Today, April 7th, is World Health Day; a day commemorated every year to mark the anniversary of the founding of the World Health Organisation. This year, the theme is depression and the campaign slogan is “let’s talk”. No better time for me to highlight a problem that I consider to be a neglected tragedy, that is Postpartum Depression (PPD). More specifically I wish to draw attention to postpartum depression among teen mothers.
Well, perhaps the best way to start off is to share some dazing words of a teenage mother, a survivor of PPD, narrating her feelings after the birth of her baby:
“Everything around me seemed so strange, so awful, so confusing… I hated myself and I wasn’t sure I knew how to love my baby… I felt huge waves of anxiety and uncertainty… I was gripped by sadness, overwhelmed by fear and too ashamed to talk about how I felt. I felt trapped and deserted; I longed for my old life. I couldn’t hold back my tears, I cried, my baby cried a lot, we both cried...”
This kind of emotional turmoil might not seem like the typical experience of a new mother when ordinarily one would expect the mythical mummy bliss, excitement and tender loving welcome to a newborn. But the reality is that postpartum depression affects a significant proportion of mothers, more so first time mothers. Statistics by the World Health Organisation show that worldwide, about 10 per cent of pregnant women and 13 per cent of women who have just given birth experience a mental disorder, primarily depression. In developing countries, the figures are higher, standing at 16 per cent during pregnancy and 20 per cent after child birth. In Kenya, the Ministry of Health approximates that one in every 10 women develop depression after giving birth.
Postpartum depression is a mental health disorder that starts in or extends into postpartum period up to 12 months after delivery. Symptoms vary and include sleeping and eating disturbance, mental confusion, loss of self-esteem, anxiety, lack of interest in the newborn baby, insecurity and suicidal thoughts. Prolonged or severe mental illness hampers the mother-infant attachment, breastfeeding and infant care. Maternal depression has been linked directly to low birth weight and undernutrition during the first year of life, as well as increased sickness episodes, incomplete immunisation and poor cognitive development in young children. In some cases, the condition can degenerate to postpartum psychosis so severe that a mother commits suicide or infanticide. Multiple risk factors for postpartum depression have been suggested as no single cause has been identified. Personal vulnerability, personal traits and social factors such as poverty, unplanned pregnancy, single parenthood and marital discord have been cited.
Researchers have found that twice as many teenage mothers are at risk of developing PPD as their older counterparts. Teenage mothers undergo unique personal and social challenges that predispose them to depression. In many cases, unmarried pregnant girls are shamed, stigmatised and face rejection from their parents and peers. Men who impregnate them often deny responsibility or subject them to intimate partner violence. Furthermore, teenage mothers tend to have limited access to health services and less-than-ideal medical care when they do seek services. Even when they can and are willing to continue with education, they are often denied the opportunity to get back to school. In Kenya, teenage pregnancy is a serious challenge with an estimated 18 per cent of teenagers having begun childbearing. In six counties (Samburu, Nyamira, Tana River, West pokot, Homa Bay and Narok) more than one in four teenage girls have begun child bearing (KDHS, 2014). As the government and stakeholders implement strategies to address the high teenage fertility, it is critical to ensure teenage mothers receive care that not only addresses their physical wellbeing but also their mental health. This should start by recognising that PPD is a common problem that negatively impacts maternal and neonatal outcomes hence the need to invest in measures to screen and treat teenage mothers for depression as part of routine antenatal and postnatal care.
Today, as we celebrate the World Health Day attention is being drawn to the importance of talking about depression as a vital component of recovery. The stigma surrounding mental illness, including depression, remains a barrier to people seeking help throughout the world. Talking about depression helps break down this stigma, ultimately leading to more people seeking help. This applies, as well, to talking about and committing to doing more to reduce teenage pregnancy, providing adequate care for mothers suffering depression and ending social prejudices and systemic failures that perpetuate postpartum depression.
Written by Kimani Karuga, Technical Manager, County Innovation Challenge Fund (CICF), Options Consultancy Services Ltd.