Dhaka Bangladesh : On Low-Income Women, Confinement and Postpartum Depression
Anaise Williams
U.S. Fulbright Project

Nothing has changed since before the birth, I just have to take more care and feed another person, she says simply while passing me a cup of cha with ginger. Shopna had her first baby 6 months ago in her family’s Bangladeshi village in Borishal, assisted by her mother and aunt, and returned to Dhaka 3 months after the birth to be with her husband, a furniture maker in the slum. Today I, unintentionally of course, woke her up at 11am while knocking on the locked door to her single room to do a follow-up interview for my project on postpartum depression.

Her baby is plump and I have yet to hear him cry. Now healthy, he suffered from diarrhea two weeks back, in which Shopna paid for an expensive [$1.20] rickshaw ride to the public diarrhea hospital for medicine, the last time she left her complex. Shopna, the baby, her husband, and her brother-in-law share the room, of which three quarters is taken up by a single large bed.

They share a toilet, water pump, and cooking area with six other rooms of families. The room has a dresser with a mirror that collides with the bed on one wall, and the wall over the bed has pieces of newspaper and magazine pictures taped to it. The rest of the walls are sea green with peeling to reveal a tan color, and all walls lack windows. On the small floor space there is a water bucket, knives and large pans where Shopna prepares food before taking it out to the fire pit.

She describes her day as waking up, cooking, feeding the baby periodically, washing clothes, lying down, and then further cooking: none of her chores require her to leave the complex. I initially found the extremity of physical confinement surprising, and soon after I realized that the physical restriction is in the presence of other modes of confinement, which characterize most low-income Dhaka women’s experience of motherhood, and unequivocally contribute to the onset of postpartum depression.

As a recent graduate of University of Rochester, I am now on a U.S. Student Fulbright grant in Bangladesh to conduct anthropological research on new mothers’ experience with postpartum depression in Dhaka slums. I am staying in Bangladesh for a year; the first two months I took an intensive Bangla language course and then transitioned to James P. Grant School of Public Health at BRAC University to begin my research. With a translator, I spend three to four days a week in the slum visiting and revisiting women who have given birth in the last six months to understand their daily lives, family dynamics, stresses, health problems and access to healthcare. My end objective is to produce two things: a strategy for maternal health workers to create a protocol for identifying postpartum depression and an ethnographic piece that captures how women experience and explain post-birth tension.

Urban Migration
Only four of the 31 interviewed low-income women were born in Dhaka. The majority of the mothers I spend time with live alone with their children and husband, having migrated to Dhaka after marriage. Most women go back to their village only two times a year, and otherwise leave the slum just for rare health reasons. The limitation on physical movement is amplified by how urban migration requires a reconstruction of community and a breaking down of women’s support networks. Contrary to popular belief, urban slum communities do not reflect social support systems found in villages. The women I meet and their neighbors have a distinct tie to their village and view the slum as a place to focus on economic prosperity and surviving; very few women say that they have friends in the neighborhood. While neighbors intermingle and babies are held and cuddled by all the women and children in the area, the trust between residents is not comparable to that of village networks.

The women whose husbands allow them to work express eagerness to do so, but there is often not an available person that the women can rely on to supervise the babies, unlike in the village. About half of the women I interview did have jobs before the birth, all of which, except for one maid, were at garment factories, but resigned after delivery and few plan on returning. Kohinoor continued to work at the garment factory after her second son was born and, while telling me this, commented, and look at how he turned out. He worries me so much. The boy has a long list of health complications related to a previous lack of supervision.

Restrictions imposed by family dynamics
While a limitation on physical movement is most obvious, family and socio-structural modes of confinement are most concerning and emerge from the cultural expectation of wives and mothers. Every woman I speak to says that her contact with friends decreased after marriage, and even more after the birth of her first child. Ireen says that after women in Bengali culture are married, the husbands don’t like it if they have too much contact with their friends. They just want women to look after the home rather than have their own personal lives. She continued to say that husbands keep their friendships, if not increase the strength and number of friendships. After marriage women move in with the husband’s family. In a few extreme cases, young women are not allowed to see or talk to friends or family. 17-year-old Sonia was asked where most of her friends are, and her mother-in-law, who refused to not be present for the interview, answered for her saying: after she got married to my son I stopped letting her relatives and friends come here, because they say ‘oh you’re letting my daughter get thinner and you’re making her work’, and we don’t want to hear that and don’t want people to say stuff like that, so we stopped her friends and family from coming. Interviewer: Okay so the family says that, why don’t you let her talk to her friends? Mother-in-law: Friends aren’t necessarily well-wishers. The limiting and nonconsensual replacement of friendship with motherhood, which is socially and timely linked very tightly with marriage, on top of being physically confined, I predict contributes greatly to the onset of postpartum depression.

