Asian women experiences of post natal depression

Asian Women Experiences of Post Natal Depression

 
Abstract
The study examined the experiences of postnatal depression among Asian women. The relevant data were gathered using a qualitative method. Five women from the Asian community participated in semi-structured interviews. The collected data were analysed using a thematic approach, which involved the identification of common patterns depending on the research objectives and questions. The result showed that the psychosocial setting and stressors increase the likelihood of PND occurrence after delivery. Psychosocial factors including economic stress, level of support from family members and friends, and hopelessness have a significant impact on women after delivery. The results also indicate that environmental stressors among new mother’s influences postnatal depression. Accordingly, the findings revealed that postnatal depression should be addressed through subjecting the individual to counselling programs. However, the findings for this research are based on the information provided by five women from Bangladesh community. As a consequence, future scholars need to increase sample population to enhance the generalisability of the results.
Keywords: Postnatal depression, Bangladesh community, Psychosocial, Stressors, Risk factors 
Table of Contents
Abstract 2
1.0 Introduction 4
1.1 Background Information 4
1.2 Problem Statement 5
1.3 Rationale of the Study 5
1.4 Research Questions 6
1.5 Aim and Objectives 6
2.0 Literature Review 7
2.1 Postnatal Depression Risk Factors 7
2.2 Interventions to Reduce Postnatal Depression 8
2.3 Cultural Differences in Postnatal Depression 10
3.0 Methodology 11
3.1 Participants 12
3.2 Materials 12
3.3 Research Design 13
3.4 Procedures 13
4.0 Results and Analysis 18
4.1 Introduction 18
Theme 1: Psychosocial Settings and Stressors 18
Theme 2. Environmental Stressors 19
Theme 3. Family Relations 19
Theme4. Method of Improving Well-being of Mothers 20
5.0 Discussion 21
5.0 Conclusion and Recommendations 23
5.1 Conclusions 23
5.2 Recommendations For Practice and Future Studies 24
References 25

 
Asian Women Experiences of Post Natal Depression
1.0 Introduction
1.1 Background Information
Giving birth and having a new baby are emotive experiences and during this time women are vulnerable to psychological issues including adjustment disorders, depression and anxiety. Extensive research has been conducted worldwide to show that postnatal depression (PND) is a universal experience, cultural norms, customs and attitudes lead to differing views in clinical presentations, associated factors, prevalence and experience (Goyal, Park & McNiesh, 2015). Asian countries such as India and Bangladesh that are still developing are generally espoused to more conservative perspectives regarding the nature of mental disorders, the role of women and reproduction. Mehta and Mehta (2014) stated that the cultural factors limit discussions regarding PND and henceforth, affect the well-being of Asian women. The behaviours of depressed mothers can lead to a lack of support from the husband, regret for marriage, marital conflicts, economic productivity of women and families, social functioning and quality of life.
Despite being a common maternal depressive disorder, most women in Bangladesh remain in silence and fear to share their issues which affect possibilities of seeking necessary assistance needed to maintain positive well-being (Gausia et al., 2019). Henceforth, this population is susceptible to extreme harm in society. Globally, the incidence of PND is between 13% and 40% depending on whether the country is developed, developing or underdeveloped (Azad et al., 2019). The risk that leads to high incidences of PDN in low-income nations includes ethnicity. For instance, in India, the incidence of PDN varies from 11% to 16% within the first 4 months after delivering a child. On the other hand, the pervasiveness of PDN in Bangladesh community is approximated to 22% (Edhborg, Nasreen & Kabir, 2015). Depressed mothers demonstrate lower levels of affection and collaboration with their children and can also affect the cognitive, social and emotional development of the children.
