“Society: Don’t blame anyone, don’t blame my husband, my in-laws or my family- they are not responsible for anything. I felt the way I felt because of myself… I lost the Nima I knew… Please let me go in peace.”
These words were discovered in an unsent draft on Nima Bhakta’s phone after she passed away in late July of 2020. The 31-year old Indian-origin California-native died by suicide as a result of the postpartum depression she endured after giving birth to her infant, Keshav, who was seven months old when she died. “It was something you guys wouldn’t understand because the Indian society does not fully understand postpartum depression,” Nima had said.
Postpartum depression (PPD) is a complex condition that can impact a new mother’s mental and emotional state as a result of hormonal and physical changes. Different from “baby blues” (where 70-80 percent of new moms experience sadness, restlessness and fatigue), PPD symptoms are more severe if left untreated. New moms with PPD may feel prolonged helplessness, withdraw from their friends or families, or have harmful thoughts towards themselves or their baby.
Medical experts predict that women who are of lower socioeconomic status, lack a support system, or have a history of anxiety or mental health disorder are at higher risk for PPD. A traumatic delivery or issues with breastfeeding and bonding with the baby are other factors. In India, PPD is also exacerbated by domestic violence and abuse towards mothers (which has increased during lockdown) and the socio-cultural preference for a male child. A staggering 42 percent of Indian women who had a girl child reported PPD.
Truth is, PPD impacts thousands. Nima’s story, as told by her older sister Priya Bhakta, is one example.
Nima grew up in a loving, close-knit Gujarati family in Southern California. She earned a bachelor's degree in business, married her soulmate, and was a hotelier in Arizona. Her childhood and young adulthood were normal and simple.
But when it came to life post-pregnancy, Nima’s PPD symptoms were evident from the day she came home.
“Nima was always organised. But with Keshav, she was overly obsessive and paranoid,” explains Priya to VICE. “She labeled each of Keshav’s items, changed his entire outfit at the sight of any spit up, and even timed his peeing. She was a mile a minute.”
Priya told VICE that over time, Nima became more reclusive despite her husband and family’s best efforts to be supportive. At her six-week postpartum checkup, she lied to her doctor, “I am fine. Things are fine.”
They put her in touch with a therapist, though her sessions were conducted telephonically due to pandemic limitations. Therapy was still not enough.
The family decided a combination of therapy and prescribed medication may be a better treatment plan. But Nima refused consistent medication out of fear that it would pass to her son via breastfeeding.
Nima was also ashamed of the help she was seeking. She couldn’t reconcile why she needed treatment while other mothers, including her own sister, seemed to cope alone. In Nima’s view, she was failing to meet her own and society’s expectations.
The South Asian community is finally waking up following Nima’s death. #BreaktheStigma4Nima is trending on Twitter and Instagram. Countless women worldwide have shared their personal narratives with PPD. These stories share a common theme: Curing PPD needs to be a two-fold endeavour that removes cultural stigma coupled with allocating hospital and medical resources to provide long-term support.
Both abroad and in India, the community is notoriously silent on discussing sensitive topics, especially as it relates to institutions of marriage and childbirth. There is a cultural expectation among South Asians that joyous moments should be celebrated, not associated with struggle and depression.
PPD, though, is a global issue that transcends all cultures. Addressing stigma regardless of geography is not an easy feat. According to Dr Navya Mysore, family medicine specialist and the national programme director of sexual and reproductive health at a platform offering concierge medical services, education is vital.
“The main obstacle that we need to overcome is to educate individuals with the proper information about PPD,” says Mysore, who herself experienced a complicated pregnancy. “It truly takes a village to raise a child and there is a responsibility to take care of the mother and recognise when she is struggling. The more we can be vulnerable and transparent, the more we can say this can happen to anyone.”
Transparency, however, is difficult to achieve within a private community.
As a US-raised, India-born child of immigrant parents, I can count the number of times I have sat down with my parents and had an intimate conversation about my feelings. Most discourse is superficial whereas matters of genuine importance are pushed under the rug. This isn’t unique to my experience as an Indian-American, but open dialogue is rare among South Asians anywhere, especially in India. It’s easier to stay silent than to have awkward discussions, especially when it comes to stigmatised mental health concerns.
This conversation is long overdue, and we cannot keep delaying it.
Whether home is New York City or New Delhi, the conversation must start internally to remove outdated mentalities. Within our households, families need to learn the intricacies of postpartum pregnancy, and normalise these feelings. We need to be allies. Allyship is openly discussing new moms’ experiences, offering reassurances, connecting to external resources, and most importantly, being non-judgemental. Otherwise, cultural expectations can crush women during a vulnerable time. For a South Asian mom, it may mean not seeking help no matter how dire the circumstance.
Awareness also means understanding that despite the effectiveness of social media, a filtered photo or an Instagram story is never the full reality of what moms endure. If a new mother’s story does not fit the “picture-perfect” model, she does not need to be ashamed.
More needs to be done externally too. Leah Gooen, a medical social worker at New York’s Presbyterian Hospital, stresses the importance of offering new moms options while they’re still in the hospital. She provides each mom a list of PPD agencies as well as information on how to access therapists or psychologists based on their zipcode and insurance.
“When [a mom] is in the throes of depression, she doesn’t have the emotional energy to ask for help,” she tells VICE. “We want to honour the patient’s right to self-determination but when they are in a place where they can’t think, caregivers and family need to intervene, especially in life or death situations.”
Given the exorbitant costs of childcare, pandemic births, and overall high stress, Gooen believes more women will be prone to PPD in the current circumstances.
There needs to be more community-based effort for programming globally. For example, the United Kingdom employs a Family Nurse Partnership, where a specially trained family nurse visits first-time mothers from early stages of pregnancy until the child is two. Such an enterprise emphasises how motherhood is an ongoing journey and similar resources should be employed everywhere.
Nima’s family will continue to honour her legacy by selecting the Postpartum Support International/Perinatal Mental Health Alliance for People of Color (PSI PHMA-POC) for donations. The organisation plans to create an online support group specifically for South Asian women with PPD and to provide scholarships for South Asian mental health professionals to receive specialised training in perinatal mental health.
The dialogue around PPD is just starting. For Nima, for all new and future mothers, let’s continue talking.