, 2004). In a systematic review by Gavin et al. (2005), the combined point prevalence Gefitinib manufacturer of postpartum depression (PPD) was estimated to range from 6.5 to 12.9% during the pregnancy and the first-year postpartum, based on 28 studies from Western or high-income countries. The strongest predictors of maternal depressive symptoms postpartum have been reported to be a past history of

psychological disturbances during pregnancy, poor marital relationship, low social support, and stressful life events (O’Hara & Swain, 1996). In a recent systematic review from low- and middle-income countries (including Bangladesh), Fischer et al. (2011) cited a prevalence of almost 20% for common mental illnesses, such as depression and anxiety postpartum. The strongest risk factors reported by Fischer et al. (2011) were, for example, socio-economic disadvantages, a lack of intimate empathy, a lack of emotional and practical support, having hostile in-laws, and having an experience of intimate partner violence. In a longitudinal study among rural Bangladeshi women, the prevalence of depressive symptoms was found to be18.3% during pregnancy, 14.1% at 2–3 months, and 31.7% 6–8 months postpartum (Nasreen, 2011). In high-income countries, childbirth is rarely a life-threatening event any longer (Eberhard-Gran,

Pexidartinib order Garthus-Niegel, Garthus-Niegel, & Eskild, 2010). A vast majority of women give birth in hospital, and the mother and infant are usually discharged from hospital within 2 days after giving birth after being provided with instructions concerning infant feeding, diet, and exercise (Jain

& Levy, 2013). Compared to the Western countries, giving birth in Bangladesh is still hazardous for women and 76% of the deliveries take place at home with help from traditional birth attendants. Almost 80% of maternal deaths occur in the rural parts of the country (Mamun et al., 2012). In Bangladesh, a traditional practice is for the new mothers to rest for 40 days Isotretinoin after childbirth, to eat a special diet, and stay indoors during the first postpartum period. As the new mother is regarded “unclean” due to menstrual bleeding, she is not allowed to either wash or prepare food, and therefore housework is generally done by the others (Eberhard-Gran et al., 2010). In a literature review of 14 studies from five continents, Bina (2008) focused on the association between cultural factors and postpartum depressive symptoms and arrived at some conflicting results. In eight of the studies, she found that cultural rituals had an alleviating impact on the depressive symptoms and that a lack of cultural traditions led to increased prevalence of depressive symptoms postpartum. One study reported a lack of association, and the other suggested that cultural traditions could contribute to postpartum depression. Bina (2008) emphasised the importance of the mothers’ perception of support as being satisfactory.