Lived Experiences of Mothers with Postpartum Depression in Rural Tanzania

Rehema K. Rajab^{1, 2,} , Getrud Joseph Mollel³, Felister Kiwelu⁴, Kioneneema Koshuma⁵, Fahad S. Mwakalebela^{1, 2}, Ramadhani M. Bofu⁶, Josephine Mkunda⁷ and Marceline F. Finda^1,

¹Department of Environmental Health and Ecological Sciences: Ifakara Health Institute, Morogoro, Tanzania

²School of Life Science and Bioengineering: Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania

³Department of Biomedical Research and Clinical Trials: Ifakara Health Institute, Morogoro, Tanzania

⁴St. Francis Referral Hospital, Ifakara - Morogoro, Tanzania

⁵College of Health and Allied Sciences: St. Francis University, Ifakara - Morogoro, Tanzania

⁶Ministry of Health, Dodoma, Tanzania

⁷School of Business Studies and Humanities: Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania

Cite this paper:
Rehema K. Rajab, Getrud Joseph Mollel, Felister Kiwelu, Kioneneema Koshuma, Fahad S. Mwakalebela, Ramadhani M. Bofu, Josephine Mkunda and Marceline F. Finda. Lived Experiences of Mothers with Postpartum Depression in Rural Tanzania. American Journal of Public Health Research. 2025; 13(5):228-237. doi: 10.12691/ajphr-13-5-4

Abstract

Introduction: Postpartum depression affects 15-20% of mothers globally, yet remains under-researched in low-resource settings like rural Tanzania, where maternal health efforts prioritize physical over mental well-being. Cultural stigma, limited healthcare access, and socioeconomic hardships aggravate PPD, yet women’s lived experiences are rarely documented. This study aimed to explore the narratives of mothers with PPD in southern Tanzania to uncover the challenges, coping mechanisms, and unmet needs, which are crucial in informing tailored interventions and policies. Methods: A qualitative approach was used, involving ten semi-structured in-depth interviews with purposively selected mothers of infants less than 24 weeks, scoring ≥ 26 on the Edinburgh Postnatal Depression Scale, indicating severe depression. The study explored the lived experiences, community interactions, and perceived drivers of mental health disorders in this context. Results: Four major themes emerged: Parenting while dealing with depression, including difficulties bonding with the baby, suicidal thoughts, attempts, and consideration of harming or abandoning the baby; Factors that trigger depression episodes, such as lack of support, difficult livelihoods, early marriage, unplanned pregnancies, difficult pregnancies and deliveries, and domestic violence; Coping mechanisms include primary confiding in trusted friends; and Recommendations for services and support systems including awareness campaigns, strengthening healthcare capacity, providing targeted support, and involving both the government and community structures. Conclusion: Findings highlight a critical gap in awareness and support for PPD among women in low-income settings. Despite enduring profound sadness, alarming thoughts, and challenging circumstances, many women lacked knowledge that PPD is a health condition, reflecting broader societal neglect and stigma surrounding mental health. Addressing these gaps requires urgent efforts to raise awareness, ensure accessible interventions, and foster supportive environments within families and communities.

Keywords:
Postpartum depression Lived experiences Rural Tanzania Maternal mental health Mental health support

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References:

