week 11ppp

Postpartum Depression among African Women Living in Rural Area in Nigeria Allison Nnaka

Walden University

Opening Statement/Introduction

This research will explore how self –reported depressed Nigerian adolescent and adult mothers’ experience postpartum depression. Postpartum depression is a serious mental health issue that affects women irrespective of age, race or ethnicity. Although there has been an influx of postpartum depression literature, few studies employ a sociological perspective, and even fewer focus Nigerians. The study will provides a theoretical framework of fragmented identify to explain socio-cultural factors contributing to postpartum depression among Nigerian adolescent and adult mothers. The research will demonstrate the distinct features compares to that of the adult women, such as the stigmatization of teen pregnancy and motherhood,, body image issues, changing identity and intergenerational conflict problems faced by many adolescent mother. Moreover, most Nigerians fail to seek mental health treatment, and approximately 75% of postpartum depression cases are undetected, and untreated.

Background of the study

Postpartum depression is a mood disorder that affects about 10-15 percent of adult mothers every year with depressive symptoms lasting more than sx months among 25-50 present of the affected individuals. Approximately 48 percent of adolescent mothers experience depressive symptoms. Postpartum depression often occurs between a few months to a year; studies report postpartum depression four years following birth. Postpartum mood disorders are classified into three categories according to the severity. The first , postpartum blues, which is the least form of typically lasting a few days to a couple of weeks after giving birth and affects approximately 50-85 percent of all new mothers and according to some studies is a precursor to postpartum depression (Watanabe et at., 2008). The second postpartum mood disorder, postpartum depression, is ore severe, causing a great deal of problems for the mother. If left untreated postpartum depression often results in bouts of crying, guilt, feelings of inadequacy and detachment from the baby. A third type of postpartum mood disorder, postpartum psychosis, affects less tan 2 women per 1.000 births, causes delusions, rapid mood swings, confusion and hallucinations and is most likely to occur during the first three months following delivery.

Problem statement

Depression during pregnancy poses a risk to the fetus both directly and indirectly in terms of maternal nutrition, drugs, alcohol, smoking, and noncompliance with prenatal care plans. The chances for obstetrical complications such as intrauterine growth retardation, premature labor and placental abruption are increased, possibly due to increased catecholamine levels in the depressed mother (HHS, 2007). The emotional and physical well - being of the new mother is vital to the health of the entire family. For example, PPD can place a strain on the relationship between the woman and her partner and will make family life more stressful. In addition to the personal distress of feeling sad and unhappy, postpartum depression can have more insidious consequences, such as disturbed mother-infant relationships and impaired cognitive and emotional development of the children. Limited studies were found identifying antenatal and immediate postpartum factors in women who experience postpartum depression. Identifying factors that predict development of PPD early in the pregnancy and postpartum period would allow for the development and assessment of strategies for the prevention and treatment of this devastating mood disorder

Purpose of the Study

The study focuses on the socio-cultural experiences of depressed Nigerian mothers, Gosdlin( 2005) found that the stigmatization and the lack of postpartum depression information and education prevents the Nigerian adolescent mothers from seeking mental health care. The narrative will compare self-reported depressed Nigerian mothers (adolescents and adults) to understand the complexities of barriers, beliefs, and traditional healing systems: and views of depression. The following are the goals of the study: (1) to identify cultural and age specific postpartum depressive symptoms, which could apply to various race and ethnic groups; (2) to identify the lack of detection of Nigerian postpartum depression by mainstream medicine, and increase the awareness of Nigerian postpartum depression; (3) to suggest culture specific postpartum behavioral interventions and (4) to explore the consequence of postpartum in regards to breastfeeding and mothers’ perceptions of their babies.

Research question(s)

· How does the transition into motherhood shape the everyday experiences of the self-reported depressed Nigerian adolescent and adult women?

· How can mental health of self-reported depressed Nigerian adolescent and adult mothers be understood within socio-cultural context?

· How does the pregnancy experience affect motherhood among self-reported depressed Nigerian adolescent and adult mothers?

Theoretical or conceptual framework

Postpartum depression, as a social phenomenon, is virtually absent from the literature. Very few studies examine mental health as it relates to motherhood, culture, gender and age. To understand postpartum depression as it is experienced by Nigerian adolescents it is important to consider the experienced of depressed Nigerian adult mothers. Comparing the two groups highlights the knowledge gaps in literature. Specifically, this study delves into pregnancy and motherhood while also considering the socio-cultural explanations of depression including its relationships to and perpetuation of socially constructed myths of motherhood. First, the definition of postpartum depression is examined along with specific symptoms and risk factors among both adolescents and adults. Additionally, pregnancy and motherhood are explored within the context of Nigerian culture and adolescent. Consequences of untreated postpartum depression and its impact on the mother, baby and family are also investigated. Socio-cultural explanations of depression and specific barriers to mental health care are examined between both groups of mothers.

