A look at nutriton and postpartum depression
All this month we are focusing on mothers and maternal health. This week we take a look at an issue that doesn’t receive a lot of attention–particularly in global health and development spheres–but is vital for the health and well being of mothers and their children: Postpartum Depression or PPD.
PPD is only one manifestation of postpartum mood disorder on a continuum that goes from the more common “baby blues” to the more severe “postpartum psychosis:”
Prevalence
PPD has been called the “most common complication of pregnancy” with approximately one in eight mothers (10-15%) experiencing PPD during the first year of their child’s life. Postpartum depression can affect any new mother regardless of her:
- Age
- Level of education or income
- Experience of pregnancy
- Number of pregnancies or number of children
However according to the Mayo clinic, some women may be more susceptible to PPD if their pregnancy was unplanned and/or unwanted and if they have:
- A history of depression
- Had PPD after previous pregnancies
- Experienced stressful events during the last year
- Relationship problems
- Weak support system
- Financial problems
Impact on Maternal and Child Health
Maternal depression is associated with child psychological and physical health as well as nutritional status. PPD can impact a woman’s ability to:
- Take care of herself
- Effectively carry out daily responsibilities
- Take care of her baby (including proper infant feeding)
PPD and Nutrition
Nutrition impacts all facets of health including mental health. For example, according to research by Bodnar and Wisler has found that:
- Poor omega-3 fatty acid status increases the risk of depression. Fish oil and folic acid supplements each have been used to treat depression successfully.
- Folate deficiency reduces the response to antidepressants.
- Deficiencies of folate, vitamin B12, iron, zinc, and selenium tend to be more common among depressed than non-depressed persons.
Nutrition during pregnancy can have a profound impact on mood. As Bodnar and Wisler explain:
- “Childbearing-aged women are particularly vulnerable to the adverse effects of poor nutrition on mood because pregnancy and lactation are major nutritional stressors to the body. The depletion of nutrient reserves throughout pregnancy and a lack of recovery postpartum may increase a woman’s risk of depression.”
Treatment
Treatment for PPD includes:
- Counseling
- Antidepressants
- Hormone therapy
- Lifestyle changes including healthy eating
Nutrition interventions can be inexpensive, safe, easy to administer, and generally acceptable to patients.
What the CARE Nutrition Plus Team is doing
CARE has trained 47 community and nutrition workers and 317 community counselors in Bangladesh on the delivery of basic psycho-social support services to women and their families.
Training included information on:
- PPD
- How to provide quality, personalized support for women experiencing PPD
- The “steps to wellness” that help to empower women to help themselves
- How to help individuals create a plan of action that will help them assess their strengths and needs
- How to build a supportive community for women experiencing PPD
These trained nutrition counselors are now equipped to identify PPD, provide support and tools to women who are struggling with mood disorders after delivery.
Click here for more information on PPD from the Centers for Disease Control. For more detailed information on the science behind nutrition and depression click here.
Clip Art source: newsinhealth@nih.gov
Share a Meal this Mothers Day
Mothers Day is celebrated all around the world to honor the women who nurture and nourish us. This coming Sunday the US will celebrate along with mothers in Window of Opportunity countries Bangladesh, Peru and Sierra Leone. Mothers in Nicaragua are celebrated later in the month on May 30th. Mothers in Indonesia have their day on December 22. Mothers Day celebrations are similar around the world–festivals are organized, mother are given flowers, cards and other small gifts, and many families share a meal together. However, the idea of sharing a meal is a complex one influenced by cultural and religious gender norms.
Eating Order
Women produce between 60-80% of the world’s food; however despite their critical role in enabling food security, women’s nutritional needs often go unmet in impoverished and middle-income households. It is a common cultural practice in many countries for the male breadwinner to eat first during meal times. Children–especially sons–eat next, while women and girls eat last. By the time women and girls eat, there may be very little or no food left. Even during pregnancy, special care is not always taken to ensure women receive enough food.