1.2 Problem Statement
Given the fact that PND is a leading cause of maternal morbidity and potentially contribute to increased rates of maternal mortality, the condition has attracted much attention from researchers that study the health of women for the last few years (Islam et al., 2017). Different preventive measures have been implemented but the root causes, especially in Bangladesh, has remained a challenge because of multifactorial aetiology that is complex (Masood et al., 2015). Chronic social adversity in women plays essential roles particularly in Asian countries that are characterised by risk factors such as conflicts between mother and daughters-in-law, conflicting influences of culture and polygamous marriages (Nasreen et al., 2015). The widely recognised cultural differences that lead to differing prevalence rates include a greater emphasis on family and social relationship among Asian community that leads to high dependence rates on extended family, own mothers and partners (Ghaedrahmati et al., 2015). Asian women are simply being ignored and not receiving the support or treatment they need for PND. Majority of the existing studies on PND have focused on Western countries and have neglected women from the low-income countries such as India and Bangladesh.
1.3 Rationale of the Study
PND is a public health issue that needs evidence-based interventions that can be implemented by the relevant stakeholders in Bangladesh community. The study is based on providing sufficient information that can lead to effective care for women that experience depressive symptoms during and after birth. Approximately 22% of women experience depression after delivery in Bangladesh community which implies that the country is highly affected by this mental disorder in Asia and most effective intervention strategies are needed to overcome the situation (Gressier et al., 2017). Different stakeholders such as family members, governments, policymakers and healthcare professionals should provide necessary support in addition to existing measures by governmental and non-governmental organisations.
1.4 Research Questions
i. How do psychosocial setting and stressors in women’s life regulate or augment the likelihood of PND occurrence after delivery?
ii. To what extent do the environmental stressors influence postpartum depression in new mothers?
iii. Do family relations affect the level or onset of PND after childbirth?
iv. Are there existing prevention strategies that are culturally appropriate to improve the well-being of mothers in Bangladesh community?
1.5 Aim and Objectives
The primary aim of the study is to closely examine women experiences of having a baby and after birth in Bangladesh community who went through PND but have fully recovered. To achieve this aim, the study was based on the following research objectives:
i. To evaluate the risk factors of PND among new mothers in Bangladesh community.
ii. To explore the burden of PND in Bangladesh community.
iii. To establish the association between family and societal factors and PND in the community. 
2.0 Literature Review
2.1 Postnatal Depression Risk Factors
A study conducted by Shakeel et al. (2015) reveal that PND can cause severe outcomes for women, children and families and existing literature provide different risk factors including relational, psychopathological, socio-demographic and other issues that are associated with labour and birth experience. Evagorou, Arvaniti & Samakouri (2016) stated that the family of the personal history of depression is a risk factor that increases the possibility to develop PND. Another element identified by Nilaweera, Doran and Fisher (2014) is traumatic birth including medical complications such as prolonged and painful labour, premature delivery and unexpected C-section which affect a woman’s mental and emotional well-being. Birth disappointment is also a risk factor if the expectations of the mother are not met such as being surrounded by supportive individuals, fulfilling labour and childbirth and remaining calm and natural. Murray et al. (2015) indicated further that relationship difficulties have severe impacts on the emotional well-being along with controlling or abusive behaviour of the partner. Some of the behaviours include efforts to exert control, controlling finances, the threat of physical abuse and yelling can lead to mental problems.
Ding et al. (2014) acknowledge that stressful live events including job loss, divorce and other major life changes can also significantly contribute to PND. Dørheim, Bjorvatn and Eberhard-Gran (2014) disagree with the findings of Ding et al. (2014) by stating that troubled pregnancy characterised by immobility and high degrees of monitoring along with severe morning sickness can increase stress among the women during postnatal period. Other risk factors include financial difficulties, lack of social support, history of abuse (verbal, physical, sexual, emotional) and previous pregnancy loss or fertility issues (Gaillard et al. 2014; Dørheim, Bjorvatn and Eberhard-Gran, 2014). The risk factors can be categorised into psychological, obstetric, biological, social and lastly, lifestyle changes. Psychological elements are based on low self-esteem that leads to parenting stress, the reluctance of the baby gender, number of life events and recent pregnancy.
