It is increasingly common to hear about new mothers suffering from postpartum blues or depression — the feeling of sadness or hopelessness a woman may have in the first few days, weeks or months after childbirth. But what about new fathers?
A study, “Postpartum experiences of first-time fathers in a Tanzanian suburb: a qualitative interview study,” conducted in Ilala Municipality, Dar es Salaam, offers an in-depth view of new fathers’ experiences with postpartum depression (PPD).
The study demonstrates that new fathers in metropolitan suburban populations in low-income countries face considerable challenges relating to health of themselves and their families.
The study was conducted in Ilala municipality, Dar es Salaam, Tanzania. Ten ﬁrst-time fathers were purposively selected using the inclusion criteria: willingness to participate, perceiving them-selves and their infants to be healthy, and living with the mother of the infant. Their infants were all born at health facilities.
The midwife helped to recruit fathers through their partners who attended reproductive and child health (RCH) clinics between four and 10 weeks post birth. The fathers’ partners were to be involved in another similar interview study. The two RCH clinics were located at a health centre and at a dispensary in Ilala. Written and oral informed consents were obtained and reassurance on conﬁdentiality was given.
• Fathers expressed joy and happiness resulting from having their ﬁrst-born infants that opened a new chapter for their lives.
• Fathers expressed concerns over increased household chores, ﬁnancial expenditure and generally increased responsibilities.
• Fathers reported that they strove to respond to partners’ and infants’ needs and that they felt frustrated and helpless when they failed.
• Fathers did not feel welcomed but rather excluded at RCH clinics and were not always allowed to be part of the mother and infant care. The health workers sometimes demanded informal payments in exchange for good service.
• The fathers were concerned about maternal and infant feeding during the postpartum period. Poverty, lack of information, partners’ work, and traditional practices were hindrances.
• The fathers who wanted to be involved in care at RCH clinics often felt excluded. The belief that RCH clinics are only for women needs to be changed in order to make the men equal partners of the programmes.
• When the mother and infant stayed with relatives, the fathers had limited time to spend with them. Some fathers made daily visits; others could not due to distance and work. They expressed concerns over missed opportunity to be present, learn about child issues and provide support.
It was concluded that these new fathers struggled to gain confidence and experience while engaging in family matters during post partum.
Changing gender roles in the suburban Tanzanian society in general and their personal experiences of transition to fatherhood both facilitated and made the postpartum period problematic. The health sector does not respond with respect to fathers’ concerns for family health and needs for support.
So what do the baby blues feel like?
For new mothers, the postpartum depression symptoms may include; Feeling sad and crying a lot, having trouble sleeping, eating or making decisions or feeling overwhelmed and feeling unable to do a good job of taking care of the baby, the sources indicate.
It is called paternal postpartum depression (PPPD) when it affects men, explains Nadia Ahmed, a psychologist and lecturer at Hubert Kairuki Memorial University in an interview with Your Health.
She says, “The condition may affect their interaction with their partners and newborns, as they often would experience irritability, emotional restriction and symptoms of major depressive disorder.”
Adding, “The phenomenon is primarily in women, and there are several biological reasons as to why it happens. However fathers can experience other mental health related issues during and after their partners have given birth as that can be a very stressful time.”
Available studies have estimated that anywhere from 2 per cent to 25 per cent of fathers are affected, hence screening new fathers for postpartum depression is as important as screening mothers, mental health specialists recommend.
Between 5 and 10 per cent of new fathers in the United States suffer from PPD, according to U.S. Centers for Disease Control and Prevention data. One study shows that the risk goes up to 24 to 50 per cent for men whose partners suffer from PPD.
According to Ms Ahmed, the risk factors for postpartum depression in new fathers include; financial difficulties, a family history of depression, also hormonal changes.
Ms Ahmed who is also the founder of Mind Matters Counselling and Human Development, further concludes that most of the postpartum depression cases are unreported and would be seen as culturally not normative especially among African men, noting that a major cause of not reporting is due to the stigma.
“Fathers with postpartum depression are also less likely than mothers to ask for help, and a lack of awareness about paternal depression could be making it more difficult for them to tackle the problem,” says Ms Ahmed.
“There is also the culture of not talking about one’s problems. Especially in our African societies,” she adds.
However, Ms Ahmed warns that the condition may affect the development of the child if one or both parents suffer from postnatal depression or other mental health-related disorders.
“Newborns are very dependent on both parents. Therefore, when one or both parents suffer from PPD or PPPD, they become unable to meet all the needs of that newborn, which in turn it affects or stunts child’s development. Therefore, both parents should be screened for the condition as it affects both genders not only the mothers,” says Ms Ahmed.
What to do to curb postpartum blues?
“The condition can happen two to three days after childbirth and can last up to two weeks. They usually go away on their own, and the victim doesn’t need any medical treatment,” says Justus August, the applied Psychologist at the Aga Khan Education Service Tanzania in an interview with Your Health.
But Mr August further advises the new fathers who are likely experiencing the condition to ask for help from their partner, family and friends in order to help them feel better.
“We do not have enough right people to confide in and keep secrets with them...they do not respect confidentiality, as they do judge, they do not have right ways to help people,” says Mr August.
A registered nurse-midwife at Arusha-based Olturumet Hospital, Ms Augusta Komba tells Your Health that she usually receives new moms who suffer from postpartum depression after childbirth, but according to her, she has never attended or received cases of PPPD linking new fathers.
“Of course, I acknowledge that postpartum depression can also occur in new male parents, but it is rare to find such cases being reported at the hospitals,” says Ms Komba who doubles as District Nursing Officer (DNO) for Arusha.
“As a nurse-midwife, I have helped a number of pregnant women who were abandoned by their partner during the pregnancy. Some men reject their female partners during pregnancy, and even when a baby is born, but this case is different from PPPD,” she adds.
However, the DNO recommends that health workers should welcome fathers and discuss strategies for good family health during postpartum period.
“Counselling couples together could facilitate their support for each other in optimising health postpartum,” advises Ms Komba.
Postpartum services in Tanzania
Traditionally, postpartum support in Tanzania has been provided by informal networks including relatives, friends and traditional birth attendants. These traditional networks might not be available in suburban areas as many new parents have migrated from their regions of origin.
Findings from aforementioned study recommends and calls for programmes on gender relations, which are supporting constructive masculinities and facilitate new fathers’ active participation and responsibilities in parenting, family health and their relations with their partners.
Previous research elsewhere has found that paternal involvement has many positive outcomes for children, such as boys displaying less hostile behaviour than children with absent dads, reduced delinquency for both sexes, considerably higher IQ scores for children in their early development years, and lower levels of emotional distress.
That is on top of studies showing fathers who suffer from PPD report lower levels of communication with their partners, as well as increased rates of substance abuse and domestic violence, sources say.
Lastly, interviewed experts and studies recommend that health workers should welcome fathers and discuss strategies for good family health during post partum. Counselling couples together could facilitate their support for each other in optimising health post partum.