Gender based eating order contributes to chronic malnutrition throughout the life cycle, increased disease burden, anemia, insufficient weight gain during pregnancy and poor pregnancy outcomes.
Challenging Eating Order to Improve Women’s Nutrition
CARE is integrating discussions on gender and sexuality and cultural food practices into maternal health programs. Community health workers are encouraging men to eat with their wives to help ensure a more gender equitable distribution of food within households and contribute to overall health improvements.
Help CARE Make a Difference
Make a donation to CARE in your mother’s honor by visiting: http://www.care.org
Celebrating Mothers
“Motherhood is near to divinity. It is the highest, holiest service to be assumed by mankind.”
― Howard W. Hunter
It’s May, and in May we honor mothers. All this month, our blog will focus 
on the important role mothers play in families and communities, and we’ll also take a look at the unique challenges they face.
We’re going to begin the month by discussing how maternal malnutrition affects maternal morbidity and mortality. We often discuss the links between maternal nutrition and child health outcomes, but we don’t often discuss the relationship between malnutrition and maternal health outcomes.
Nutrition and Maternal Mortality and Morbidity
According to research conducted by Johns Hopkins Bloomberg School of Public Health, “four main causes of maternal mortality (preeclampsia, hemorrhage, obstructed labor, and infection) may be amenable to nutrition interventions.”
- As discussed in our April 4th blog, calcium has been associated with reducing preeclampsia and hypertension.
- Good nutrition early in life can help prevent stunting, which is associated with obstructed labor.
- Iron, folate, B12, and vitamin A supplementation can contribute to the prevention of maternal anemia, which has been associated with hemorrhage.
- Good nutrition helps prevent infections which are associated with sepsis and other potentially fatal complications.
Malnutrition and infection are inextricably linked and can exacerbate one another in what is called the malnutrition-infection complex.
The Malnutrition Infection Complex
Malnourished mothers are at risk of falling into the malnutrition-infection complex, a term that refers to the relationship between malnutrition and infectious disease, “during which malnutrition inhibits immune response, and infectious disease can exacerbate malnutrition.” Not only does undernutrition increase the severity and duration of infection, but frequent infectious illness can exacerbate undernutrition and micronutrient deficiency. Put simply, malnourished mothers are more likely to be ill, which can contribute to a number of pregnancy complications.
Continue to follow us throughout the month as we focus on mothers and nutrition and learn more about the how our programs are working to mitigate the health risks associated with pregnancy and motherhood.
Picture sources: http://www.sweetmothermag.com and interkulturelle-zusammenarbeit.org
This week some of the Window of Opportunity team members are participating in CARE’s Engaging Men and Boys training, a workshop that encourages participants to explore the ways gender norms–social expectations of appropriate roles and behavior for men (and boys) and women (and girls)–influence health outcomes, safety and economic status. Gender norms can contribute to gender inequality, which continues to be a universally pervasive challenge in the field of global health and development; and many agree that in order to achieve gender equality, NGOs (nongovernmental organizations), CBOs (community based organizations), national and local governments and communities must work with everyone in a society in order to achieve positive social change.
The Expert Group Meeting on the Role of Men and Boys in Achieving Gender Equality in 2003 (convened by the United Nations Division for the Advancement of Women), the Agreed Statement of the 48th Session of the Commission on the Status of Women in 2004, the Program of Action of the 1994 International Conference on Population and Development and the Platform for Action of the Fourth World Conference on Women in 1995 (United Nations, 1996) all “affirmed the need to engage men and boys in questioning prevailing inequitable gender norms” (WHO 2007). Preliminary research has found that men and boys have the ability to change attitudes and behaviors around reproductive and sexual health, maternal and child health and women’s empowerment issues.
Gender norms and maternal and child nutrition
So how do gender norms influence maternal and child nutrition? Here are just a few examples of how socially constructed gender norms influence how, when and what women and children eat:
- In certain societies, it may be typical for women to eat last during meal times. This may limit the quantity and quality of the food women consume. This is particularly a concern for pregnant and lactating women who have greater caloric needs.