2.2 Interventions to Reduce Postnatal Depression
Howell et al. (2014) state that PND can be managed through cognitive-behavioural therapy (CBT) which is a psychological intervention that contributes to the reduction of depression symptoms up to six months post-intervention. The study conducted by Pearson et al. (2013) indicates that CBT focuses on the identification of patterns of distorted negative thinking and places emphasis on the link between behaviour, feelings and thoughts. Post-natal mothers experience automatic thoughts associated with negative content and CBT can help people to get opportunities for changing the behaviour. DeMontigny et al. (2013) emphasize that the approach integrates clinical practice interventions such as cognitive restructuring, modelling and problem solving to yield positive outcomes. Both Howell et al. (2014) and DeMontigny et al. (2013) suggested that the main areas focus on when dealing with women with PND changes in life events, unresolved disagreements in interpersonal relationships and roles they play in the society. Consequently, this psychosocial intervention focuses on improving mental health whereby cognitive behaviours and distortions are managed, along with helping the affected person to develop personal coping techniques that are targeting how to solve current problems and also enhance emotional regulation.
Miller et al. (2013) revealed that person-centred approach can also be used whereby the healthcare professional taking care of the depressed woman pays attention to personal goals, desires, wants and needs and require empathy, unconditional positive regard and genuineness while delivering care. Strong interest should be seen in the experiences of the patient and person-centred intervention can be implemented through the use of a wide range of frameworks. According to the findings of Stewart and Vigod (2016), the key components to consider are highlighted as follows: appropriate involvement of the patient’s family and friends, promoting physical and emotional support, emphasising freedom of choice, fostering trusting caregiving relationships, respecting the individuals’ needs, preferences and values, providing meaningful care, being responsive and knowing the patient as an individual. Hiscock et al. (2014) pointed out that the biographies of a patient and the family need to be comprehensively understood to achieve person-centred care when dealing with women diagnosed with postnatal depression. To gain more details of the patients and personal aspirations in future, caregivers should pay attention to the life experiences and stories.
Goyal, Park and McNiesh (2015) argued that doctors can describe medications that include antidepressants that have direct effects on the brain by altering the chemical that regulates the mood. Differences in mood can be realised after several weeks of taking the prescribed medications. Although, Edhborg, Nasreen and Kabir (2016) proposed that different side effects of the antidepressants need to be considered and examples include dizziness and decreased sex drive. While breastfeeding it is important to understand that there are antidepressants which are not safe and thus, the need to discuss with the healthcare professional before taking the medications (Gressier et al., 2017). Hormone therapy, for instance, may be recommended when the oestrogen levels of the woman with PND are low. Therefore, it implies that the use of antidepressants can help in sleeplessness, concentration, feelings of not being able to cope, hopelessness and irritability.
Dørheim, Bjorvatn and Eberhard-Gran (2014) revealed that despite lack of evidence on the long-term risks, the antidepressant chemicals can be passed through breast milk to the infants. Nasreen et al. (2015) differ with these findings by suggesting that feeding options need to be discussed with the doctor to ensure the right treatment is selected to enhance the safety of both the mother and the child. Tricyclic antidepressants (TCAs) are not appropriate for women with frequent suicidal thoughts, and a history of epilepsy or heart disease. Nilaweera, Doran and Fisher (2014) recommended that suitable medication can include selective serotonin reuptake inhibitors including sertraline and paroxetine. In cases of postnatal psychosis whereby a woman has irrational behaviour, suicidal thoughts and hallucinations, tranquillizers can be described.
Another significant intervention identified by Shakeel et al. (2015) is an ideal support from the family, friends, caregivers and healthcare professionals. The woman’s recovery from PND is highly determined by support and patience from friends and families. Murray et al. (2015) declared that women can be encouraged to share feelings with a professional counsellor or support group and thus, seek help that can be useful to overcome the situation. Stewart and Vigod (2016) contradicted the previous studies by arguing that healthcare professionals should also be given necessary support that can lead to the development of skills, knowledge and experiences that can improve their confidence when they communicate with women regarding emotional distress. Therefore, increasing community and social support can be achieved through strategies such as normalising the adjustment to motherhood, learning relaxation skills, engaging in exercise and increasing activity outside the home, getting help in the management of the household demands and looking after the infant, meeting others and signposting to local support networks.
