CHENNAI: Tenty-seven-year-old Uma had been complaining about experiencing pain while breastfeeding ever since she gave birth to her son a month and a half ago. However, no one in her family took her complaints seriously. It is alleged that she finally threw her son into the Velachery lake in the wee hours of last Saturday. Police suspect that mounting depression may have pushed her to this act.
Uma and Venkanna (30), had migrated to Chennai from Andhra Pradesh five years ago in search of a job. Venkanna found employment at a supermarket, while Uma started working at a clothing store. A senior police officer who conducted inquiries with Uma and members of the family said the couple got married two years ago. “Recently, she had a baby and after a few days began complaining of pain while feeding the child. She even told her husband to give the baby to her mother to look after but he refused and told her to ‘adjust’. Later, the woman’s sister and mother moved to their house to talk to her about feeding the child, but failed,” said the police officer.
“At one point, a fight blew up and the husband accused the wife of being more concerned about her health and of neglecting the child. This added to the mounting depression which probably forced the woman to kill the child,” added the officer.
While it is not known if Uma suffered from what is known as postpartum depression (PPD) and if that played a role in her alleged crime, PPD is a serious condition about which there is little awareness and which can cause new mothers to feel anger, frustration and great sadness which they could express either through an inability to care for the child or even, sometimes, violence towards the child.
Unfortunately, mental health experts say there is an acute lack of awareness about postpartum depression, which limits access to care and support that a woman with PPD needs.
PPD is a complex mix of physical, emotional and behavioural changes which occur after a woman gives birth. Mothers affected by postpartum depression can show impairments in cognitive performance, behaviour disturbance and attachment insecurity. Women may even commit suicide due to PPD. While doctors mainly attribute PPD to a hormonal imbalance in the body after childbirth, some of the other triggers of PPD can be painful or complicated pregnancies, stress, tension with the husband or in-laws, financial difficulties and other health issues. Still, most women do show signs of depression, but families, due to lack of awareness, fail to notice or understand what they are undergoing.
In fact, even women with PPD can have difficulty identifying the illness. Lawyer Amba Salelkar of the Equals Centre for Promotion of Social Justice in Chennai recounted her experiences with PPD. “After the baby was born, the inability to sleep and other factors, including hormonal changes, aggravated my temper issues. I could feel there were new symptoms and I was initially blind-sided. It was much latter that I realised I had PPD. Often, PPD can be mistaken as baby blues,” she explained.
“When we stress on the importance of breastfeeding and such, we should also stress that if a woman says she is unable to breastfeed, she is supported and allowed to use formula milk in the best interests of the mother and child. Doctors should create an atmosphere for women to open up on such issues, even if women do not approach them specifically to discuss these issues. Pediatricians should be roped in to help identify when a woman is going through PPD and intervene as new mothers will definitely meet pediatricians,” she added.
Dr R Mangala of SCARF (Schizophrenia Research Foundation) in Chennai noted that while awareness of PPD was indeed low, the number of such cases seemed fewer compared to some other countries, perhaps due to the presence of family support for new mothers in India.
“When a woman has her first child, there is usually family support to help look after the mother and the child, even if they experience some kind of depression. However, there is often less support during subsequent pregnancies which may cause the signs of PPD to be more pronounced,” she said. Further, women do not approach doctors regarding PPD, the doctor said. It is the family that mostly brought women for treatment, that too when they noticed changes in behaviour that were unacceptable, Dr Mangala pointed out.
In one case, a new mother in Chennai, had attempted suicide and tried to kill her mother after developing ‘delusional guilt’. “This is when the family brought her for treatment. We found she was already being treated for depression when she got pregnant. Also, she had previously undergone a medical termination of pregnancy (abortion). With the family’s support she was treated with medication,” she said.
Given the stigma attached to seeking mental health case, there is a long way to go in raising awareness about PPD , especially in rural areas, doctors said. More so, because of the cultural importance, we give to the mother-child relationship, which is often idealised. This makes it harder for women, bound by social constraints, to express their feeling in India. As they suffer in silence, without help, many try to harm themselves.
A city-based gynecologist described the symptoms that family could notice as such: the mother might become dull, not feed the baby, not take care of the child, stop eating, throw tantrums, become abusive, anxious, fearful or tense for trivial reasons. Even if a slight change is noticed, they should be taken to a psychiatrist immediately. Doctors also noted that the depression a new mother may experience rarely becomes suddenly extreme. Rather, like in the case of any physical illness, the depression builds up over time.
Doctors urge families to be alert to even slight changes in behavior. Of late, doctors have started discussing PPD with pregnant women so they can seek timely help if required. If this becomes the norm among all doctors, awareness may ensure more women are able to access help.
If you are in distress or feel suicidal, call the Tamil Nadu government health helpline at 104 or the Sneha Suicide helpline at 044-24640050.
Need to seek help
It is important to intervene before the depression worsens
- Persistent sadness, anxiousness or “empty” mood
- Severe mood swings
- Feelings of frustration, irritability, hopelessness
- Feelings of guilt, shame, worthlessness
- Trouble bonding with the baby
- Feeling inadequate in
- taking care of the baby
- Changes in appetite
- Poor self-care
- Social withdrawal
- Insomnia or excessive sleep
- Fear that you cannot care for the baby or fear of the baby
- Worry about harming self, baby, or partner
Onset and duration
Usually begins between two weeks to a month after delivery. A study done at an inner-city mental health clinic has shown that 50% of postpartum depressive episodes there began prior to delivery. PPD may last several months or even a year. Postpartum depression can also occur in women who have suffered a miscarriage
18.6 per cent of mothers affected by PPD in low- and lower-middle-income countries, according to a WHO study in 2017. The study says mothers in developing countries are more succeptible to the disorder
15.3 per cent, around one in 10 women get depressed immediately after giving birth, according to most suveys, but the numbers in India ranges between 15.3 per cent and 23 per cent, estimates the National Mental Health