Last month, a 29-year-old pregnant woman from Chitwan was taken to the Mental Health Department of the Tribhuvan University Teaching Hospital as she always suffered from extreme sadness.
During counselling, the woman told the doctors that her relationship with her husband, who is in the Middle East, was not good.
“The woman had been suffering from prenatal depression,” said Dr Mita Rana, a clinical psychologist at the hospital. “Now her condition has become much better after counselling.”
Prenatal depression and postnatal depression that lead patients to take their own life are major causes of maternal deaths happening in Nepal from non-maternity causes. Many women suffer extreme sadness, anxiety, fatigue, and changes in sleeping and eating habits during pregnancy or after childbirth.
Doctors say in extreme cases, women suffering from any of these conditions may harm themselves.
According to a recent report by the National Statistics Office, suicide is the main cause of maternal deaths occuring in Nepal from non-maternity causes.
“Every year a lot of women die by suicide during their pregnancies,” said Dr Phanindra Baral, chief of the mental health section at the Epidemiology and Disease Control Division. “It is the second main cause of maternal deaths after excessive bleeding during childbirth, also known as postpartum haemorrhage, and pre-eclampsia [pregnancy-related high blood pressure disorders].”
The recently unveiled report shows that in every 100,000 live births, 151 women died from maternity-related complications.
Nepal had reduced the maternal mortality rate from 539 per 100,000 births in 1996 to 239 per 100,000 births in 2016—for which the country even received a Millennium Development Goals award. The report showed 88 maternal deaths were prevented in every 100,000 live births between 2016 and 2021. The study was carried out in 2021.
Doctors say prenatal and postnatal depression can affect any time during pregnancy and after childbirth. Shifts in hormone levels during pregnancy and after childbirth can affect mood. Many women feel anxious about changes happening to their bodies. Some may even have financial concerns and some worry about taking on new and additional responsibilities.
Experts say both excessive bleeding after childbirth, also known as postpartum haemorrhage, pre-eclampsia (pregnancy-related high blood pressure disorders) and suicide, are preventable.
However, the government does not have any counselling programme under which it can address prenatal and postnatal depression and psychosis as of now.
“We do not have any government-backed counselling programmes yet to address maternal deaths from suicides,” said Baral, chief of the mental health section at the Epidemiology and Disease Control Division. “We are planning to start counselling for maternity-related psychosis and depression in the near future.”
According to Baral, the counselling services will initially be started at Paropakar Maternity Hospital in the ongoing fiscal year with financial as well as technical support from the World Health Organisation and would later be expanded to other major maternity hospitals in the coming years.
Doctors as well as nurses serving in maternity hospitals will be trained to counsel pregnant and postnatal women.
Changes in appetite, decreased interest in physical activities, family and social interactions, fatigue, sleeping more than usual, insomnia, feeling sadness, and hopelessness are among the problems pregnant and postnatal women face during pregnancies or after childbirth.
Doctors say a lot of maternal deaths can be prevented through counselling and awareness. They say that awareness is not only necessary for pregnant and post-natal women, but also for their family members.
“In such a situation, the role of family members, especially the husband, will be very much important,” said Salikram Bhattarai, a clinical psychologist. “Women must be provided with all kinds of support, including moral and emotional support.”
If you or someone you know is considering suicide, please contact the following helplines.
Nepal Mental Hospital suicide hotline: 1166
Tribhuvan University Teaching Hospital suicide prevention hotline: 9840021600:
Patan Hospital crisis helpline for suicide prevention: 9813476123
The Transcultural Psychosocial Organisation: 16600102005
Arjun Poudel is a health reporter for The Kathmandu Post. Before joining the Post, he worked for Sagarmatha Television, Naya Patrika, Republica and The Himalayan Times.
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