Lack of social services and structural resources
Two women I interview are in serious situations because of their husbands. One woman’s husband took a second wife during her recent pregnancy, which is not uncommon in the slum, but he puts all of his financial resources into his new wife while neglecting Herfina and their six-year-old and three-month-old.

Razia had a love marriage at 15 and now has a six-month-old son at age 18. Her husband is a bus driver, but soon after their marriage she realized his addiction to several different street drugs and his lack of work ethic. Before the baby he would go to work for only three to six days a month, and now goes

to work for seven to ten days a month. Both women worry every day about their safety and future, and when both women confront their husbands with financial or emotional concerns, physical and sexual abuse follows.

The dominance of and dependence on the husband is real, and no legal or social support exists for mothers to turn to. Neither woman recognizes a possibility of leaving her husband or seeking counseling advice. I gave Herfina contact information for a counseling service for abused woman, and to my utter alarm her husband beat and threatened to kill her and the baby after discovering this. Since second marriages and neglected women and children are relatively common, legal services for abused women are emerging, but both social acceptance of and mobility of women to reach these services is missing.

The social structure of marriage, in that women give up all dependence ties (and sometimes even contact) with their biological family and transition to the home of their husband, leaves them with little power or safety nets after marriage. This is emphasized in urban slums as when a husband decides to neglect and her family-in-law is in the village, her husband is not as pressured to be dedicated. In such devastating situations, both the structure of marriage and the expectations of motherhood confines women to their situation with few if any outlets.

Poverty itself perpetuates and reinforces the particular cultural norms that are detrimental and confining. When Ruma told me that she has no friends in Dhaka, I asked her if her friends are in the village and she told me I never really had friends in my childhood because I worked [as a house maid] when I was a kid {age 6], and then from then on I went to work at a factory and while working I was married. So I have never had friends. When little girls aren’t able to go to school and start working at age 5, they are never able to develop friendships and when facing challenges as a new mother and wife they have no one to talk to or turn to for help. While everyone recognizes that poverty is limiting in all senses of the word, every single new mother in the slum cites finances as a cause for her tension. If her children have to be pulled out of school because school fees [$3.75 per month] cannot be paid then they too face child labor, lack of friendship development, child marriage, and an unchanging view of the definition of motherhood.

Motherhood as a restriction
Being an anthropologist and [mostly] a cultural relativist, I value the diversity of views on motherhood. While I respect Bengali marriage culture and the intense religious dedication to childbearing, the fact remains that postpartum depression is rampant and a source of it protrudes from overarching societal norms.

In Bangladesh, the pressure to be a mother is more extreme then I could have ever imagined before arriving here. While in the slum interviewing, I say I’m married for safety purposes, and the immediate question is, do you have children yet? It’s incredible how even I, an American who views couples who don’t want children as totally acceptable, am influenced by the pressure and immediately feel defensive, explaining that I was married just before I moved here, my husband is in America, and upon returning I am very excited to have children. Responding approvingly, the older Bengali grandmother says, a woman has the duty to deliver children. A wife without children is not understood, and even marginalized in her later years. Therefore we see that not only does motherhood confine women, it defines them. When a strict definition is so embodied in actuality, there is little room to move and explore; this creates maternal depression. Poverty reinforces it.

Not once does Shopna, or the women around her, complain to me about her baby or her responsibility to motherhood or to her husband. Her depression is different from types seen in middle-class United States, where women struggle with regrets regarding when they had children, how they should have studied harder or another subject, and should have persevered past the gender norms, their parents’ lack of support for education, or the cultural support for marrying and having children when they could have done other things, and from this consider ways to mediate such regrets.

The mothers I interview have nothing to regret because the choices were never there in the first place. The maternal depression, both in experience and in origin, is not similar. Is it possible for one, or for a culture of women, to accept depression as part of life and adapt to it? It is a question I am struggling with. A community health worker told me that she sees many women who are depressed after birth or after marriage, but according to her they don’t want to do anything about their situations. There is, however a difference between not wanting and unable to act, and ultimately resources and social rules twist into what Dhaka low-income women perceive as possible or not possible at all.