Future Research
Gender, Pregnancy, and Mental Health
Framing the Issue
Pregnancy is a gendered
experience. But we may not know as much as we think we do about the gendered
experience of pregnancy when we take into account into account the diverse
identities of women through an intersectional lens.
In our technologically
advanced, information society, there is a plethora of information available to
expecting women. There are books ranging from the best-selling What to Expect When You Are Expecting to
self-authored books by celebrities. Medical information is readily available on
the internet from hospitals to sites such as WebMD. There are pamphlets and
literature given by health care providers. But there are also a mass of
internet sites aimed at expectant moms. They include not only articles about
pregnancy and child issues, but message boards, where women ask and give advice
(and at times “police” each other). What does this have to do with pregnancy
being a gendered experience?
We need to take into account
the cultural messages about gender that this information advocates in addition
to the cultural messages women are given by friends and family. In this sense,
these sources define what a good mother is in relation to gendered
expectations. It also might be the case
that they point to how a good mother is
from a white middle class perspective.
Yet, my inquiry into
pregnancy as a gendered experience is not just about understanding if the
cultural mandates proposed about the experience lack an intersectional focus.
Moreover, I seek to understand mental health issues, in particular depression
and anxiety, as they relate to the gendered pregnancy experience. Thus, this
research has roots in various fields within sociology and feminist studies.
These include sociology of gender, intersectionality, medical sociology , the
medicalization of pregnancy, and welfare state issues.
In the past, the focus on
mental health in relation to pregnancy has been on post-partum depression, often
called the “baby blues.” In the academic realm, Verta Taylor’s book, Rock-a-bye
Baby: Feminism, Self-help and Postpartum Depression, discusses this
issue in depth through though an analysis of self-help groups of women
experiencing post-partum depression. Post-partum depression is often
characterized as a time of melancholy as new mothers, lacking essential sleep
and adjusting hormone levels, feel isolated and sad as they care for a new
infant. Although post-partum depression is still a concern, a new issue is
being discussed. This is depression during pregnancy.
It is estimated that one in
ten women experience pregnancy during depression. Yet, this statistic might not
tell the whole story, which is part of my interest in this subject. The number
might be low because do all women who experience depression during pregnancy
report this? Why would they report it or not?
Which women are more likely to repot this? These questions are central
to my interest in this research.
Stemming from reading the
medical literature given to pregnant women by providers, a concern of untreated
depression during pregnancy is that women who are depressed may be more likely
to engage in “risky” behaviors such as substance abuse that might harm the
growing fetus. But now that the issues of depression during pregnancy has came to light and there are numerous
pharmaceutical remedies for treating depression, a new concern has arose. That
is, is it safe for women to use anti-depressant medication during pregnancy?
There seems to be an increase
in medical studies detailing the effects of using anti-depressants medications
during pregnancy. However, like most medical studies, there are some methodological
issues. First, the sample sizes in the studies tend to be low, making
generalizability an issue. But moreover, the studies lack adequate control or comparison
groups. For example, studies usually only look at the effects of mothers who
took anti-depressants (and hence we assume they were depressed) versus mothers
who did not (we do not know if they were depressed, but might assume they were
not). Thus, the results show how medication affects the fetus of mother who was
depressed compared to women who may not have been depressed. Not the best comparison,
especially when health professionals are beginning to discuss how stress,
depression, and related ailments of the mother affect the fetus. A better
comparison would be to compare mothers who are all depressed who did and did
not take the medication. Granted, there are some studies that show that certain
anti-depressants, such as Prozac, have caused heart abnormalities in the
fetus/baby. Therefore, there is needed information stemming from these studies.
Yet, the studies on other anti-depressants, such as Zoloft or Buspar, have not
shown the same extreme effects and this is where the comparison between
depressed women and those who are not seems crucial.
Why does this matter and how
does it link to this proposed study? First,
there are debates about if medications should be used to treat
depression at all and if the use of anti-depressants is the result of
pharmaceutical companies push for profits.
The purpose of my study does not focus on this debate and I take the
stance that depression is real and medication can help . Even so, this debate does
link to ideals of a good mother (and hence gender). For some, a good mother
would not ingest anything during her pregnancy that might harm the fetus. Moreover,
this also relates to the question of why
a woman would be depressed during pregnancy? If you are depressed, you are not
fulfilling the womanly, mother role. Our culture tells us that expecting women
have a glow, should be happy about expecting, and at all costs, do everything
they can to ensure the best life for the new child.
