1. Each year, nearly 200,000 women die after delivery
The World Health Organisation reported in 2014 that, worldwide, an estimated 289,000 women die from “complications related to pregnancy, childbirth or the postnatal period.” Two-thirds of these (almost 200,000) occur after the baby has been delivered. Because of this, or in spite of this, WHO states that: “Compared with other maternal and infant health services, coverage for postnatal care tends to be relatively poor.”
The disparity between high- and low-income countries on this front is striking. WHO estimates that in high-income countries the risk of death is one in 3,400, while in low-income countries it's one in 52. In 2013, the organisation found that 99% of maternal deaths occurred in developing countries. The sub-Saharan Africa region accounts for 62% of this figure, where the leading cause of maternal death is postpartum haemorrhage.
2. In the Democratic Republic of the Congo, only 35% of women receive postnatal care
While in Kenya, fewer than 20% of women use postnatal care services. WHO identifies the contributing issues as being “[a] lack of education, poverty and limited access to health care facilities.” Women who had access to secondary education were found to be more likely to use postnatal care, as were those who were more financially stable, and those who lived in urban areas.
3. In low-income countries, 15% of women develop potentially life-threatening problems after birth
WHO found that in 2015: “births in the richest 20 per cent of households were more than twice as likely to be attended by skilled health personnel as those in the poorest 20 per cent of households.” Millions of women have no medical assistance as they give birth, leading to long-term health complications. Postnatal care is, at this point, crucial – but few women in low-income countries are able to access it, often with fatal results.
Lack of education, financial stability and access to health centres aren't the only issues faced by women in low-income countries. These areas have often been subject to conflict, political unrest and natural disaster.
4. In 2012, birth trauma was the seventh largest killer in Afghanistan
Among the top ten causes of death in Afghanistan, birth trauma kills more people than both tuberculosis and road injuries. It has widely been reported how unsafe the country is for pregnant women, and maternal deaths may be worse than current figures suggest.
5. In the US, routine postnatal care usually consists of just one visit with a doctor
WHO recommends that a woman not only receives postnatal care within the first 24 hours of birth, but also that she has three more visits with a doctor or midwife. And yet in the US, women routinely have just one medical visit six weeks after birth.
Alison Stuebe, a researcher on the Fourth Trimester Project, says that: “The baby is vulnerable and precious and has resources devoted to it, and American culture doesn’t appreciate that the mother is recovering from a process.” Her colleague, Kristin Tully, pointed out one negative consequence of this. “Women don't know the range of what’s normal, when to seek guidance, and whom to ask."
Women in the UK also receive just one postnatal check, and not all GP surgeries offer it routinely.
6. In the UK, a third of mothers feel they're discharged from hospital too soon
In 2014, the Royal College of Midwives discovered that 40% of women were discharged from hospital before they were ready to leave. This survey also found that only a third of midwives felt they had enough time to review postnatal care plans. In addition, many women report being passed onto health visitors after just three midwife visits – a cause for concern, given that they don't have the same level of training in maternal healthcare.
“The continuing shortage of midwives particularly in postnatal care […] means that organisational needs are preventing midwives giving care based on clinical need," Cathy Warwick, chief execute of the Royal College of Midwives, said. “Women are not getting the best possible postnatal care. This can have a massive impact on the health and wellbeing of the mother and her baby after the birth and well into the future.”
She went on: ”We are seeing women being discharged earlier without adequate support. This leads to readmissions and more cost to the NHS. It is a false economy.”
7. 58% of UK mothers with PND do not seek medical help
When charity 4Children did a survey on new mothers, they discovered that over half of the women with PND did not go to their doctor. The NHS reports that this: “was often due to them not understanding the condition, or fearing the consequences of reporting the problem.”
In the survey, the most popular reason for not seeking help was found to be “thinking [that] it was not serious enough to warrant professional treatment”, followed by the fear of what would happen if the women told someone. The report recommended a campaign to generate awareness of the symptoms of PND, which could also eradicate the stigma surrounding it.
8. Internationally, this figure is estimated to be around 80%
WHO has estimated that 300 million women suffer worldwide from postnatal depression. But in areas like West Africa, mothers are often unable to get help. Katherine J Gold, a specialist in the study of postnatal depression in West Africa's women, explained: “Physicians in sub Saharan Africa usually have access to basic medications used to treat depression, but patients may not be able to pay for those medications, especially on an ongoing basis. If there are limited resources, mental health usually ends up taking a back seat to acute physical illness.”
In a 2014 consensus of Guinea, it was found that there were just four psychiatrists serving a population of over 12 million people.
One study estimated that, worldwide, 80% of women do not seek help for postnatal depression. The stigma of mental health was cited as a key reason.
9. In Japan, suicide is the leading cause of death among new mothers
It was recently reported that, in the year after childbirth, suicide is the leading cause of maternal death in Japan. Between 2015 and 2016, 92 women took their lives after giving birth. Kenji Takehara, a researcher who conducted the study, said that: “In general, new mothers are discharged from the hospital in the second week after giving birth and are particularly anxious about their ability to raise their child.”
Leader of the research team, Rintaro Mori, added: “Staff at birthing facilities, paediatric departments and local governments should work together to spot early signs of mothers experiencing declining mental health, and give them community-wide support.”
10. Poorer women are 11 times more likely to develop PND
If you are from a lower-income background, studies show that you're more likely to develop postnatal depression. A sample of nearly 200 new mothers found that those who had four socioeconomic risk factors (having a low income, no university education, being unemployed or unmarried) were 11 times more likely to suffer from PND.
The study explains that: “Low socioeconomic status is often associated with a lack of social support, low self-esteem, younger age, and an absence of spousal financial and social support.”
How can I help?
There are charities dedicated to improving postnatal care around the world: