So I’m sitting in my office, minding my own business (not really) and I see this tweet:
PostPartum depression non-existent in other cultures. Here’s why!
Oh goodness. There goes Katherine’s mood today.
Postpartum depression is NOT non-existent in other cultures. Sorry. Wrong. And here’s why tweets or headlines like this make me so angry: As @DoNotFaint tweeted on Twitter after seeing it, it’s shaming to state things like that. It makes women who have postpartum depression feel even worse, as though we’re the only spoiled losers on the planet who have figured out how to make new motherhood miserable.
The headline linked to a story on Breastfeeding.com entitled “How Other Cultures Prevent Postpartum Depression” by Kathleen Kendall-Tackett. At first, it appears her story at least from her headline doesn’t say PPD is non-existent elsewhere. Whew. But then I read this: ” In their classic paper, Stern and Kruckman (1983) present an anthropological critique of the literature. They found that in the cultures they studied, postpartum disorders, including the ‘baby blues,’ were virtually non-existent. In contrast, 50% to 85% of new mothers in industrialized nations experience the ‘baby blues,’ and 10% to 20% experience postpartum depression. ”
She goes on to present information on the types of cultures that treat their new mothers with care, using such rituals as bathing, massage and seclusion or confinement.
I’m not aware of data that shows these rituals prevent postpartum depression. The definition of prevent means to keep something from happening. A study published in the August 2009 issue of the Journal of Affective Disorders, for instance, examined 16 different studies and concluded that there is little consistent evidence that the Chinese postpartum custom of confinement or “doing the month” reduces postpartum depression among Chinese mothers.
Every time someone says postpartum depression, or postnatal depression, is non-existent elsewhere, it rankles. I’m not saying those who say are meaning to shame or hurt sufferers, but that it does have that effect. I decided to do a quick, cursory online review today about this “non-existence”, and found the following data on mothers suffering from postpartum depression in countries other than the US, Canada, UK and Australia:
- Prevalence of postpartum depression in a Morroccan sample – between 5 and 11%
- Prevalence and social correlates of postnatal depression in a low income country (Pakistan) – potentially more than 30%
- Prevalence of postpartum depression in Saudi Arabia – 22% in this 2009 study
- Prevalence of postpartum depression in India – 23% in Goa and 16% in rural south India
- Prevalence of postpartum depression in Austria – 21.3% according to a 1997 study
- Prevalence of postpartum anxiety and depressive disorders in Germany – 6% with PPD and 11% with postpartum anxiety in this 2008 study
- Prevalence of postpartum depression in Chile – up to 50% in lower-income women says this 2007 study
- Prevalence of postpartum depression in Brazil – 20% according to this study of women in Southern Brazil from 2008
- Prevalence of postpartum depression in Singapore – 10% according to this study from 2011
- Prevalence of postpartum depression in Nigeria – 27% in one hospital in 2006
- Prevalence of postpartum depression in Turkey – in this study in Eastern Turkey in 2002 it was 22%
- Prevalence of postpartum depression in Ethiopia – 16-19%
- Prevalence of postpartum depression in Finland – 22% in this 2003 story
- Prevalence of postpartum depression in Sudan – 10-15% per this study published in 2011
- Prevalence of postpartum depression in Mongolia – 9% says this study from 2008
- Prevalence of postpartum depression in France – 11%, where they have 16 weeks paid leave
- Prevalence of postpartum depression in China – one study published in 2007 says it is 15% and so did this study from last month (14.2%)
I could keep going. Do I need to keep going?
As stated in this report by the World Health Organization, “About 10-15% of women in industrialized countries, and between 20-40 % of women in developing countries experience depression during pregnancy or after childbirth. Perinatal depression is one of the most prevalent and severe complications of pregnancy and childbirth.”
Now, let me say I fully agree with Tackett’s premise that we treat new mothers in the US like crap. Fully!!!!! As in 100,000%!!!! It’s terrible how little we do to support them and I love how some other cultures revere and protect the new mother. I’m not saying such practices as those listed in the article couldn’t or wouldn’t help.
What I am saying is that I completely disagree with the assertion that postpartum depression doesn’t exist elsewhere. It does. We don’t need to shame mothers with PPD in order to prove that we should do better in this country in terms of how we treat new moms.
