This summer, I gained first-hand exposure in the field of global mental health. To recap, I studied the prevalence and risk factors of postpartum depression within the context of Indian culture and marginalization as a Research Fellow of the MINDS Foundation. My experience offered a window into the narratives of peri- and postnatal women living in underserved communities in urban India. During my short time, I was afforded perspectives that I could not have gained elsewhere.
Studying mental health in a lower-middle income country (LMIC) surfaces a large number of the structural determinants of health, such as poor access, gender disparities, varying sociocultural models of illness and disease, and, most intrinsically, poverty. I conducted my interviews about postpartum depression in the maternity ward of Sion Hospital. Sion is a large government medical institution in urban Mumbai, nearby Dharavi, one of the most populated slums on the planet. Space is a precious commodity in a city of almost 20 million residents, and every corner of Sion is always occupied. Every day, hundreds of new mothers and soon-to-be mothers and their families rely on Sion for free visits. In fact, during this fragile period from conception to a baby’s first steps, Sion’s services, which cost little to nothing, represent the very center of these mothers’ lives. Furthermore, it’s no secret that high maternal and infant mortality rates continue to haunt extensive legions of India’s poor. The fight to birth safely is, therefore, among the obstacles facing underserved women in India.
Additionally, my interviews with the patients in the Sion maternity ward offered a window into their self-identified priorities and barriers related to their mental health. For example, many women deny the existence of phenomena such as peri and postnatal depression (“How can a mother possibly be depressed after having her child?”) despite exhibiting signs and symptoms. Most of such insights point to a need for antistigma initiatives and equitable access to mental health intervention. Although the idea of mental health had emerged as a westernized concept, the goal of global mental health as a field became quite clear to me with these interviews: to decolonize the delivery of care. Rather than having the omniscient clinician unilaterally sharing their ideas with the patient and reinforcing inequalities, it is important for the care-provider to learn about the distinct contexts of their patients. More importantly, it is imperative to recognize the social, political, and economic forces at work in order to properly understand, and consequently treat, the patient. Thus, like in any subfield of healthcare, humility and empathy must be prioritized for tackling the global burden of mental illness.
In addition, on a more personal level, my everyday experiences in Mumbai have reaffirmed my interests for pursuing a career in mental health research. I am now more familiar with the kind of work I want to do in graduate school and beyond: (1) assessing the risk factors and barriers associated with mental health problems, both at the individual and structural levels, (2) and implementing this insight into developing and piloting interventions that are sustainable, contextually-adaptive, preventive, and aimed at eliminating disparities in access.
Sion Hospital, Mumbai, Maharastra, India