Cultural Barriers for South Asian Mothers

Jaccha-baccha dono theek hain 

(Translation: Mother and baby are both fine.) 

This is the most common line the doctor or nurse says to the family members waiting outside the delivery room. This usually only accounts for physical health, but what about mental health? 

As a mental health practitioner, mothers often tell me “Nobody really asked how I felt” or “Would it be right to feel sad when my child was born?” This year’s World Mental Health Day theme is “Lived experiences heard: real voices, real change”. But how will a mother be heard if nobody asks her? 

Reviews of Indian studies put postpartum depression at roughly one in five mothers (19 to 23.5 per cent), though many of these studies used screening questionnaires, not a clinical diagnosis. So how come such a common experience is treated with silence and stigma? In many families I work with, stress is seen as part of the normal routine, and acknowledging it can signal weakness. Women are raised to view everything as their duty and responsibility, which sometimes makes them normalise distress until it becomes unmanageable. 

These perceptions can be observed across South East Asia and other collectivistic societies. It takes a village to raise a child but sometimes that village can feel overwhelming too. With it comes unsolicited advice passed on with the label of experience: “We have also raised kids. Cover your head, don’t go out for 40 days, don’t eat this, don’t overreact.” Although this advice may be given with “good intent”, the pressure to conform can reinforce a lack of autonomy and subtly teach a mother that sacrifice is a normal part of her identity. 

One of the most common cultural barriers, which I heard both as a new mom and in my practice, was “Shukrana karo” (be grateful).  When a mom raises a concern, she might hear, “What do you have to be sad about? You have all the help, and you wanted this child.” Slowly she begins to doubt whether she is even allowed to feel anything but happiness. But in reality, a mom’s gratitude and love for her baby does not stop her from experiencing physical and emotional exhaustion.

These experiences carry valuable lessons about community support and culturally-sensitive care for mothers.

First and foremost, a mother needs to be given a chance to find herself again among all the internal and external voices. While it’s important to involve families in maternal healthcare, it’s also crucial to preserve a mother’s authority over her decisions. Her “village” needs to build a safe space for her to normalize expressing her battles and triumphs. It could begin with letting her use uncomfortable words such as “distressing” or “traumatic”, rather than covering up her experience under more palatable terms such as “being tired”.

Secondly, members of the family and community should be taught about postpartum depression and other common perinatal mental health conditions. They should be able to recognise the signs that signal immediate help, such as talk of self-harm, confusion, or seeing or hearing things that are not there. In trials in Goa and Pakistan, trained peers delivering the Thinking Healthy Programme helped more mothers recover. 

The WHO recommends screening every mother for depression and anxiety with a tested questionnaire, and assessing and treating those who screen positive. India had no national maternal mental health programme as of a 2023 review, but Kerala’s Amma Manasu already screens mothers through public health nurses at routine antenatal and postnatal visits. The conditions for screening matter. Screening should take place at routine visits, in the mother’s own language, with the family out of the room, and with a trained interpreter where there is a language barrier. 

Furthermore, translating a questionnaire may not be enough to identify challenges. Many mothers will not say they have “depression,” so a diagnosis can be hidden by the unique ways cultures use language. Service providers should explore the deeper meaning of a mother’s words and keep asking her how she is feeling even after the six-week check. Mothers may say they are tired, that they feel weak, that their body aches, or that they have “tension” - a word used across South Asia for anything from everyday stress to severe distress.  

Service providers should also be aware of the cultural differences that create barriers. Some South Asian women in intergenerational homes may not have privacy for calls or letters from services. And in other cases, mothers experience stigma, mistrust, fear that their baby could be taken away, and a lack of awareness about what services exist.

When a woman begins her transition into a new identity as a mother, she doesn’t stop being a wife, a daughter or a sister. And that version of her also deserves to be cared for. Sometimes the simplest things, like feeling heard and being seen, can heal the parts of her that feel lonely. 

While we are busy wondering whether the baby has slept or eaten well, we most definitely need to observe the silent battles that mother could be facing. While the world focuses on making her a better parent, we need to move our vision towards including mental healthcare in maternal care, and stop treating it like a luxury. 

Her birth as a mother needs to be acknowledged and celebrated, just like the baby’s. 

Because she was also born that day.

Learn more about Dr Rati Khurana.