Postpartum Depression: Between Social Denial and Economic Hardship

Postpartum depression (PPD) is different from the baby blues in terms of both duration and intensity. While baby blues are a temporary phase of sadness and irritability which generally occurs a few days after childbirth, PPD may appear two to eight weeks after childbirth and last up to a year. As Dr. Stuebe notes, “One of the important things about postpartum depression is it's not just feeling sad.” It often entails intense anxiety alongside other serious symptoms.

A Painful Realization

In June 2022, the “Women and Feminists” workshop was organized at the FES School of Feminism by the Algerian Feminist Journal (JFA). Many questions were asked during this workshop, among which was the following: Where does our feminism come from? I said that it came from my reality and that of women around me. Our feminism emerges from the “why” that torments each one of us. Why was I subjected to violence? Why was my neighbor raped by her husband? Why did my mother experience so much brutality in her lifetime?

I was also asked about my feminist project, and I said that it was to “popularize postpartum depression.” Here as well, I asked myself why. Why did my mother hate me? Why did everyone tell me that I was the daughter of a mad woman? Why was my mother admitted to a psychiatric hospital two to three times a year? Why did she think everyone looked at her in a strange way at work? Why did she quit her job? Why did she choose to live in such a precarious situation?

Madness Is Not a Diagnosis

At 23 years old, my mother watched me come to this world premature and too small to survive, according to doctors. The first two days after childbirth were difficult for her. She could not bring herself to touch me and did not want to come near me. Distressed and lost, what awaited her outside the hospital would not make the situation any better. Rejected by her in-laws as well as her own family, she lacked support and a point of reference. My birth did not improve things: she had hoped she would have a boy, or at least a healthy fair-skinned daughter, as she would often say.

At a very young age, I understood that she had never loved me. I often asked myself why, but the only answer I ever got was: “She’s sick. Your mother is mad.” No one understood that she was suffering from undiagnosed PPD which was evolving to schizophrenia.

My mother was 28 when she got divorced. She then found herself alone, without family or a job, and most importantly, without a diagnosis. She was suffering from an illness she didn’t know existed. Without any family support, she decided to attend a training to become a Medical Secretary and soon found a job at a public hospital. My mother, who could not take care of herself, was now working in a sector where she would have to take care of others and lift up their moods. In Algeria, the public administration sector, as well as the trade and services sectors include a large share of working women amounting to 89.9%.  These sectors mainly hire women, and most importantly, underpay them.

My mother made 30,000 DZD per month, a salary that allowed her to feed herself and buy some clothes. Unfortunately, she was suffering from undiagnosed PPD which had evolved to schizophrenia. “In postpartum psychosis, depression may be combined with suicidal or violent thoughts, hallucinations, or bizarre behavior. Sometimes postpartum psychosis includes a desire to harm the baby” (MSD Manual). Due to this new illness, work had become an unbearable responsibility for her. She took long-term sick leaves justified by her frequent psychiatric hospitalizations and the side-effects of her treatment (physical weakness, fatigue, etc.). She was now alone at home and receiving a minimum wage of 17,000 DZD per month.

Silenced and Neglected

PPD is rarely discussed in Algeria, and is often referred to as madness or dementia, among other names. The Algerian family does not understand that a mother’s rejection of her child, her chronic fatigue, her anxieties and confusing behavior stem from an illness. Existing medical structures prioritize the baby's health over the mother's, neglecting postpartum follow-ups.

The lack of social awareness and of a public health policy covering a free and mandatory medical psychological follow-up for mothers exacerbates the marginalization and abandonment of these women, whose illness is often ignored by those around them. PPD affects not only the mother but her entire family.

The Struggle for Work

“Women’s employment rate in Algeria was 12.9%”, noted Economist Mouloud Hedir, as reported by El Moudjahid newspaper on March 6th 2022. On the other hand, UNESCO states that 63% of higher education graduates in Algeria are women. This reality reflects the ongoing struggle of Algerian women in the workforce. While it is challenging for women graduates to secure jobs that provide financial stability, one can only imagine the compounded difficulties faced by women coping with illnesses such as PPD, navigating multiple challenges every day.

The women I discussed this topic with, who have PPD, admitted that finding a job was extremely challenging for them. Without the support of a relative, friend, or partner, they often lacked the energy and ability to start a new career or return to a previous job to secure some financial agency. They felt incapable of managing the pressure and stress of work. In the case of the two women I met, they found themselves alone after their divorce, opting to retain custody of their children and support them independently. They managed to secure a housekeeping job that paid them 2,000 DZD per house, an amount that would not even allow them to rent an apartment. As a result, they were compelled to return to their parents' home, where they and their children were not fully accepted and were perceived as a significant burden.

From Awareness to Action

PPD is a major public health issue which requires urgent attention. If we are able today to talk about manic depression, bipolar disorder, schizophrenia, and other psychiatric illnesses, we can break the silence surrounding PPD. Individuals suffering from psychiatric disorders benefit from medical follow-ups and social security, and work in different economic sectors. Their ability to lead a more or less manageable life is due to the treatments, reception, easy diagnosis and popularization of psychological and psychiatric illnesses.

The professional growth of new mothers can be facilitated first and foremost by recognizing PPD as a public health issue. It’s important to train healthcare professionals to detect PPD symptoms and support women. Awareness must also be raised among Human Resource personnel to create conscious and understanding environments for new mothers returning to their careers.  

Investing in public health policies for PPD prevention and treatment can bring positive economic impacts for families and society. By supporting mothers to achieve financial independence, they can better support themselves and their children in a system that often lacks essential services like housing and healthcare. Creating supportive work environments that accommodate workers' needs ensures mothers avoid experiencing oppression and instability. PPD represents not only a health concern but also an economic challenge, requiring a comprehensive approach of medical, social, and economic support to improve the lives of affected women and their families.

The views expressed in this article are not necessarily those of the Friedrich-Ebert-Stiftung.