[1]	M. W. O. Hara and J. E. McCabe, “Postpartum Depression: Current Status and Future Directions,” 2013.
[2]	N. I. Gavin, B. N. Gaynes, K. N. Lohr, S. Meltzer-Brody, G. Gartlehner, and T. Swinson, “A Systematic Review of Prevalence and Incidence,” vol. 106, no. 5, pp. 1071–1083, 2005.
[3]	C. El-Hachem et al., “Early identification of women at risk of postpartum depression using the Edinburgh Postnatal Depression Scale (EPDS) in a sample of Lebanese women,” BMC Psychiatry, vol. 14, no. 1, pp. 1–9, Sep. 2014.
[4]	N. K. Gebregziabher, T. B. Netsereab, F. A. Alazar, Y. G. Fessaha, A. H. Sium, and N. K. Ghebrehiwet, “Translation and Validation of the Edinburgh Postnatal Depression Scale for Eritrea: A Screening Tool for Postpartum Depression in Primary Health Care Facilities,” Int J Womens Health, vol. 17, pp. 299–310, Feb. 2025.
[5]	J. Slomian, G. Honvo, P. Emonts, J. Y. Reginster, and O. Bruyère, “Consequences of maternal postpartum depression: A systematic review of maternal and infant outcomes,” Women’s Health, vol. 15, p. 1745506519844044, 2019.
[6]	P. J. Surkan, C. E. Kennedy, K. M. Hurley, and M. M. Black, “Maternal depression and early childhood growth in developing countries: systematic review and meta-analysis,” Bull World Health Organ, vol. 89, no. 8, p. 607, Aug. 2011.
[7]	K. Herlosky, “Postpartum Maternal Mood among Hadza Foragers,” 2018.
[8]	R. Saharoy, A. Potdukhe, M. Wanjari, and A. B. Taksande, “Postpartum Depression and Maternal Care: Exploring the Complex Effects on Mothers and Infants,” Cureus, vol. 15, no. 7, p. e41381, Jul. 2023.
[9]	G. J. Mollel, M. Finda, D. Msacky, and F. Kiwelu, Abstracts of Tanzania Health Summit 2020. AIJR Publisher, 2021.
[10]	P. P. Walsh, A. Banerjee, and E. Murphy, “The UN 2030 Agenda for Sustainable Development,” Sustainable Development Goals Series, vol. Part F2740, pp. 1–12, 2022.
[11]	M. F. Finda et al., “Linking human behaviours and malaria vector biting risk in south-eastern Tanzania,” PLoS One, vol. 14, no. 6, pp. 1–23, 2019.
[12]	H. S. Ngowo, E. W. Kaindoa, J. Matthiopoulos, H. M. Ferguson, and F. O. Okumu, “Variations in household microclimate affect outdoor-biting behaviour of malaria vectors [version 1; referees: 2 approved, 1 approved with reservations],” Wellcome Open Res, vol. 2, no. 0, pp. 1–18, 2017.
[13]	M. Nweke, M. Ukwuoma, A. C. Adiuku-Brown, A. J. Okemuo, P. I. Ugwu, and E. Nseka, “Burden of postpartum depression in sub-Saharan Africa: An updated systematic review,” S Afr J Sci, vol. 120, no. 1–2, pp. 1–12, 2024.
[14]	MoHCDGEC, “Tanzania Demographic and Health Survey Indicator Survey (TDHS-MIS) 2015-2016,” Dar es Salaam, Tanzania, and Rockville, Maryland, USA: MoHCDGEC, MoH, NBS, OCGS, and ICF, vol. 1, no. 1, pp. 1–630, 2016.
[15]	J. G. Uriyo, A. Abubakar, M. Swai, S. E. Msuya, and B. Stray-Pedersen, “Prevalence and Correlates of Common Mental Disorders among Mothers of Young Children in Kilimanjaro Region of Tanzania,” vol. 8, no. 7, pp. 1–7, 2013.
[16]	African Union. Agenda 2063: The Africa We Want. African Union; 2015. Available at: https: //au.int/en/agenda2063/overview Accessed: May 08, 2025.
[17]	URT. The Tanzania Development Vision 2025. United Republic of Tanzania; 2000. Available at: http:// www.mof.go.tz/ mofdocs/overarch/Vision2025.pdf Accessed: May 8, 2025.
[18]	B. Levis, Z. Negeri, Y. Sun, A. Benedetti, and B. D. Thombs, “Accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression among pregnant and postpartum women: systematic review and meta-analysis of individual participant data,” BMJ, vol. 371, Nov. 2020.
[19]	T. N. Basit, “Manual or electronic? The role of coding in qualitative data analysis,” Educational Research, vol. 45, no. 2, pp. 143–154, 2003.
