Postpartum depression: When the baby blues don’t fade

Motherhood is supposed to bring joy. Instead, for many women in Bangladesh, it ushers in sleepless nights, crushing isolation, and a mental health crisis that often remains hidden behind smiles and baby photos.

For Yeasmin Mustary Badhan, a clinical psychologist, that crisis began even before her child was born. Married in January 2023 and pregnant by April, she faced criticism from family members who believed she should have waited longer to have a child. By her sixth month of pregnancy, severe physical discomfort left her feverish and in tears. When her baby arrived prematurely, the support she expected never came.

Left to care for a newborn largely alone with her husband, Badhan found herself overwhelmed by criticism rather than practical help.

“Instead of lecturing me on how to put the baby to sleep, what I really needed was for them to actually take the baby and put them to sleep themselves,” she recalls.

The physical and emotional toll was immense. Caring for her child and managing household responsibilities caused her episiotomy stitches to tear repeatedly, while exhaustion affected her memory and emotional resilience.

Recovery came only after treating a severe vitamin deficiency, seeking psychiatric support, and cutting ties with toxic relatives.

Badhan survived. Many women do not recover so easily.

Across Bangladesh, postpartum mental health struggles continue to collide with family pressure, social stigma, cultural misconceptions, and a healthcare system ill-equipped to respond.

Two different realities of motherhood

For generations, maternal distress after childbirth was brushed aside as simple mood swings, “tantrums,” or the inevitable “baby blues” experienced by new mothers.

Recent research, however, paints a far more alarming picture.

A landmark national study titled “The Burden of Postpartum Depression and Its Socio-Demographic and Obstetric Correlates Among Parturient in Bangladesh”, published in the international journal PLOS Mental Health in 2025, revealed postpartum depression (PPD) to be one of the country’s most neglected public health challenges.

Conducted by researchers from the Institute of Epidemiology, Disease Control and Research (IEDCR), the study screened 540 women between 4 and 12 weeks after childbirth. Participants were selected from primary, secondary, and tertiary healthcare facilities to provide a representative national snapshot.

The researchers found an overall postpartum depression prevalence of 47.78 percent, nearly half of the surveyed women. Even more concerning, almost 30 percent of women met the clinical threshold for major depression.

The findings align with the “Postpartum Depression in Bangladesh: A Comprehensive Report” (2026) compiled by R.A.V.E.N. Research Intelligence.

While rural communities generally reported prevalence rates between 18 and 24 percent, urban slums and hospital-based surveillance studies documented rates ranging from around 40 percent to more than 60 percent.

Dr. Murtaza Zakiul Abrar, Cognitive Behaviour Therapist and Conflict & Crisis Intervention Specialist, explains that the symptoms of PPD extend well beyond occasional sadness. Women experiencing PPD may struggle with persistent low mood, lose interest in activities they once enjoyed, and experience overwhelming guilt, irritability, anger, hopelessness, suicidal thoughts, as well as significant disruptions in sleep and appetite.

“These debilitating symptoms are directly linked to altered neurotransmitter functions in the brain, specifically involving serotonin and dopamine,” he added.

Why cities report more depression than villages

The burden of postpartum depression does not manifest uniformly across Bangladesh.

According to Dr. Zakiul, clinical depression appears more frequently in urban settings, where mothers face intense social expectations, isolated nuclear family structures, and an overwhelming flood of often contradictory parenting advice from television, social media, and online forums.

Rural communities, meanwhile, present a different picture.

Many women adopt what Zakiul describes as a form of “radical acceptance” of hardship. Generations of social conditioning have normalized suffering to such an extent that many women do not identify their emotional distress as a medical problem. As a result, depression may remain underreported even when psychological suffering remains severe.

Sakila Yesmin, a faculty member and research lead at BRAC Institute of Educational Development (IED), argues that the issue remains profoundly neglected by both policymakers and healthcare administrators.

“There is a pervasive, damaging belief among the public and healthcare administrators that the condition will automatically heal,” she says.

She said postpartum depression is closely associated with poverty, domestic violence, marital conflict, and extramarital relationships among low-income households and urban slums.

For many mothers, the struggle is inseparable from the daily fight for survival.

Rabeya Khatun, a mother of two from Jhalokathi, had no time to rest each day after her delivery. The 22 year old’s mother-in-law said the pain is a woman’s fate.

“If I sit down to cry, my husband says I am lazy and trying to avoid chores”, she said.

