Women in
Myanmar enduring the misery of postpartum depression can expect to suffer in
silence and one reason is a paucity of health professionals with knowledge of
the illness.
THE BIRTH
of a baby is typically a time of celebration, joy and good fortune. Yet there
are those who find themselves with a far different experience – one of
crippling depression, physical exhaustion and even thoughts of suicide. The
cause is an easily detectable yet widely undiagnosed culprit: postpartum
depression.
Also
called postnatal depression or postpartum blues, postpartum depression is a
form of clinical depression that can affect both sexes after childbirth, though
it most commonly diagnosed in women.
The symptoms include anxiety, low energy,
extreme sadness and sleep deprivation.
The exact
cause of PPD is unknown, but hypothesised potential causes include genetic
predisposition and hormonal changes resulting from pregnancy. External factors
such as birth-related trauma, major life events or changes, low social support
and socioeconomic status have also been suggested as being likely to increase
the risk.
"Many of us don’t know what it is and
because of that we suffer in silence."
“[In
Myanmar] training on postpartum depression and any other forms of mental health
disorders is poor to non-existent,” said Ms Gracia Fellmeth, a researcher at
Oxford University who has studied PPD in Myanmar. “General healthcare staff,
such as medics, nurses and midwives, normally receive very little teaching on
this subject.”
Fellmeth’s
statement isn’t unfounded. Staff at Yangon Central Women’s Hospital said they
were not aware of PPD treatment being provided there. Mr Daniel Crapper, the
deputy country director of Population Services International, a US-based
non-government organisation that has provided reproductive health and other
programs in Myanmar since 1995, said the organisation has “no specific
information or knowledge” about PPD in Myanmar.
The 2006
World Health Organization Assessment Instrument for Mental Health Systems
(WHO-AIMS) found that there were 265 people working in mental health facilities
or private practice in Myanmar, a rate of 0.477 for every 100,000 people, with
no mention of maternal-specific resources – a statistic that further highlights
the lack of mental health care in the country.
“This
topic is something that is neglected and ignored in society,” said Daw Htar
Htar, the founder and director of Akhaya Women, an organisation that engages
and educates women about emotional, social and sexual health issues.
“Many of
us don’t know what it is and because of that we suffer in silence,” she said.
Htar Htar
said common birthing practices and procedures typically remove power from the
mother. They are often a source of increased anxiety and stress, both of which
are considered possible triggers of PPD in women.
“Women in
Myanmar are often cut when they are giving birth,” she said, referring to the
procedure known as an episiotomy that makes birth easier and prevents severe
tears. “Even when they don’t want to be, they are given no choice and it can be
traumatising.”
Some
post-natal rituals and traditional beliefs, such as isolating the mother for
long periods, can also create added stress on postpartum mothers, she said.
“Women
are often considered the lowest in their life after they give birth. People
consider them dirty and untouchable,” Htar Htar said. “In some parts of Myanmar
women are subjected to practices such as being wrapped with a mat and
instructed to stand over boiling water, so that they are ‘purified’, causing
them to pass out. These things are hard on women.”
The side
effects of PPD can also have social and economic ramifications that linger long
past the depression itself.
There can
be negative financial effects because many employers are “unwilling to employ
women with mental disorders due to a lack of knowledge and understanding of the
conditions”, said Fellmeth. “Women who previously were financially independent
or able to contribute to household finances may therefore no longer be able to
do so.”
Fellmeth
said evidence was emerging that showed perinatal depression – associated with
the period immediately before and after birth – could also affect the newborn
child.
“There is
a growing body of evidence that shows perinatal depression has lasting physical,
cognitive, social and emotional effects on children,” she said. “Mothers with
depression are less likely to form a strong bond with their infants and less
likely to breastfeed. Infants of depressed mothers are more likely to have low
birth weight and experience stunting, malnutrition and diarrheal infections in
childhood.”
However,
there have been some positive developments. NGOs and research projects, such as
the one in which Fellmeth is involved, are taking steps to gain a better
understanding of methods for diagnosing and treating PPD in Myanmar.
“We found
that if women were not depressed, they didn't mind being asked these questions:
If they were depressed, they were pleased to have an opportunity to talk,” said
Fellmeth. “For many women it was the very first time they had ever had the
opportunity to talk about how they feel and they were thankful for the
opportunity.”
Screening
tools for PPD, such as questionnaires, have been translated into Myanmar and
have proven effective in early detection of the disease. A class of drugs known
as selective serotonin reuptake inhibitors that provide relief from the
symptoms of PPD are becoming increasingly available at health centres and
hospitals.
Htar Htar
said the number of doctors with training in PPD was slowly increasing, but they
were more likely to be concentrated in big cities such as Yangon and Mandalay.
She said
many cultural changes were needed in order to address women’s health issues
more comprehensively.
“Until
women are seen and included as equal to men, there will always be unfair
practices in this country,” she said. “There is still much to be done.”
Victoria
Milko
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