The perinatal period, which spans from pregnancy through to the first year after childbirth, can be a particularly challenging time for many women. After giving birth, around 80% of new mothers experience what is commonly known as the ‘baby blues’. This typically occurs within the first two weeks following birth and is characterised by emotional ups and downs, tearfulness, irritability, and heightened sensitivity. These feelings are often explained by the hormonal and chemical changes in the body after childbirth, plus the life adjustments and new routine a new parent has to get used to.
However, for approximately 27% of mothers, these feelings can often persist and become more severe, evolving into more serious mental health challenges such as anxiety and postpartum depression. If left untreated, these conditions can have a long-term lasting impact on the mother’s well-being, her relationship with the baby, and the wider family.
My undergraduate placement year in perinatal psychiatry has allowed me to gain first-hand insight into the struggles many women endure, and how they often remain silent about the challenges they face due to feelings such as embarrassment and guilt. As someone from an Indian background, this experience has highlighted the challenges faced by South Asian women during the perinatal period, where societal misconceptions and cultural differences have limited the understanding of these disorders.
Although perinatal mental health issues are a universal experience, the stigma around them in South Asian communities is particularly pronounced due to conditions not being recognised as medical disorders. This has created a cultural barrier for women to seek and access help.
Studies show a notably higher prevalence in south Asian countries, such as India, Pakistan and Bangladesh, ranging from 10 percent to 39 percent, compared to 7-15% in high-income countries. Furthermore, South Asian Women in the UK are more susceptible to developing postnatal psychiatric illness compared to their White counterparts, emphasising the need for increased awareness and culturally sensitive support in addressing perinatal mental health issues across diverse communities.
What factors contribute to maternal mental health stigma in South Asian communities?
Maternal mental health is rarely discussed in South Asian communities due to the heavy stigma shaped by cultural, social, and systemic factors. As women, we rarely speak about mental health during pregnancy, even though factors such as tiredness, exhaustion, postpartum recovery, and the demands of caring for the family can significantly impact our well-being.
While South Asian cultures emphasise collectivism and family support, traditional gender roles often prevent women from opening up about their mental health struggles due to potential feelings of guilt and shame. Literature has identified key determinants, such as marital problems, conflict with in-laws, lack of social support, and dissatisfaction with the infant’s gender, on the development of postnatal depression in South Asian women in the UK.
Pressures of motherhood
In traditional Indian communities, motherhood is often a central focus in the eyes of the older generation once a woman is married, though this is gradually changing for the better. Women without children may often get asked by their elders when they plan on having children or why they haven’t had any yet, without consideration of other factors that could be affecting these decisions. Challenges such as miscarriage, endometriosis, polycystic ovarian syndrome, and mental health disorders are rarely discussed or understood, yet profoundly affect a woman’s ability to conceive, carry and raise a child.
Family expectations
It’s a common tradition in Indian culture to visit a family’s home once a new baby is welcomed. Most of the time, this is because of excitement and wanting to meet the new baby. However, this can have a detrimental impact on the new mum, as it can often mean she isn’t able to rest and take time to herself or bond with her baby as much as she’d like to.
Societal expectations and cultural norms can also heavily restrict a mother’s freedom and worsen her mental health. Women are often expected to live with their in-laws, assume household responsibilities, and are discouraged from spending time outside the home to visit friends and family for extended periods. This mindset is usually restricted to families where the older generation may be much more traditional and set upon the "old ways" and traditional gender roles.
These restrictions, combined with the societal stigma surrounding mental health issues, can exacerbate feelings of isolation and stress. The pressure to maintain family honour and fulfil traditional roles can prevent women from seeking help, further straining their mental well-being due to the lack of support.
Gender disappointment
Gender disappointment refers to the subjective feeling of emotional distress some parents or the wider family may feel when discovering the gender of a child, particularly in cultures where one gender is favoured over another. In many South Asian communities, there is a preference for sons, as they are seen as heirs to the family wealth and responsible for the care of ageing parents- whereas daughters are viewed as financial burdens due to cultural practices like the dowry system.
Although not all South Asian families hold these views, it is an issue that persists within the mentality of the older generations. This societal preference can heavily impact maternal mental health, especially during the perinatal period.
I am fortunate to come from an Indian family that rejects these outdated views. As the eldest of three daughters, my family celebrated our accomplishments, with my mother and grandfather proudly challenging anyone who suggest we are less valuable because we are not sons.
However, many women may either hold this mindset or experience pressure from their in-laws to birth a son, and are unfairly blamed when they give birth to a daughter - even though science tells us this is not the case. This can elicit feelings of shame and guilt as they may feel they have failed their family, or they may face isolation and emotional abuse from their families, increasing the risk of postpartum depression.
More education and awareness need to be brought into South Asian communities and the challenges women face during the perinatal period so that women can feel comfortable accessing help and discussing how they feel with friends and family without feeling guilty and ashamed.
Yes, motherhood is a beautiful experience, but it comes with challenges and struggles, and we as women should not be made to feel guilty about feeling low or irritable during pregnancy and after childbirth. Although traditionally we have not been educated on the negative feelings we may experience, it is up to us to break down the stigma and continue educating women, so they don’t feel alone.