[20]	E. N. Emmanuel, D. K. Creedy, W. St John, and C. Brown, “Maternal role development: the impact of maternal distress and social support following childbirth,” Midwifery, vol. 27, no. 2, pp. 265–272, Apr. 2011.
[21]	P. L. Ruchala and D. C. James, “Social support, knowledge of infant development, and maternal confidence among adolescent and adult mothers,” Journal of obstetric, gynecologic, and neonatal nursing: vol. 26, no. 6, pp. 685–689, Nov. 1997.
[22]	S. F. Kaaya et al., “Socio-economic and partner relationship factors associated with antenatal depressive morbidity among pregnant women in Dar es Salaam, Tanzania,” Tanzania J Health Res, vol. 12, no. 1, Jul. 2010.
[23]	D. Goyal, C. Gay, and K. A. Lee, “How much does Low Socioeconomic Status Increase the Risk of Prenatal and Postpartum Depressive Symptoms in First-Time Mothers?” Women's Health Issues, vol. 20, no. 2, p. 96, Mar. 2010.
[24]	O. Yator, M. Mathai, T. Albert, and M. Kumar, “Burden of HIV-Related Stigma and Post-Partum Depression: A Cross-Sectional Study of Patients Attending Prevention of Mother-to-Child Transmission Clinic at Kenyatta National Hospital in Nairobi,” Front Psychiatry, vol. 11, p. 532557, Feb. 2021.
[25]	T. J. Rochat et al., “Suicide ideation, depression and HIV among pregnant women in rural South Africa,” Health N Hav, vol. 5, no. 3, pp. 650–661, Mar. 2013.
[26]	A. Sawyer, S. Ayers, H. Smith, L. Sidibeh, O. Nyan, and J. Dale, “Women’s experiences of pregnancy, childbirth, and the postnatal period in the Gambia: A qualitative study,” Br J Health Psychol, vol. 16, no. 3, pp. 528–541, 2011.
[27]	A. Holopainen and T. Hakulinen, “New parents’ experiences of postpartum depression: A systematic review of qualitative evidence,” JBI Database System Rev Implement Rep, vol. 17, no. 9, pp. 1731–1769, 2019.
[28]	C. Atuhaire, G. Z. Rukundo, L. Brennaman, S. N. Cumber, and G. Nambozi, “Lived experiences of Ugandan women who had recovered from a clinical diagnosis of postpartum depression: a phenomenological study,” BMC Pregnancy Childbirth, vol. 21, no. 1, pp. 1–16, 2021.
[29]	A. A. Wardrop and N. E. Popadiuk, “Women’s experiences with postpartum anxiety: Expectations, relationships, and sociocultural influences,” Qualitative Report, vol. 18, no. 3, pp. 1–24, 2013.
[30]	C. T. Beck, “Predictors of postpartum depression: An update,” Nurs Res, vol. 50, no. 5, pp. 275–285, 2001.
[31]	A. C. Tsai et al., “Antenatal depression case-finding by community health workers in South Africa: feasibility of a mobile phone application,” Arch Women Mental Health, vol. 17, no. 5, p. 423, Oct. 2014.
[32]	R. Negron, A. Martin, M. Almog, A. Balbierz, and E. A. Howell, “Social support during the postpartum period: Mothers’ views on needs, expectations, and mobilization of support,” Matern Child Health J, vol. 17, no. 4, pp. 616–623, May 2013.
[33]	Upadhyay et al., “Postpartum depression in India: a systematic review and meta-analysis,” Bull World Health Organ, vol. 95, no. 10, p. 706, Oct. 2017.
[34]	N. Jannati, J. Farokhzadian, and L. Ahmadian, “The Experience of Healthcare Professionals Providing Mental Health Services to Mothers with Postpartum Depression: A qualitative study,” Sultan Qaboos Univ Med J, vol. 21, no. 4, p. 554, Nov. 2021.
[35]	A. Kazemi et al., “The Experiences of Pregnancy and Childbirth in Women with Postpartum Depression: A Qualitative Study,” Iranian Journal of Psychiatry and Behavioral Sciences 2018 12:4, vol. 12, no. 4, 2018.
[36]	R. A. Burgess, M. Jeffery, S. A. Odero, K. Rose-Clarke, and D. Devakumar, “Overlooked and unaddressed: A narrative review of mental health consequences of child marriages,” PLOS Global Public Health, vol. 2, no. 1, p. e0000131, Jan. 2022.