While previous studies have examined socio-cultural aspects of mental health few have been applied to postpartum depression thus a significant gap in the literature remains. The relationship between society, culture and postpartum depression is examined throughout this dissertation. Focusing on the unique experiences of self-reported depressed Nigeran adolescent and adult mothers contributes to the postpartum literature while also suggesting cultural interventions necessary to treat this specific population.

Postpartum depression cannot simply be reduced to a chemical imbalance or hormonal abnormalities. Rather, depression after childbirth can be understood as a social phenomenon that exists and is maintained through an existing social structure found outside of the individual mother. The social construction of postpartum depression, including possible causes and affects must be explored through the experiences of motherhood, pregnancy and birthing all of which are typically examined through the lens of Native, and working class Nigeria, ignoring a variety of socio-cultural factors and structural constraints unique to Nigerian mothers.

Consequence of untreated postpartum depression, among a national sample of Nigerian mothers, is analyzed through three types of regression analyses and is addressed in the next chapter.

Design

Qualitative method will be implemented using samples from both the same underlying population- self-reported depressed Nigerian mothers. Grounded theory, theory derived from the data, examines the different ways in which Mexican American adolescent and adult mothers experience depression during the postpartum period while discovering specific socio-cultural meanings attached to pregnancy, motherhood and depression. Theory developed from the qualitative interviews is also used to analyze the impact of untreated postpartum depression. Specifically, the mothers’ perceptions of their child’s physical health and whether or they breastfed and for how long will highlight the complexities of postpartum depression calling attention to the ways in which a depressed mother’s sense of self compromises perceptions of her child’s health and breastfeeding behavior. Medical research finds that mothers whom breastfeed experience lower levels of stress than non-breastfeeding mothers, which can have positive health effects on both the mother and the child. Studies suggest that breastfeeding protects mothers from stress, often a precursor to anxiety and depression, and that depressed mothers are most likely to stop breastfeeding. Therefore, the relationship between postpartum depression and breastfeeding is scrutinized. It will explore how the pregnancy, motherhood and depression experience shape the social identities of self-reported depressed Nigerian adolescent and adult mothers.

Methodology

Data will be collected which will provide assistance to understand the effects of maternal depression on health perceptions and breastfeeding behavior. Participant will be interviewed twice using two distinct semi-structured interview guides totaling 24 interviews. Mothers will be interviewed twice due to the sensitivity of the topic and the time needed for each question. Participants from both groups will be recruited from owerri local government area in the eastern part of Nigeria. Several recruitment strategies will be employed including: creating and disseminating flyers, calls and emails to different pregnancy centers, schools and health clinic throughout owerri local government area, online and print ads, church bulletins and personal and professional contacts. Print ads in local newspapers, in both English and Ibo language. Sampling will be recruited base on the following criteria: (1) 18years of age; (2) self-reported depression;(3) eight weeks to a year postpartum, to distinguish depression from the more common “baby blues” (4) Have never sought care from a mainstream healthcare professional for depression; and (5) have never taken medication to treat depression.

The Nigerian adult will be included based on the same criteria expect for age which is 19 years or older. Qualitative data will be analyzed using a grounded theory approach based on a multi step technique developed by Strauss and Corbin. Each of the transcripts and depression scales will be hand coded. After the initial read of each transcript, codes will be assigned based on emergent common themes. Codes will include normalizing and controlling depression, pregnancy complications, social support, childcare stress, conflict within interpersonal relationships, perceptions of baby, body image etc. A separate codebook for the adolescent and adult mothers will be created based on the same 29 open codes, which were then collapsed into categories. For example, the code pregnancy related complications will be deconstructed and grouped based on specific issues indicated by participants such physical and emotional difficulties. Upon categorizing codes, subcategories will be created through the process of linking codes with specific statements illustrated in the data, which led to the development of themes, thus generating theory explaining how postpartum depression is socially constructed among Nigerian adolescent and adult mothers. Specifically this study examines how the experiences of pregnancy, motherhood and depression differ between these two groups of mothers.

Limitations

There are limitations to this study, some of which are methodology in nature whereas other constraints pertain directly to the nature and sensitivity of the topic. Due to the integration of qualitative techniques, studies employing qualitative design encompass the limitations commonly associated with qualitative methods. Therefore, special attention should be given to the fundamental principle of Qualitative Method, which states that all methods have strengths and weaknesses and that the strengths are complementary and the weaknesses do not overlap. For instance, the qualitative findings cannot be generalized to larger populations of self-reported depressed Nigerian adolescent and adult mothers because of the relatively number of participants and if use nonprobability sampling. In addition to constraints facing the components of the study, there is also the limitation of priority that in this case will be given to the study. The lack of current, and available data to examine postpartum depression in general, and specifically Nigerian mothers of varies in ages. Also, the stigma attached to the topic mental health made it more difficult for an outsider to elicit sensitive information.

