Postpartum Depression in Saudi Women: Culture and Biology Collide

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Postpartum depression (PPD) is one of most common complications of childbirth. Currently, the prevalence rate of PPD is between 10–15% of mothers who recently delivered. Many women experience some emotional disturbances in the month after giving birth, often typified by crying, anxiety, and irritability. The “baby blues,” a normal, temporary period after childbirth, usually resolving a few weeks after delivery; however emotional disturbance may predict the development of chronic mood disorders that can have a lasting negative impact on the mother and her family.

Its high profile in the United States often overshadows its presence in nations outside the western hemisphere. In fact, compared to its prevalence of 10-20% in developed industrial countries, it is estimated that developing nations hold a prevalence of 20-40%.

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Figure: From Postpartum Depression and Miriam Carey

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Figure: From Postpartum Depression: Information for Rehabilitation Counselors

Saudi Arabia is one of the largest countries in the Middle East in size and population. Its recent economic growth and development has led to improvements in medical care and technology. However, psychological services are still in short supply for most of the population, most of all, pregnant women.

As an OB/GYN resident in Saudi Arabia, I found that most of my patients do not know about PPD and the vast majority of the time, do not seek help, even when having experienced similar problems in previous pregnancies. In addition, those mothers can be very young in age, with low educational levels, simply accepting the status quo. Conversely, a recent study showed that women who work and have children in Saudi Arabia have marginally increased prevalence of PPD. Researchers interpreted these results as stemming from the pressures of financial need: while Saudi Arabia’s economic development is growing fast, social systems to support low income families are non-existent.

The Saudi health system must improve their health policy and increase awareness of the risk and complications of PPD. Given the wide reach that primary health care services have in Saudi Arabia, general physicians must be involved in identifying the risk factors and early signs of PPD to prevent its complications. In addition, OB/GYN physicians must be familiar with PPD and at the very least, know the required methods available to detect PPD during standard postpartum visits. More specifically, physicians have to be familiar with Edinburgh Postnatal Depression Scale, the standard, validated scale used to measure a woman’s postnatal mood that has also been translated into Arabic.

Women whose PPD is identified are often shuffled around different specialists in the prospect of acquiring treatment. Unfortunately most Saudi primary care physicians did not have adequate training in identifying this condition, let alone the basics of its treatment. Moreover, OB/GYN staff usually refer any patients they believe to have any sort of psychiatric disorder to psychiatrists. Large hospitals usually have psychiatrists as well as a psychiatric ward, but hospitals like this are few throughout Saudi Arabia. However, knowledge of the postpartum needs of women is improving as recently, the new Health minister, D.Alrabeaah recommended that the government establish two large and well equipped hospitals to serve the community, especially poor and medically underserved communities.

PPD is also affected by a woman’s home life. Postpartum support from husbands is low in Saudi Arabia and it represents one of the major obstacles to improving a woman’s postnatal state. Husbands must be educated about the needs of their wives and provide support. Moreover, the child’s gender can often contribute to a mother’s PPD. When a mother delivers a baby girl, they tend to receive less care and support from mothers, sisters, and family. Saudi culture prefers boys for their potential to add to family wealth and productivity. These cultural expectations and beliefs must be fundamentally changed if mothers are to feel supported and worthy of their family’s care. To do this, people should be educated, starting with young children and women, who often serve to perpetuate these beliefs of unequal gender worth.

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Figure: From Ica’s Tales of Mommyhood

From my experience as a Saudi citizen and physician, the only real support new mothers can receive after delivery is from immediate family, especially their own mothers, who usually take their daughter and the new baby to stay with them for 1-2 months. While families can increase a woman’s risk of experiencing PPD, this much needed support serves to help a woman acclimate to her role as a mother to a new child.