Wow, I'm actually surprised by those statistics, which clearly means that I've bought into the myth that our treatment of mothers leads to isolation and depression. Seeing them now, I think they make an important point. Any mother can experience PPD, and it does not mean that she has done anything wrong. It also doesn't mean that the people around her have done anything wrong, which is another group that may feel shamed when faced with that kind of headline.
Thanks for your comment Amber. I think LOTS of people are surprised at how common PPD (and anxiety, and depression or anxiety during pregnancy) is around the globe. It doesn't mean that the way we treat mothers doesn't have an impact. I'm sure it must in some way, and I think we need major change. You have to wonder whether we could reduce the prevalence by changing maternity policies. At the same time, there's so much more that can contribute to a mother getting PPD than just policy.
– K
I haven't read the article, but I do know that the stats don't count the millions of women who suffer and never get help. How can you count those you don't know about? And in countries where women can't just walk around talking about these things, of COURSE their rates are going to be lower…because those women are not being counted.
Also…um…pass those massages and such this way in five weeks, please!
I saw that yesterday and had to scratch my head. And coming from KK-T? I was more than..surprised.
I love when fire comes out of your fingers like this.
😉
Ditto what Diane said – very surprised to see this coming from a well known and respected researcher. I guess that's what gets eyeballs to the page. She could have written the same article without affirming that it's "non-existent". We also need to bear in mind that she quoted ONE article (that would never happen in a peer-reviewed article, but passes online unfortunately) and that article is ALMOST 30 YEARS OLD. So it hardly applies to today's society, whether in the 1st, 2nd, 3rd, or 99th world!
I suspect too that like other things, those stats are low because of unreported cases in other cultures where it is even more stigmatized. It is hard to admit even here where there is some public awareness. I also object to the prevention myth. It may be that we can do more to help but I doubt that we can completely "prevent"? It does happen to people and awareness is what is needed. It is not helpful to imply " failure." but people need to know it is okay to ask for help.
I get dismayed when I see PPD and related issues described as the 'baby blues', which is a delightful way to trivialize a really serious problem.
Ditto!
@Lucy I also find the term "baby blues" trivializing, condescending and just plain insulting. It should be relegated to conversations about (young) Paul Newman's eyes, in my humble opinion.
I'm really lucky and get to see a doctor/psychiatrist who specializes in perinatal mental health; she sees patients and does some really amazing research. But her research, in New York City, through major hospitals and with the help of large research universities, frustrates her to no end because people, pregnant women and new mothers in particular, just can't seem to accurately report their own symptoms. There are good moments, where they're able to talk about what's going on. There are also bad moments, when a participant in a study has agreed to talk to my doctor for her research and then suddenly feels she has nothing to say. That is among women who have already reported perinatal emotional complications. In fact, most of them have been hospitalized.
Is there any greater sign of shame than the inability (or refusal) to talk about the thoughts and moods that have taken over a woman's brain and begun to run her life?!
There's also this problem, as a friend doing research with homeless toddlers as she earns her PsyD pointed out to me: a low-income woman who admits that she is depressed often fears that social services will take her baby away from her. Because admitting to a social worker who sees neglect cases all the time that you don't have the energy to want to feed the baby could trigger an investigation into whether or not you are feeding the baby. My friend's opinion is that "cases" labeled as maternal neglect could often be prevented or resolved with a child going back to the birth mother if she, the mother, received effective treatment for PPD.
As you know, this headline made me extremely angry. I'm going to stop now, before my comment is as long as your blog post, but I'm honored that you used my words and very glad that I could help you put such eloquent words to why, exactly and precisely, this is so very wrong.
This is great information.
These statements that postpartum periods are blissful earth goddess bonding times everywhere but America absolutely shames women by trivializing their postpartum depression. It also puts an unfair burden on their friends and family that somehow it is their fault for not doing enough. I have seen families get very defensive when a woman tries to talk to them about the problems she is experiencing.
I DO think women need extra care postpartum. But there is an epidemic of overly romanticizing birth, nature and our body in America. Nothing about life, death, birth, nature or our bodies is perfect.
Honestly, do you really want to be trapped in a hut with your mother and mother-law nagging at you about everything you do with your baby for a month?
Interesting point on how this might affect friends and family as well!
