INDIA: Postpartum Depression, Women, and the Indian Society in Between

(Certain names in the story have been shortened to protect the person’s identity.)

AASHNA MALPANI WRITES– I hear a piercing wail in the background. My source puts the phone on hold for a minute, then returns with apologies: “Sometimes I wish I never had him.” She sounds exasperated, complaining about how she hasn’t had a second to herself lately.

Nidhi K., a 28-year-old housewife in Kolkata, gave birth to a boy just six months ago. Since then, she has been faced with overwhelming anxiety and fear, severe mood swings, trouble producing breast-milk, and a return of her vertigo.

Dr. Aarya K. Rajalakshmi, resident doctor at Drexel University in Philadelphia, characterizes Nidhi’s symptoms as typical postpartum depression (PPD). She says, “PPD is a depressive disorder that has its onset generally within four to six weeks after childbirth. The challenge with most psychiatric problems is that they are all in a continuum, but PPD has certain features that mark the difference. When the woman continues to be despondent, gloomy, tearful or irritable for more than two weeks, that’s when we start paying closer attention.”

Courtesy: American Family Physician

According to a 2017 study published by the World Health Organization, 22% of the 20,043 Indian women surveyed suffered from postpartum depression. Several risk factors contribute to the onset of PPD, such as lack of support from the husband, domestic violence, a past history of psychiatric illness, and the birth of a female child.

Between caring for her infant and a joint-family of six, Nidhi has no time to tend to her own mental health and instead dismisses the concept of “nonsense such as (postpartum) depression.” She goes on to tell me, “Children take so much. Then there’s your husband and your household obligations, and then the social stigma if you don’t live up to familial expectations. And if you’re sad, you’re sad. That’s just how it is.”

Nidhi’s refusal to acknowledge signs of PPD is nothing out of the ordinary. The assumption that an Indian mother must be the image-incarnate of the goddess Durga speaks to what is demanded of women in India. Given this pressure, it’s no surprise that the country’s most recent National Mental Health Survey stated that women are more likely than men to suffer from all forms of depression.

PPD is just one mental health problem. Dr. Rajalakshmi goes on to explain how India’s conservative societal norms further hinder awareness of virtually all mental health concerns. She says some people abstain from visiting mental health professionals or even talking about problems for fear of being judged or ostracized. This is particularly harmful to women with PPD, for many remain uninformed about the disorder as well as the subsequent need for immediate medical attention.

“There is this notion that it is the mother’s role to be taking on all the burden of motherhood. So when someone comes out and complains about the stress she’s enduring, there’s this tendency of people to be very scornful, and judge her as someone who’s shirking her responsibility towards motherhood. So we see a tendency to not want to request help,” Dr. Rajalakshmi tells this reporter.

It was this stigma that prevented Smitha P., 39, a former teacher at Welland Gouldsmith School in Kolkata, from approaching a psychiatrist. Even after being diagnosed with chronic depression recently, symptoms which worsened after her second pregnancy in 2001, she said, “I don’t think Indian women really have postnatal depression. Even if they do, it is probably a path to getting back your body.”

Similarly, Rashmi S., 40, a fashion designer in the same city, was entirely unfamiliar with PPD. “I am shocked to know this exists. My friends haven’t talked about it. When you’re holding that baby in your hand, how can you be depressed? When you see it smile, how can you be sad? I don’t understand.”

Although there are exceptions to the rule, there is indeed a failure to recognize and address mental health issues on the part of India’s general public. The National Institute of Mental Health warns that if left untreated, PPD can last for months or even years, affecting the mother’s general health and her capability to bond with and care for her baby.

“(Indian) people, for one, need to have realistic expectations with respect to the mother’s role and responsibilities. They need to be accepting and open to recognizing a problem, and then be willing to encourage help. Indian society is not so much so a single unit, and because of that it’s all levels that we need to bring changes in,”

Dr. Rajalaskhmi points out that both institutions and individuals must begin to embrace rather than shun the concept of mental health problems and treatment.

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