Twenty-six-year-old Charity Tusingwire was excited about being pregnant. She had all her pregnancy and post-pregnancy schedules well planned. She knew the millions of things she would do with her baby girl. But little did she know that things would not turn out the way she had hoped. 

She spent hours in labour and was completely traumatised. That was the beginning of her postnatal depression (PND). 

"Mine was so bad. First, I hated what I had gone through, and then there was also the fact that the stitches took too long to heal. I hated sex and even swore never to have it again; I hated myself and the way I looked. The new experience of motherhood simply overwhelmed me because this meant less sleep. I got so depressed that every time I closed my eyes all I could think about were the labour pains,” Tusingwire explains.

Bridget Neza, a mother of two and resident of Kabuga says that because she had people around all the time, it was hard to notice her depression. She gained a lot of weight and the baby failed to breastfeed among other things.

"When you have people around you, the depression is less. I guess that’s a way to fight it. Also, I need to get my body back to shape. I did the same old exercises and diet but I started dieting when the baby was nine months old because babies need good feeding,” Neza says.

According to Dr. Rachna Pande, a specialist in internal medicine at Ruhengeri hospital, postnatal or postpartum depression is a state of depression which starts within minutes to up to four weeks after child birth. Usually it is women who are affected, prevalence varying from 11-40 per cent of child births, but at times men are also affected. Depression is common in women of different ages and life stages.

Like Tusingwire and Neza, several women go through different experiences during and after birth. Some women already know what to do yet others are still suffering from PND and clueless on what to do. 

"We receive many cases of women with PND. These cut across from young to old and poor to rich. I have personally seen about 10 women with this problem in less than six months. The exact reason is not known. Some studies suggest hormonal changes of pregnancy to be responsible but this has not been conclusively proven” Dr. Pande says.

She further notes that the stress of child care, insecurity, physical weakness, lack of support and being a single mother are some of the other causes cited.  

"Motherhood can be both rewarding and satisfying. However, the stress and pressures of raising a child affect ones wellbeing. The postnatal period is difficult for new mothers.”

"Apathy, refusal to feed, unexplained crying, reduced interest in surroundings or in the child itself, insomnia or hypersomnia are some the symptoms of postnatal depression,” the doctor says.

According to Denyse Umutesi, a midwife at Kigali’s La Croix du Sud Hospital, PND is so grave that sometimes it leads to suicide or even the killing of the  baby.

"This happens especially if the baby was a result of rape or even when one is not sure about the father of the baby. Depression starts straight away,” Umutesi says.

The prevalence on depression especially for new mothers is between 20-40 per cent and is common though not given much attention, according to Pauline Wanjiku, a relationship counselor in Kicukiro.

"There comes a point when the body makes huge hormonal adjustments now that one is no longer pregnant and is instead breastfeeding. This may make you vulnerable to PND, and if you also have the following problems, you may feel overwhelmed. If one finds it hard to breastfeed the baby, the baby has irregular sleeping patterns or finds it difficult to sleep. So as a mother, you will find it difficult to adjust to the changes your body is experiencing,” Dr Alphonse Butoyi, a gynecologist at Kibagabaga Hospital says.

Dr Samuel Kagali, a gynecologist at Kacyiru Police Hospital, agrees and says that the changes in a mother’s diet, sleep and activities can result in poor eating habits and exhaustion. Combined with ongoing depression and high levels of anxiety, this will in turn reduce the body’s immunity and ability to fight infection, hence postnatal depression.

"Eventually the emotional distress of depression and anxiety may be expressed in increasing physical symptoms that might be felt as pain, headaches, chest pain or difficulty in breathing,” Kagali says.

But postnatal depression is a perfectly curable condition. Good counseling for the mother and family, psychological support, good nutrition with vitamin supplements and low dose antidepressants help the affected mother to recover.

In order to overcome her PND, Tusingwire talked to doctors who told her that it would wear off if she adjusted her life and accepted the fact that she had brought to the world a new being. "So it all started with accepting and all became fine as time went on,” she says.

Wanjiku also advises that a new mother should rely on her family. "Most people rarely know they are depressed yet this is the perfect time for family to help mothers avoid the stress,” Wanjiku says.

"Getting support from your midwife and other healthcare professionals will help reduce your risk of developing postnatal depression,” Karen Kleiman, a therapist on babycenter.com says.

Postpartum depression exists worldwide despite what some people might have you believe.

"I also believe one in five women get postpartum depression worldwide. That’s 20%, which is a hell of a lot of women. Not the often quoted 10% or 15%, but 20%,” says Katherine Stone on postnatalprogress.com. 

Depression is different from usual mood fluctuations. Depression induces a sustained feeling of sadness for two weeks or more and interferes with the ability to function at work, school or home. 

Effective treatments include psychosocial treatment and medication. The active involvement of depressed people and those who are close to them in addressing depression is key. The first step is to recognise the depression and reach out for support. The earlier the treatment begins, the more effective it is.

"We have some highly effective treatments for depression. Unfortunately, fewer than half of the people who have depression receive the care they need. In fact in many countries this is less than 10%,” says Dr Shekhar Saxena, Director of the Department for Mental Health and Substance Abuse. "This is why World Health Organisation (WHO) is supporting countries in fighting stigma as a key activity to increasing access to treatment.”