Sikh Women's Health Initiative

Mental health issues are a common experience in pregnancy but are not as often discussed, especially among the Punjabi community. As many as one-fifth of people experience mental health issues when they are pregnant, and suicide is one of the biggest causes of maternal mortality, or death due to pregnancy-related reasons.

While mental health issues in pregnancy and after can be challenging to experience, it is very important to address this, because if these issues are left untreated, they have effects far wider than the mother’s mental health. These conditions can also increase risk for problems with the baby during pregnancy, childbirth, and after birth, including stillbirth, preterm birth, low birth weight, difficulty bonding after birth, and neurodevelopment of the infants. Thus, identifying and treating mental health conditions in pregnancy is extremely important.

Signs You Should Pay Attention To

It is not uncommon to experience baby blues in the first 2-3 days after childbirth, which 70% of women experience. This can manifest in feelings of anxiety, frustration, anger with the newborn baby/significant other and result in excessive crying, trouble sleeping, and difficulty caring for the baby. Postpartum depression, on the other hand, can present up to a year, but typically starts 1-2 weeks after childbirth. It is critical to seek help when struggling during this time, as it is a very common experience for mothers.

Certain cultural norms make it more challenging for Sikh women to recognize that this is not a rite of passage and that there are many supportive interventions, including medications, to help during this very challenging time of lack of sleep, fatigue, and multiple competing priorities that make it all seem insurmountable without help.

Cultural Factors Affecting Postpartum Depression Risk in Punjabi Women

Cultural and Religious Context

South Asian women, including Punjabi women, are shown to have a higher risk for postpartum depression compared to other women. This can be due to multiple factors:

Community Support and Isolation

Punjabi women are not usually taught or encouraged to share emotions with their family and friends. While Sikh culture highly values family and community, and this can help support new mothers emotionally and physically, it can also lead to feelings of isolation if mothers are struggling mentally and these issues are not openly discussed or acknowledged in their family or close circle. Because of this, mothers with mental health issues may feel even more isolated and may be shunned by their family or circle if they speak about mental health or try to access care.

Also, many new Sikh mothers are immigrants from Punjab, India, Pakistan, and many other parts of the world. Sometimes, mothers may have left behind their families and their own mothers or support network of women, and this can make them feel even more isolated.

Cultural Expectations

In many Sikh families, there are very strong cultural expectations about motherhood and the role of the mother in the family. This is said to be the “happiest time in a woman’s life,” but on the other hand, feelings of depression or sadness can be seen as you not experiencing the joy that you should be feeling, and not being a loving mother or a good person. These expectations to be the happiest in your life can be a big burden, adding a lot of pressure on the shoulders of a new mother. Mothers may feel, or be made to feel by others, that they are inadequate or already failing as mothers if they are struggling with postpartum depression.

Breastfeeding

While in the West, breastfeeding in public, or even around just your family, is becoming more normalized and accepted, this is not usually the case in Punjabi and Sikh communities. Breastfeeding in front of family or while you’re out is not typically accepted or encouraged. Breastfeeding can be a difficult experience for some mothers, and these norms around breastfeeding in isolation can increase mothers’ feelings of being alone, isolated, and inadequate if they’re struggling with feeding their baby.

Role of the Family in Childcare

In Punjabi and Sikh communities, the baby is typically seen as belonging to the family, not just being the child of the mother. Mothers may be expected to hand over the baby and its care to other family members, especially older women, who may have a say in how the mom should care for her child. This can lead to a silent conflict which can leave mothers feeling more isolated and separated from other forms of social support.

Husbands may also have full-time jobs and paternity leave is not a common practice in Punjabi or Sikh men. Not having the support of your spouse during a very transformational time, especially if there is conflict with family, can be challenging. Furthermore, arranged marriage is common, and the relationship between the mother and father may not always be a strong foundation, which can cause even more difficulty for new mothers.

Postpartum Traditions

The first 5 weeks after childbirth is known as “Sawa Mahina” in Punjabi. This is a cultural tradition with many rituals that promote rest, healing, and bonding. While this is a time of immense support and care for the mother, she may also feel restricted, in terms of diet, activities (including sexual activity), and childcare. Other female family members may also sleep in the room to help the mother out with the new baby, and while this can offer great support, mothers may also feel a lack of privacy. This, along with the cultural expectations of family involvement, can be overwhelming for mothers, who may feel like they cannot say anything.

Sleeping-in with your baby is very common in Sikh and Punjabi culture, and this expectation can lead to reduced sleep for mothers, which can worsen feelings of sadness or depression.

Religious Beliefs

Sikhism emphasizes the importance of “Chardi Kala” – high spirits – and accepting God’s will. This can provide support and help mothers feel grounded, but it can also make others feel guilty or weak for experiencing anxiety or depression postpartum, and feeling that they should be able to overcome these serious issues just through faith and prayer alone.