Part One of a two-part Q&A
Ever since I experienced a childbirth complication, after delivering my daughter in 2003, I have been a global maternal health advocate. The focus of No Woman, No Cry, the documentary film I made in 2010 and Every Mother Counts, the organization I founded that same year have both been on maternal mortality reduction, but as a women and health advocate I am concerned with every aspect of maternal health and well-being.
It's essentially our reproductive systems that differentiate us from the opposite sex. That's what makes us unique and powerful, but also vulnerable to a number of potential dangers. On the list of health risks women are subjected to, mental health seldom reaches the top. And while there are a lot of stigmas around many diseases, there may not be a close rival to the stigma those with diseases of the mind face each day. Mental illness pushes those who are already marginalized in developed and developing societies, even further into the margins.
When I began to travel across the U.S. with No Woman, No Cry, I was asked many thought-provoking questions about what I saw and was able to capture on film. One question that comes up consistently is about perinatal mood disorders, and more specifically about postpartum depression (PPD). Did Janet, Lightness, Monica or Orfa suffer from postpartum depression? My answer is, I honestly don't know. Clinically that is. I knew enough about the lives of each of these women, however, after spending several days documenting the final days of their pregnancies, their harrowing labors and deliveries, to suspect they all suffered from some degree of difficulties related to postpartum mood disorders.
I met Dr. Jessica Zucker in the spring of 2011. She's a clinical psychologist whose practice specializes in maternal mental health in Los Angeles. Dr. Zucker has a background in international public health and is passionate about reproductive issues facing women globally. In her practice she weaves together her global health experience with her clinical skills as she assesses and treats perinatal mood disorders and other mental health challenges women face during the process of pregnancy and beyond. Jessica writes and lectures extensively on these issues. She has worked in developing countries (i.e. Africa, Nepal, India) and so I asked her about PPD in those regions where she worked.
CTB: Jessica, while there has been some progress around the de-stigmatization of PPD here in the U.S. it seems to not even be on the radar in many developing countries I have visited. It can't be that we think it doesn't exist, but why are we not addressing maternal mental health like the pandemic it clearly is?
Dr. Jessica Zucker: Perinatal mood disorders have been named the most common complication associated with childbirth. Postpartum depression is indeed a public health crisis. What we know is that in the United States, 15 percent to 20 percent of new mothers, or approximately 1 million women each year, experience perinatal mood and anxiety disorders. What we don't know is how widespread postpartum depression is in the developing world.
Unfortunately, data has not been collected in any consistent way on maternal mental health related issues in developing countries. After doing extensive research and talking with colleagues in the public health arena as well as within the psychology community, my hunch is that mental health issues are not addressed given the various other challenges being juggled that are more immediate -- basic needs such as food, shelter, and maternal and infant mortality. When basic survival is threatened, psychological processes are not a priority.
My longtime concern, however, is that we have not widened the global health conversation to include the mental wellbeing of the mother and her offspring. If a mother isn't thriving psychologically, her baby experiences the ramifications. Consequently, the child may not have the opportunity to form a solid foundation of relational attachment, trust, or emotional connectivity. The mental health of the mother invariably impacts the family, the community, and culture at large.
Clearly the indicators for and the assessment of postpartum depression may vary across the globe taking into account other public health dilemmas that take place in various countries as well as culturally determined rituals. It is safe to assume that women worldwide are experiencing postpartum mental health challenges. The need to fortify women in every culture is an obvious benefit to the family and future generations globally. Given the glaring U.S. statistic, it seems imperative that this public health crisis be addressed systematically across the world.
Read part two of this two-part Q&A between Christy Turlington Burns and Dr. Jessica Zucker about motherhood and mental health around the world.