2.3 Cultural Differences in Postnatal Depression
Although PND is recognised across different cultures, Di Florio et al. (2017) pointed out that it is constructed as an illness in some cultures and as a transient in others. According to O’Mahony, Donnelly, Bouchal and Este (2013), the primary challenges experienced by healthcare professionals in Western countries such as the UK is developing a culturally sensitive approach to PND care for migrant mothers from developing nations such as India and Bangladesh. Cultural factors play an essential role in PND as they trigger and lead to alleviation of the depressive symptomatology of postpartum depression. Vliegen, Casalin and Luyten (2014) further state that fewer studies are available that investigate the impact of cultural differences on PND despite the variety of literature that examines cultural aspects. Nevertheless, Gausia, Fisher, Ali and Oosthuizen (2019) argued that the literature is inconclusive regarding the varying levels in the prevalence of PND across women from different communities or income groups. Studies (O’Mahony, Donnelly, Bouchal and Este, 2013; Vliegen, Casalin and Luyten, 2014) revealed that South Asian women living in the UK experience stigma associated with the view that depression is culturally unacceptable since a woman needs to fulfil her role in the society. African, Black Caribbean and Indian women are expected to be strong and the culture in these communities is affected by the history of slavery.
 
3.0 Methodology
This chapter explains the steps and assumptions followed during the collection and analysis of data and interpretation and presentation of the results. According to Abutabenjeh & Jaradat (2018), employing appropriate strategies fundamentally helps in ensuring credible and reliable results are developed in regards to the research question and objectives. This research was based on a qualitative method that allows collection of in-depth data concerning the research phenomenon. Therefore, the primary sections that guided the process of collection, analysis, and presentation of the findings are extensively explained based on various sections including participants, materials, design, procedure, ethical considerations, and analyses.
3.1 Participants
The participant’s involved Asian women in Bangladesh community who went through post-natal depression after delivery were selected using purposeful sampling technique. Ames, Glenton and Lewin (2019) stated that purposeful sampling is the process of selecting participants depending on specific elements such as availability and willingness. In this case, 5 Asian women who experienced post-natal depression were selected. However, most of the legible participants based on aspects such as understanding of the research phenomenon, availability, and willingness were excluded because they never experienced post-natal depression after delivery.
3.2 Materials
Before the actual interview, a pilot testing was conducted which involved one participant and examined clarity and credibility of the interview questions. The outcome of the pilot test indicated that the interview questions could be easily understood by the participants. Additionally, a smartphone was used to record interview transcripts before sorting and analysing using a thematic approach. Adequate data was recorded which saved time required for the collection and analysis of the information. During the interview, participants were allowed to seek clarification about what was expected.
3.3 Research Design
The study used an interpretive phenomenological design. According to Smith and Osborn (2015), the design emphasises on divergence and convergence experiences of the small number of participants while examining the research phenomenon. Since qualitative studies are inductive, the phonological design allows the researcher to structure participants experience the way they occur. The approach offered an opportunity to explore conditions that trigger postnatal depression (Smith and Osborn, 2015). As a consequence, a detailed examination of the personal lived experience of the participants which led to the formulation of appropriate answers to the research questions and objectives.
Moreover, the philosophy guides the researcher during the collection, analysis, interpretation, and presentation of the results. Therefore, interpretivism philosophy was employed because the research was based on a small sample population and investigation of qualitative data. According to Saunders, Lewis & Thornhill (2012), interpretivism philosophy allows the researcher to analyse and synthesise the elements of the study to access a reality. Additionally, this approach emphasises on a qualitative analysis hence allowing the understanding of the research phenomenon through direct experience. This philosophy was also preferred because it is associated with high validity as the information is honest and trustworthy.
3.4 Procedures
The primary data was collected through one on one interview where 5 Asian women were requested to provide their opinion based on experience. Interviews were preferred because it offers the opportunity to collect in-depth information regarding a research phenomenon. There is a chance for the researcher to make clarification and ensure participants provide right responses to the research phenomenon. Each interview session took between 15-20 minutes.