The idea that not all women
are happy during pregnancy is not new. For example, take Naomi Wolfe’s book “Misconceptions: Truth, Lies, and the
Unexpected on the Journey to Motherhood”. Or, when talking to expecting
women, there are some common complaints about the fatigue, the weight gain, and
other physical ailments that can take a toll on their mental health. Doctors, partners of the expectant, and even
the books state that a pregnant women’s hormones change during pregnancy, which
may affect a women’s mental state. Medical providers do acknowledge that women
who have experienced depression in the past are more likely to experience it
during pregnancy. So, pregnancy may not be a happy experience due to chemical
issues, social expectations, or both.
Yet, if a pregnant women is
depressed, if she has or has not experienced depression before, will she admit
this and seek help? This is where I
would like to bring in what I think may
be a contradiction with the medical sociology literature and
feminist/sociological literature on reproduction.
Social Status, Gender, & Pregnancy Expectations
While previous research has
looked at mothering, post-partum depression, teenage pregnancy, and high
fertility rates among certain groups, few seem to look solely at the experience
of pregnancy and mental health. Building upon my graduate coursework in the
sociology of health and medicine, my foundation in the gender and reproduction
literatures, and my prior work experiences in the mental health and disability
field, I will explore mental health and pregnancy through an intersectional
gendered analysis. Looking at pregnancy through this framework shows the
different ways diverse women experience this time and how social institutions
and other actors involved view and construct this experience for diverse women
in different ways.
My interest is in comparing
how diverse social statuses, such as race, class, religion, and other social
factors and institutions, such as welfare, social networks, and medical
providers, impact how women experience pregnancy and mental health during this
time. What cultural and gendered discourses do women use to understand their
pregnancy experience? How does this relate to which women are more likely to
suffer depression during pregnancy or how depressive symptoms might escalate
for women with chronic depression? Who is more likely to admit their
difficulties and seek help? Why might this differ across diverse women? This is
important research because not only is mental illness stigmatized in society,
but it is even more so during pregnancy because of gendered expectations to be
happy, self-sacrificing, and a good mother while pregnant. While the medical
sociology literature shows that in general those who are white and higher
status have better mental health because of access to health care and social
networks, does this hold true during pregnancy because of the increased
attention to gender and motherhood as social statuses? Are diverse women held up to the same
“perfect motherhood” standards that begin when women are pregnant? Are higher
status women less likely to admit feelings of depression and not take medication
if needed because they see it as a potential risk to their social standing and
ideas of being a good mother? How do social support networks that may buffer
depression vary during pregnancy among diverse women, particularly when we take
into account not only race, ethnicity, and social class, but age, educational
background, and career status?
As discussed previously, new
medical discourse states that depression and a mother’s stress can have a
negative effect on the fetus. Yet, the medical studies on the effects of
mothers’ use of anti-depressants during pregnancy are limited in a few ways. Thus,
how do the few medical studies on the effects of anti-depressants during
pregnancy on the fetus affect medical providers’ recommendations and/or pregnant women’s decisions to take medication
if needed? How might these decisions about medication, or even conversations
about medication with care providers, be affected by women’s differing social
statuses? How does this relate to
gendered discourse about the self-sacrificing good mother who should not ingest
anything that might be harmful to the baby, even if the mother’s mental health
might be in question and affecting the fetus?
Proposed Methods & Data Collection
This will be a qualitative
study consisting of interviews with both women and medical professionals,
observations of support groups and other events if possible, and content
analysis of both the literature presented to pregnant women concerning mental
health and websites where pregnant women seek and discuss information on
pregnancy.
Importantly, the methodology
presented here is a proposed one. This study would need to be approved by an
institutional review board and I am aware of the sensitive nature of studying
mental health issues and pregnancy. Thus, this is a proposed methodology that
would be revised in regards to these factors.
In thinking about recruiting
women for interviews, I would like to talk with women who both have experienced
depression during their pregnancy and characterized it as such and pregnant women
in general. I would like to include the latter category as not only a
comparison, but also to discern if women across the two groups may have had
similar feelings and struggles, but may have characterized it differently (i.e.
not attesting that they had/have depression) because of how mental health
issues are stigmatized in general and possibly more so during pregnancy. Again,
because of the sensitive nature and unique category of women I would like to
speak with, possible ways of recruiting people would be advertisements about
the study in places where pregnant or new moms go, such as medical offices, WIC
offices, and related sites depending upon IRB approval.
Possible Interview
Questions
I provide here tentative
questions that could be asked during interviews with different respondents
Health Care Providers
How often do your pregnancy
patients discuss mental health concerns with you?
How do they discuss with you?
Are they nervous? Shy? Embarrassed?
Do you provide information to
all your patients about depression or mental health during pregnancy? Why or
why not?
How do you discern mental
health might be an issue for a patient?
How do you approach the patient? What resources do you recommend?
Have you ever prescribed
anti-depressants for a pregnant patient?
What factors influenced your decision to do this?
