Stories and podcasts WBW Stories Postpartum Depression in Africa: A Faceless Killer I spent most of my school breaks as a child visiting with my godmother in her maternity clinic. Playing around in the hospital space with the other children formed much of what my childhood was about: mothers and babies. Predictably, I was well-schooled on the female body before high school biology classes. I mostly remember it as a happy childhood; I had many friends, and the tragedies of adulthood hadn't yet tarnished my innocence, but when it did, it left an indelible stain behind. A healthy new mother was found sprawled on her bedroom floor, a few weeks after she was discharged, with her baby. There was an empty bottle of Valium beside her and her hungry baby had cried himself to sleep in his cot. She had been dead for hours. It was a very sad day at the clinic, and even today, I still shudder at the memory. In a culture where suicide is taboo and motherhood is seen as the crown of every woman's life, her death was the knottiest oxymoron ever. The husband complained about her increasingly blue moods, crying bouts, and guilt over everything. This was my first encounter with Post Partum Depression (PPD). To talk about PPD is to understand first that women in Africa are oftentimes judged by their fertility, where motherhood is 'her' achievement: the purpose for which she was born, why she is even human. Little thought is given to the post-partum health of the mother, aside from the fact that if she could survive childbirth, then there is nothing to worry about – and that her priority is to now nurse her physical body to anticipate another pregnancy. The physical health of the mother is well catered for, but nobody says anything about her mental health because this kind of health is less understood. A mother who has had a baby is ‘supposed’ to be happy, to show off her achievement, and to be ultimately content with her elevated status. It is either madness or wizardry not to be. But PPD is not madness, psychosis, or wizardry. People get depressed all the time, but it is the timing of PPD that makes it different. It is the mental response of the body to a physically and psychologically exhausting process. The symptoms are not any different from general depression like insomnia, mood swings, lethargy, irritability, and suicidal thoughts, though in new mothers, who are grappling with hormonal changes, physical repercussions of pregnancy and childbirth, oftentimes disrupted sleep schedules, and anxieties around ability to parent effectively, PPD is almost a perfect storm of compounding factors. PPD is rarely as severe as the story above. In fact, it is experienced by a significant percentage of women all over the world but in Africa, the statistics may not be so clear, because the illness is rarely reported and admission for a ‘mental mishap’ is often stigmatised. It can be short-lived with the right mental health support. Many mothers have overcome PPD by themselves, the way one gets over grief at the death of a loved one, but if left untreated, it can become a long-term problem. Though recovery is entirely possible, not everyone gets there. There are those, like the woman from my godmother's clinic who have no idea why they feel so faulted, worried, guilty and irritated, who believe that there is something wrong with their ability to be a good mother; those who without close support, understanding, and treatment, will only suffer unnecessarily further. Without understanding of what is happening to them during this time, many who do manage to overcome PPD and go on to have more children in the future may never get over the first guilt. They are wracked by shame and guilt, questions that have no answer: How could they not have loved their baby? But it is, of course, not love that is missing – it is attachment as a result of mental health. And it is not a failure of the mother at all. Love can always grow, but we must give ourselves the best possible chance to create the attachment that fosters it. This is where mental health care is so vital. Understanding PPD as a health issue, triggered by biological factors – like decrease in neurotransmitter levels – will better prepare mothers to handle their mental health. It will encourage them to seek for help, rather than suffer or even die in silence. Understanding the timing of PPD will help healthcare professionals to organise mental health monitoring of women who need extra attention. Until now, healthcare in Africa has focused mainly on physical care, but knowing neurosis can be as fatal as physical ailments must encourage us all to make provisions for a different kind of health, too: mental health. When the type of system that factors mental health into other processes is in place, it will be easier for women suffering from depression and even those suffering from other mental health issues to seek for help and treatment. Ignoring PPD or other forms of mental illnesses, will not make them go away and will in time, manifest as a failure of the health system. Creating awareness about PPD and taking serious measures to prevent capable but demoralised mothers from suffering in silence will contribute significantly to improving the maternal healthcare delivery – for a better Africa, and a more healthy world. About the Author.