Abstract
Background: Traditional postpartum practices intend to provide care to mothers, but there is mixed evidence concerning their impact on postpartum depression (PPD). It remains unknown if there is a unique impact of postpartum practices on PPD separately from other social support, or if practices differentially affect those with prenatal depression. This study aims to understand if chilla (چ له), a postpartum practice in Pakistan defined by receiving relief from household work, familial support, supplemental food, protects against PPD independent of other support and whether this varies by prenatal depression. Methods: Data come from the Bachpan cohort study in Pakistan. Chilla participation and social support were assessed at three months postpartum. Women were assessed for major depressive episodes (MDE) and depression symptom severity in their third trimester and at six months postpartum. Adjusted linear mixed models were used to assess the relationship between chilla participation and PPD. Findings: Eighty-nine percent of women (N=786) participated in chilla. In adjusted models, chilla participation was inversely related to MDE (OR=0·56;95%CI=0·31,1·03) and symptom severity (Mean Difference (MD)=-1·54;95%CI: -2·94,-0·14). Chilla participation was associated with lower odds of MDE (OR=0·44;95%CI=0·20,0·97) among those not prenatally depressed and with lower symptom severity among those prenatally depressed (MD=-2·05;95%CI:-3·81,-0·49). Interpretation: Chilla is inversely associated with MDE and symptom severity at six months postpartum. Interventions aimed at preventing and treating PPD should consider the potential benefits of chilla and similar postpartum practices. Funding: NICHD (R01-HD075875) and NIMH (U19MH95687) supported this study. The Carolina Population Center provided training (T32-HD091058) and general support (P2C-HD050924). Declaration of Interest: The authors have no conflicts of interest to disclose. Ethical Approval: This study was approved by institutional review boards at the Human Development Research Foundation (HDRF), the University of North Carolina at Chapel Hill, and Duke University.
Highlights
Traditional postpartum practices are intended to provide care to mothers, but there is mixed evidence concerning their impact on postpartum depression (PPD)
Though postpartum practices in Asian cultures are intended as supportive mechanisms for new mothers and the baby, there is mixed evidence concerning the impact of postpartum practices on PPD
Study design and participants Data come from the Bachpan study, a cluster randomized perinatal depression trial nested in a longitudinal birth cohort in rural Pakistan
Summary
Traditional postpartum practices are intended to provide care to mothers, but there is mixed evidence concerning their impact on postpartum depression (PPD). Postpartum practices are richly documented in Asian, Hispanic, African, and Jewish cultures and are described by anthropologists and cultural psychiatrists as customs that “mother the mother” through formalized social support [1, 3,4,5] They are intended to provide care to mothers by limiting their household activities, providing a special diet, taking care of their needs, and easing their transition into motherhood [1]. Such practices may have long term benefits on maternal and infant health, including maternal mental health, and need to be considered when thinking about protections against postpartum depression (PPD) [1, 4, 6]. Though postpartum practices in Asian cultures are intended as supportive mechanisms for new mothers and the baby, there is mixed evidence concerning the impact of postpartum practices on PPD
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