How do you view the risks and
benefits of using anti-depressants during pregnancy?
Do you feel other providers
you know or work with are concerned about depression during pregnancy?
From what sources do you
learn about mental health during pregnancy?
Why do you think depression
is an issue during this time period?
Why would you not recommend
medication for depression for a pregnant woman?
When do you think depression
during pregnancy became a concern in your field?
Are there certain criteria of
your patients that would promote you to discuss mental health concerns with
them?
Do women characterize their
experiences with terms such as depression or do they talk in general about
struggles they are facing?
For midwives only
Do you think midwives deal
better with women’s mental health concerns during pregnancy?
How do you deal with women
who are struggling?
What do you recommend to these women?
For Pregnant Women in General:
Please describe your
pregnancy experience. What did you enjoy about it? What was difficult or
problematic? Physically? Mentally?
Are you partnered or
married? Do you have other children? Do
they live with you? Do you have family that live near? Do you have trusted
friends?
Did you work during your
pregnancy? Did you go back to work after? What type of work did/do you do? Was your work supportive of your pregnancy?
Was this a planned pregnancy?
Please describe what you mean.
Did you have ideals about
what pregnancy would be like? Where did these stem from?
Did your experience match
your ideals? Why or why not? How did this make you feel?
From whom or where did you
get advice on pregnancy related issues? Did you trust the advice? Did you use the advice? How did it make you
feel when you received advice?
Would you characterize
pregnancy as a mentally challenging time? Why
or why not?
How did others’ expectations
of you while pregnant affect you? (i.e. did people assume you were happy about being pregnant or say you
were glowing?)
For Pregnant Women Who Were Treated During Pregnancy for
Depression
Was depression something you
experienced before or just during pregnancy? Was it worse during your pregnancy? Why do you think it
was?
Who do you think was
supportive of you during this time? (i.e. doctors, partners, friends). Who did
you talk to? Why?
Did you express your concerns
to your doctor/midwife? How did they
react?
Did you take medication for
depression during your pregnancy? How long? Why did you decide to take it? Who prescribed it for you? Did you ask for it
or was it recommended? How did you weigh the potential risks and benefits?
Why do you think you were
depressed during pregnancy? What stresses or social factors might have impacted
this?
Do you think the medication helped you? Were
you judged by anyone for taking medication?
If you told people you were
depressed, did they try to explain why you were depressed? How so? (i.e. its hormones, etc).
Would you have more children
after this experience? Why or why not? If yes, what would you do differently?
How would you characterize
your pregnancy experience? Is it what you expected? Do you think other people
have similar experiences or yours is unique?
Do you think your behaviors
were scrutinized more by people (i.e. med professionals, friends, etc) because
of your depression (or other social statuses such as race, class, welfare,
etc)?
What pregnancy
recommendations or ideals were hard for you to follow? Why?
How did you cope with your
feelings during the pregnancy?
What advice would you give to
other pregnant women who are similar to you?
What advice would you
give to women who experience depression during pregnancy?
Did you use the internet for
information during your pregnancy? What sites? How did you use the information?
Did you feel that the information applied to you?
Did you read and/or
participate on message boards regarding pregnancy? Ones about depression? What was said? How did you
feel about the information?
Have you ever experienced or
struggled with depression or other mental health concerns in the past? How did
you deal with this? Did these manifest
during your pregnancy?
Support Groups
I would also like to conduct
ethnography at support groups for women suffering depression during pregnancy
or post-partum (i.e. as many are devoted to women in both categories) and/or at
similar events. From some preliminary general research on this, support groups
for women experiencing depression during pregnancy or post-partum are sponsored
by hospitals and medical providers in some geographic areas. Other avenues
might be general support groups for women suffering depression. I would like to conduct research in these
settings to see not only what type of women would attend these groups and why,
but also how the women talk about their experiences in this type of setting,
how the medical professionals who run the group act and how the women interact
with each other. Is it unique because the women all have suffered depression?
Are they supportive? How so? How does the group foster a vision of gender?
Websites
The following is a sampling
of websites that provide context to my interest in this study and could be used
for content analysis. I am particularly interested in the websites aimed at
expecting mothers and parents where message boards are present. These capture
the interaction of mothers discussing pregnancy issues and hence cultural
messages about gender and motherhood. It
is important to note that discerning social class or other social statuses of
the women who post would not a completely accurate measure, but can be
discerned by the content of the comments and
information we have on internet use. But it is also important to note
that all of the websites are important in that these are publically accessible
sites that women are able to access via search engines on the internet.