Kuwait, a neighboring country, shares the same beliefs and cultural values and generally experiences similar issues with PPD. In recent years, the government of Kuwait took many steps forward in improving the mental health of its citizens, particularly those afflicted with PPD, and I hope the Saudi government uses these changes as an example to make strides in its own mental health system for women.

In conclusion, it is imperative that we improve access to PPD screening by increasing training for primary care physicians and OB/GYNs and on a more long term level, change cultural attitudes that decrease a husband’s involvement in the postpartum period and places greater value on one sex over the other.

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5 Responses to “Postpartum Depression in Saudi Women: Culture and Biology Collide”

  1. josemuribe Says:

    Sadly, the impact of postpartum depression in too frequently underestimated around the world. The suffering from the depression is great for the mother and the risk of suicide/infanticide in some cases in an additional concern. The infants also suffer negative consequences due to the changes in the interactions with a depressed mother.
    I agree that physicians, OB/GYNs and other health care workers need to play an active role in increasing awareness about postpartum depression. Their credibility will help understand that it is a treatable condition and also help decrease the stigma that might surround mental illness.

  2. ehatef Says:

    Thank you for bringing up this important women health matter. Unfortunately postpartum depression (PPD) is a neglected problem even in western countries.

    You provided a comprehensive discussion about factors playing role in PPD and some recommendations to overcome the problem. I want to emphasize the role of cultural and educational factors on this problem. I believe an important issue about PPD is the fact that many people do not feel comfortable to seek help for their psychiatric problems. I am from Iran and have practiced medicine there. I found it much easier to talk to people about their physical issues rather than their psychological problem. The problem is the same among pregnant women. Many women focus primarily on the health of their newborn and find it difficult to talk about their psychological problems after pregnancy. In most cases women might get special treatment by family and friends during pregnancy but the attention shifts from women to their newborn right after child delivery which makes it even more difficult for women to seek help.

    As you mentioned the role of husband and family is also very important. They could be the source of support and more importantly they could detect the changes in women’s mood and function after the pregnancy. They might be the first people who detect PPD and should be educated to communicate with women about their psychiatric issues and encourage them to ask help from professional people.

  3. jyang80 Says:

    I appreciate you for sharing this aspect of women that isn’t brought up a lot even amongst women ourselves. And it’s also something different and new reading about it in relation to Saudi women.

    I see a lot of similarities in the Chinese culture as well. Most women don’t talk about it. They are assumed to suppress any PPD because they’re role is to take care of families. Meanwhile, the husbands should not bothered with such problems because they should be focusing on working and making money. Moreover many see this as solely an incurable psychological problem and thus become outcasts in their community.

    I feel the number one aspect to tackle in order to improve the care of mothers with PPD is to educate the families about the condition and try to ameliorate the sexism culture. Moreover, emphasizing the role of fathers in providing emotional support to the family can further relieve pressures off the mothers. Even something as simple as this can help “cure” mothers from PPD.

  4. udoanosike Says:

    Thanks for raising this issue that has been a neglected health problem in women in many parts of the world. Post- partum depression has remained unattended to by policy makers in both developing and developed countries. Families should be educated to provide emotional support to affected mothers until they recover from the illness.

    Practicing OB&GYN presently in Riyadh, I do understand the cultural setting of Saudi Arabia and efforts should be channeled towards health education to tackle gender inequality and ignorance associated with post-partum depression.

    Also, the family of any woman undergoing postpartum disorder, should be given adequate social support ’cause it can be quite a difficult period for them. Assisting the woman to take care of the baby will relief her from much burden and improve her health condition.

  5. Nahla Enany Says:

    I come from a country with almost similar culture and attitudes. In Egypt, the husband and his family would throw all the responsibility of the newly born baby on the mother. Some husbands even leave the house most of the time because they get annoyed with the babies crying.

    Underestimating the burden, stress and responsibility the woman feel after delivery worsens PPD symptoms. I agree that increasing awareness of the disorder, increasing the husband’s involvement and support to the mother will be a must to tackle this issue.

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