• Wednesday, Oct 16, 2019
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The elephant in the room

  • Published at 11:39 pm October 7th, 2019
Mother
Photo: BIGSTOCK

Post-partum depression is causing women to suffer in silence

Post-partum depression (PPD) is a common, non-psychotic mood disorder which is associated with pregnancy and childbirth. It usually develops within the first year of childbirth.

Despite it being predominantly linked to women, it can affect both parents, and the family as well. 

PPD is characterized by general depressive symptoms, including a persistent feeling of sadness and low mood, lethargy and fatigue, feelings of guilt, hopelessness, self-blame, and an inability to bond or care for the baby, coupled with thoughts of harming the baby. In more extreme cases, suicidal and self-harming thoughts can develop.

PPD can affect anywhere from 0.5% to 60.8% of mothers across the world. An accurate range of global PPD prevalence is difficult to measure, given that many who are afflicted are unlikely to be diagnosed due to social stigma; countless others also may not be aware of this form of depression, compelling them to suffer in silence.

Therapy and medication is the most common form of treatment for PPD, but it is not readily available, accessible, or affordable for all those who are afflicted.

In Bangladesh, mental health is not an oft-discussed topic and there is very little research on PPD. In rural settings, PPD among women has been closely linked to low economic status, nutritional status, physical violence and domestic quarrels, stress, past mental and depressive symptoms during pregnancy, and perinatal death.

There is limited data studying the burden and risk factors of PPD among women in urban slums. This is a critical area which needs to be addressed, given that a third of Dhaka’s population lives in slums. Moreover, by the coming decade the urban population will increase by 50% due to rapid urbanization. 

A new study by icddr,b has endeavoured to bridge this information gap. A total of 374 women from three different urban slums were interviewed as part of this study.

The adapted version of Edinburgh Postnatal Depression Scale (EPDS), a 10-item questionnaire to assess the interviewee’s depressive feelings, was used to detect depressive symptoms during the post-partum period. Nearly half the women (48.7%) were first-time mothers, and around 50% were employed in some capacity before their pregnancy.

An overwhelming 69% faced intimate partner violence before their last pregnancy, while 48% faced it during their pregnancy.

With the application of the EPDS scale, this study found that 39.4% of women in urban slums were suffering from post-partum depression. Mothers who had little education were more likely to have PPD than those who had secondary education (49% vs 26%). Other risk factors associated with PPD among women in urban slums include perinatal or postnatal death, unplanned pregnancy, financial worries, pressures of current jobs or loss of jobs due to pregnancy, and lack of open communication with their partners regarding their feelings. 

The evidence from this study has only added to the growing body of literature which stipulates that the burden of PPD among women living in slums was higher when compared to their counterparts living in rural areas.

Maternal mental health services should be integrated into existing maternal health services, given that mental health awareness is slowly on the rise in Bangladesh. 

In 2018, the National Mental Health Act replaced the 105-year old Lunacy Act.

It outlines legislation which will provide a legal foundation to ensure service provisions for care and treatment of persons with mental disorders.

Additionally, the 2016 Essential Health Service Package includes diagnosis and management of common mental disorders in primary health care settings. 

However, only 0.44% of the country’s total health care expenditure budget has been allocated to provisions for mental health.

While the new National Mental Health Act is a good starting point, more initiatives need to be taken and interventions to be developed, especially social insurance programs to curb the financial barriers many women face when trying to access care for their mental health. 

Farasha Bashir is Communications Specialist, Communications at icddr,b.