Maternal depression in rural Pakistan: the protective associations with cultural postpartum practices

Abstract

Background: Traditional postpartum practices are intended to provide care to mothers, but there is mixed evidence concerning their impact on postpartum depression (PPD). It remains unknown if there is a unique impact of postpartum practices on PPD separately from other types of social support, or if practices differentially affect those with existing prenatal depression. In Pakistan, chilla (‫چ‬ ‫ل‬ ‫ه‬) is a traditional postpartum practice in which women receive relief from household work, additional familial support, and supplemental food for up to 40 days postpartum. This study aims to understand if chilla protects against PPD independent of other support and whether this relationship varies by prenatal depression status. Methods: Data come from the Bachpan cohort study in rural Pakistan. Chilla participation and social support (Multidimensional Scale of Perceived Social Support) were assessed at 3 months postpartum. Women were assessed for major depressive episodes (MDE) with the Structured Clinical Interview, DSM-IV and for depression symptom severity with the Patient Health Questionnaire (PHQ-9) in their third trimester and at 6 months postpartum. Adjusted linear mixed models were used to assess the relationship between chilla participation and PPD. Results: Eighty-nine percent of women (N = 786) participated in chilla and almost 70% of those that participated took part in all of chilla's aspects. In adjusted models, chilla participation was inversely related to MDE (OR = 0.56; 95%CI = 0.31,1.03) and symptom severity (Mean Difference (MD) = − 1.54;95%CI: − 2.94,-0.14). Chilla participation was associated with lower odds of MDE (OR = 0.44;95%CI = 0.20,0.97) among those not prenatally depressed and with lower symptom severity among those prenatally depressed (MD =-2.05;95%CI:-3.81,-0.49). Conclusions: Chilla is inversely associated with both MDE and symptom severity at 6 months postpartum above and beyond social support. Specifically, chilla is inversely associated with MDE among those not prenatally depressed and with lower symptom severity among those prenatally depressed. This relationship signals an opportunity for interventions aimed at preventing and treating PPD in this region to draw upon chilla and similar traditional postpartum practices in creating community-based, low-cost, sustainable interventions for maternal mental health.

Determining factors for the prevalence of depressive symptoms among postpartum mothers in lowland region in southern Nepal

“…In this study, postpartum depressive symptoms were found among one-third of mothers which accounted for 33.7% (95% CI: 29.2–38.5%). This finding is consistent with previous studies undertaken in a different time in different areas, where the prevalence of PPD among mothers during this course were 30.3% in Paropakar Maternity and Women’s Hospital (PMWH), Kathmandu, Nepal [ 21 ], 34.6% in South-East Nigeria [ 21 ], about 39.4% in urban slums of Dhaka, Bangladesh [ 16 ] and 34.6% in Karachi, Pakistan [ 41 ] using EPDS score. In Nepal, Several studies reported the prevalence of postpartum depressive symptoms among mothers were ranging from 10–30% during different periods in the different settings using an EPDS score cut-off ≥10–13 [ 20 – 22 ].…”

Psychometric Validation of the Multidimensional Scale of Perceived Social Support During Pregnancy in Rural Pakistan

“…This transitioning phase is called chilla in the regional language and lasts for 6 weeks after the birth of the baby. Perhaps this transition of a socially active pregnant woman to a narrow social role of a postpartum woman may explain why the family, spouses, and friends are no longer seen as three distinct sources of social support in the postpartum period (Lemasters et al, 2020).…”

“…It was later crossculturally adapted for use among postpartum women in Pakistan, by Akhtar et al (2010). However, Akhtar et al (2010) found it to have a unidimensional construct in Pakistan, perhaps due to its relevance to postpartum women and the traditional birthing practice of chilla in the postpartum period (Lemasters et al, 2020). In addition, this disparity in factor structure may have resulted due to traditional statistical heuristics utilized by Akhtar et al (2010).…”

Depression by Association? Mental Well-Being of Women in Urban Slums of Pakistan

“…Studies conducted in Pakistan over the past decade have set the prevalence range between 22% and a whopping 60% for anxiety and depression (Ahmed, Enam, Iqbal, Murtaza, & Bashir, 2016). These high rates coupled with an annual population growth rate of 2.4% (Pakistan Bureau Of Statistics, 2017) warrants a look at the mental health of the caretakers of the future generation(Niloufer Sultan Ali, Mahmud, Khan, & Ali, 2013;Gulamani, Shaikh, & Chagani, 2013;LeMasters et al, 2020;Maselko et al, 2016;Rahman, Lovel, Bunn, Iqbal, & Harrington, 2004).…”

“…The importance of maternal health and well-being is as important for the growth and development of young children as it is for the mother (Nusrat Husain et al, 2017;Naerde, Tambs, Mathiesen, Dalgard, & Samuelsen, 2000). This consideration of adverse effects on the children calls for urgent focus to maternal mental health beyond that of the pregnancy and post-partum period that has been studied relatively more in our population (Niloufer S Ali, Azam, Ali, Tabbusum, & Moin, 2012;Niloufer Sultan Ali et al, 2013;Gul, Sherin, Jabeen, & Khan, 2017;Gulamani et al, 2013;LeMasters et al, 2020;Rahman et al, 2004;Shah & Lonergan, 2017).…”