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Maternal Depression in Rural Pakistan: The Protective Associations with Cultural Postpartum Practices

21 Pages Posted: 8 Mar 2019

See all articles by Katherine LeMasters

Katherine LeMasters

University of North Carolina (UNC) at Chapel Hill - Department of Epidemiology

Nafeesa Andrabi

University of North Carolina (UNC) at Chapel Hill - Department of Sociology

Lauren Zalla

University of North Carolina (UNC) at Chapel Hill - Gillings School of Global Public Health

Ashley Hagaman

University of North Carolina (UNC) at Chapel Hill - Carolina Population Center

Esther O. Chung

University of North Carolina (UNC) at Chapel Hill - Department of Epidemiology

John A. Gallis

Duke University - Department of Biostatistics and Bioinformatics

Elizabeth L. Turner

Duke University - Department of Biostatistics and Bioinformatics

Sonia Bhalotra

University of Essex

Siham Sikander

Human Development Research Foundation (HDRF)

Joanna Maselko

University of North Carolina (UNC) at Chapel Hill

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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.

Keywords: postpartum, depression, practices, support, Pakistan

Suggested Citation

LeMasters, Katherine and Andrabi, Nafeesa and Zalla, Lauren and Hagaman, Ashley and Chung, Esther O. and Gallis, John A. and Turner, Elizabeth L. and Bhalotra, Sonia and Sikander, Siham and Maselko, Joanna, Maternal Depression in Rural Pakistan: The Protective Associations with Cultural Postpartum Practices (March 6, 2019). Available at SSRN: https://ssrn.com/abstract=3347899

Katherine LeMasters (Contact Author)

University of North Carolina (UNC) at Chapel Hill - Department of Epidemiology ( email )

Chapel Hill, NC 27599
United States

Nafeesa Andrabi

University of North Carolina (UNC) at Chapel Hill - Department of Sociology ( email )

Chapel Hill, NC 27599
United States

Lauren Zalla

University of North Carolina (UNC) at Chapel Hill - Gillings School of Global Public Health ( email )

Chapel Hill, NC 27599
United States

Ashley Hagaman

University of North Carolina (UNC) at Chapel Hill - Carolina Population Center ( email )

CB# 8120, University Square
123 West Franklin St.
Chapel Hill, 27599-2524
United States

Esther O. Chung

University of North Carolina (UNC) at Chapel Hill - Department of Epidemiology ( email )

Chapel Hill, NC 27599
United States

John A. Gallis

Duke University - Department of Biostatistics and Bioinformatics ( email )

Durham, NC 27708
United States

Elizabeth L. Turner

Duke University - Department of Biostatistics and Bioinformatics ( email )

Durham, NC 27708
United States

Sonia Bhalotra

University of Essex ( email )

Wivenhoe Park
Colchester, CO4 3SQ
United Kingdom

Siham Sikander

Human Development Research Foundation (HDRF) ( email )

Rawalpindi
Pakistan

Joanna Maselko

University of North Carolina (UNC) at Chapel Hill ( email )

102 Ridge Road
Chapel Hill, NC NC 27514
United States

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