Meghan and Harry in Fraser Island, Australia in 2018. Photo / Getty Images
A wave of responses from women who have experienced depression and suicidal thoughts is shedding light on the stark differences between how pregnancy is perceived and lived.
Oprah Winfrey's interview with Meghan and Harry has clearly become a spark for international discussions about racism and the state of Britain's royal family. And it has brought new attention to another issue as well.
Meghan's revelation of her mental anguish 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 for many.
The experience of life-threatening pregnancy complications, mental as well as physical, is strikingly common. If it has not happened to you, it has almost certainly happened to someone you care about, though you may not know it.
Twitter was soon filled with people sharing their own stories of depression, anxiety and suicidal thoughts during and after pregnancy.
"The interview brought back for me that really bad time in my life where I felt like I was spiralling down a drain, when my thoughts just would not let me be," Wendy Molyneux, a mother of four and the showrunner of the animated series Great North, who experienced debilitating postpartum anxiety after having her fourth child, said via direct message.
Pragya Agarwal, a data scientist and the author of a forthcoming book about the history and science of motherhood, said that after giving birth to premature twins, "I just wanted to disappear."
"I was really close to just wanting to go away, basically, to not be here, and not just live," she said. "I would cry and sit in my car in the supermarket car park."
Members of the royal family are expected to be a very particular type of celebrity, a sort of human embodiment of charming respectability. Now, in her post-palace life, Meghan has become an avatar of the disconnect between societal expectations of pregnancy and the reality — and that collective misperception, experts say, is adding to the danger.
Most statistics suggest that 15 per cent to 25 per cent of women experience depression during or after a pregnancy, but that range is likely to be an underestimate.
"Due to the stigma around disclosing negative mood at this time as well as how difficult people find it to be taken seriously, this figure is likely to be much higher," Emma Svanberg, a clinical psychologist who specialises in peripartum — the time before and after childbirth — mental health, said by email.
In a 2017 survey of 1,000 British women, nearly 50 per cent of respondents reported experiencing a mental or emotional problem, but half of these had not had this problem identified by a health professional.
Meghan did not say whether she had been diagnosed with peripartum depression or any other condition. But experts increasingly advocate extending specialist care to women who experience serious distress during or after pregnancy, whether or not they fit a specific diagnosis.
"Some researchers have suggested that we should, rather than looking at particular diagnostic categories, refer instead to 'perinatal distress' to encompass the complexity of the difficulties experienced at this time," Svanberg said.
The stakes, after all, are extremely high. Pregnant people risk stroke, haemorrhage, infection and other complications that can be deadly for parent and baby. But mental distress is one of the most serious risks of all. In developed countries, suicide "is a leading cause of death in the perinatal period (The leading cause of death in 2003)," Svanberg wrote.
Discussions of pregnancy and mental health often focus on pregnancy hormones' effect on mood. But while that is a factor, there is substantial evidence that other stressors play a role as well — so much so that approximately 10 per cent of fathers also experience postpartum depression.
"Meghan was a pregnant woman living in an unfamiliar country and isolated from her family and social support, with enormous and new pressures placed on her in her role as well as the pressures felt by all women in the perinatal period," Svanberg said. "I cannot begin to imagine going through this with criticism, hostility and judgment. How could there not have been an emotional fallout to that?"
Meghan also discussed the bigotry she faced on account of her mixed-race heritage, which may have compounded her risk. "Studies show that women who experience structural racism are at even greater risk of postpartum depression and anxiety," said Payal K. Shah, a human rights lawyer and Reproductive and Sexual Health Law Fellow with the University of Toronto Faculty of Law.
"People of colour are more likely to experience mental health problems and less likely to receive appropriate help," Svanberg said. 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 Black women's pain during birth, which can deprive them of the medication and care they need.
The popular image of pregnancy as something happy and straightforward, troubled only by cute problems like wanting to put pickles on ice cream, or brief ones like a painful natural delivery, can mean that those who have 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 'self-sacrificing mothers,' who ought to prioritise the purported needs of their families and children even over their own survival and well-being," said Shah, who has worked on reproductive and maternity rights issues around the globe. "These stereotypes lead to stigmatisation of health care for pregnant women or mothers who experience depression or anxiety, rather than only joy or contentment."
"There is also an assignation of blame, that there must be something wrong in what we are doing if we are not feeling 100 per cent," Agarwal said. "Women are also made to feel guilty about being frail, overemotional and nervy."
Although some in the British news media have criticised Meghan for claiming victimhood despite her wealth and privilege, many of those with more firsthand experience saw her story as a sign that these problems could happen to anyone, no matter the circumstances.
Molyneux said that she was moved to hear Meghan speak so frankly during the interview.
"I felt a big wave of relief wash over me to see this incredibly accomplished person admit she'd had mental health struggles," she said.
"For people who are less privileged than me, women in jobs where it's less safe to admit you are struggling, they can point to this person who has wealth and privilege — a literal duchess — and say, 'This isn't my fault, it can happen to anyone, and I need help.'"
Where to get help:
• 0800 543 354 (0800 LIFELINE) or free text 4357 (HELP) (available 24/7)
• https://www.lifeline.org.nz/services/suicide-crisis-helpline
• YOUTHLINE: 0800 376 633
• NEED TO TALK? Free call or text 1737 (available 24/7)
• KIDSLINE: 0800 543 754 (available 24/7)
• WHATSUP: 0800 942 8787 (1pm to 11pm)
• DEPRESSION HELPLINE: 0800 111 757 or TEXT 4202
• NATIONAL ANXIETY 24 HR HELPLINE: 0800 269 4389
If it is an emergency and you feel like you or someone else is at risk, call 111.
Written by: Amanda Taub
© 2021 THE NEW YORK TIMES