THANK YOU for this! For me, knowing PPD is perhaps a universal experience (universal in 10-30% of women, that is) highlights the biological/physiological aspects of the condition. I have to slightly disagree with the posters above regarding the "baby blues", though. I see post partum mood as a spectrum, with "happy" at one end and "post partum psychosis" at the other. In between are "baby blues" (sadness/malcontent) and "post partum depression" (a clinical diagnosis following a specific set of criteria). Certainly calling PPD or PPP "baby blues" would be trivializing, but I think suggesting that the post partum blues don't exist also trivializes depression.
Actually baby blues isn't a mental illness. It's not mild PPD. It's just a hormonal adjustment that happens to the majority of mothers in the first couple of weeks after having a baby, and it resolves on its own.
Honestly, I kinda had this feeling that the way motherhood has evolved… Or devolved in this country has proliferated PPD in our society. It seems to me motherhood would be more overwhelming and anxiety producing if you haven't lived alongside other women who are in the thick of it. There is a YouTube video for everything, but feeling connected and supported by a community while you are going through a change like that would have a tremendous impact. I guess I kinda assumed that tribal cultures had less instances of PPD, but based on the information that you have provided I will accept that it isn't true.
Consequently, it makes me feel less like a whiny middle class SAHM with all my 'tragic' first world problems. And I like that, very much!
I wonder what the rates of csections are in these other countries… Not that it's causal but for me it was certainly correlational.
"Consequently, it makes me feel less like a whiny middle class SAHM with all my ‘tragic’ first world problems. And I like that, very much!"
Love that!
Over 10 years ago, when I met Dr. Righart, the swedish researcher ( remeber the crawling newborn ), who told me that postpartum depression is rare in breastfeeding moms. He believed that it had something to do with prolactin levels. However we know now that postpartum depression is related to the levels of oxytocin. In breastfed moms the level of oxytoci in the serum and saliva remains high. Moms who do not breastfeed or do breast-milk feeding have lower oxytocin levels and are at high risk for developing post-partum depression. In our office we screen moms for post-partum depression. Look up the article by Grewen et al in Psychophysiology 2010;47, 625-632.
Eh. I breastfed for 20 months, my daughter never had formula, and I certainly had PPD. Probably more important are risk factors like: personal/family history of depression, PMS, difficulty with major life transitions in the past, etc. Breastfeeding's great, but certainly no cure-all.
I'm with Amy on this one. I EBF (ed) and I developed PPD. All of these other things need to be taken into account.
Touraj's comment seems a little too facile to me, too. I was blindsided when PPD hit me, and I exclusively breastfed both my babies for over 6 months. Thankfully, it passed without medication.
It's interesting to note that the medical research (as opposed to the anecdotal evidence) is still indeterminate on this subject. For example, a recent study identified mothers who were attempting early breastfeeding but were experiencing difficulties or pain. They were followed for several weeks to see if their rate of PPD was higher than successful breastfeeding mothers. It turns out their PPD rate was in fact higher, but this begs another question: Why? Touraj would say that it's because they weren't getting as much oxytocin. But it's also possible that they were feeling shamed by their "failure" to breastfeed in a culture that has come to treat BFing not just as an earned badge of womanhood, but as the most loving act a woman can perform for her children. I know many women who have felt crushing guilt – years afterwards – over giving up their attempts to breastfeed, even when it was clearly destroying their health and sanity. Which is cause and which is effect?
I just love the smart and interesting conversation you are all having here. Thank you for being my readers.
How do C- sections correlate with the biochemical factors Touraj? Even when Moms having C-sections breastfeed I mean.
The other danger is in marginalizing any of those who do not fit the profile and we statistically "should not" have PPD. It doesn't help them, when they DO have it.
So I'm wondering- if a strong support network doesn't *PREVENT* PPD, does it decrease the severity and/or length of PPD?
I won't pretend to know the answer to this, but it makes perfect sense to me that a strong support network would help *treat* PPD (making it feel less extreme). Therapists have always pushed for me to do things like connect with a support network–kind of like this one!–and practice self-care, as well as mindfulness. These are three things that have, I'm told by my doctors, been extensively studied and proven to work well. If a culture of postpartum care includes a focus on a new mom, it's going to include these things that are actively therapeutic
The support I got from my mom (I'm Chinese, so I did the one-month confinement where my mom lived with us and cooked for us) was very helpful. I think it definitely helped to alleviate some of the initial depression and anxiety. However, after she left, things got a lot worse.
