Between stigma and support: a qualitative inquiry into help-seeking behaviour for postpartum depression care in Kerala, India

Postpartum depression (PPD) adversely affects women, infants and their families. For various reasons, women are less likely to seek assistance for mental health issues during the perinatal phase, despite the availability of perinatal services. The study focuses on postpartum women’ experience in a given context of the South Indian state Kerala, with an impressive record in public health and mass education. To explore the barriers and facilitators of help-seeking behaviour for depressive symptoms among postpartum women in Malappuram district, Kerala, India. This study utilised a qualitative descriptive design focusing on PPD among postpartum women (within 6 weeks) identified as screen-positive through community screening. Only those screened positive for PPD symptoms and given consent for detailed personal interviews (12 women) are included. The interview followed a phenomenological approach to reflect their experience with PPD and postpartum life in the given setting. The interviews were conducted in local language and transcripts were later translated into English. Thematic analysis and coding were done with the support of Quirkos software. The facilitators for help-seeking behaviour identified include awareness and social support. The barriers consist of a lack of awareness, inadequate social support, financial distress, reliance on spiritual treatment, absence of social connection, stigma, judgments, and fear of medication side effects. This study identifies barriers and enablers affecting help-seeking behaviour among women identified with PPD symptoms in Kerala, India. It advocates for a multi-sectoral collaborative approach that incorporates individual, family, community, and systemic factors to diminish stigma, elevate awareness, and reinforce support networks. Policymakers are urged to address these areas to improve diagnosis, treatment, and lessen maternal morbidity.