Living with severe perinatal depression: a qualitative study of the experiences of labour migrant and refugee women on the Thai-Myanmar border

Abstract

BackgroundPerinatal depression is an important contributor to maternal morbidity and mortality worldwide. Migrant women, particularly those resettling within low- and middle-income settings, are at increased risk of perinatal depression due to multiple stressors experienced before, during and after migration. Evidence on migrant perinatal mental health to date has focused largely on women in high-income destination countries, leaving the voices of displaced women in low-income settings unheard. This study addresses the current evidence gap by exploring the experiences of migrant women living on the Thai-Myanmar border.MethodsIn-depth interviews were conducted with pregnant and post-partum labour migrant and refugee women on the Thai-Myanmar border who had been diagnosed with severe depression. An interview guide covering women’s current and past life experiences, social support and the impact of depression on social and occupational functioning was used as a prompt. Thematic analysis was used to identify themes emerging from women’s narratives.ResultsEleven pregnant and post-partum women with severe perinatal depression took part. Participating women provided extensive insight into the many difficult aspects of their lives that they perceived as contributing to their depression status. Predominant themes emerging from women’s narratives included difficult relationships with partners, challenging life situations, mechanisms for coping with depression and impressions of mental health care.ConclusionsLabour migrant and refugee women with severe perinatal depression face a wide range of chronic stressors at the individual, household and community levels that are likely to have both short- and long-term negative effects on their mental well-being and day-to-day functioning. Participating women responded positively to the mental health support they received, and findings provide important insights into how services might further support their needs.Electronic supplementary materialThe online version of this article (10.1186/s12888-018-1815-7) contains supplementary material, which is available to authorized users.

Migrant Burmese women living in southern Thailand and motherhood: An ethnographic study

“…The transition to motherhood can be difficult, and for some women it can be a distressing time, especially if the woman is separated from her usual support network (Asnong et al, ; Benza & Liamputtong, ; Fellmeth et al, ). Studies of migrant women from various ethnic groups, now living in high‐income countries (HIC), report a higher risk of health complications in pregnancy and childbirth, and a greater risk of maternal and infant death (Almeida, Caldas, Ayres‐de‐Campos, Salcedo‐Barrientos, & Dias, ).…”

“…Studies of migrant women from various ethnic groups, now living in high‐income countries (HIC), report a higher risk of health complications in pregnancy and childbirth, and a greater risk of maternal and infant death (Almeida, Caldas, Ayres‐de‐Campos, Salcedo‐Barrientos, & Dias, ). In particular, migrants in low–middle‐income countries (LMIC) face many barriers and are at increased risk of physical (Crozier, Chotiga, & Pfeil, ) and mental health problems when they are pregnant (Fellmeth et al, ). This is primarily because migrant women are often separated from families and support systems and experience financial hardships, poor working conditions (e.g.…”

“…This is primarily because migrant women are often separated from families and support systems and experience financial hardships, poor working conditions (e.g. low wages; job insecurity; long working hours; and dirty, high‐risk, dangerous, and difficult work), and difficulties in adapting to life in a new country where the traditions and culture are different (Fellmeth et al, ). Many studies report that migrant women experience significant barriers accessing maternity services, including communication problems and limited language proficiency (Heaman et al, ; Phanwichatkul, Burns, Liamputtong, & Schmied, ).…”

“…Recently, there has been a sharp increase in the number of migrant workers coming from Burma to Thailand. The majority of Burmese migrants in Thailand work in low‐skilled, poorly paid occupations, such as in factories and the construction industry, often with dangerous, dirty, and poor working conditions (Lehane & Ditton, ; Mon, ), potentially impacting the health of women in pregnancy and after birth (Fellmeth et al, ; Noom & Vergara, ). Migrant workers (especially illegal Burmese/Myanmar migrant workers in Thailand) have low wages and cannot afford health care (Lehane & Ditton, ; Srivirojana, Punpuing, Robinson, Sciortino, & Vapattanawong, ).…”

“…In a study of unmarried Cambodian migrant women living in Thailand, it was found that many did not understand or have access to birth control, and there was a high rate of induced, unsafe abortions (Hegde, Hoban, & Nevill, ). Migrant adolescents living on the Thailand–Burma border have a lack of support within families and marriages, which causes them to have a fear of childbirth (Asnong et al, ; Fellmeth et al, ). In refugee camps in Thailand, a very low number of Karen women (mainly from Burma) attend antenatal care, and this lack of monitoring during pregnancy is associated with low birth weight babies and babies born small for gestational age (Wichaidit, Kaewkungwal, Sirivichayakul, Taechaboonsermsak, & Suvithayasiri, ).…”