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Perinatal Mental Health in India ~Women Deserve Better



I was asked to give a talk about postnatal depression to a group of professional counselors who volunteer for a pregnancy helpline. The helpline is the first of its' kind here in India, and offers a valuable resource for girls, women and mothers by providing accurate information and support from conception and pregnancy through childbirth. Now, whenever I am asked to do something important like give a talk about a subject like this, I know it is as much for me as it is for others; probably more so! This research has opened my eyes not only to the sad plight of women and girls here in India, but also to the beliefs, cultural practices and in turn, systems that silently fund the continuation of abuse, violence and profound lack of reverence for women and for life. Not only did I find this research confronting, but deeply personal. I am a woman and like billions of others I know rape, I know abortion and I know what it has been to live with the mental, emotional and spiritual ramifications of this kind of abuse. It is real, the impact is not isolated to the dark corner's of one's memory, but touches every aspect of our lives, our families', our societies, and our future generations.


Rape and violent acts against women in India occur at a rate of 3 per hour; that is over 72 women being raped every day. Can you believe that 26,280 women per year (reported cases) are being sexually violated and the consequences of these violent attacks fall on the girls and women who are left bereft of compassionate support, care and solutions. To add to this, 15.6 million girls and women are aborting their pregnancies, that's an abortion taking place every 2.5 seconds. Abortion in India is the third leading cause of maternal mortality because 67% of these abortions are occurring in unsafe conditions and as a result eight women die every day because of it.


Getting pregnant outside of marriage here is profoundly shameful, even when the conception is the result of violence, rape, or incest. Regardless of how the baby arrived in her womb, she is often seen as a disgrace to her family and her community. She may be cast out, beaten, and often has no choice but to abort the pregnancy in a back ally. The shame lives on in her, and casts a dark shadow over her mental and emotional life. There are no words, but many secrets.


The stigma and shame around mental health disorders is palpable, but at least in developed countries where significant funding has been given to raising awareness and education, more and more people are disclosing their experiences and getting the support they need. However, here in India, as in other developing countries, there is very little awareness, education or resources. The stigma surrounding mental health is debilitating to the point of nervous system shut down. For women, particularly those living in poverty, with a lack of education and support, she suffers in silence. I was shocked to learn that in one study as many as 38% of the women experienced significant mental health disease throughout the perinatal continuum. In a systematic review of postpartum depression the overall incidence was 22%. However, since data collection systems that track perinatal mental health are greatly lacking, these numbers are conservative at best.


During my research I was surprised to learn that the very first screening project for perinatal mental health disorders is about to be launched this year in the state of Karnataka. There is one other state where this pilot study will be conducted farther to the north. Women who attend antenatal appointments will be asked two questions:


Have you suffered from or were treated for mental health issues in the past?

Of late, have you been experiencing stress, anxiety, fear, or sadness?


If a woman answers yes to either or both questions the practitioner is to ensure the woman is counseled and given help to seek appropriate treatment. It's a start! I recommend you cut and paste this link into your browser and watch this short five-minute film. You will hear from the women themselves.


Change happens slowly, but it does happen. It has to begin somewhere, and that somewhere is always right here. I see the women, the girls, the children and the babies. I can't separate myself from them. They may be conditioned by a culture different to my own, but we all have the same heart, the same blood. We love, we cry, we devote ourselves to life. We live here alongside each other, together on this sacred earth we call home. We live in different countries with different boundaries, but the boundaries are imagined. The boundaries that separate us are convenient at best as they serve to protect our hearts from feeling others' pain. But, when the heart breaks, and it does, the boundaries break too. There is no turning back, no turning a blind eye anymore because it becomes all too apparent that the suffering and pain of others, is ours to bare. When we realize that the violent acts in the world, from rape to female genocide are seeded in the womb and passed down from generation to generation, how then can we cast blame, turn a blind eye and walk the other way. This is not just their problem, it isn't just India's problem, it is also ours.




I feel a fire in my belly, a rage, a fierce NO rising and a desire to be a voice for them, for me, for all the future babies, little girls, our daughters, the young women, mothers and grandmothers. A voice for those who have not yet found theirs. Once, I didn't have a voice, but I do now; a really loud one!!! Women here, women everywhere, need sisters and brothers to stand alongside them, to say NO MORE and to show them by example what it is to matter in a world that treats life so casually.


As the world health organization aptly states, there truly can be no health without mental health and when a mother is in a state of well-being she is aware, she realizes her abilities, and is able to cope with the normal stresses of her life. She can work productively and be a valuable contribution to her family, community and world. We need well women, because without them, there will be no end to violence and no peace for future generations to come.


May all souls feel welcomed

May all babies be received in love

May all children feel protected and supported

May all women embody dignity and self-respect



References

Baylin, J. (2013). The New Science of Trust and Mistrust. The Neuropsychotherapist 3, 68-79


Centre for Perinatal Excellence (COPE). Mental Health in the Perinatal Period: Australian Clinical Practice Guideline (October 2017). Retrieved from: www.cope.org.au


Essential Skills to Support Perinatal Mental Health: Six Approaches for your Practice Toolbox. PANDA online course. https://panda.litmos.com.au/course/1030689/module/1183972/Scorm?LPId=0


G Fellmeth, M T Kishore, A Verma, G Desai, O Bharti, P Kanwar, S Singh, H Thippeswamy, P S Chandra, J J Kurinczuk, M Nair, F Alderdice, Perinatal mental health in India: protocol for a validation and cohort study, Journal of Public Health, Volume 43, Issue Supplement_2, October 2021, Pages ii35–ii42, https://doi.org/10.1093/pubmed/fdab162


Nikhat N, Saira M, Athar AM, & Ali A. Maternal mental health and its determinants – A community-based cross-sectional study in Aligarh, Uttar Pradesh. 2021. Vol:65 (1) pp. 16-21 Retrieved on March 3rd, 2023 from:https://www.ijph.in/article.asp?issn=0019-557X;year=2021;volume=65;issue=1;spage=16;epage=21;aulast=Naaz;type=0


Seng, J & Taylor, J (2015). Trauma informed care in the perinatal period. Edinburgh, UK: Dunedin Academic Press. Chapters 1-5


Upadhyay RP, Chowdhury R, Aslyeh Salehi, Sarkar K, Singh SK, Sinha B, Pawar A, Rajalakshmi AK, Kumar A. Postpartum depression in India: a systematic review and meta-analysis. Bull World Health Organ. 2017 Oct 1;95(10):706-717C. doi: 10.2471/BLT.17.192237. Epub 2017 Sep 5. PMID: 29147043; PMCID: PMC5689195






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