Maternal postpartum depression

Gender equalityHealth

Notes to broadcasters

Save and edit this resource as a Word document.

According to the World Health Organization’s website, “Depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration. These problems can become chronic or recurrent and lead to substantial impairments in an individual’s ability to take care of his or her everyday responsibilities. At its worst, depression can lead to suicide, a tragic fatality associated with the loss of about 850,000 lives every year.”

Depression is common, affecting 121 million men, women and children worldwide. Depression is among the leading causes of disability worldwide and will be the second leading cause of disability globally by 2020. Depression can be reliably diagnosed and treated by health care providers, but fewer than 25 % of those affected have access to effective treatments.

One time that depression may begin is following childbirth, often with severe negative outcomes for mother and child. Recognition and treatment of this problem lead to positive outcomes for both.

The following script aims to raise awareness of the symptoms of maternal postpartum depression, the impact that depression can have on everyday life, the common misconceptions about depression, and the need to treat depression.

Before broadcasting this script to your listeners, find out about mental illness in your area. Depression is only one type of mental disorder. How common is depression? What are the short-term and long-term effects of depression? What kinds of services exist to treat depression in your area? Try talking to mental health services in your area or in the capital city of your country for more information about depression and other mental health issues. By broadcasting this information, you can help to improve the mental health of your listeners and offer valuable information that other radio programs may not be providing.

These radio spots can help start discussions about mental health problems faced by women and children in your area. You can use this script as a role play by hiring local actors to read the parts. You might want to follow the script with a phone-in discussion about mental health problems.

Script

CHARACTERS:

Shakina: A 45- year-old grandmother who clings to the old way of life in her village
Ashanti: A 42-year-old grandmother concerned about her only daughter Sylvia, who has just had a baby and has not shown up to work today
Layla: A 32-year-old mother of two girls and a friend of Sylvia
Johari: A young, intelligent 28-year-old mother who knows the local health worker

HOST:
Depression affects the lives of over 120 million men, women and children worldwide. One time that depression may begin is following childbirth – often with severe negative consequences for mother and child.(Short pause)Good(day/morning/evening). Welcome to our program, (name of program). Today we are going to hear a conversation between three village women who are weaving baskets and chatting while they work. The three women – Ashanti, Layla and Shakina – are concerned about Ashanti’s daughter Sylvia who has not shown up to work today. Sylvia has just given birth and is showing signs of depression. Let’s listen to their conversation:

Sounds of basket weaving and village life – people talking, animals making sounds – in background throughout script.

SHAKINA:
Sophie, could you pass me some of those reeds please?

ASHANTI:
Here you go.

SHAKINA:
Thank you. Oh no, I’ve cut my fingers again. Every time I do this I cut my fingers.

ASHANTI:
You should be more careful.

SHAKINA:
That’s what my daughter always tells me.(In a high-pitched voice)“You’re never careful enough Mom, you are never careful enough.”

LAYLA:
You get used to it after a while.

SHAKINA:
Yes, I guess that’s true. By the way, Ashanti, where is your daughter?

ASHANTI:
Sylvia?(Sadly)She hasn’t been feeling good since she had her baby.

LAYLA:
It’s been two weeks since she’s helped us weave baskets.

ASHANTI:
I know. I asked her to come but she’s crying all the time.

LAYLA:
Hmmm. Sylvia…she didn’t used to cry that much.

ASHANTI:
I don’t know what’s happened to her. The baby is crying all the time and Sylvia is not eating well. She’s not sleeping either.(Confused)I don’t know… I just don’t know what to do. She is so skinny now.

LAYLA:
I don’t think that it’s a problem. That happened to me when I had my baby, but the feeling went away after a few days. I couldn’t sleep. I was so tired and I felt stressed. I was very angry with the baby because she was always crying. But tell Sylvia the feeling goes away.

ASHANTI:
I told her to go see the village health worker, but she just can’t get herself out of bed.

