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How Other Cultures Prevent Postpartum Depression

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by Kathleen Kendall-Tackett
August 16, 2012

Is ours not a strange culture that focuses so much attention on childbirth—virtually all of it based on anxiety and fear—and so little on the crucial time after birth, when patterns are established that will affect the individual and the family for decades?
—Suzanne Arms

As citizens of an industrialized nation, we often act as if we have nothing to learn from the Third World. Yet many of these cultures are doing something extraordinarily right—especially in how they care for new mothers. In their classic paper, Stern and Kruckman (1983) present an anthropological critique of the literature. They found that in the cultures they studied, postpartum disorders, including the “baby blues,” were virtually non-existent. In contrast, 50–85 percent of new mothers in industrialized nations experience the “baby blues,” and 15–25 percent (or more) experience postpartum depression.

What makes the difference?
Stern and Kruckman noted that cultures who had low incidence of postpartum mood disorders all had rituals that provided support and care for new mothers. These cultures, although quite different from each other, all shared five protective social structures:

1. A distinct postpartum period. In these other cultures, the postpartum period is recognized as a time that is distinct from normal life. It is a time when the mother is supposed to recuperate, her activities are limited, and her female relatives take care of her. This type of care was also common in colonial America, when postpartum was referred to as the “lying-in” period. This period also functioned as a time of “apprenticeship,” when more experienced mothers mentored the new mother.

2. Protective measures reflecting the new mother’s vulnerability. During the postpartum period, new mothers are recognized as being especially vulnerable. Ritual bathing, washing of hair, massage, binding of the abdomen, and other types of personal care are prominent in the postpartum rituals of rural Guatemala, Mayan women in the Yucatan, and Latina women both in the United States and Mexico. These rituals also mark the postpartum period as distinct from other times in women’s lives.

3. Social seclusion and mandated rest. Postpartum is a time for the mother to rest, regain strength, and care for the baby. Related to the concept of vulnerability is the widespread practice of social seclusion for new mothers. For example, in the Punjab, women and their babies are secluded from everyone but female relatives and their midwives for five days. Seclusion is said to promote breastfeeding and it limits a woman’s normal activities. In contrast, many American mothers are expected to entertain others—even during their hospital stay. Once they get home, this practice continues as they are often expected to entertain family and friends who come to see the baby.

4. Functional assistance. In order for seclusion and mandated rest to occur, mothers must be relieved of their normal workload. In these cultures, women are provided with someone to take care of older children and perform their household duties. As in the colonial period in the United States, women often return to the homes of their family of origin to ensure that this type of assistance is available.

5. Social recognition of her new role and status. In the cultures Stern and Kruckman studied, there was a great deal of personal attention given to the mother. In China and Nepal, very little attention is paid to the pregnancy; much more attention is focused on the mother after the baby is born. This has been described as “mothering the mother.” For example, the status of the new mother is recognized through social rituals and gifts. In Punjabi culture, there is the “stepping-out ceremony,” which includes ritual bathing and hair washing performed by the midwife, and a ceremonial meal prepared by a Brahmin. When the mother returns to her husband’s family, she returns with many gifts she has been given for herself and the baby. The following is a description of a postpartum ritual performed by the Chagga of Uganda. It differs quite a bit from what mothers in industrialized countries may experience.

Three months after the birth of her child, the Chagga woman’s head is shaved and crowned with a bead tiara, she is robed in an ancient skin garment worked with beads, a staff such as the elders carry is put in her hand, and she emerges from her hut for her first public appearance with her baby. Proceeding slowly towards the market, they are greeted with songs such as are sung to warriors returning from battle. She and her baby have survived the weeks of danger. The child is no longer vulnerable, but a baby who has learned what love means, has smiled its first smiles, and is now ready to learn about the bright, loud world outside.

  • Sodowsky

    This information needs to spread like wildfire

  • Kellicaslin

    Great article!

  • Annie

    awesome article, wise words!!!

  • Brdgrl

    I did my grad thesis on similar things. What I thought I found though was that results for other countries almost 20 years ago were MUCH lower than they are in those same countries now. Whether the surveys are more culturally appropriate now or what, there has been found to be some very high rates of PPD in third world countries, shown in research between 2000-2006.

    I REALLY wanted to find research that supported the whole “Mothering the New Mother” concept. Unfortunately, that’s not what I found.

    I totally agree though about the ridiculous of the American way of treating new mothers, and the expectations of them, and mothers throughout the child-raising years. Impossible standards, mythical, way over the top expectations…

    • Euromouse

      Do you think there may be a correlation between a more modern lifestyle in these countries and a higher incidence of PPD?

