The pandemic is intensifying postpartum depressionWith restrictions on movement, families cannot travel to extend support, and new mothers fear infection if they go for check-ups.
When Garima discovered she was pregnant for the first time, she was thrilled at the prospect of welcoming her baby into the world. As her due date neared, she had made final arrangements for her mother to travel all the way from Jhapa to be with her and help out with the new baby. But when she gave birth at Paropakar Maternity Hospital in Kathmandu on June 10, except for her husband, there wasn’t anyone to welcome her baby boy.
“My mother couldn’t visit us in Kathmandu due to Covid-19 and I feel like I am missing out on a lot of the initial support after birth,” said 22-year-old Garima, who asked to be identified by her first name only. “At times, I burst into tears because it becomes overwhelming to navigate having a new baby without anyone to help us.”
In Nepali society, childbirth is a family affair where the women expect to get social support from their immediate family members especially from their mothers or mothers-in-law to assist them during delivery and postpartum periods. However, due to the lockdown, Garima’s mother couldn’t come to be there for her. Garima is now taking care of herself and her baby all alone while her husband goes to work during the day. Garima worked as a housekeeper before her pregnancy.
While Garima, who lives in a rented room at Satdobato, is struggling to adjust to parenthood without any social support, she said that the pandemic has also aggravated a seemingly endless barrage of fear and angst.
“I am scared to go to hospital for routine check-ups and even interacting with people feels like risking contagion. This uncertainty has made me anxious so much that I am neither feeling myself nor enjoying motherhood,” said Garima.
Various studies have suggested that 1 in 7 women experience postpartum depression and anxiety disorder. These mental health problems are often triggered by neurobiological factors and environmental stressors. And now, the Covid-19 and the consequences of preventive measures, like social distancing, have only made things worse for many new and expecting mothers—exacerbating social isolation, delay in the access to health care and lack of social support during perinatal and postpartum periods.
A recent study published in Frontiers in Global Women’s Health also found that the pandemic is increasing the risk of postpartum depression and other maternal mental health illnesses in Canada.
In the study, of the 900 women surveyed (520 were pregnant and 380 had given birth in the past year), researchers found that the depression symptoms substantially elevated from 15 percent to 41 percent while moderate to high anxiety symptoms also went from 29 percent to 72 percent during the pandemic.
“While pregnancy and the postpartum period are already vulnerable times for women, it seems likely that uncertainties caused by the pandemic will further worsen their mental health. I am concerned about what this could do to parents, with essentially no help from their social support network,” said Karuna Kunwar, a senior psychologist at the Centre for Mental Health and Counselling Nepal (CMC-Nepal), an NGO providing mental health and psychosocial services and counseling.
According to statistics that predates Covid-19, the prevalence of postpartum depression (PPD) was between 5 and 22 percent in Nepal. However, Kuwar believes that due to the low priority given to screening for maternal mental health, the actual percentage of women suffering from such depression even before the pandemic should have been higher.
During the lockdown in Nepal, antenatal and postnatal visits all but stopped due to a lack of services and public transport means. According to the data published by the Family Welfare Division of the Department of Health Services, there was an almost 200 percent rise in maternal mortality rate during the lockdown while maternal mental health issues were also increasingly documented.
“Due to Covid-19, many pregnant women are being deprived of antenatal and postpartum check-ups and counselling. And then, there are other concerns regarding newborns' health, and financial constraints brought by the pandemic, which also add to their psychological distress,” said Rukumani Tripathi, a midwife in Kathmandu who also works as a counsellor.
Although pregnant women are not at a high risk of contracting Covid-19, compared to other groups, Tripathi believes that the death of a young woman in her postpartum period on May 16, which was also the first witnessed Covid-19 related death in Nepal may have also increased the stress among the pregnant women.
As of Tuesday, there were 21,009 confirmed cases of coronavirus infection and 58 Covid-19-related deaths.
Tripathi, along with two other midwives from the Midwives’ Society of Nepal, has been running a phone-in counselling service to provide both clinical and psychological advice to worried mothers-to-be and new mothers. According to Tripathi, they received more than 600 calls during the four months of the lockdown from all over the country and even after it was lifted, they are getting over 50 calls each week.
Along with the Midwives’ Society of Nepal, the Paropakar Maternity and Women’s Hospital and Transcultural and Psychosocial Organization in Kathmandu are also offering telephone counselling.
“Most women call in a state of panic. Some say that they are having trouble sleeping because they are too overwhelmed regarding the whole situation. Some of them burst into tears because they cannot go for regular check-ups while others are worried about transmitting the virus to their babies,” said Tripathi.
When the country went into lockdown in March, thousands of Nepali migrants from India began to arrive at the Nepal-India border to enter the country. There were also pregnant women, who were forced to stay in the quarantine centres, which were far from maternal and child friendly while one woman was reported to have given birth at a quarantine centre in Karnali Province.