Yet experiences differ dramatically across households.

Helen Sultana, a 27-year-old mother from Kurigram, said she never recognized postpartum distress as a distinct condition.

“I had no problem dealing with my kid as relatives used to come and take care of him and as time went I got habituated with the crying, sleepless nights and tantrums.”

The contrast reveals a critical reality: support systems matter.

Among wealthier women, the triggers often look different. Career interruptions, identity loss, and fears of falling behind professionally or socially can become major sources of anxiety and depression.

The consequences extend far beyond mothers themselves.

Sakila said a depressed mother often undergoes an involuntary emotional detachment, leading to the unintentional neglect of her infant’s basic needs for bathing, feeding, and structured sleep.

“This early relational trauma actively hinders the infant’s critical brain development, creating cognitive and behavioral vulnerabilities that can last a lifetime”, she said.

While some women recover within weeks when surrounded by strong emotional support, untreated postpartum depression can persist for six months or even a year.

“Eventually,” she warns, “it can morph into a chronic, life-long threat to the mother’s mental stability.”

Rural superstitions and the lost refuge of ‘Atur Ghor’

Many women continue to rely on traditional healers or kabiraj for pregnancy and postpartum complications.

Some cultural practices support maternal well-being. Others contribute to dangerous delays in seeking medical treatment.

These beliefs become particularly dangerous when postpartum mental illness enters the conversation.

In many communities, severe behavioral changes after childbirth are still interpreted as spiritual possession or “jinn-er achor.”

Mental health professionals argue that understanding postpartum depression requires understanding childbirth itself.

During pregnancy, the body sustains extraordinarily high levels of hormones such as progesterone for nearly ten months. Once the placenta is delivered, these hormone levels drop dramatically.

Historically, Bangladeshi society unintentionally created a buffer against this biological vulnerability through the tradition of the atur ghor.

The atur ghor was a secluded space where mothers and newborns spent approximately 40 days after childbirth. While modern public health experts criticize the practice for its poor hygiene standards, it provided one undeniable benefit: rest.

Family members assumed responsibility for cooking, caregiving, and household work, allowing mothers time to recover physically and emotionally.

Today, the atur ghor has disappeared, without offering any alternative.

Afia Iffat, 32, mother of a one-and-a-half-year-old child, said whenever she complained about her complications, her mother and relatives told her they also gave birth and never faced any problems.

“They say I’m just acting”, she said.

When depression crosses into Psychosis

Dr. Helal Uddin Ahmed, Associate Professor of Child, Adolescent & Family Psychiatry at the National Institute of Mental Health & Hospital, categorised postpartum conditions into three distinct types: baby blues, postpartum depression (PPD), and postpartum psychosis.

“While baby blues are normal physiological emotional changes that resolve without intervention, PPD is a severe depressive illness affecting 15 percent to 35 percent Bangladeshi mothers, Postpartum Psychosis is a far rarer but catastrophic clinical emergency, occurring in 1 to 2 mothers out of every 1,000 live births”, he said.

Driven by severe neurochemical disruption and profound sleep deprivation, mothers affected by psychosis may experience hallucinations and delusions. Some become convinced their child is evil, possessed, or has been replaced by another infant. Others perceive their baby as a threat.

Such distorted beliefs can lead to infanticide.

Helal recalls witnessing one such tragedy during his time at the National Institute of Mental Health and Hospital (NIMH), where a mother killed her child within eight days of birth.

Zakiul cautions that such tragedies rarely emerge from a single cause.

Financial hardship, son preference, intense maternal anxiety, and the absence of support from husbands often converge, pushing vulnerable mothers toward a breaking point.

Building a system that protects mothers

Experts agree that Bangladesh’s current approach is failing women.

A mother identified as severely depressed is often given nothing more than a verbal referral to a distant specialist facility that may be financially or geographically inaccessible.

Studies show Bangladesh has less than one psychiatrist per 100,000 people.

Experts suggest postpartum depression screening should be integrated into routine postnatal care and child immunization programs. Frontline health workers should be trained to identify symptoms and provide basic psychological support through evidence-based interventions.

Helal said, “Many seminars related to postpartum depression have taken place across the country, but they have not reached the right audience yet.”

He further recommends compulsory prenatal and postnatal counseling sessions for husbands and family members so they can better understand the emotional realities of childbirth and provide meaningful support.

Science is no longer in doubt. What remains uncertain is whether the country is prepared to treat maternal mental health as the national public health emergency it has become.

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