[37]	S. GelchuAdola and D. Wirtu, “Effects of early marriage among women married before reaching 18 years old (qualitative study approach),” Frontiers in Sociology, vol. 9, no. November, pp. 1–10, 2024.
[38]	I. Y. A. Banu Ergocmen, Faruk Keskin, “Child, Early and Forced Marriage in Turkey: Data Analysis of Turkey Demographic and Health Surveys,” UNFPA, 2020.
[39]	M. Abebe, Y. S. Asgedom, A. Y. Gebrekidan, and T. M. Tebeje, “Antenatal depression among pregnant women in Ethiopia: An umbrella review,” PLoS One, vol. 20, no. 1, p. e0315994, Jan. 2025.
[40]	L. Muskens, M. G. B. M. Boekhorst, W. J. Kop, M. I. van den Heuvel, V. J. M. Pop, and A. Beerthuizen, “The association of unplanned pregnancy with perinatal depression: a longitudinal cohort study,” Arch Women Mental Health, vol. 25, no. 3, p. 611, Jun. 2022.
[41]	M. Johansson, Y. Benderix, and I. Svensson, “Mothers’ and fathers’ lived experiences of postpartum depression and parental stress after childbirth: a qualitative study,” Int J Qual Stud Health Well-being, vol. 15, no. 1, 2020.
[42]	S. James, “Women’s experiences of symptoms of posttraumatic stress disorder (PTSD) after traumatic childbirth: a review and critical appraisal,” Arch Women Mental Health, vol. 18, no. 6, p. 761, Aug. 2015.
[43]	S. Ayers, “Thoughts and emotions during traumatic birth: A qualitative study,” Birth, vol. 34, no. 3, pp. 253–263, 2007.
[44]	P. Koirala and M. Chuemchit, “Depression and domestic violence experiences among Asian women: A systematic review,” Int J Womens Health, vol. 12, pp. 21–33, 2020.
[45]	H. A. O’Mahen and H. A. Flynn, “Preferences and perceived barriers to treatment for depression during the perinatal period,” J Women Health, vol. 17, no. 8, pp. 1301–1309, Oct. 2008.
[46]	C. L. Dennis and N. Letourneau, “Global and relationship-specific perceptions of support and the development of postpartum depressive symptomatology,” Soc Psychiatry Psychiatr Epidemiol, vol. 42, no. 5, pp. 389–395, Jun. 2007.
[47]	N. L. Letourneau, C. L. Dennis, N. Cosic, and J. Linder, “The effect of perinatal depression treatment for mothers on parenting and child development: A systematic review,” Depress Anxiety, vol. 34, no. 10, pp. 928–966, Oct. 2017.
[48]	C. L. Dennis, “The effect of peer support on postpartum depression: A pilot randomized controlled trial,” Canadian Journal of Psychiatry, vol. 48, no. 2, pp. 115–124, 2003.
[49]	L. Tang, X. Zhang, and R. Zhu, “What Causes Postpartum Depression?" Tang, L., Zhang, X., & Zhu, R. (2021). What Causes Postpartum Depression and How to Cope with It: A Phenomenological Study of Mothers in China. Health Communication, 36(12), 1495–1504. Health Community, vol. 36, no. 12, pp. 1495–1504, 2021.
[50]	C. L. Dennis and L. Chung-Lee, “Postpartum depression help-seeking barriers and maternal treatment preferences: A qualitative systematic review,” Birth, vol. 33, no. 4, pp. 323–331, Dec. 2006.
[51]	P. Klainin and D. G. Arthur, “Postpartum depression in Asian cultures: A literature review,” Oct. 2009.
[52]	W. Sword, S. Watt, and P. Krueger, “Postpartum health, service needs, and access to care experiences of immigrant and Canadian-born women,” JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing, vol. 35, no. 6, pp. 717–727, 2006.
[53]	N. K. Grote et al., “Collaborative care for perinatal depression in socioeconomically disadvantaged women: a randomized trial,” Depress Anxiety, vol. 32, no. 11, pp. 821–834, 2015.
[54]	P. Leahy-Warren, G. McCarthy, and P. Corcoran, “First-time mothers: Social support, maternal parental self-efficacy and postnatal depression,” Journal of Clinical Nursing, vol. 21, no. 3–4, pp. 388–397, Feb. 2012.