Dhana Kumari was one of the pregnant women, who in June spent 14 days in a quarantine centre in Karnali after returning from India. Dhana Kumari recalled that she was deprived of basic necessities such as hot water bags, iron tablets, fruits and more than that emotional support from her loved ones.
“I was seven months pregnant at that time and I thought I was left to die there. I was sad and weak. Even now, I get emotionally triggered, even by thinking of the condition inside the quarantine centre,” said the 20-year-old, who is expecting her baby at the end of August.
Although reproductive health and mental health are interwoven, mental health issues of women during perinatal and postpartum periods are often overlooked, while the focus in Nepal has always been on safe motherhood, contraception and abortion, psychologists say. However, Tripathi feels that the pandemic has made everyone realise that the mental wellbeing of new mothers is as important as their physical health.
“In our society, mental health issues continue to be associated with secrecy, taboo and shame and in such a situation, many women suffering from perinatal and postpartum depression and anxiety don’t get diagnosed and even if they mention their concerns, family and friends often dismiss them by saying that feeling anxious and overwhelmed is just part of new motherhood,” said Tripathi. “However, Covid-19 has in a way exposed that mental health problems are real, and we all need to take them seriously.”
While many new and expecting mothers are reaching out to telephone-counselling, Kunwar from CMC-Nepal said that there are still very few people seeking in-person counselling regarding maternal mental health. “Maybe it is because one can seek help anonymously via telephone counselling. It may also be convenient for people who are still reluctant to go outside the house amid pandemic,” said Kunwar.
As for Garima, she wasn’t aware that there are telephone counselling facilities available for mothers like her. However, now that she knows, she said that she will call one of the counselling facilities to seek help. “I hope I will be able to get some suggestions about motherhood,” said Garima.
Helplines for Clinical and Psychological Counselling:
Midwives’ Society of Nepal: 16600100046
Transcultural and Psychosocial Organization: 16600102005
Paropakar Maternity and Women’s Hospital: 01-4260405
Frequently asked questions about the coronavirus outbreak
UPDATED as of September 22, 2020
What is Covid-19?
Covid-19, short for coronavirus disease, is an illness caused by the coronavirus SARS-CoV-2, short for severe acute respiratory syndrome coronavirus 2. Common symptoms of the disease include fever, dry cough, fatigue, shortness of breath and breathing difficulties. In severe cases, the infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death.
How contagious is Covid-19?
Covid-19 can spread easily from person to person, especially in enclosed spaces. The virus can travel through the air in respiratory droplets produced when a sick person breathes, talks, coughs or sneezes. As the virus can also survive on plastic and steel surfaces for up to 72 hours and on cardboard for up to 24 hours, any contact with such surfaces can also spread the virus. Symptoms take between two to 14 days to appear, during which time the carrier is believed to be contagious.
Where did the virus come from?
The virus was first identified in Wuhan, China in late December. The coronavirus is a large family of viruses that is responsible for everything from the common cold to Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). After an initial outbreak in Wuhan that spread across Hubei province, eventually infecting over 80,000 and killing more than 3,000, new infection rates in mainland China have dropped. However, the disease has since spread across the world at an alarming rate.
What is the current status of Covid-19?
The World Health Organisation has called the ongoing outbreak a “pandemic” and urged countries across the world to take precautionary measures. Covid-19 has spread to 213 countries and territories around the world and infected more than 31,405,983 people with 967,505 deaths and 22,990,260 recoveries. In South Asia, India has reported the highest number of infections at 5,557,573 with 88,943 deaths. While Pakistan has reported 306,304 confirmed cases with 6,420 deaths. Nepal has so far reported 65,276 cases with 427 deaths.
How dangerous is the disease?
The mortality rate for Covid-19 is estimated to be 3.6 percent, but new studies have put the rate slightly higher at 5.7 percent. Although Covid-19 is not too dangerous to young healthy people, older individuals and those with immune-compromised systems are at greater risk of death. People with chronic medical conditions like heart disease, diabetes and lung disease, or those who’ve recently undergone serious medical procedures, are also at risk.
How do I keep myself safe?
The WHO advises that the most important thing you can do is wash your hands frequently with soap and water for at least 20 seconds or use hand sanitizers with at least 60 percent alcohol content. Avoid touching your eyes, nose and mouth with unclean hands. Clean and disinfect frequently used surfaces like your computers and phones. Avoid large crowds of people. Seek medical attention if symptoms persist for longer than a few days.
Is it time to panic?
No. The government has imposed a lockdown to limit the spread of the virus. There is no need to begin stockpiling food, cooking gas or hand sanitizers. However, it is always prudent to take sensible precautions like the ones identified above.