Ethical concerns

The entire participant will be informed of the possible risks, which will be minimal. Due to the sensitivity of the subject matter participants will be referred to a culturally competent community mental health clinic in Imo-State Nigeria that provides both counseling and medical treatment to the indigent. Several mothers stated that they would seek mental health care upon receiving the information. Several of the adult mothers may become emotional and cry during the interviews and may also express their emotional relief that they will be able to openly talk about their feelings. The key findings will be derived from the qualitative interviews with self-reported adolescent and adult Nigerian mothers. The social construction of postpartum depression calls attention to policy and clinical implications while considering future areas of research.

Significance of the study

This research is important and significant. First, Nigerians are the fastest-growing ethnic group in Africa and rise in population. The recent in Nigerians accounts for ¼ of the African population growth in five years. Nigerians comprise a large portion of the lower socioeconomic class; they experience high level of stress, which has been linked to anxiety and depression. The Nigerian mothers, compared to western world women have a high fertility rates. As a result, they are at an increased risk (65%) of developing postpartum, compared to non-Nigerian. However few studies have examined the postpartum experiences of racial/ethnic women. Moreover, fewer studies have explored Nigerian adolescents’ beliefs and perceptions, symptom experience, and postpartum help seeking behavior. Research has suggested, however, a link between level of acculturation and depression among Nigerian teens. Explicitly, acculturation often creates intergenerational conflict, leading to depression. The need to further explore postpartum among Nigerian adolescents is important.

In addition, although mental health disparities among Nigerian are well established, to my knowledge, there are no mixed methods comparative studies that focus on the experiences of self-reported depressed Nigerian mothers across age groups. This research is unique because it considers the overall experiences of Nigerian mothers among age groups. This research is unique because it considers the overall experiences of Nigerian mothers of all ages, which is imperative to understanding the overall quality of maternal health. The qualitative approach study is to seek to understand Nigerian postpartum depressive experiences, which may be applied to other racial/ethnic groups. The major focus of this study will be qualitative in-depth interviews of Nigerian adolescents, using a comparative sample of adult Nigerian mothers, within ethnic qualitative design. It will explore the postpartum depression within the context of pregnancy and motherhood to understand the socially constructed identities of self-reported depressed Nigrian adolescents and the meaning attached to depression compare to Nigerian adult sample. The qualitative analysis focuses on the meaning attached to everyday experiences and perceptions of physical health of their babies.

This research presents a sociological approach to postpartum depression, which is most often viewed as medical issue. Specifically, social and structural factors associated with the onset, diagnosis and treatment of postpartum depression have been largely neglected in previous studies. Therefore, unlike the prior studies, this research will explore the depressive experience and the consequences of postpartum depression among Nigerian mothers while considering the role of culture, myths of motherhood, stigma and the medicalization of childbirth. This study will also explore pregnancy as related to depression. Research indicates the need for further exploration in the link between anxiety and depression.

Implications for social change

Mothers with the postpartum condition start living in solitude (Poulin, 2006). They feel safer when they stay alone for they think staying with people they will be harmed. Some mothers do not want to see their young ones hence as a result they seek solitude to ensure they are not questioned of their actions. The mother feels they cannot provide motherly love and care to both the baby and the family at large. In order to avoid a failed motherhood responsibility the see solitude as the only answer to their condition.

Rosenfield (2006) says that violent behavior grip mothers with the condition. They view every person who makes an advance to their space as an aggressor hence they respond with verbal or physical aggression. The baby can also suffer from their mother’s aggression. The inability to bond with their babies sees them try to harm them.  In severe cases they harbor the social thoughts to both the baby and self.

Conclusion

Postpartum depression can be viewed as a socially constructed phenomenon that affects both Nigerian adolescent and adult mothers. The study compared the pregnancy and motherhood experiences of both groups while calling attention to breastfeeding behavior. Postpartum depression can best be explained through a process of a fragmented identity through which a disconnection forms between the actual situation and societal expectations. Nigerian adolescent mothers begin forming detachment from themselves, their babies, and society immediately after disclosing their pregnancies. Detachment often leads to social alienation in which young mothers are isolated and stigmatized by their peers, families, and society as a whole. Many mothers are unaware that they are withdrawing or confused as to why; therefore, they blame themselves, which prevents them from connecting with their social networks. Alienation among adolescent mothers produces a mechanical approach to mothering. Specifically, their daily lives are reduced to matters of emotional survival leading to depression.

Compared to adolescent mothers, adult mothers construct motherhood in a similar manner. Although adult mothers do not endure the stigma experienced by teen mothers, they do experience motherhood as a fragmented identity, leading to postpartum depression. Framing postpartum depression as a social construct calls attention to the numerous social, cultural, and structural dimensions of a condition often labeled and treated solely as mental disorder.

References

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HHS (2007). Research on Postpartum Depression at the National Institute of Mental Health. Retrieved from http://www.hhs.gov/asl/testify/2007/05/t20070502e.html on November 14, 2015.

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Poulin, S. (2006). The mother-to-mother postpartum depression support book: Real stories from women who lived through it and recovered. New York: Berkley Books

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