The interview transcripts were analysed through identifying common themes, patterns, and ideas that come up repeatedly. In this regard, Alholjailan (2012) established that a thematic approach is most appropriate method for analysing qualitative data in an inductive way. Hence, the approach was adopted because of flexibility that allowed the researcher to focus on research questions and objectives which leads to the formulation credible and reliable results. Therefore, analysis of the data was based on the following steps:
Familiarisation with data: During this phase, all the data collected through interview transcripts reviewed and this allowed the researcher to become familiar and immersed with the content.
Coding: Coding involved identifying important features of information that were relevant to the research question and objectives. The common terms or codes were identified in this step were used in the later stages of analysis.
Generating Initial codes: The codes were reviewed used in identifying key themes and patterns based on the research questions.
Reviewing themes, Defining and Naming Themes, and Writing Up: Initial themes were reviewed to ensure only those that provided suitable answers to the research questions were retained. After deciding on the informative name for each theme, analytical narrative was developed based on the research questions.

Table 1: Summary of Themes and Codes (Source: Author)
Interview except Codes Theme
So there was help but it’s more nobody was emotionally available for me, to the point where I felt really alone and the only thing keeping me going was my baby Emotionally, I felt really alone, keep me going Psychosocial Settings and Stressors
I did, yeah. I had a caesarean, and she almost died at the birth, so obviously it was very difficult because I had gestational diabetes while I was there, which is why it was such a difficult birth afterwards, and it wasn’t properly diagnosed during the pregnancy, so it was very difficult. Almost died, was very difficult, was not properly diagnosed, very difficult Environmental Stressors
I would say the first couple of weeks I was quite lucky because my mum and my aunty moved in with me. I felt in the night, obviously with their needs as well because they’re quite elderly, I didn’t want to disturb them, so throughout the night I wanted to manage on my own. My husband was there but because I was breastfeeding I suppose the baby only needed me, nobody else Moved in with me, to manage on my own, my husband was there Family Relations
I used the advice from the counselling, so it was just little things I could change in my daily routine to help me break out of the kind of cycle that I’d gotten myself in. I started after a while, I started letting myself like enjoy, do things like for myself instead of doing everything for the baby, I think that helped a lot to try and like pull me through Counselling, helped a lot to try and like pull me through Method of Improving Well-being of Mothers
The research complied with various ethical principles during the collection, analysis, and interpretation of data. Sanjari et al. (2014) stated that the interaction between the researcher and participants can be morally challenging because of the personal involvement of the researcher in the data collection, analysis, and interpretation process. To avoid this, it is essential to formulate or comply with ethical principles (Sanjari et al., 2014). Compliance with ethical principles helps in formulation of trustworthy outcomes. Therefore, the participants were informed in advance about the type of data to be collected and how the data was going to be used. According to Cacciattolo (2015), the principle of informed consent stresses that the researcher has a responsibility of providing comprehensive information to participants regarding the research. Some of the clarifications that were given to participants include objectives of the research, role of the participants, nature of the study, and how the information will be published and used.
Since the research involved collection of sensitive information from the participants which pose emotional distress, the researcher established a protocol for dealing with such distress. In light of this, the participants were requested to reach the researcher for counselling whenever any issues such as distress were encountered. Personal information given by participants was concealed. Anonymity was also enhanced by using letters to identify the participants which minimised susceptibility to biases. The information provided by participants was shared with third parties as a way for enhancing confidentiality.  
4.0 Results and Analysis
4.1 Introduction
This chapter provides the results for the analysis of qualitative data collected from 5 Asian women. The main themes were identified from the research questions and objectives as well as the collected data through interviews. While identifying specific patterns from the data, the focus was given to the research objectives including assessing the risk factors for PND, estimating the burden of PND in Bangladesh community, and the association between family and societal contributing to PND in the community. Identity of the interviewee has been anonymised to enhance confidentiality.
Theme 1: Psychosocial Settings and Stressors
Post-natal depression among women is a major global health concern attributed to environmental settings and psychosocial factors. According to R1 and R3, PND is caused by loneliness and lack of social support.
R1“So there was help but it’s more nobody was emotionally available for me, to the point where I felt really alone and the only thing keeping me going was my baby”.
