Stigma, ignorance complicate challenges of Nigerian nursing mothers dealing with postpartum depression

After the birth of her first child, Rabi Fakorede slipped into an emotional crisis – she was not sleeping well and had feelings of frustration and helplessness.

Eight days later, she was taken to a hospital in Ibadan, Oyo State where she was diagnosed with Postpartum Depression (PPD).

“They said I suddenly snapped that morning and was rushed to the hospital,” Ms Fakorede said months later, recalling what her relatives told her. “I lost touch with the reality around me, and my family had to care for my child.”

PPD, silent struggle

The condition, also known as postnatal depression, is a type of clinical depression that occurs in some women after childbirth. It is characterised by a persistent and pervasive feeling of sadness, hopelessness, and emotional distress that can significantly affect a new mother’s ability to function and care for her baby and herself.

PPD typically sets in within the first few weeks or months following childbirth, although it can develop during pregnancy or up to a year after childbirth.

The symptoms of PPD can vary in severity but often include persistent sadness, inability to derive pleasure from previously enjoyable activities, fatigue, poor concentration, low self-esteem, sleep disturbances, changes in appetite, feeling detached from the baby or partner, and even thoughts of self-harm or harming the baby.

Although there is no precise data on PPD prevalence in Nigeria, the National Institute of Health notes that globally, PPD is a common yet often overlooked complication of childbirth, affecting 10-15 per cent of new mothers and also impacting fathers and partners.

Unfortunately, various factors contribute to PPD’s underrecognition and inadequate treatment.

A psychiatric nurse, Esther Olowokere, said PPD is a mental health condition that can affect fathers or mothers after childbirth. Ms Olowokere said research has shown that African-American and Hispanic women face a higher risk compared to white women.

“PPD typically emerges within the first few weeks postpartum but may occur earlier during pregnancy or up to a year later,” she says.

“Those with PPD have a greater risk of developing major depression later in life, which can impair their ability to care for their newborn and handle daily tasks.”

Poor diagnosis

In Nigeria, PPD is often concealed or misunderstood as a spiritual ailment or severe mental disorder, leading to inadequate medical intervention due to ignorance and fear of stigma.

Ms Fakorede was fortunate to receive a diagnosis and treatment, but many women in Nigeria are not as lucky. One such person is Aisha Ali, who resorted to self-immolation, leading to her death.

A year after Ms Ali’s death, her mother, Talatu Isah, and other relatives still grieve and wish they had known more about PPD and its treatment.

Mrs Talatu narrated her daughter’s sad experience to PREMIUM TIMES.

“Aisha’s problems began a few days after giving birth to her daughter, Amina, at a traditional birth attendant’s home. Soon after delivery, she started exhibiting bizarre behaviour, and we mistakenly believed she was suffering from a spiritual ailment,” she said.

To avoid social stigma, the family kept Aisha’s condition secret and sought help from spiritual healers, but to no avail. Tragically, Aisha died when her daughter was just two months old, leaving her family in anguish. “I wish we had known that she could receive help in the hospital; maybe she would still be with us.”

According to Ms Olowokere, the psychiatrist, management of PPD requires professional counselling; antidepressants or hormone therapy; a family support system from spouse and understanding relations, friends or group; financial support where necessary; cognitive behavioural therapy and psychoeducational, psychotherapy and medications.

“Families can recognise PPD through proper health education through the print, electronic and social media,” she said.

Isolation of PPD

While there is no definitive profile for how a woman with PPD may behave, Lucy Nwachukwu’s experience is particularly distressing.

Her PPD led her to contemplate harming her own baby. Her husband, Mr Nwachukwu, said that during her first birth, it was a strange experience because they had never heard of such before.

His wife suddenly developed an aversion towards the baby and wanted nothing to do with it. “She was miserable and kept saying the children would ruin her life.”

Fortunately, with the support of family and medical professionals, Mrs Nwachukwu overcame PPD.

Her husband emphasised the importance of family and medical support during such dark times.

Challenges in accessing care

Regrettably, many Nigerian women suffer in silence, as treatment for PPD is primarily available in tertiary or specialised healthcare centres.

Hassana Musa, a community health officer at the MDG’s Primary Health Care Clinic in Suleja, explained their approach at the facility: “We observe new mothers during postnatal care for signs of postpartum depression and inquire about their family’s medical history. When we suspect PPD, we refer patients to general or teaching hospitals for further evaluation or treatment.”

Mrs Musa noted that many PPD patients resist referral to psychiatric hospitals due to the stigma associated with mental health treatment. She advised pregnant women, especially first-time mothers over 30, to avoid unnecessary stress, which can contribute to PPD.

Recalling her own experience, Ms Fakorede mentioned how she was stigmatised and labelled as “mad” by her in-laws and some friends. Fortunately, her family’s education and support allowed her to seek help at a tertiary healthcare facility.

“I was able to pull through because of the level of education of my family which made them seek help for me at the tertiary health facility. They were supportive all through, eased my stress, and never treated me differently.”

A clinical psychologist, Ayodele Ajeigbe, said with the right treatment and support, people who experience PPD usually make full recovery.

However, Mr Ajeigbe noted that the severity of a case determines whether PPD can be managed at home or by healthcare providers. He said mild cases, with adequate family support, may be resolved within months, but untreated or severe cases can persist for much longer.

He urged individuals facing PPD to seek help from partners, doctors, or gynaecologists, and those who know someone experiencing PPD for at least two weeks to help them seek clinician assistance.

“Postpartum depression, if left untreated, can last over a year and may lead to other diagnoses. It is better for people suffering from the ailment and their families to speak up and get help,” he said.

“People get better and enjoy their lives when they speak up and ask for help. Psychotherapy helps and some medications help as well.”

National policy, funding

Paul Lenge, a medical officer at the Jahun Maternity Project in Jigawa State, said Nigeria has a national mental health policy covering all mental health conditions, including PPD.

Mr Lenge said “the Mental Health Act of 2021,” replaced the 1958 “Lunacy Act.”

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He said the policy aims to redefine mental health, enhance access to quality mental health services, promote community understanding of mental illness, protect the rights of people with mental health conditions, establish governance structures for implementation, and address funding gaps.

On what it would cost to cater to patients of such cases, he said, “We don’t have Nigerian figures due to our poor or lack of data management. However, from NHS: In addition to the direct impact on families, it is estimated that perinatal mental health problems cost the NHS and social services around £1.2 billion annually.”