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December » 2012 » Women's Courage

Archive for December, 2012

Maternal Mental Health

December 5th, 2012

I feel that I have grossly ignored the issue of maternal mental health throughout this blog.  Before this class, I had always assumed that poor maternal health and postpartum depression were primarily Western diseases.  I could not have been more mistaken.

According to the WHO, maternal mental health is a huge issue internationally and abroad.  Roughly 8-10% of women experience depression or anxiety during pregnancy, while 13% experience these syndromes throughout the first year after birth.  Three general categories are generally used:

  • prenatal depression: depression occurring throughout pregnancy; frequently sufferers of prenatal depression experience postpartum depression as well
  • postpartum blues: normal feelings of sadness, anxiety, insomnia and emotional instability immediately following birth and lasting for up to 10 days; experienced by 50-80% of all mothers
  • postpartum depression: clinically significant depression throughout the year following birth; characterized by long periods of fatigue, irritability, despair, thoughts of self-harm, etc.
  • postpartum psychosis: relatively rare condition occurring in 1-3 in 1000 women in which mothers may experience paranoia or hallucinations


These issues are surprisingly common.  In the developed world, suicide during the first year after birth is one of the leading causes of maternal death—a cause that is entirely preventable.  Meanwhile in the developing world, women who have experienced trauma or extreme stress (from migration, poverty, disasters, conflict situations, etc) are at an increased risk for developing maternal depression.  Those who have prior history of depression or lack social networks are also at an increased risk.

Maternal depression is associated with devastating effects for both mother and child.  Mothers are placed at risk for self-harm and long-term disability or reductions in productivity.  They are at risk for a host of other physical problems, such as poor hygiene/nutrition/sleeping habits, substance abuse, and early or problematic deliveries.  Infants are also affected in numerous ways.  Babies of depressed mothers are at higher risk for low birth weights, and may suffer from impaired development throughout their early years.  For instance, mothers who suffer from depression may not be able to provide the necessary “emotional nurturance, protection and stimulation” (healthchild.ucla.edu).   As a result, key mother-infant bonding relationships may fail to form naturally, depriving the infant of key attention, language-learning opportunities, and cognitive stimulation.  Infants of depressed mothers have been observed to be more irritable, less social, less playful and show fewer facial expressions than other infants.  They are also shown to perform worse on intelligence tests at 18 months. Long-term impacts show higher rates of behavior problems, difficulties in school, and delayed social/emotional development.  Once older, these children are at greater risk for grade retention and dropout.

I personally worry about the potential for poor maternal health to perpetuate cycles of poverty and illness.  A mother seriously affected by maternal depression without access to health care and therapy may not be able to foster adequate socialization and care for her child. This child may subsequently suffer from delayed development, poor social skills, and reduced intellect.  As a result, the child will not achieve his or her full potential, and may wind up in a state of poverty from which his or her child will have difficulty surmounting.  First, recognition of maternal depression as a serious condition is needed.  Second, counseling for expectant mothers and new moms should be offered, perhaps along with courses designed to encourage mother-infant bonding for women at risk.  This is especially important in the developing world, in which mothers may be at increased risk due to past trauma and likely have impaired access to mental health services.