The Social Construction of Mental Health Inequities Experienced by Mothers Who Are Socioeconomically Disadvantaged During Early Motherhood: A Canadian Perspective

Abstract

Introduction: Early motherhood brings with it multiple challenges that can negatively impact women’s mental health (Final Report of the Commission on Social Determinants of Health, http://whqlibdoc.who.int/publications/2008/9789241563703_eng.pdf, 2008; Postpartum care of the mother and newborn: A practical guide, Geneva). Mental health problems, particularly postpartum depression are the most common postpartum morbidities experienced after hospital discharge (Acta Psychiatrica Scandinavica 110:338–46, 2004). Postpartum women who are socioeconomically disadvantaged are at higher risk for developing mental health problems with reported postpartum depression rates ranging between 19 and 30 % (American Journal of Obstetrics and Gynecology 186:899–902, 2002; BMC Health Services Research 8:203, 2008). The aim of this study was to illuminate the social organization of the experiences of postpartum women who are SED in the early postpartum weeks that contribute to mental health inequities. The research question that guided this endeavor was: How are the daily experiences/work of postpartum women who are SED determined by extra-local social relations?

Main Body: An Institutional Ethnography was implemented examining the social relations linked to the daily work/experiences of 24 postpartum women who were socioeconomically disadvantaged in the first 4 weeks at home

Discussion: Participants in our study had little time to rest and recuperate from childbirth. Our findings revealed how social constructs such as gender, class, welfare and maternity benefit policy, and medical and societal discourses on childbirth and early motherhood are embedded in the women’s daily lives and limit their choices in caring for their families and themselves in the postpartum period, and thus contribute to mental health inequities.

Implications: Making visible the social construction of the everyday work/experiences of women who are socioeconomically disadvantaged in the early postpartum period provides policy makers and healthcare providers with important knowledge about the changes needed in social relations to construct an alternate social world, one in which fewer postpartum women who are socioeconomically disadvantaged will experience mental health inequities.

Response

• Margaret Lee McArthur 

1. Thames Valley District School Board, London, ON, Canada

   Margaret Lee McArthur

Two Postpartum Monologues

Postpartum from the Inside: Beth’s Story

alone

among the numbered sad

invisible sorrows

closeted

where I ache and can’t go on

while the insistent present

coos and cries

from creaky crib

I want away

away from here

my screaming sadness

echoes bouncing

off these four walls

amplified by suckling babe

who screams and sucks

and sucks me dry

I am alone

this dusty day

the seething human mass

‘surges round’

with neither time nor words

and sees me not

hears me not

my mute motherdom

staring helpless

hopeless

while the infant wails

on and on and on

and too late

the world answers

take a pill

here’s a script

take a pill ‘cross the counter’

pop it down, deep inside

drown the desperate darkness

take a pill

and be silent, soldier

suck it up, it’s not so bad

and so,

babe in slackened, heavy arms

numb and mute

from silent private hell

I stagger on

tangled in the misty unexpressed

past hazy knowings

to this place

where what is wrong

is said to be

what’s wrong with me

my fault

they suppose

I am fixed now

bettered with a pill

but all the while I bleed

hemorrhaging inside

while the babe cries on

and on and on

Postpartum from the Outside: Beth’s Script

happy mother, smiling babe

got it all together

I know this script

the one I guess I signed on to play

but I can’t read these lines

they’re for someone else

not me

I don’t exist

in these words

who wrote this script anyway?

enter my doctor

I see who she sees—

my body

female, age 21

eyes, check; reflexes, check

blood pressure, pulse, check;

say ahhhhhh,

“you’re down she says, suicidal?”

“well … no,” I manage

“good—here’s a script for meds

take these

it will help,” she says to my body

without meeting my eyes

exit doctor

enter social worker

she doesn’t want to be here

I can tell

see what she sees…

I have no job

was shacking up

through her eyes I know it

she’s looking for man-clothes

proof that he’s here

there’s laundry everywhere

dishes in the sink

wailing baby

I hear her thought,

“should I call CAS?”

she thinks I can’t cope

yeah, it sucks

being here

exit social worker

enter counsellor

she looks at me too

can tell what she thinks too …

I’m messed up

family won’t talk to me

for three years I’m on my own

my mom was depressed

most of the time

dad, well, he was never home

and he wasn’t happy

we all knew that

now my ex lost his job

—fired—now he sits around

not here … somewhere else

… somewhere else

exit counsellor

and I’m alone

so here’s another script

I wrote this one

my name is Beth

I’m a single mom

of two, no less

that’s loaded

and comes with baggage

I hear that baggage

loud and clear

judgement rattling

inside my mind

as the scriptwriters’ story

echoes from sideways glances

and I flinch

my name is Beth

and I am not coping

you frame my needs

but my limbs hold me here

my imprisoned mind

holds me

I cannot find my story

in your world

and I am drowning in my now

that’s where you’ll find me

lost somewhere

outside your script

and inside your judgement