Breaking the Silence, Healing Together!
The experience of becoming a new mother is typically rewarding and exciting, but for some women, it can bring about a myriad of complex negative emotions known as postpartum depression (PPD). PPD was first recognized in the Diagnostic and Statistical Manual of Mental Disorders IV in 1994 as a major depressive episode occurring within six weeks of giving birth. In the International Statistical Classification of Diseases and Related Health Problems, it is characterized as a mild mental and behavioral disorder starting from 2-6 weeks after delivery. PPD is considered one of the most common complications of pregnancy, affecting 12.5% of women worldwide, with Pakistan having the highest prevalence rates in Asia, ranging from 28% to 63%, leading to significant consequences for mothers and their families.
In Pakistan, a developing country with high maternal mortality rates and limited healthcare budgets, inadequate health services, lack of social awareness, and the stigma surrounding mental health issues can have deadly consequences, including infanticide and maternal deaths.
There are many risk factors associated with PPD, Cultural and environmental factors play a significant role in the onset of PPD. The patriarchal nature of the society, where women’s needs, values, and beliefs are often suppressed, contributes to the development of PPD. Gender bias, where having female children is seen as a disappointment, leads to women feeling passive and suppressed in their homes. Cultural norms like “chila,” where women are isolated for 40 days after childbirth, result in a lack of social support. Women are expected to fulfill all household duties, leaving little time for self-care and adding to their burdens. Marital dissatisfaction, poor spousal relationships, and stigmatization of mental health issues hinder women from sharing their thoughts and feelings. Other social factors such as illiteracy, poor family planning, suppressed women’s rights, marital abuse, and lack of awareness are also at play. All these factors combined, contribute to the high rates of postpartum disorders.
Prevention and Treatment
Prevention and treatment of PPD are crucial at the primary level to avoid the onset of severe symptoms. Raising awareness among women of childbearing age and their spouses through seminars, podcasts, and public health messages is essential. Screening tools and assessments should be readily available in gynecology departments across public and private sectors, and healthcare professionals should be educated and responsible for conducting risk assessments and clinical interventions. Treatment options for PPD include antidepressants, cognitive-behavioral therapy, social support groups, interpersonal psychotherapy, dietary changes, and stress reduction exercises. Interpersonal psychotherapy has shown effectiveness in treating PPD, particularly for women who are hesitant to take antidepressant medications while breastfeeding. It recognizes the connection between depressive symptoms and interpersonal distress and focuses on improving interpersonal relationships through recognizing maladaptive thoughts, and understanding of attachment styles. Its biopsychosocial model recognizes the genetic, social and psychological factors contributing to the onset of PPD.
The impact of PPD extends beyond the mothers, affecting the entire family, as mothers are the primary caregivers in Pakistan. PPD can lead to affective dysregulation, attachment issues, and poor cognitive development in children. Early diagnosis and treatment of PPD are essential for ensuring the well-being of families and breaking the cycle of PPD’s negative effects.
Gulamani, S. S., Shaikh, K., & Chagani, J. (2013). Postpartum Depression in Pakistan. Nursing for Women’s Health, 17(2), 147-152. doi:10.1111/1751-486X.12024
Aliani, R., & Khuwaja, B. (2017). Epidemiology of Postpartum Depression in Pakistan: A Review of Literature. National Journal of Health Sciences, 2, 24-30.
Stuart, S. (2012). Interpersonal Psychotherapy for Postpartum Depression. Clin Psychol Psychother, 19(2), 134-140. doi:10.1002/cpp.1778