SHAKINA:
These young girls – their lives are too easy. You know, when I had my children, we just got up and went back to the fields right away. We had to work. Right now, it’s much too easy for them…much too easy.(Pause)Well, here’s one basket – what do you think of it? Do you like this one?

LAYLA:
I think you need a bit of work on the side.

SHAKINA:
(In a disappointed voice)More?

LAYLA:
Yes.

SHAKINA:
(Slowly)Well… maybe… ok.

ASHANTI:
The problem is that I’m the one who is taking care of Sylvia’s baby.

SHAKINA:
But that’s what you’re supposed to be doing.

ASHANTI:
I’m the grandmother; I’ve already raised my children!

SHAKINA:
But you are supposed to keep raising your children. We never stop taking care of our children. We get up in the morning and walk to get the water, get the children ready, dry the fish … And then when your children have children, you get up in the morning and get the children off to school. It’s always that way.

ASHANTI:
Pass me that rod please.

SHAKINA:
Here you go.

ASHANTI:
(Concerned)Goodness, I just don’t know what to do. She won’t stop crying, she won’t get out of bed in the morning. I don’t know what to do…where to go for help.

SHAKINA:
Who won’t stop crying?

ASHANTI:
My daughter.

SHAKINA:
Oh Sylvia… She has it too good! She has it too good. Her man doesn’t beat her. That’s the problem.

ASHANTI:
No, that’s not the problem.

SHAKINA:
Is he beating her more? Maybe she needs to get more beating because she is crying so much.

ASHANTI:
No, he tries to take care of her. He is worried about her. He doesn’t beat her. A man is not supposed to beat a woman because she cries.

SHAKINA:
Oh, that’s unusual. When I was young…

ASHANTI:
(Interrupting sharply)Hush your mouth, Shakina.(Sarcastically)When you were young, the river ran up the mountain and the bananas were blue.

LAYLA:
Just force her to get out of bed.

ASHANTI:
There is nothing I can do. She just won’t get up.

SHAKINA:
She’s probably just lazy.

LAYLA:
How could you say such a silly thing? You know Sylvia is never lazy!

SHAKINA:
Hmmm… Is she eating?

ASHANTI:
Not really. She just cries all the time and she won’t even hold the baby.

SHAKINA:
So why aren’t you helping? Aren’t you supposed to be holding the baby?

ASHANTI:
(In a tired voice)I’ve already raised my babies.

SHAKINA:
What do you think of this basket now?

LAYLA:
It looks better.

ASHANTI:
Yeah, that one is nice.

SHAKINA:
(Confidently)Ok, that’s the best basket. Well, I am the best at weaving, right?

ASHANTI:
You’re the best at talking too. So what do you think I should do?

LAYLA:
How long has Sylvia been feeling like this?

ASHANTI:
Well, the baby is two months old now.

LAYLA:
I definitely didn’t feel bad for that long.

ASHANTI:
How long did the feeling last for you?

LAYLA:
It went away after a week or so. I knew the situation wasn’t going to change, so I made the best of it.

SHAKINA:
Well, why can’t Sylvia get better?

ASHANTI:
Goodness, I don’t know.

SHAKINA:
(Puzzled)It’s a mystery. Maybe she’s just…she’s just…I don’t know…maybe a spirit has got her. Maybe a spirit has got hold of her.

ASHANTI:
Yeah, I think it is a spirit because I’ve tried everything. I’ve made her all the herbal teas, but I think somebody put the evil eye on her. She’s just not right.

LAYLA:
That sounds like someone I know in another village. She went crazy after the baby was born. Something happened…she was acting strange, then she drowned and the baby had to be given to her sister.

Sound of someone approaching.

SHAKINA:
Oh hi, how are you?

ASHANTI:
Hi Johari.

JOHARI:
Hi. I see that you are hard at work. Oh, whose basket is that? It needs a lot more work.

LAYLA:
Johari, you can start weaving that one.

JOHARI:
Alright, good.(Pause)I heard you talking about Sylvia.