- Women living in cultures where freedom of movement is limited may not be able to access regular prenatal care, during which time they could receive nutrition counseling and dietary supplements.
- Women may not be able to incorporate breastfeeding into their schedules due to heavy domestic responsibilities dictated by gender norms.
What men can do
Based on the examples above, here some ways men have helped mitigate the negative impact of gender norms on maternal 
and child nutrition in India:
- Men and women have worked together to alter eating order traditions within their households so women can eat at any time during pregnancy and lactation.
- Newlywed counseling conducted with men and women prepares the couple for pregnancy and delivery by developing plans for ensuring women receive the care and services they need during pregnancy.
- Family counseling programs and media campaigns encourage men to assist with regular household chores when children need to be fed.
Men and the Window of Opportunity
The Window of Opportunity program in Peru has been successful in incorporating men into their nutrition counseling session. Husbands are getting into the act by supporting their wives to gain sufficient weight during pregnancy and to eat well during lactation. Fathers are also working to ensure that their children receive the right food at the right time during the first 2 years of life. Thanks dads for all you do to promote health and wellness among your families!
You can read more about research on the efficacy of Engaging Men and Boys in gender equity and equality here and here.
Photo credit: kwekudee-tripdownmemorylane.blogspot.com, http://www.tooyoungtowed.org
In Honor of Earth Day: Examining the links between climate change and nutrition security
Earth Day is next Monday (April 22). This year the theme is global climate change. What will you do to recognize the day? Plant a tree? Take the bus instead of driving your car? Pick up trash in your neighborhood? How about educating yourself on how climate change impacts nutrition?
According to the United Nations Standing Committee on Nutrition: “Climate change will increase the risk of hunger and undernutrition over the next few decades… [It] will affect nutrition through different causal pathways that impact food security, sanitation, water and food safety, health, maternal and child health care practices and many socioecomonic factors.”
The Intergovernmental Panel on Climate Change has also concluded that undernutrition and hunger linked to climate change may be “the most important consequence of climate change” due to the number of people affected.
As extreme weather incidents continue to increase, so does the risk for undernutrition. Just this morning news from Kenya reported that floods are destroying crops, leveling homes, displacing families and taking lives.
How Climate Change Exacerbates Hunger:
Extreme weather
- Extreme weather patterns (heat waves, droughts, heavy rains, flooding) not only affect agriculture, they also put an economic strain on families and communities making it difficult to both produce and purchase food
- Unexpected extreme weather can destroy or pollute food storage facilities
- Climate hazards are making food production erratic in many places
Food Cost
- Decrease in food production could lead to an increase in food prices, making food less accessible to the most vulnerable populations
Disease Burden
- Climate change has a profound effect on water quality and availability,
sanitation, food safety and on waterborne, foodborne, vectorborne and other infectious diseases. All of these illnesses affect nutritent absorption and increase daily caloric needs. - Widespread undernutrition associated with climate change will make it more difficult for those who are suffering from HIV and other chronic illnesses to maintain their health and contribute to the larger economy
Effects of Climate Change on Maternal and Child Nutrition
Women, children and other vulnerable populations are less likely to be able to adapt to and cope with climate change due to their “high exposure to natural hazards [and] direct dependence on climate-sensitive resources” (UN, 2010).
Building Resilience
The UN recommends a 2 pronged approach to mitigating the risk of climate change associated undernutrition that includes immediate nutrition safety nets and long-term sustainable and climate resilient development. Recommendations for direct nutrition interventions include:
- Maternal nutrition
- Improved feeding practices for children under 2
- Promotion of breastfeeding and complementary feeding
- Improved hygiene practices
All of these recommended interventions are part and parcel of Window of Opportunity’s programming. On this Earth Day, we celebrate the fact that Window of Opportunity is helping ensure a healthy future in an uncertain climate.
