Mothers in the Crossfire: The Hidden Struggles of Postpartum Mental Health in War Zones

Introduction

War, with its relentless destruction, leaves no segment of society untouched. Amidst the towering rubble and bloodied battlefields, pregnant women are a particularly vulnerable group that is often overlooked in discussions of conflict and its effects. The physical and psychological toll that war inflicts on expectant mothers, compounded by the dire conditions of displacement, limited healthcare, and extreme stress, creates a cascade of complications that follow both mother and child from pregnancy through postpartum (i.e., after delivery) and beyond.

Effects of War on Pregnant Women

For pregnant women, the trauma of war extends far beyond the immediate physical dangers of bombings, violence, and forced migration. It disrupts access to essential healthcare services, leading to an increase in maternal mortality, premature births, and preventable complications.

Challenges in the Postpartum Period

The difficulties do not end at birth. The postpartum period brings its own set of challenges, undoubtedly accentuated by the unimaginable conditions created in war-torn countries. Maternal mental health, often overlooked, is particularly vulnerable during this time. Among the struggles faced are postpartum blues and its more serious counterpart, postpartum depression.

Definitions

Before highlighting the influence of conflict and war, it’s important to recognize the differences between postpartum blues, postpartum depression, and normal mood changes after pregnancy.

Postpartum Blues (PPB): Also known as baby blues, PPB is characterized by mild depressive symptoms that are self-limiting and occur within the first few days after delivery. Prominent symptoms include mood swings, anxiety, irritability, crying, and difficulty sleeping. This condition begins 2 to 3 days postpartum and typically resolves within two weeks. It is found in about 50 to 80% of new mothers.

Postpartum Depression (PPD): PPD is a more severe, long-standing condition affecting around 13 to 19% of new mothers, with 1 in 5 new mothers likely to develop it. It can last for months or even years if left untreated. Symptoms include persistent sadness, feelings of worthlessness, severe mood swings, difficulty bonding with the baby, changes in appetite or sleep patterns, fatigue, and, in some cases, thoughts of self-harm or harming the baby. The persistence of symptoms beyond two weeks is what establishes the diagnosis of PPD.

Prevalence in War-Torn Areas

Research has shown that women exposed to war trauma are at a significantly higher risk of developing postpartum depression. The pooled prevalence rate for PPD in war zones is approximately 30 to 50%, compared to the 10 to 15% in non-war-affected areas. War-related stress increases the risk of progression from postpartum blues to postpartum depression, particularly in mothers with pre-existing mental health issues. Risk factors contributing to this include exposure to trauma, lack of social support, economic hardship, and pre-existing mental health conditions. Displaced pregnant women also exhibit significantly higher rates of anxiety compared to their non-displaced counterparts.

Impact on the Child

Postpartum depression has profound implications for child development, affecting emotional, cognitive, and behavioral outcomes. Children of mothers with PPD are at an increased risk of developing behavioral issues, including anxiety, depression, and social difficulties. PPD can also lead to cognitive development delays, which may impair learning abilities and academic success later in life. These effects can extend into adolescence, contributing to ongoing emotional and psychological challenges. Mechanisms through which PPD influences child development include impaired mother-child bonding, reduced maternal responsiveness, and heightened family stress, all contributing to an unstable developmental environment.

Coping Strategies

Social support networks emerge as a lifeline, with family and community connections providing crucial emotional support during challenging times. Women who have someone to talk to or lean on report significant relief from feelings of isolation. While access to mental health services is often limited, those who engage with professionals find it immensely beneficial in managing their symptoms. Peer support groups also play a vital role, creating safe spaces for mothers to share their experiences and coping mechanisms. Additionally, cultural practices and rituals offer a sense of continuity and resilience, allowing women to draw strength from their traditions. However, barriers such as stigma surrounding mental health issues and the ongoing stress of conflict often hinder effective coping. This highlights the urgent need for targeted interventions that provide mental health support while considering the unique cultural and contextual factors affecting postpartum women in conflict zones.

Treatment of PPD: 

Postpartum depression (PPD) can be effectively treated through both psychological and psychiatric approaches. 

Psychological treatments include therapies such as cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and psychodynamic psychotherapy. These therapies focus on addressing cognitive distortions, improving interpersonal relationships, and exploring emotional conflicts, respectively. Studies have shown that these interventions can significantly reduce depressive symptoms and improve overall well-being in postpartum women. 

Psychiatric treatments typically involve the use of antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) like sertraline and fluoxetine, which have been found effective in managing PPD symptoms. While some women express concerns about medication safety during breastfeeding, many SSRIs are considered safe for use in lactating mothers. A combination of both treatment modalities is often recommended for optimal outcomes.

Lebanese Supportive NGOs:

1. Proud Lebanon

• +961 76608205  
•   Proud Lebanon

2. IDRAAC (Institute for Development, Research, Advocacy and Applied Care)

• +961 01583583  
•   IDRAAC

3. Embrace Mental Health Center (EMHC)

• +961 01346226 or +961 81003870  
•   Embrace Lebanon

4. Caritas Lebanon  

• +961 01429999  
•   Caritas Lebanon

5. Abaad

• +961 01388888  
•   Abaad