ASHANTI:
Oh, my poor Sylvia.

JOHARI:
(Concerned)What’s the matter?

ASHANTI:
She had her baby and she just can’t stop crying. She can’t come to work. She can’t take care of her baby.

LAYLA:
We think a spirit has taken her over.

ASHANTI:
It has to be a spirit.

JOHARI:
You know, my husband’s cousin is a big man, a doctor in Nairobi. He was telling me that sometimes after a woman has a baby she feels sad and cries a lot, but it’s not a spirit.

LAYLA:
It’s not? What can it be?

JOHARI:
This big man doctor, he says that it’s something called depression.

ASHANTI:
Depression? What’s that?(Dismissively)Those doctors don’t know about our village spirits.

JOHARI
Well maybe not, but there was a woman in the city that was crying all the time and not taking care of her baby.

LAYLA:
That sounds like Sylvia!

ASHANTI:
It does.

JOHARI:
She was not eating and she was really, really sick.

ASHANTI:
That sounds like the same spirit that Sylvia has. A baby spirit.

JOHARI:
Well, the doctor came and he brought her something and he talked to her. I don’t know what he did…but the doctor did something and the woman feels really good now.

ASHANTI:
And how is the baby?

JOHARI:
The baby is also well.

ASHANTI:
So what did the doctor say was wrong with this woman?

JOHARI:
The doctor said the woman had depression.

SHAKINA:
That’s just another word for spirits!

JOHARI:
No, it’s not. It’s like a sickness. It’s as if someone got sick, but not from spirits.

ASHANTI:
And what did he give her to fix it?

JOHARI:
I don’t know. I think he gave her some kind of medicine.

ASHANTI:
So where can I take Sylvia to get help?

JOHARI:
Well, there’s a new medical person in the clinic since last week.

ASHANTI:
(Distrustful)No, I don’t trust those white doctors from outside.

JOHARI:
(Reassuringly)He’s not white, he’s black like you and he’s from Nairobi.

ASHANTI:
Oh, I haven’t seen him yet.

LAYLA:
Does he have the medicine to make Sylvia feel better?

JOHARI:
I don’t know. They don’t always have medicine here.

LAYLA:
Maybe he could just talk to her? Maybe he could see if it’s depression?

ASHANTI:
Yeah, that’s better than nothing.(Tiredly)I can’t take care of that baby; I’m too old.

JOHARI:
Well, why don’t you go and ask if the doctor will visit and talk to Sylvia? He’s different than the other doctor that was here. This doctor likes to come and talk to everybody.

ASHANTI:
Well I hope he can fix whatever Sylvia has. Goodness knows we need some help!

JOHARI:
Why don’t you go now? Why don’t you come with me? We can finish these baskets later. Come now. We’ll go and talk to the doctor and see how he can help.

ASHANTI:
Great – let’s do that.

JOHARI:
Let’s go. See you later.

LAYLA:
We can finish these – you go.

ASHANTI:
Bye.

SHAKINA:
(Pause, then calling out as they leave)When you come back, bring Sylvia with you. She has to finish this big one here.

HOST:
Sometimes, after her baby is born, a mother feels depressed. She may lose interest and pleasure in life, she may not sleep much or want to eat food, and she may have low energy and poor concentration. These are all symptoms of what is called postpartum depression. Mothers who experience postpartum depression should get help from health workers. This is a serious condition and can become chronic, damaging both the mother’s and her children’s chances for a healthy, happy life.(Pause)Thank you for listening to our program today. Good(day/morning/evening).

Acknowledgements

Contributed by: Dr. Stan Kutcher, Sun Life Financial Chair in Adolescent Mental Health, Halifax, Nova Scotia, Canada

Reviewed by: Ricardo Salcedo, Dalhousie University, Halifax, Nova Scotia, Canada; Ainslie McDougall, Dalhousie University, Halifax, Nova Scotia, Canada; David Venn, IWK Health Centre, Halifax, Nova Scotia, Canada