, non-psychotic, depressive disorder that affects as many as 22% of new mothers in India, according to the reports released by the World Health Organization (WHO, 2021).
Many women experience a phase called the “postpartum blues” that may last up to two weeks after the delivery, typically.
What Does Postpartum Blues Look Like?
When these blues persist for a prolonged period of time with the exhibition of a constellation of other symptoms including low levels of self-esteem, guilt about their inability in looking after their child, frequent crying spells, insomnia, loss of appetite, bouts of insecurity, recurring suicidal thoughts, disinterest in one’s own surroundings, and in extreme cases: an antagonistic feeling towards their newborn, then the condition can be called as PPD.
These symptoms are usually inconsistent with the caregiver’s original personality or behaviour. PPD can start at any time, within the first year after delivery, and at times, it can last for several years.
The transition to motherhood is an extremely difficult phase for many women as it involves significant changes in the biological, physiological, psychological and social aspects of their lives.
It is also believed that these factors can make women further vulnerable to developing the mental illness. In their lifetime, women are known to be twice more likely than men in experiencing depression, especially due to their reproductive nature, and rearing of children.
Disproportionate Burden On Global South
PPD has shown a very uneven, global prevalence, with a large part of the burden falling disproportionately on the lower to middle income and developing countries like India. It has become a serious cause of public health concern with an increased mortality rate through suicides.
According to the WHO, PPD remains to be one of the biggest reasons leading to excessive disease burden in women belonging to the reproductive cohort.
The extent of damage PPD can potentially cause, if left untreated, to both the mother and the baby is massive with its effect being felt in marital relationships, and as well as in the relationship of the mother and her children in the future.
It is therefore extremely crucial to determine the presence of PPD, actively de-stigmatise the myths surrounding the disorder, efficiently acknowledge the existence of the disorder, diagnose the condition on time, treat and prevent its further likelihood.
No Services Aimed At Tackling PPD In India
Undiagnosed and untreated PPD can have long lasting, adverse implications on the emotional, cognitive, behavioural and interpersonal aspects of the mother and the baby.
Despite the existence of the National Mental Health Program (1982) and the Mental Healthcare Act (2017), maternal mental health has not yet become a priority in India.
India’s reproductive health programs also show a similar attitude and have not included any services aimed at the prevention of PPD in any capacity.
There is also a clear dearth of well documented national statistics on PPD in Indian mothers. Whatever little available data there exists, is strictly limited to certain specific geographic regions.
South India Has Highest Prevalence Of PPD
Numbers suggests that there is a higher presence of PPD in urban areas (24%). This may be attributed to the higher living costs, over-crowding, and an excessive work pressure on working mothers.
The southern region of the country which includes states like Tamil Nadu, Karnataka, Goa etc., further tops the PPD chart—with an overall prevalence of about 26%. This could be because of the increased presence of urban slums and higher rates of domestic violence.
The eastern (23%), south western (23%) and western regions (21%) follow the south in the chart. Finally, the northern region is reported to have the lowest presence of PPD.
An overall high prevalence of PPD in India can be a result of either specific geographical or cultural factors, high poverty rates, lower socio-economic status, lower levels of education, or a combination of all.
Cultural Beliefs Impact PPD
PPD occurs due to a combination of hormonal-biological, psychological, familial, social and cultural factors.
Studies that have looked into various cultures have revealed that PPD can be only entirely understood when the cultural factors are taken into account, along with the bio-medical, social and psychological perspectives.
Cultural beliefs and practices of a society that a person lives in can have a notable impact on their emotional state and can be crucial in dealing with major life transitions such as pregnancy and childbirth.
In a society like India, where conversations around mental health are discouraged and stigmatised.
Women Are Expected To Be ‘Good’ Mothers
It is a heavily taboo topic and reaching out for professional help is often a herculean task for the mothers suffering from PPD, as it entails a possibility of them being labelled as lazy or ill-equipped to manage caregiving responsibilities.
In addition to that there exists an overt socio-cultural romanticisation and pedestalisation of motherhood. This essentially thrives on the idea that a woman is supposed to find her biggest happiness and contentment in life via giving birth to a child and being a mother.
Historically, women have been conditioned to believe that being a mother is the only way to prove their femininity and self-worth.
When a woman fails to rise upto this pedestal of being a “good mother”, she is severely looked down upon and heavily ridiculed.
