“When Their Joy Turns into Pain”: A Qualitative Phenomenological Study of Postpartum Depression among Southern Pakistani Mothers

Background The majority of women across the world suffer from postpartum depression (PPD), a mental health condition that affects women’s lives after delivery. In middle-income countries like Pakistan, PPD is not considered a serious condition and is deliberately stigmatized. In this qualitative study, we explored sociocultural, emotional, and structural determinants of PPD among Pakistani women. Methods We employed a qualitative research design and conducted interviews with 21 postpartum women in two hospitals in the marginalized Southern Punjab region of Pakistan. A thematic analysis was then used to generate themes. Results: Five major themes were identified causing PPD in the Southern Punjab mothers: 1) healthcare providers' attitude and support, 2) limited spousal and family support and postpartum depression, 3) anxiety as a result of sudden alterations in body and appearance, 4) postpartum breastfeeding depression, and 5) lack of sleep and postpartum depression. Multiple sub-themes contributing to these major themes were: healthcare providers' insulting attitude before and after birthing, masculinity standards and emotional concealment, emotional neglect and internalized shame, limited family support and lack of time for self-care, body shaming and stigmatization by in-Laws, loss of appetite and disappointment with infant's appearance, physical load and suicidal Ideation induced by breastfeeding burden, emotional strain of breastfeeding twins, body image and weight loss, decline in sexual desire, and guilt of feeling emotionally distant as a mother. Conclusion PPD among Southern Pakistani women is strongly connected with social, cultural, interpersonal, and structural factors. Therefore, it cannot be treated without socio-culturally tailored maternal mental health interventions that cover not just biological but also emotional support, respectful maternity care, and social protection. Incorporation of postpartum mental health screening and counseling into primary healthcare is the most essential intervention to ensure maternal health and early childhood development outcomes.