Window of Opportunity has a brand new video!
In our newest video, Walter Vilchez Davila, Director of Nutrition at CARE Peru; Adelmira Valez, a community health worker; Ciro Rojas Ramos, Nutritionist for the Window of Opportunity; and two mother participants explain how Window of Opportunity is helping mothers, children and communities in Peru.
You can also access this video and others in our collection on our video archive .
Thanks for watching!
For more information about CARE and our programs, please visit www.care.org
Under Pressure: Mothers, babies and hypertension
This Sunday the World Health Organization (WHO) recognizes World Health Day, a day that marks the anniversary of its founding in 1948. Each year a theme is chosen to highlight a particular public health concern. This year, the focus in on high blood pressure, also known as hypertension. Hypertension is associated with a number of serious health problems including:
- Heart attack
- Stroke
- Kidney failure
- Blindness
- Irregular heartbeat
- Heart failure
Hypertension is a global concern affecting 1 in 3 adults worldwide; and like most illnesses, hypertension disproportionately affects people living in low to middle income countries. An alarming 40% of adults living in African countries are estimated to be hypertensive.
Hypertension in young women
High blood pressure is not typically associated with women of reproductive age. For example, women in the United States typically do not develop high blood pressure until they have gone through menopause. However, there are always exceptions, and trends are shifting. Early onset hypertension is becoming more common in the United States. Some studies estimate that 1 in 5 young adults in the US have hypertension. Early onset hypertension can be caused by a number of factors including:
- Diabetes,
- Poor diet,
- Obesity,
- Lack of physical activity,
- Alcohol abuse and
- Tobacco use
Hypertension during pregnancy
Hypertension can develop during pregnancy as well, a condition called gestational hypertension. Researchers from Cambridge University studying gestational hypertension report that, “changes in the placenta during pregnancy alter how much oxygen the growing baby receives. This can trigger the release of free radicals that… cause blood pressure to rise.” Gestational hypertension can be transient, subsiding after the 12th week of gestation. However it can also develop into chronic hypertension and may cause a condition known as preeclampsia. Preeclampsia can affect the mother’s kidney, liver, and brain.
Preeclampsia in the United States
Preeclampsia can cause seizures (also known as eclampsia), the second leading cause of maternal death in the U.S. Preeclampsia is also a leading cause of fetal complications in the United States, including low birth weight, prematurity, and stillbirth.
Preeclampsia and eclampsia in 3 Window of Opportunity Countries
As with hypertension, preeclampsia is more prevalent in the developing world. The WHO estimates that preeclampsia is 7 times higher in the developing world than in the developed.
Bangladesh:
According to Begum et al the majority of cases of eclampsia occur in 
patients who had no or irregular antenatal care and the majority of eclamptic patients who die arrive at the hospital too late to access care.
Indonesia:
Preeclampsia is considered one of the main complicating factors for pregnancy in Indonesia and is attributed to poor diet and obesity.
Peru:
Preeclampsia has been associated with intimate partner violence (IPV), depression and migraines in Peru. According to a study by Sanchez et al, women who experience IPV are almost twice as likely to have preeclampsia during pregnancy. Similar research reports that women who experience depression are 2 to 3 times more likely to be diagnosed with preeclampsia. A study by the same team found that:
- Women who have a history of headache have a 2.4 fold increased risk for preeclampsia
- Women who have a history of migraine have a 3.5 fold increased risk
- Women who have migraines during pregnancy have a 4 fold increased risk
Prevention
Early and regular antenatal care provides an opportunity to screen for chronic hypertension and gestational hypertension throughout pregnancy. The Window of Opportunity works with local health professionals to encourage women to access medical care and dietary supplements that may help with mitigating risk. Folic acid and calcium have both been associated with preventing preeclampsia in pregnant women. By encouraging women to access care during pregnancy, the Window of Opportunity is helping ensure women have safer pregnancies and children have a healthier start at life.