Medical Websites About Depression, Anti-Depressants and
Pregnancy
Mayo Clinic
http://www.mayoclinic.com/health/antidepressants/DN00007
WebMD
http://www.webmd.com/baby/guide/pregnancy-depression
Organization’s
Websites About Mental Health and/or Depression During Pregnancy
Mental
Health America Maternal Depression Guide
http://www.mentalhealthamerica.net/go/maternal-depression
March
of Dimes
http://www.marchofdimes.com/pnhec/188_15663.asp
World
Health Organization: Gender and Mental Health
http://www.who.int/mental_health/prevention/genderwomen/en/
International
Association for Women’s Mental Health
http://www.iawmh.org/about.htm
National
Asian Women’s Health Organization
http://www.nawho.org/site/c.ipILKTOCJsG/b.3522897/
African
American Women’s Mental Health
http://www.blackwomenshealth.com/2006/articles.php?id=56
National
Latino Behavioral Health Association
http://www.nlbha.org/
Scientifically Focused Sites on Studies About Anti-Depressants During
Pregnancy
Science Daily
http://www.sciencedaily.com/releases/2008/11/081124081150.htm
US Department of Health and Human Services
http://www.ahrq.gov/research/may08/0508RA8.htm
Healthy Place
http://www.healthyplace.com/other-info/mental-illness-overview/antidepressants-during-pregnancy-and-nursing/menu-id-198/
Parenting Websites Including Article, Commentary, and Message Boards About
Depression, Anti-Depressants, and Pregnancy
Babycenter.com
http://www.babycenter.com/404_is-it-safe-to-take-antidepressants-during-pregnancy_2343.bc
I-Village
http://messageboards.ivillage.com/iv-pppregndep
I-Am_Pregnant.com
http://www.i-am-pregnant.com/encyclopedia/D/Depression-during-pregnancy/
Berkeley Parents' Network:
http://parents.berkeley.edu/advice/pregnancy/antidepressants.html
Parents.com
http://www.parents.com/pregnancy/my-body/is-it-safe/taking-antidepressants-during-pregnancy/
http://www.parents.com/baby/health/postpartum-depression/how-depression-affects-your-family/
http://www.parents.com/dgroups/index.jsp?plckForumPage=Forum&plckForumId=Cat%3a464c6917-7212-40cf-af32-063fa4981ccbForum%3af1cba18c-6712-4888-bf7e-bb9ea8c27e22
Importance of Study and Funding
My research will make
important contributions to the growing fields of the medicalization of
pregnancy and illness and mental health and gender. This research is timely and
fundable because of the current debates centering on the risks and benefits of
using any medication during pregnancy, but particularly anti-depressants.
Because of its links with the medical field, this study has potential to be an
interdisciplinary, collaborative project with those interested in gender,
reproduction, and/or mental health. Hence, possible fields for collaboration
might include Gender and Women’s Studies, Anthropology, Social Work, Nursing, Psychology, Psychiatry, and other
medical fields and specialties such as Obstetrics and Gynecology. Thus, the results
of this study would be of use not only to sociologists and other social
scientists, but also to medical professionals who have increased their
attention to this issue, which augments this study’s fundability.
Potential Funding Sources and Places to Look for
Funding
Below, I list potential
places to seek funding for this study. Most of the ones listed are national or
larger agencies. I will also search for and seek funding from local or state
organizations in the area I will be located when I begin this project. For
example, there may local women’s organizations that provide funding for
research on these issues. With these different funding sources, I would apply for the most relevant ones to this
project. I list these different sources to highlight the range of funding that
is potentially available, and in particular for women’s mental health during
pregnancy and post-partum.
National Institute on Mental
Health
http://www.nimh.nih.gov/research-funding/grants/index.shtml
National Institute on Drug
Abuse
http://www.drugabuse.gov/funding/resfundslist.htm
United State’s Governments
Health and Human Services:
Women’s Health
http://www.womenshealth.gov/fund/
Agency For Health Research and Quality
*to note
is that they have funding for research on depression during pregnancy and post-partum
(see second link). Even though this may not be
available at the time of my proposed
research, it is important to highlight this area as a concern of potential funders.*
http://www.ahrq.gov/fund/grconix.htm#process
http://grants.nih.gov/grants/guide/pa-files/PA-09-175.html
National Mental Health Information Center
http://mentalhealth.samhsa.gov/funding/
Substance Abuse and Mental Health Services Administration
http://www.samhsa.gov
Grant Makers in Health
http://www.gih.org/topics3985/topics_list.htm?attrib_id=8497
American Medical Women’s
Association
http://www.amwa-doc.org/index.cfm?objectid=FFA1FB0A-D567-0B25-5F6567CDF851D6B9
Foundation Center
* a site to search for funding opportunities*
http://foundationcenter.org/
Women Grants
*a listing of funding sources for women and
research about women and girls*
http://www.fundsnetservices.com/women.htm
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