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Reclaiming the joy of motherhood

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Pursat Province

A new study on maternal mental health suggests poverty, other economic factors contribute to rising rates of depression among Cambodia's new or expecting mothers

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ELEANOR AINGE ROY

Thorn Limly, 25, sits with her third child, delivered after a day and two nights in labour. Her mother and two-year-old daughter are behind her. 

MATERNITY wards can conjure images of joyful mothers clutching snugly wrapped newborns and basking in the warmth of the life they've delivered after a painful struggle.

However, at Pursat General Hospital the struggle has just begun for many new mothers, whose emotional suffering lingers long after the physical pain of childbirth has ebbed.

A recent study on mental illness among expecting and new mothers discovered that 20 percent of women - almost exclusively poor women - suffer some form of depression or anxiety during pregnancy and in the first six months after giving birth.

Mental health experts say by 2020 depression could be the second-most widespread global disease, and the situation in Cambodia will be no exception, where health indicators are among the worst in Southeast Asia.

The study, funded by the NGOs Reproductive and Child Health Alliance, Voluntary Services Overseas and Transcultural Psychosocial Organisation, identified links between mental health problems in mothers and low birth weights and poor infant growth in their children.

Researchers in Pursat province interviewed 297 women for the study, many of whom provided candid details about the depth of their depression.

Social factors

Seap Srey Neang, 24, recently gave birth to her first child. She lives in the isolated commune of Phteah Prey in Pursat province and has been married for one year. Her husband spends most of each day looking for work.

"Throughout this pregnancy, I have been mostly unhappy. I had heard that it was very difficult to deliver a baby and I was scared. Now that I have the baby in my arms, I think I am even more scared," she said.

Seap Srey Neang said economic matters weigh most heavily on her mind.

I HAVE  THIS CHILD NOW, AND I JUST DON’T KNOW WHAT TO DO.

"I don't know how I am going to support this child because my husband and I cannot even properly feed ourselves. I am worried that if the child gets sick we won't have the money for treatment. For the last three months I have had trouble sleeping and I don't feel like eating very much. I have this child now, and I just don't know what to do."
The troubles facing Seap Srey Neang are among the most common cause for maternal depression and anxiety, the report found. The leading cause is poverty, followed by unplanned pregnancy and a stressful life event, typically the loss of a job.

Respondents to the study who suffered the job loss of a family member were nine times more likely to suffer depression than those who did not.

Misconceptions

Krouch Chanthy, 41, has delivered babies for 20 years in the stark, disinfectant-tinged atmosphere of Cambodia's maternity wards.

She has had no mental health training and said the emotional well-being of her patients is not her concern.

"Depression? What is depression?" she asked. "Many of the women who come in here are scared, but that is normal. Having a baby is a very difficult thing. I don't really like to talk to my patients about their feelings and worries, though if they asked me, I would listen."

Pursat hospital's maternity ward is at capacity as Krouch Chanthy wends her way through the crowd of soon-to-be mothers who will be whisked to a sterile recuperation room after delivery for a few hours' rest, and then on to a packed general ward equipped with beds made of wooden slats.

Thorn Limly, 25, recently delivered her third child. Her husband is a fisherman, and the pregnancy was unplanned. To pay for the hospital fees, Limly was forced to borrow US$75 from a neighbour.

Now she is anxious about how she will repay the debt, particularly because of the high interest rate the neighbour is charging for the loan.

"Whenever I'm pregnant, I am not happy because I worry we haven't got enough money. I had to borrow money ... to give birth, and how will I repay him? The only way I can see is to give him some of our rice crop at harvest time. But then, what will we eat ourselves?"

The maternal mental health study in Pursat was undertaken, the researchers say, to gauge a potential risk to society, not to establish a current trend.

It identified low birth weights and slow infant growth were highest in babies from the depressed group of mothers, as mental distress interfered with mothers' ability to follow pre- and postnatal care instructions and saw them shy away from seeking help or advice.

Mental health services in Cambodia have only been available in the last 16 years. The Kingdom has only 26 psychiatrists and 45 psychiatric nurses nationwide - approximately one psychiatrist for every 625,000 people.

Mental health services are also only available in 10 of the country's 24 provinces and municipalities.

Cambodia has no specific maternal mental health programs in operation and little collaboration between reproductive health and mental health services.

Without such services, experts predict an increasingly bleak outlook for a growing number of Cambodia's young mothers.

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