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When Mom is Sad: Maternal Depression in Low-Income Countries » Women's Courage

When Mom is Sad: Maternal Depression in Low-Income Countries

January 31st, 2013 by crennels Leave a reply »

We spoke in class this week about the trajectory of a woman’s life in developing countries, a path that is disadvantaged from birth due to gender. In thinking of topics in mental health that begin early in life, I chose to focus this blog on maternal depression. Postpartum and peripartum depression influence the lives of mothers and their children and damage the bond between them. In developing countries, precipitating factors and lack of treatment make this danger even sharper. This post will aim to outline the problem of maternal depression in low-income countries, and to introduce some  proposed interventions.

 

Maternal depression has myriad effects. Concerning the mother’s health, experiencing postpartum depression means it is more likely that a woman will be chronically depressed (1). Children of depressed mothers will be less likely to develop crucial secure attachments with their parent. This, in turn, will impact on their cognitive development. Studies note that mothers in “low-income countries” experience life stressful situations that lend to depression. Researchers cite economic stress, poor marriages, and domestic violence in particular (2, 3).
Both sets of researchers also mention the birth of a female child as a cause of depression in and of itself. This is particularly germane to our discussions in class this week; we were able to see the economic and social burden of becoming pregnant with a female child. While the event of a child’s birth should be joyous, for women in low-income countries it can be the source of maternal depression.

 

It is interesting to consider the variations in treatment of maternal and postpartum depression in the western world versus low-income countries. Depending of course on socioeconomic status, depressed mothers in the “developed” world often have access to treatment and drugs to ease their symptoms and their minds. Their disease is acknowledged and their plight given the consideration it requires. Mothers living in impoverished areas, in contrast, lack these benefits. According to research from Purdue University and others, in developing countries “antidepressants are infrequently used because of the lack of psychiatrists, high cost of medications, and low rates of patient adherence” (source 2, p. 4). The patient adherence factor intrigued me; why would patients, if given access to these treatments, not comply? The answer may lie in social stigma or a lack of recognition that they suffer from a treatable disease rather than simply sadness. A lack of education about the efficacy of antidepressants may also be to blame.

 

What can be done about maternal depression in low-income countries? Researchers acknowledge that social factors leading to mental unrest must be targeted. A future mother’s health should be monitored during her pregnancy, and there should be a focus on the interaction between mother and child upon the birth of the child. One suggested pathway is to first focus on social factors, then to give still-depressed mothers some form of psychological counseling, and finally to turn to drugs (2). This seems a wise approach, especially considering low rates of patient compliance with antidepressant medication. As part of counseling programs for these women, researchers also advocate a specific focus on gender (3). If the birth of a female child is a source of depression, efforts should be made to alleviate that stressor.

 

In considering these suggestions, I found myself torn. On the one hand, I agree with a holistic approach to maternal depression in low-income countries. It must be acknowledged that economic, familial, and social stressors disproportionately burden mothers in low-income countries. Addressing these factors presents an enormous challenge; how, for instance, can one mediate the effects of long-standing and deep-rooted discrimination against female children? How can one lower the incidence of domestic violence to improve the health of mother and child? Mental health is intricately connected to social environment and influences. Improving circumstance will improve mental health. That transition may come slowly, but better circumstances certainly lend to improved mental health.

 

Another perspective: social factors are relevant and important, especially for mothers in this situation. There are, however, genetic factors that lead to depression, which is often chemical in origin. The power of antidepressants should not be underestimated, and perhaps this approach will improve lives more quickly than comprehensive social change.

 

Then again, there really is no need to decide.  Both approaches are crucial, and both depend on culture, time, tradition, and the hope for change. Improved economic status, aided by education, will help women to reduce financial stress. The economics of medicine must be changed to create accessible treatment. Bias against female children must be shifted so that a child’s birth becomes a happy event rather than a distressing one. Mental illness must be de-stigmatized for women to accept it and take medication.

 

This is a complex issue, but an important one to realize and take steps to address. The first step in any intervention should be to meaningfully acknowledge the problem at hand.

References
1. Murray, L. Sinclair, D., Cooper, P., Ducournau, P., & Turner, P. 1999. “The socioemotional development of 5-year-old children of postnatally depressed mothers.” Journal of Child Psychology & Psychiatry, 40, 1259-1271.

2. Wachs, T., Black, M., & Engle, P. 2009. “Maternal Depression: A Global Threat to Children’s Health, Development, and Behavior and to Human Rights.”  Purdue University, University of Maryland School of Medicine, and California Polytechnic State University.

3. Patel, V., Psych, M.R.C., Rodriguez, M., & DeSouza, N. 2002. “Gender, Poverty, and Postnatal Depression: A Study of Mothers in Goa, India.” American Journal of Psychiatry 2002: 159: 43-47.

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3 comments

  1. Kathryn says:

    I was really interested in your post. I think maternal depression is a really important issue, especially because the physical and mental health of a woman is directly tied to the health of her child and of her whole family. I agree that it is important to target the social factors that lead to mental unrest, but I also recognize the need for antidepressants as a medical intervention. I agree with you that both approaches are needed – we need social interventions that target the social context and the stressors that contribute to maternal or postpartum depression in combination with the medical interventions that can help treat the underlying biology of the disease.

  2. Chloe says:

    This was an interesting blog post to read after having just done the reading on maternal and reproductive health for this week. It is not hard to imagine how a new mother could be depressed in many situations. So many pregnancies worldwide are unwanted. Many women are impregnated because they are raped or are forced to have unprotected sex with their husbands. Many of these women are so young, still children themselves, not mentally ready to handle the responsibilities of being a mother. Many women know that this new life they have brought into the world will suffer horribly, especially if she are a girl. Giving birth should be a time of joy and celebration for a mother, but because of circumstances outside of their control, for so many women, giving birth comes with depression.

  3. jenees says:

    This was a difficult topic to write about, and I appreciate that you were able to communicate your ambivalence towards different treatment aspects.

    Acknowledging the social, genetic, and cultural factors that lead mothers to have postpartum depression was very interesting and thoughtful.

    Your post definitely got me interested to learn more about the factors that lead to low patient adherence in regions where women are able to see a psychiatrist and obtain medication.

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