    • ph

      In many Asian cultures, especially Taiwanese and Chinese cultures, “mothering the new mother” has been a steadfast tradition that carries out to this day. It’s traditionally consisted of a seclusion period of at least a month where the mother and baby are cared for and pampered. Bathing was not allowed and there are strict regulations on what type of foods can be eaten (These are because in traditional Chinese medicine, certain “cold” foods and interaction with water due to bathing can harm the already vulnerable and weakened mother. Also, back in the old days, there were no heaters or hair dryers, so bathing was really not allowed after birth. The Chinese believe that if the seclusion month is done successfully, in which all the rules have been adhered to, many of the mother’s previous body issues and ailments will improve significantly after the month. Nowadays, there are even specialized “hotels” with suites that accommodate the new mother and her baby (and often the husband or mother of the mother lives with her as well). They have 24hour service with experienced staff (similar to doulas). All food, temperature, etc is regulated, and for those that cannot stand to not bathe or wash their hair for a month, people will even wash your hair and bathe you with filtered and sterilized water at the appropriate temperature and dry your hair immediately afterwards. Many women I know swear by this, and they say they used to have certain issues such as digestive issues, period pain, joint pain, migraines, and that going through a successful seclusion month healed their bodies of these ailments.

      I think Korean cultures also do similar seclusion practices. (not sure though)

    • Michelle Missm

      This is such a fascinating topic! Please see my comment above for my thoughts. But the jist of them are that I really think that global industrialisation and the irradiation of traditional ‘tribal’ life are the causes of the increased reported cases of PPD.

      I guess I would be interested to know if the cultural groups are still practising the exact post birth rituals outlined above or if those too had suffered the fate of adaptation via ‘modernisation’ or even had been forsaken altogether in the light of new ‘advanced technology and science’.

  • Karen

    I love the last sentence…”the health of our families depends on it (the care we give new mothers)” Great article.

  • Vsun81

    Great article! The social support is so important in the postpartum period. In traditional Chinese culture you have to stay home for one month to rest and take care of your newborn. There are many other restrictions in diet and bathing also. Limited or no visitors in that time period but you have someone to help with meals and cleaning, etc. After the month is over.. you have a big party to celebrate the mom and baby! It is all a bit extreme but I think it really puts the focus on the mother’s recovery from childbirth and relieves her of some stress to focus on the newborn.

  • Anonymous

    I am a black woman from South Africa and traditionally we go home to our mothers after we have the baby, we stay there anything from 6 weeks to 3 months depending on culture or on the individuals…I don’t know if it decreases PND but we are never alone and we always have someone to help us with everything from taking care of the baby to letting us sleep and feeding us (which is why we get so fat) lol. Some strict cultures only allow people to meet and see the baby after 3 months, but nothing is cast in stone, families and cultures are different, so no two situation are the same. I am pregnant now and know that i couldn’t do it alone without the help of someone in my family….My sister lives in Europe and has only had the luxury of my mom being there for 3 weeks after both her babies were born. I commend and admire any mother who gives birth and gets right back into it with no or very little help…it cannot be easy

  • Michelle Missm

    I disagree with your disagreement Katherine :). There are several problems with the critique presented in your post, the first and most troublesome being the fundamental flaw of comparing the statistics of a country, to those of a culture – two very different yet not unrelated things. Whilst countries influence the cultures within the to varying degrees and I am sure there could be the possibility of a country have one all encompassing homogeneous culture, I would hypothesise that 99% of the worlds countries are home to many many cultures, be they striking different or almost undetectably different.

    The statistics you provide while interesting, do not actually reference a single cultural group (unless you count socio-economic status as a culture) nor does it specify whether the population of the studies either self identified as being a member of a particular culture (or “countryman”/nationality) or more importantly whether or no the actually used/experienced any or all of the post birth depression prevention practices outlined above.

    Of course while there are many other issues, not only with your post, but with the ongoing affects of globalisation/industrialisation on all facets of our highly technological modern and rapidly tradition-forsaking lives; they are far too numerous (and to complex) to list here (as seen in the comment below this is a thesis worth subject); so I will end by saying that must all remember it is also a flaw to look at cultural practices in a vacuum. They do not even work that way within the groups they were extracted from, the reality being much more holistic, interconnected, correlated and continuous. However, the fact remains that beyond your personal undisclosed disagreements, the information you provided does not actually “disprove” the claims made in this post or the researchers’/blog author’s conclusions.

  • Helen Oyintando Ilitha

    “It makes women who have postpartum depression feel even worse, as though
    we’re the only spoiled losers on the planet who have figured out how to
    make new motherhood miserable.”

    Honestly, this sentence in your article really irritated me. I loved my baby. I was over the moon to have her in my arms. But the complete lack of support I encountered knocked me for six. I did not “make motherhood miserable”. What sane minded person would craft a sentence to the effect that women go out of their way to rubbish such an important experience in their life?