The thing about PPD is that it doesn't always hit just in the month(s) immediately following birth. So even providing a ton of support in the beginning will not necessarily be right when the mom needs it most.
So I definitely think we need to do a better job of providing support to new moms in the U.S., and better support would definitely help, but it won't prevent PPD altogether.
I think you're spot on, Katherine. This doesn't frame it right at all, and after all the time women spend wondering why – why did I get it? Why me and not my friend? Why?! – this type of argument totally trivializes some of the real reasons and it suggests that something we do – or don't do – could change the outcome. I don't think so. You could have put me in a spa with massage and lots of rest and people to help me and baby and I still think I would have gone off the cliff at some point when I had to do it on my own.
Interesting statistics, though. Some of those countries are really high, and I do wonder if it's because of women's roles and the stigma associated with admitting something's wrong.
Also, 2 comments from my mom. Don't you love that she gets fired up about this? 😉
Dear Robin and Katherine, It made me angry, that's why! Grrrrr! I know absolutely that you tried your best with all you had and it didn't unseat the monster. And that you can't let your mother or your aunts or your friends raise your children. You have to do it yourself in the end. I don't think we know nearly enough about the biochemistry of it, the relationship to what happens when you have a vaginal birth as opposed to a c-section and what sleep deprivation does (among other things). Bound to vary significantly from person to person. It infuriates me that easy sounding answers are raised like suggesting that just breast feeding or just social customs can totally prevent or even that total prevention is possible. It may be some things alleviate but let's choose our words carefully. I spent the last 3 months of 2011 listening to people who felt marginalized because of PPD and indeed other forms of depression. People are asking me when I am going to do "your blue hair thing" again; it may be a lifetime project. Pat answers indicate an intolerable intolerance. Now I am going to have a calming cup of chamomile tea. And Emily, PPD is tragic. Don't ever feel silly about something so serious.
Love that Robin. Same with me. You could have given me massages and surrounded me with aromatherapy and essential oils and held my hand and told me I'd be okay (which many people did) and I still would have been sick. Maybe less sick, I don't know. But in my case I really needed professional help.
– K
Thanks for taking this on! I really dislike the assumption that depression and postpartum issues are only the bane of an indulgent existence
I don't think you can understand Postpartum Depression if you haven't experienced it personally. When I had my first child in 2005 I didn't know what it was and I don't think anyone else did either. I was frankly a basket case most of the time. I had my second child not quite 2 years later in 2007 and it was worse. I literally imagined tossing the baby over the railing in my second story apartment. It was HORRIBLE. I kept thinking how can I think this about my own child. From what I'd researched it seemed that this depression tended to get worse with every pregnancy. So I was very afraid of how bad it would be when I found out I was expecting my 3rd child. My baby is 3 months old now, and I've made it a point to be brutally honest with my family and friends so they can help me take care of my needs so I don't have a meltdown. We have an agreement that if I feel like I'm going to drown us all in the river, they'll babysit my kids NO QUESTIONS NO JUDGMENT!
Because societies modernize in tandem, it would be more accurate to compare past cultures with current cultures. Just like metabolic disorders, cardiovascular diseases, obesity, autoimmune disorders, mental disorders, et al, were extremely rare (or non-existent) in primitive cultures a century ago, my guess is that the same applies to postpartum depression.
As for the comments to the effect of “you don’t know” or “I’ve experienced it myself” and so on, those come off as peculiarly defensive and insecure; not to mention they are nothing more than subjective personal anecdotes. To experience something is not akin to have expertise. In fact, it can tarnish any objective and balanced views you may have had otherwise.
Thought I’d share the latest on depression around the world … http://www.washingtonpost.com/blogs/worldviews/wp/2013/11/07/a-stunning-map-of-depression-rates-around-the-world/
Katherine – I’m doing research in my university library, studies on the prevalence of PND in multiple cultures across the globe. Google brought your article up as I poked around the web. I truly enjoyed your take on this; there aren’t many articles about this on the web and also not alot of research….thanks for your insight in to this..Kathy
You’re welcome Kathy!
There are several problems with the critique presented in this post, the first and most troublesome being the fundamental flaw of comparing the statistics of a country, to those of a culture – two very different yet not unrelated things. Whilst countries influence the cultures within them to varying degrees and I am sure there could be the possibility of a country have one all encompassing homogeneous culture, I would hypothesise that 99% of the worlds countries are home to many many cultures, be they strikingly different or almost undetectably similar.
