Over recent years, researchers have found evidence which indicates that the prevalence of postpartum depressive symptoms crosses cultural boundaries and is reported to be at least as high in non-Western countries as in Western countries. However, qualitative studies about new mothers' experiences from non-Western countries, such as Bangladesh, are rare, particularly in rural areas. This study aims to describe the experiences and concerns of rural Bangladeshi mothers with postpartum depressive symptoms. Open narrative interviews were conducted with 21 mothers with depressive symptoms 2-3 months postpartum, consecutively selected from a longitudinal study about prevalence and risk factors of perinatal depressive symptoms. Inductive content analysis was used to analyse data and three themes emerged: family dynamics, living at the limits of survival, and role of the cultural context after childbirth. These themes were based on six categories and 15 subcategories. The findings show that troublesome family relationships, including intimate partner violence and violence in the family, influenced the mothers' mental well-being. They and their families lived at the limit of survival and the mothers expressed fear and worries about their insecure situation regarding economic difficulties and health problems. They felt sorry for being unable to give their infants a good start in life and sad because they could not always follow the traditional norms related to childbirth. Thus, it is important to focus on the depressive symptoms among new mothers and offer counselling to those showing depressive symptoms, as the cultural traditions do not always alleviate these symptoms in the changing Bangladeshi society today.
Background The prevalence of intimate partner violence (IPV), a gross violation of human rights, ranges widely across the world with higher prevalence reported in low- and middle-income countries. Evidence related mainly to physical health shows that IPV has both direct and indirect impacts on women's health. Little is known about the impact of IPV on the mental health of women, particularly after childbirth. Objective To describe the prevalence of IPV experienced by women 6-8 months after childbirth in rural Bangladesh and the factors associated with physical IPV. The study also aims to investigate the association between IPV and maternal depressive symptoms after childbirth. Design The study used cross-sectional data at 6-8 months postpartum. The sample included 660 mothers of newborn children. IPV was assessed by physical, emotional, and sexual violence. The Edinburgh Postnatal Depression Scale assessed maternal depressive symptoms. Results Prevalence of physical IPV was 52%, sexual 65%, and emotional 84%. The husband's education (OR: 0.41, CI: 0.23-0.73), a poor relationship with the husband (OR: 2.64, CI: 1.07-6.54), and emotional violence by spouse (OR: 1.58, CI: 1.35-1.83) were significantly associated with physical IPV experienced by women. The perception of a fussy and difficult child (OR: 1.05, CI: 1.02-1.08), a poor relationship with the husband (OR: 4.95, CI: 2.55-9.62), and the experience of physical IPV (OR: 2.83, CI: 1.72-4.64) were found to be significant predictors of maternal depressive symptoms among women 6-8 months after childbirth. Neither forced sex nor emotional violence by an intimate partner was found to be significantly associated with maternal depressive symptoms 6-8 months postpartum. Conclusions It is important to screen for both IPV and depressive symptoms during pregnancy and postpartum. Since IPV and spousal relationships are the most important predictors of maternal depressive symptoms in this study, couple-focused interventions at the community level are suggested.
Intimate partner violence (IPV) during the first year postpartum is common in Bangladesh, and many infants are exposed to hostile and aggressive environment. The aim of the current study was to investigate how IPV (physical, emotional, and sexual) impacts on the mother's perception of her infant's temperament 6 to 8 months postpartum, and whether maternal depressive symptom at 6 to 8 months postpartum is a mediator in this association. A total of 656 rural Bangladeshi women and their children 6 to 8 months postpartum were included in this study. Data were collected by structured interviews. The women were asked about physical, sexual, and emotional IPV; depressive symptoms (Edinburgh Postnatal Depressive Symptoms [EPDS]); and their perception of infant temperament assessed by the Infant Characteristic Questionnaire (ICQ). Descriptive analyses were conducted for prevalence of IPV and maternal depressive symptoms. Mediation analysis was conducted with a series of linear regressions with types of IPV as independent variables, ICQ including its subscales as dependent variables and maternal depressive symptoms as potential mediator. All the analyses were adjusted for the woman's and her husband's ages and number of children of the couple. Nearly 90% of the mothers reported some kind of IPV at 6 to 8 months postpartum. All types of IPV were directly associated with the mother's perception of her infant as unadaptable. Maternal depressive symptom was a mediating factor between physical IPV and the ICQ subscales fussy-difficult and unpredictable. In addition, depressive symptoms mediated between sexual and emotional IPV, and the mother's perception of the infant as unpredictable. The results showed that IPV influenced how mothers perceived their infant's temperament. It is important that health care professionals at maternal and child health services enquire about IPV with possibilities to refer the family or the mother and infant for appropriate support.