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Postpartum Depression: Stigma forces young Kashmiri mothers to suffer in silence

Failure to seek medical help restricts women from embracing motherhood for years

After the birth of her first child, Aasima Jan was elated. After almost four years of struggling with infertility, she couldn’t believe she had given birth to a healthy baby girl. “The first time I saw her, I cried with joy. It felt nothing short of a miracle,” recalled the 32-year-old. However, for the following three days in the hospital, Aasima experienced what she calls the ‘weirdest of emotions.’ She was joyful at one moment and tearful the next.  

She was told that it is normal for new mothers, especially those with c-sections, to have these feelings and they would go away on their own in a week or two. But that never happened. With each passing day, she felt more isolated and hopeless; uncontrollable crying and sleepless nights became frequent. “The guilt of not being a happy mother was devastating. I couldn’t understand what was wrong with me,” Aasima said.  “Even the sight of my newborn didn’t make me smile.”

Blaming the massive hormonal shifts post-childbirth for long, Aasima finally confided in her childhood friend about her anxiety. Sensing postpartum depression - a term that Aasima had never heard before - she was suggested to seek professional help. “No doctor had ever mentioned it to me before my daughter’s birth,” she said.

A psychiatrist diagnosed her with mild postpartum depression and a few counselling sessions is all that took Aasima “to feel like myself again,” she said. “I wish I was warned before. I wouldn’t have to struggle for months, had I known it was a medical condition all along.”

Postpartum depression (also referred to as postnatal or peripartum depression) is a serious, but treatable mental health problem associated with certain mood and anxiety disorders occurring after childbirth. It can affect both males and females; however, women are reportedly at a greater risk of developing it, owing to the biological, emotional and social changes in their roles as mothers. Symptoms include extreme sadness, agitation, sleep deprivation, feelings of guilt, shame or inadequacy, and loss of energy and appetite. 

“If left untreated, it can turn to psychosis and there can be suicidal or homicidal tendencies as well,” Dr Zaid Ahmad Wani, a psychiatrist at the Institute of Mental Health and Neurosciences (IMHANS), Kashmir told South Asian Today.

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He said that up to 70% of new mothers experience “baby blues” which is a short condition involving irritability and restlessness and usually dissipates within a few days or weeks, whereas postpartum depression is a severe condition that requires medical attention. Its onset is within 4-weeks of delivery and may continue for months, or even years. 

A 2017 report by the World Health Organisation found 22% of Indian mothers to be suffering from postpartum depression. The global prevalence is around one in seven women. While there is no existing cross-sectional data available on postpartum depression in Kashmir, a localised study in Srinagar, Kashmir found that depression was present in 10% of the women during their postpartum period. 

The covid-19 pandemic is expected to have added to these rates. An increase in risk factors like maternal isolation, increased psychological risk during a socio-economic crisis, relationship conflicts, and decreased contact with healthcare professionals, impacted the perinatal mental health in Kashmir, found a study.

According to Dr. Zaid, who witnesses only around 50 cases of postnatal psychiatric disorders a year, the prevalence can be much higher than the ones actually receiving treatment. “The lack of awareness and stigma results in a treatment gap. Many women with postpartum depression choose to conceal their condition, and even if they share it with their close ones, the taboo associated with mental health limits their access to medical help.”

He added that very few of his patients continue with the treatment even after getting diagnosed with postpartum depression. 

This story is often repeated by women in Kashmir. Rehana* (name changed upon request), a banker, everyday drops off her son at preschool on the way to work. But 3 years ago, when he was born, the situation was far from normal. Rehana’s depression was triggered when she struggled with breastfeeding. “Few weeks after birth, my son all of a sudden stopped latching as my milk supply had dried. We started feeding him formula, but he wouldn’t stop crying” she said. “I felt like I wasn’t doing enough for him.”

Her condition was exacerbated when she found it difficult to juggle her responsibilities as a new mother and worker. Her job demanded leaving behind her newborn with her in-laws, and “even though he was in safe hands, I feared for his life every time,” she said. Rehana’s son wasn’t a good sleeper right from the start and this added to her physical and emotional exhaustion. “I had no time to rest. I remember screaming back at my crying son in the middle of the night.”

On one hand, she felt inadequate as a mother and on the other, she blamed her newborn for all the problems. “There were times when I wanted to abandon him and run,” Rehana said. “It was chaotic. My feelings made no sense, but I didn’t know how to reach for help.” During her follow-up checkups to her gynecologist, she felt too ashamed to admit it. She looked for her symptoms on the internet “the fear of being judged stopped me from sharing it even with my close ones,” she said.

Rehana never received any treatment and it took her two years to heal. However, she said that she dreads the thought of having a second child.  

Not enough professionals

Experts also say that the shortage of mental health professionals affects the delivery of mental health care. A study published in the Indian Journal of Psychiatry revealed that India has 0.75 psychiatrists per lakh population, while the desirable number is anything above 3. The mental health atlas 2017 stated that India has 0.07 psychologists per lakh population.  

Dr Zaid said, “The lack of proper literature regarding postpartum depression and not having ample mental health professionals can widen the treatment gap.” He added, “We need more professionals like counsellors, psychiatric social workers and psychiatric nurses to deal with psychiatric illness including postpartum depression.” 

It's not normal to suffer

“You are not the only woman to give birth, we too have gone through this,” is what Shabnum Gul, 36, got to hear when she tried voicing her woes to the elder women in her family. The rapid weight gain after giving birth to her second child had saddened her to an extent that she started hating herself. Embarrassed to let anyone see her, she confined herself to her room. “I felt flawed. I stopped eating and drinking and all I wanted was my old life back,” she said. 

This frustration often poured out as anger and arguments with her husband. “I was called a pathetic wife, an incompetent mom and was accused of gaining sympathy,” she sighed. The thoughts of how the society was viewing her as a mother multiplied her anxiety, but unaware of her condition, she never sought any help. “I didn’t have any issues with my firstborn, so I never thought I would have postpartum depression this time,” said Shabnum.

Psychologist, Laila Qureshi, while calling motherhood a roller coaster ride, stressed the importance of familial support to women suffering mentally. “A childbearing woman goes through a lot, both physically and emotionally, and she wants her husband and her family to recognise her struggle, but the lack of support and understanding often pushes her into depression,” she said. “When the realism of motherhood doesn’t match their expectations, they regret their choices. Gynecologists can play an important role in sensitising women about postnatal behavioural changes, she opined.

Laila has counselled many Kashmiri women post-pregnancy and believes that the stigmatised views towards mental illness stem from the older generations. “Our elders try to normalise the struggle for new moms and want us to think of the problems as just a phase of life. It impacts the acceptability of mental health issues,” she said.

South Asian Today is an independent media company committed to amplifying South Asian writers and artists. If you like our work, please become a member or buy us a coffee here. Your support enables us to keep our journalism open for all and publish South Asian writers. Please support us by becoming a member and helping us remain free of a paywall. It starts at just $5/month. 
About the author

Farzana Nisar is an independent journalist based in Kashmir. She reports on health, gender, human rights, education and culture. Tweets @farzananisar66



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