Silent Struggles

In the heart of Rajasthan's vast desert landscape, amidst the vibrant hues of its culture, lies a silent and overlooked battle postpartum depression (PPD). For countless new mothers in the state's rural and urban regions, the joy of childbirth often comes entwined with emotional and psychological turmoil that remains largely unspoken.

Sunita Devi (name changed), a 24-year-old mother from Jaipur rural, after delivering her first child found herself overwhelmed by feelings of low mood, crying spells, restlessness and decreased sleep, which persisted beyond two weeks of postpartum blues. Subsequently, she started shouting and abusing her family members, but when she reached the stage where she could harm her child and herself, her family members became alarmed and rushed to the psychiatric centre in Jaipur.

Dr Gaurav Rajender, associate professor, department of psychiatry, Sawai Man Singh (SMS) Medical College, Jaipur said that Devi was diagnosed as a case of PPD with psychotic symptoms and was admitted to the hospital. With treatment and counselling by doctors, she gradually improved within a period of 17-18 days. He said, “During this period, strict vigilance was kept so that she does not harm herself and her child was separated from her to prevent harm. After discharge, she followed up with doctors and fully recovered within 1-2 months.”

Her family members were counselled that the patient would have a higher chance of developing similar symptoms in consequent pregnancies and it should be brought to the notice of the treating gynaecologist, Dr Rajender added. The mental health expert highlights that around 20% of women globally face the risk of developing depression, with women being particularly prone to depressive and anxiety symptoms. "During pregnancy and postdelivery, the risk of mood disorders increases, leading to potential suffering and adverse effects on both mother and child," he explained.

Dr. Rajender explained that mothers with PPD often experience intense feelings of sadness, hopelessness, helplessness, and low self-confidence. These feelings can lead them to believe they are inadequate, that they are not good mothers, or even that having a child was a mistake. In severe cases, this negative thinking can result in self-harm or harm to the child. Some mothers may also develop psychotic symptoms, such as believing the child is bad or hearing voices (auditory hallucinations) instructing them to harm the child. He said that 5-10% of women in India develop depressive disorder during pregnancy or after delivery.

Dr Deepa Chaudhary, professor, department of Obstetrics and Gynaecology, SMS Medical College working with Mahila Chikitsalaya in Jaipur said cases of PPD are more in women where there is disharmony in the family if the first child is a girl the pressure of second child to be a boy, if the women had PPD earlier and there is sudden withdrawal of hormones postdelivery and if there has been any history of mental illness in her parent’s side then there are chances that PPD may flare up.

“There is nothing to worry about if any woman suffers from PPD as it is curable, but timely counselling and treatment of a psychiatrist is very important,” she added.

A few mothers may turn violent due to PPD, but she should not be left alone and the baby should be breastfed before taking medicines, Dr Chaudhary said.

Dr Narendra Gupta, Rajasthan convener of Jan Swasthya Abhiyan on the question of more cases of PPD from urban or rural Rajasthan said, “It is difficult to say that from where the cases are more, but one is for sure that whether rural or urban if the woman postdelivery gets proper support from her parents, in-laws, spouse and relatives then cases of PPD will certainly be less.”

Bhupesh Dixit, a public health expert working as senior programme officer (mental health) with SRKPS, a Jhunjhunu-based NGO working in the field of health in Rajasthan said that the concept of PPD is not widely recognized In Rajasthan's deeply traditional society. The new mothers are expected to quickly embrace their roles, balancing household chores, taking care of the newborn, and attending to family duties. The lack of awareness and cultural stigma surrounding mental health issues often forces women to suffer in silence, without understanding that they need and deserve help. According to the World Health Organisation, 15-20% of women suffer from mental disorders during pregnancy and post-delivery in India. In Rajasthan approximately 22 lakh women get pregnant every year as per the pregnancy and child tracking system of the state government and 3 lakh to 4 lakh women suffer from mental health issues during the perinatal period, which is a big number, he added.

He said that the communitybased assessment checklist (CBAC form) is filled out by the ASHAs and health workers in rural areas to get details about non-communicable diseases (NCDs) and the form has two questions in part D: PHQ 2 which are - Over the last 2 weeks, how often have you been bothered by the following problems? 1. Little interest or pleasure in doing things? 2. Feeling down, depressed or hopeless? {Anyone with a total score greater than 3 should be referred to CHO/MO (PHC/ UPHC)}. If these questions are answered then the mental health situation of the pregnant women can be detected early and accordingly counselling/treatment can be started.

Dixit said that as of now these questions are not filled as the ASHAs, ANMs, and other medical staff have not been trained and sensitized. Once they are trained then the prevalence of PPD in rural areas can be assessed. Pregnant women and their caregivers can be made aware that the women during pregnancy and post-delivery may face depression during the Pradhan Mantri Surakshit Matritva Abhiyan, which is held on the 9th day of every month. In case of any problem, these women can immediately contact the doctor for necessary treatment. He also suggested that ASHAs make 6-7 visits at the house under home-based newborn care (HBNC) to check the newborn and at this time she can talk to the mother and find out if she is facing any problem or any negative thoughts are going in her mind, accordingly she can be referred to nearby doctor for counselling and treatment.

The state government runs Telemanas, a toll-free helpline number 144166/18008914416 to extend mental health consultation and for emotional support for the people having any mental issues.