A lack of awareness about postnatal depression in Sierra Leone has led to women’s stigmatisation and mistreatment. Not least because the effects on the family are intergenerational, says Abdulai Jawo Bah, the government should finally treat it as a public health concern.
This post is part of Njala Writes, a blog series resulting from a writing workshop hosted at Njala University, Sierra Leone in June 2019, in collaboration with the LSE Firoz Lalji Centre for Africa.
Parents of newborn babies in Sierra Leone often have a lot of questions. Was this the right time to get pregnant? What have I gotten myself into? How can I take care of my baby?
For the vast majority of mothers in the country, these questions are considered part of the ‘baby blues’ – a mild sadness, crying, or anxiety which usually wears off a week or two after delivery. But for up to 19.6 per cent of new mothers in low and middle-income countries, these emotions spiral into postpartum depression, a persistent and serious condition characterised by feelings of sadness, worthlessness, low self-esteem, poor concentration and severe anxiety. In severe cases, mothers have infanticide or suicidal thoughts.
Why postpartum depression matters
One of the midwives in a Community Health Centre in the Kono district shared with me her experience with postpartum depression (a district 212 miles from Sierra Leone’s capital city, Freetown, a densely populated, multi-cultural diamond mining community with a population of 505,767). She offered to share her story to empower women to seek help for postpartum depression symptoms and for the government to design for these women psychosocial interventions. Here is her story in her own words:
Mental health is quite different and people don’t report to the hospital like in the case of malaria, it’s something which you can detect for example when you see mothers beating their kids or pushing them.
Postpartum depression (PD) is the most common form of perinatal mental illness, which is commonly referred to as ‘pwel heart’ in the local lingua franca (creole). During our training in midwifery, our curriculum just briefly mentioned it, but it was not covered it in depth as a module.
The most common causes of PD in my practice are unwanted pregnancies among teenagers, as well as a women suffering from early menopause, who experience erratic menstruations and unexpectedly become pregnant.
Teenagers are often stigmatised by adult pregnant women for attending clinics and being pregnant at such a tender age. I addressed this issue by separating their days for antenatal visits. Sometimes these teenagers had been raped by family members, drivers or securities, but they are often blamed and the perpetrators go unpunished.
Sometimes partners prevent their wives from adopting family planning measures but, when they become pregnant, they blame their partners for it. These women often go unsupported.
Here’s the story of Fatu:
I came one time and a baby was crying incessantly, I asked if her mom was around and my colleagues answered in the affirmative. I went downstairs, entered the ward and saw the woman lying down faced to the wall and the baby still crying. I called the mom twice and asked if she’s not hearing the cry of the baby, before she could finally raise her head, look at me and lay her head back. I asked my colleague what’s the problem with her, she told me since she gave birth to the baby she had not breastfed her, completely detached herself from the baby and not talked to anyone.
I walked towards the mom and called her twice before she could raise her head and when I asked her what’s going on she started crying and told me she’s not interested in the baby. I asked her if she could offer me the baby, she laughed without any response. When I asked if she’s eaten and the response was no. I got her some food and carried the baby in my arms.
I initiated a conversation by asking her what the problem was. She replied that her partner denied being the father to the unborn baby and her parents expelled her from their house and told her not to take the baby home.
I asked for her mom’s telephone number and if I could call her. Initially she objected, but later agreed and gave me the number. I called the mom, who came and explained to me she has invested tremendously in educating her and becoming pregnant was completely unacceptable. I consoled the mom and explained to her the implications of abandoning them and she finally accepted to take them. Later, I educated her on postnatal care as she started breastfeeding the baby for the first time.
Postpartum depression affects a large number of women in Sierra Leone, who suffer in silence. Due to a lack of knowledge of the condition and stigma for women suffering, people don’t talk about the issue.
The case of Fatu above is just one of many. Postpartum depression is caused by a wide range of factors, such as a lack of partner support, obstetrics complications and unwanted pregnancies. People often fail to recognise PD as a medical condition and, for those who do recognise it, they decide not to seek help because of the attached stigma, denial or a lack of understanding. This must be considered a public health issue and urgently addressed due to its negative effects on the mother, baby and the family. The problem becomes intergenerational.
Photo: Direct Relief, Flickr