Caregiving Loads Needs To Be Shared
As a society we have for years endured this rather toxic environment for child bearers that naturally pre-disposes women to reproduction, rather than giving them the independence to introspect on their own readiness and willingness to become care-givers and parents.
The birth of a baby is often considered to be an occasion of happiness that calls for a celebration in almost all Indian households. Any other feelings such as anxiety, or sorrow related to childbirth are tabooed and invalidated by the society.
This makes it further difficult for women to seek timely help fearing the repercussions of their behavior which could be anything ranging from marital separation, social exclusion, and/or abandonment.
But, it is beyond time we change this narrative to understand that childbirth can also be a traumatic event for a significant section of the birth givers because of the overwhelming chunk of responsibilities that come at once by being a parent.
Where Is The Space For Self-Care?
This is more often than not accompanied with hormonal, physiological and psychological changes and also sometimes, responsibilities from work for working mothers.
Society, since time immemorial, has taught women to think of themselves only as caregivers and nurturers to such an extent that it has now become next to impossible for them to think of self-care while being a mother.
Such redundant socio-cultural practices along with other biological risks make one in five Indian women belonging to the child bearing cohort extremely susceptible to PPD.
A preference for sons, financial stringency, distressed and estranged interpersonal relationships, lack of social and emotional support, and experience of any kind of violence, are all some of the main risk factors that are statistically correlated with the development of PPD.
People With PPD Need Professional Help
The family members and partners play a very crucial role in identifying the disorder and facilitating timely medical intervention or other essential psychological help for the mothers.
In addition to that, a supportive family structure and understanding spouses can aid the process of recovery.
They can prevent the condition from getting further worse by being empathetic towards the mother and providing her with constant psycho-social support, which is of utmost importance.
But, in no way does this imply that PPD can be completely cured by the counsel of family members alone as PPD has causes that are sometimes strictly biological and hormonal.
It is a serious medical condition and not some whimsical thought that, in all honesty, needs strict professional consultations.
Discharged Soon After Delivery
Lower accessibility to resources coupled with poor training practices have markedly affected the ability of healthcare professionals in India in efficiently recognising and managing PPD in mothers.
Moreover, in India (unlike in western nations), women are mostly discharged from the hospital within a short span of 48 hours after childbirth. This duration is even shorter in public hospitals.
Short hospital stays do not give enough time for the doctors to recognise earlier symptoms of PPD and provide the mother with necessary consult.
Furthermore, the post-natal care in India is mostly focused on the health of the infant rather than that of the mother’s.
Therefore, it becomes imperative to devise such interventions that is not just limited to addressing the biological variables of PPD but also acknowledges the socio-cultural risk factors associated with the disease.
Awareness Campaigns: Only The First Step
Policies should be focused on spreading awareness and establishing normalcy of the disorder across rural and urban regions thus paving way to an improved possibility of timely identification, solid diagnosis and efficient management.
Healthcare professionals must be well trained to identify PPD at its early stages itself, and should also be encouraged to have proper counselling and awareness sessions with the expecting parents about PPD.
They should actively indulge in correcting any misconceptions, and stereotypes that may surround the disorder with their patients and their families.
Three levels of preventative steps can be taken to minimise the prevalence of PPD and alleviate the complications associated with it.
Three-Pronged Approach To Tackle PPD
On the primary level there should be a collective effort by the government and the stakeholders to de-stigmatise mental health problems, provide the required education, and family planning resources especially at a community level.
The secondary step should be to ensure active antenatal checkups and routine screening of pregnant mothers to catch the symptoms at the early onset itself.
On the tertiary level, there should be an effort to prevent any kind of relapse by making sure to get regular check-ins with the doctor in the post natal period.
Targeted Interventions Required
The current epidemiology of PPD is mostly relied on a few regional based studies, with a massive shortage of any systemic and robust nation-wide evidence that deals with not only the overall burden of PPD in India, but also looks into the data related to pre-natal depression and other risk factors associated with it across the country.
This is an important pre-requisite in order to provide a more nuanced understanding of the situation.
This would help the policymakers, medical health-care professionals, primary care providers and other health authorities to come up with more informed, effective and targeted interventions directed towards reducing the presence of PPD.
These should be equally accessible to mothers across the country, without placing any socio-cultural, economic or other such barriers in front of them.