Psychosocial factors are the potential causes of PND among women. These factors influence women’s physical health outcomes via psychological mechanism. These variables comprise economic stress, hopelessness, assistance with house chores, and cleaning and taking care of other children. Feelings of loneliness are common among mothers after delivery especially when they are not assisted to take care of the baby and others chores. Sometimes, mothers feel resentment as their partners go to work each morning. Women need critical support when nearing deliveries and after delivering their babies. Within this period, she should be assisted to execute routine and demanding tasks as an approach for reducing the likelihood of post-natal depression.
Theme 2. Environmental Stressors
Postpartum times are stressful periods for new mothers as they learn to bond with their babies and balance the needs of infants apart from tending to their individual psychological and physical well-being. According to R3, delivering through C-section exposes an individual to PND.
“I did, yeah. I had a caesarean, and she almost died at the birth, so obviously it was very difficult because I had gestational diabetes while I was there, which is why it was such a difficult birth afterwards, and it wasn’t properly diagnosed during the pregnancy, so it was very difficult”.
Some new mothers experience difficulties during delivery of infants which increases their susceptibility to PND. These difficulties could be medical-based due to challenges such as C-section deliveries or physical disability for some new mothers. As a consequence, new mothers experiencing personal challenges or infant-related illnesses are more likely to experience post-partum depression than physically-normal new mothers with healthy babies.
Theme 3. Family Relations
The findings showed that family relations enhance the likelihood of experiencing PND after infant delivery, but during pregnancy. According to R3 and R4, the level of support or relationship with the husband or family members greatly determines whether new mothers will be depressed after delivery or not. During the period after delivery, responsible husbands take care of all responsibilities performed by women such as feeding and taking care of kid.
“I would say the first couple of weeks I was quite lucky because my mum and my aunty moved in with me. I felt in the night, obviously with their needs as well because they’re quite elderly, I didn’t want to disturb them, so throughout the night I wanted to manage on my own. My husband was there but because I was breastfeeding I suppose the baby only needed me, nobody else”.
The findings show a connection between PND and individuals relationship with family members. For instance, specific characteristics of the husband including being supportive could inherently reduce the chances PND. Improvements of mother-husband or mother-family relationship with reduce the level of depression among mothers after delivery. Being alone with the child even when there’s a healthy relationship between the mother and other family members may be challenging. After giving birth, the mother requires both emotional and physical help which reduces anxiety, depression, and frustration.
Theme4. Method of Improving Well-being of Mothers
According to R3, the well-being of mothers can be improved through counselling session. Women suffering from post-natal depression should book for psychotherapy counselling sessions to discuss their condition with psychiatrists or psychologists and determine the best solutions to prevent PND.
“I used the advice from the counselling, so it was just little things I could change in my daily routine to help me break out of the kind of cycle that I’d gotten myself in. I started after a while, I started letting myself like enjoy, do things like for myself instead of doing everything for the baby, I think that helped a lot to try and like pull me through”.
Counselling programs will enhance an understanding about the potential methods of improving their well-being. For instance, such programs will enable them set realistic life expectations on all aspects related to their baby to minimise the pressure of failed expectations. Mothers will be encouraged to seek early medical attention from qualified physicians to prevent rapid progression of the disorder.  
5.0 Discussion
The findings revealed that psychosocial factors affect most women after delivery with the potential of resulting in PND. While considering the psychological and social predictors for women after delivery, it is evident that the interpersonal factors and stress are critical psychosocial aspects for postnatal depression in women. The findings are consistent with the study of Nilaweera, Doran and Fisher (2014) and Murray et al. (2015) who established that interpersonal factors relate to the social environment of women after delivery. The ability of women to receive adequate psychosocial support and assistance reduces the potential for postnatal depression as compared to women who have to grapple with negative relationships within their environment. Besides dealing with depressing situations, anxiety and a previous history of depression are also psychosocial factors that may impact on the vulnerability of women after delivery (Ding et al., 2014).
