Oprah Winfrey’s interview with Meghan and Harry has clearly become a spark for international discussions about racism and the state of the British royal family. It also brought new attention to another problem.
Meghan’s revelation about her mental distress during and after her first pregnancy, including thoughts of suicide so significant that she feared being left alone – and that the palace had been a barrier to the help she needed – sounded painfully familiar to many .
The experience of life-threatening pregnancy complications, both mental and physical, is remarkably common. If it didn’t happen to you, it almost certainly happened to someone you care about, although you may not know it.
Twitter soon filled with people sharing their own stories of depression, anxiety and suicidal thoughts during and after pregnancy.
“The interview brought me back to that really bad moment in my life when I felt like I was sinking down the drain, when my thoughts just didn’t leave me alone,” Wendy Molyneux, mother of four and producer of the animated series Great North, who experienced debilitating postpartum anxiety after having her fourth child, said in a direct message.
Pragya Agarwal, a data scientist and author of an upcoming book on the history and science of motherhood, said in an interview that after her twins were born prematurely, “I just wanted to disappear.”
“I was very close to wanting to just leave, basically, not to be here, and not just to live,” she said. “I cried and sat in the car in the supermarket parking lot.”
The members of the royal family are expected to be a very particular type of celebrity, a kind of human personification of enchanting respectability. Now, in her post-palace life, Meghan has become an avatar of the disconnect between society’s expectations of pregnancy and reality – and this collective misunderstanding, experts say, is increasing the danger.
Most statistics suggest that 15 to 25 percent of women experience depression during or after pregnancy, but this variation is likely to be underestimated.
“Due to the stigma surrounding revealing negative mood right now, as well as the difficulty that people think of being taken seriously, that number is likely to be much higher,” Emma Svanberg, clinical psychologist specializing in peripartum – in the past and after childbirth – mental health, said by email.
In a 2017 survey of 1,000 British women, almost 50 percent of respondents reported having a mental or emotional problem, but half of them did not have this problem identified by a health professional.
Meghan did not say whether she was diagnosed with peripartum depression or any other condition. But experts are increasingly advocating the extension of specialized care to women who experience severe suffering during or after pregnancy, regardless of whether they fit into a specific diagnosis or not.
“Some researchers have suggested that we should, instead of looking at specific diagnostic categories, refer to ‘perinatal distress’ to cover the complexity of the difficulties experienced at this time,” said Dr. Svanberg.
After all, the stakes are extremely high. Pregnant women are at risk of stroke, hemorrhage, infection and other complications that can be fatal to both parents and baby. But mental suffering is one of the most serious risks of all. In developed countries, suicide “is a major cause of death in the perinatal period (THE leading cause of death in 2003), ”wrote Dr. Svanberg.
Discussions about pregnancy and mental health often focus on the effect of pregnancy hormones on mood. But while this is a factor, there is substantial evidence that other stressors also play a role – so much so that approximately 10% of parents also suffer from postpartum depression.
“Meghan was a pregnant woman who lived in an unknown country and isolated from her family and social support, with huge and new pressures placed on her in her role, as well as the pressures felt by all women in the perinatal period,” said Dr Svanberg. “I can’t imagine going through this with criticism, hostility and judgment. How can there not have been an emotional consequence for this? “
Meghan also discussed the prejudice she faced because of her mixed heritage, which may have increased her risk. “Studies show that women who suffer from structural racism are at even greater risk of depression and postpartum anxiety,” said Payal K. Shah, human rights lawyer and fellow in Sexual and Reproductive Health Law at the University’s Faculty of Law from Toronto.
“People of color are more likely to have mental health problems and less likely to receive adequate help,” said Dr. Svanberg. Maternal mortality rates for black women in Britain are four times higher than for white women, and studies have shown that medical workers tend to underestimate the pain of black women during childbirth, which can deprive them of medications and care they need.
The popular image of pregnancy as something happy and direct, disturbed only by beautiful problems, like wanting to pickle ice cream, or brief, like a painful natural birth, can mean that those with more difficult pregnancies can face stigma and dismissal if they ask for help.
“At the root of barriers to maternal mental health care are gender stereotypes that promote the idea that women should be ‘mothers who sacrifice’, that they must prioritize the supposed needs of their families and children over their own survival and well-being, ”said Ms. Shah, who has worked on reproductive and maternity rights issues around the world. “These stereotypes lead to stigmatization of health care for pregnant women or mothers who are suffering from depression or anxiety, rather than just joy or contentment.”
“There is also an attribution of blame, that there must be something wrong with what we are doing if we are not feeling 100 percent,” said Agarwal. “Women also feel guilty about being fragile, overly emotional and nervous.”
While some in the British media have criticized Meghan for claiming victimhood despite her wealth and privileges, many of those with more first-hand experience have seen her story as a sign that these problems can happen to anyone, regardless of circumstances.
Molyneux said she was touched to hear Meghan speak so frankly during the interview. “I felt a great wave of relief wash over me when I saw this incredibly accomplished person admit that he had mental health problems,” she said.
“For people who are less privileged than me, women in jobs where it’s less safe to admit that you’re fighting, they can point to that person who has wealth and privileges – a literal duchess – and say, ‘This is not my fault, it can happen to anyone and I need help ‘”.