The statistics you provide while interesting, do not actually reference a single cultural group (unless you count socio-economic status as a culture) nor do they specify whether the population of the studies either self identified as being a member of a particular culture (or “countryman”/nationality) as opposed to ex-pat for example. More importantly the statistics you listed do not identify whether or not the cultural group actually used/experienced any or all of the post birth depression prevention practices outlined in the post by Kathleen Kendall-Tackett.
Of course while there are many other issues to address; not only with the accuracy of this post (such as your use of both 1st and 3rd world countries’ collected postpartum depression rates even though this post is clearly opened by highlighting its focus specifically on “third world wisdom not to be ignored by industrialised nations”); but also an acknowledgement of the ongoing effects of globalisation/industrialisation on all facets of our highly technological modern and rapidly tradition-forsaking lives; they are both far too numerous and complex to list here (this is truly a thesis worthy subject matter). We must all remember it is also a flaw to look at cultural practices in a vacuum. They do not even work this way within the groups they were extracted from. The reality is that cultural practices and traditions fit within a holistic, interconnected, correlated and continuous framework.
I will conclude by (re)stating that, beyond your personal disagreements with the assertion that postpartum depression is practically non existent in certain cultures where the detailed practices are traditionally utilised and moreover the disturbing claim that this information shames mothers suffering from PPD, the statistical data and information you have provided in this blog post does not actually “disprove” the claims made in the cited article or the researchers’ and Kathleen Kendall-Tackett’s conclusions.
And I will conclude by saying that stating that PPD is virtually “non-existent in other cultures” is silly and wrong. And it absolutely does impact moms and how they feel about what they’re going through. I know this from the thousands and thousands of mothers I’ve spoken with over the last decade. I’m sorry you find that disturbing, but it doesn’t make it untrue.
My dear husband and I currently expecting our first baby, due in 3 weeks, hence I am currently finishing Kathleen Kendall-Tackett’s book on breastfeeding, (the one from which you took the quote on postpartum depression) so read I the passage. I don’t think Kathleen Kendall Tackett meant to shame mothers in any way, shape or form. I’m not being an internet troll, but my opinion is that you jumped the gun and were overly defensive and so took her comment completely out of context. In reading her book, it’s obvious that what she meant was, that in the USA women have far less cultural and family support to help them, postpartum, transition into motherhood. She is correct in THAT, being that American families are often living far apart or are separated or alienated or simply not as family oriented, in the old-fashioned sense, as they were in times past (and still are in many foreign countries) (did I mention I lived abroad for seven years, and have seen how family oriented many other cultures are? It’s astounding, how close they are in many places. ALSO… guess which country has NO LAWS to provide women with paid Maternity Leave postpartum? You got it! The USA! In the USA only 4 states provide Maternity Leave, I happen to be fortunate to work in one of those few states that DOES provide paid leave, (if you worked for a year for a company with over 50 employees). I feel TOTAL compassion for all the women who work in states that offer them NOTHING. They hand out welfare and disability but drop the ball on brand new, exhausted and aching new moms and newborn babes who need their moms. Some women must return to work in two weeks (UNPAID weeks or using vacation time, and even if they had a C-section… So, yeah, for moms forced back to work without ample time to REST and BOND with their baby or get baby settled into a feeding and sleep pattern, why wouldn’t the fatigue and stress contribute to greater incidence of baby blues or depression? I don’t know if she’s right or wrong, but she’s championing SUPPORT and care for new mothers, and saying if they had more support like in other countries they may be less likely to fall into depression, if anything she is LESSENING the blame and shame on new moms by saying, “American new mothers aren’t getting the support they need” and it is TRUE that MOST foreign countries provide many many months of paid leave (France is 5 months, many others offer far more, even up to a year, some offer full pay, some partial) for all new mothers. Plus many countries have closer family structures to boot, so I have to disagree with your article and your criticism of the author, Ms. Kendall Tackett, who clearly NEVER implied that American women are spoiled and rich so they get post-partum depression more than foreign women. Perhaps you didn’t read the book, and that would explain why you took it out of context. But she says that in other countries women receive more support post partum so they don’t get it as often. Which makes sense to me.
I like what you said about being brutally honestly, and asking those who can support you for help in the moment you most need it. I find self love and care does wonders for me!