The findings showed that environmental stressors have an influence on postnatal depression among women after delivery. The environment shapes the behaviour and further determines how they can focus on reducing their vulnerabilities. The failure to receive appropriate support relating to care within the healthcare institutions after delivery results in distressing conditions for women who have to bear the pressures for their survival (Nasreen et al., 2015). The continuity of care also provides an opportunity for women to increase their knowledge and awareness regarding child protection and growth. However, a less supportive environment in the acquisition of appropriate medication and clinical support correlates with a higher degree of postnatal depression among women after delivery.
The postpartum duration for mothers is challenging with the potential onset for anxiety and depression. Family relations provide a basis for support by increasing assistance for mothers after delivery. Positive family connections reduce the risk of postnatal depression as mothers have an opportunity of sharing their issues and receiving help from their immediate family members. The results are consistent with the findings with Stewart and Vigod (2016) who established family relations also provide an opportunity for undisrupted mother-infant bonding and an ultimate socio-emotional development. Postnatal depression among women is often associated with lower tolerance and hostility towards family members. Poor family relations disrupt the mother’s ability to provide appropriate care for the new born babies with the societal and household member expectations further lowering their recovery period. Poor family relations increase the women’s less responsiveness and aggression towards their family members and subsequently increasing their risk for postnatal depressive symptoms.
Various cultural strategies are available for preventing postnatal depression among women across Bangladesh. Counselling programs will enhance early screenings during the prenatal and natal periods provide an in-depth comprehension of the risk factors for women within their settings. Cultural practices including checking on the social background and economic viabilities for women provide an opportunity for reducing their vulnerabilities (Shakeel et al., 2015). The routine clinical practice of screening attempts to identify women at risk while emphasising on early interventions including individualised interventions for their improvement. Psychological interventions including the cognitive behavioural therapy and interpersonal therapy provide a means of improving a woman’s perception while reducing the extent of their depressive situations.  
5.0 Conclusion and Recommendations
5.1 Conclusions
The study aimed at examining women experiences of women after delivery who went through PND and how the managed to recover. To achieve this, the main objectives were to assess the risk factors of PND and the association between family and social factors and PND in the community. Women dealing with traumatic and psychological stressors have a higher potential of experiencing postnatal depression after delivery owing to the changes in their lifestyle and need to adapt to the needs of their babies. The psychosocial environment and women’s support system after delivery may either reduce or increase the risk of PND. The new environments can trigger anxiety with environmental components including noise, room temperatures arousing their fear of their surroundings. Women may experience environmental stressors within their homes. Lack of privacy may impact on their ability to effectively care for their babies thereby triggering painful experiences and consequently increasing their susceptibility to postnatal depression. Women require close support from their family members in overcoming their fears and difficult situations within their families. During the period, they often experience emotional distress with which family relations can foster on reducing the fright and panic while offering a means of reassurance to the individuals. Therefore, families that fail to effectively ascertain issues affecting the women after their delivery not only increase their risk of rejection but also developing postnatal depressive conditions.
Specific cultural perspectives integrated within the classrooms such as parenthood classes and the continued provision of care and support for women enriches the sustainability of psychological and psychosocial strategies for reducing their susceptibility. The interventions enhance the provision of supportive psychosocial and emotional education as individuals and within groups aiming to increase their situational awareness and resilience during child development. The initiatives can also involve undertaking postnatal psychosocial debriefing which focus on developing the cultural understanding of the woman’s situations relating to their experiences during previous conditions during delivery.
5.2 Recommendations for Practice and Future Studies
The findings will help Asian people and the Bangladesh community who are based in the United Kingdom to acknowledge the dynamics supporting the existence of PND among new mothers, and to reduce the stigma connected to childbirth in Asian communities. As a result, it will promote positive birth experiences whereby supportive and nurturing care is provided to promote the feeling of safety, shared decision making, privacy, respect, trust and confidence among Asian women. The healthcare sector can implement policies that foster quality care-giving to reduce incidences of postnatal depression. Additionally, the study specifically focused on PND among Asian women and this limit its generalisation of the findings among all women who experiences the problem after delivery. Additionally, the findings are based on few individuals who participated in an interview. Therefore, future scholars should address these issues by focusing on the cause and management of PND among mothers from different races. Consequently, the findings can be applied by practitioners and stakeholders preventing or managing PND among mothers after delivery.  
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