Time to address maternal depression: A crucial concern for public health practitioners.

July 24, 2012

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Having a child can be one happiest event in a woman’s life. While life with a new baby can be enthralling and worthwhile, it can also be difficult and stressful at times. A woman goes though many physical, social and emotional changes when she is expecting, and after she gives birth

Having a child can be one happiest event in a woman’s life. While life with a new baby can be enthralling and worthwhile, it can also be difficult and stressful at times. A woman goes though many physical, social and emotional changes when she is expecting, and after she gives birth. The saddle of responsibilities, fear of economic and social insecurity and change in lifestyle creates disorder in many women. These changes can leave new mothers feeling sad, anxious, overwhelmed or confused, and many of them end up being in the worst stage of aggravation – impacting the lives of the newborn and other family members.

Addressing this issue and considering the importance of peri-natal depression as a public health concern, BRAC’s Research and Evaluation Division (RED) organized a national conference on “Peri-natal Mental Health: Breaking the Vicious Cycle” at the BRAC Center Inn Auditorium on the 16th of July, 2012. A number of research papers were presented related to the relationships and findings on maternal depressions – the dynamics, variables and its long term impact on the nation eventually.

Neerja Chowdhury, keynote presenter of the session talked about the importance of maternal depression issues in the public health sector. Among other issues – the direct and most visible impact is its effect on the child’s growth. In her study, she mentioned about 7 million children are underweight in Bangladesh and if only we could properly address depression issues of the mothers during and after child birth, about 1.7 million fewer children were underweighted.

Dr. Hasima-E-Nasreen, Head of the Health research of BRAC RED has presented her paper titled “Magnitude and consequences of peri-natal depressive and anxiety symptoms in rural Bangladesh”. Relationship with the husband, close relatives and caregiver, level of intimate partner violence, economic status, education and environment are some of the factors that force the mother’s depressive behavior during pregnancy. She mentioned – “18% of women we studied in two rural areas of Bangladesh were diagnosed as having depression during pregnancy, and 14% during 2 – 3 month postpartum and 32% 6–8 month postpartum. The depressed and anxious women were much more likely to give birth to very small babies, and that they affect infant growth and motor development, consequently extending the burden of disease to the next generation.” Maternal depression can lead to increase maternal deaths as the chances of suicidal attempts increase in the extreme situations. This also leads to increase infant death rates for lack of proper care.

The session moved on further when Dr. Zarina Nahar Kabir from Karolinska Institute, Sweden discussed how Men’s level of education explains intimate partner violence – resulting maternal depression in rural Bangladesh. Her research renders an interesting connection – women whose husbands have 5 or more years of schooling are 60% less likely to experience intimate partner violence than that of the women whose husbands are illiterate – thus the more educated men in the community, the less depressed are the women during pregnancy.

Dr. Maigun Edhborg, also from Karolinska Institute explained the affect of maternal depressive and anxiety symptoms on the mother’s emotional tie to the infant. Depressed mothers are less likely to have growing bondage with her child, as her thoughts are derived by her own frustrations. The more depressed the mother become, the less she cares about her child, which eventually creates distance and dissatisfactions among the family members.

The worst part of the prolonged depression is its long term effect on the child’s development. Dr Jena Hamdani from ICDDR, B highlighted the correlation of maternal depression and 18 months post partum anxieties with children’s physical and cognitive development. Mother’s extended depressive behavior substance negatively on the child’s nutritional status, cognitive growth, and social and behavioral development, which in turns has reflections on their language and expressions, vocalization, emotional tone, perception and approach, activities and cooperative attitude as well. Dr. Hamdani’s study shows that the pervasiveness of maternal depression is much higher in the urban part of Bangladesh than that of in the rural areas.

The nationwide impact of maternal depression are huge, as the children signifies the future generation – growing up they are expected to contribute towards the community with healthy physical and mental state. Addressing the importance of this issue, Aktari Momtaz, Additional Secretary of the Ministry of Health, Government of Bangladesh mentioned that government is already working on improving maternal and child health condition. A combined effort of NGOs, Government, International Organizations and other stakeholders can identify more specific causes and tackle peri-natal depression.

In the end, Dr. Sadia Afroze Chowdhury, Public Health Specialist, the World Bank, Washington DC, USA concluded that the grounds and the abiding impact of maternal depression came out right the way through the session. This was a call for taking policy initiatives to improve the overall situation, providing a platform for researchers, practitioners and policy makers to share knowledge and ideas on improving and mainstreaming peri-natal mental health in public health initiatives and implementation.