The issue was in the spotlight a year ago in a particularly tragic case, but Open Files asks if much has changed despite lots of discussion of postpartum discussion in the media.
On November 3, 2023, Latvian Television reported the disappearance of new mother Anna Jansone ater the death of her new daughter. Anna's body was found only in July this year. The tragic story started discussions about how new mothers are cared for during the postpartum period.
It was also a starting point for Ekaterina Zilpauša, founder of the 'MammaMammai.eu' association to start a collection of signatures demanding emotional and practical support for mothers during pregnancy, childbirth, and the postpartum period.
"My motivation was that I simply couldn't accept that even this would mean nothing," Zilpauša told Latvian Radio. In the initiative, she calls for evaluating the possibilities of expanding state support for new parents - introducing preventive counseling to prepare for childbirth, providing continuous support during childbirth and wider monitoring after childbirth.
Over the past two years, several studies have been conducted on the experience of childbirth in Latvia, and their results vary - in one study, 36% of women admitted that they had experienced violence of one sort or another during childbirth, in another, it was about 17%.
This year, the Center for Disease Prevention and Control (SPKC) collected the latest data from patient experience surveys. In them, about 13% of women mentioned that they suffered from physical, verbal or emotional violence during childbirth. The data, however, provide only a little insight, as the survey was completed by around 3% of all women who gave birth last year. There were 386 of them.
413 women were also surveyed by Zilpauša, asking if they would like the same support team in place for their next birth? 26% answered negatively.
"In what percentage of dental procedures does violence occur? Well, if we look at it this way - how is it that this moment, when a woman is so vulnerable, that there is any percentage at all? Well, how can it be?!" asked Zilpauša.
In February of this year, her initiative reached the Saeima, and at the end of March, the deputies decided that the government should develop an action plan. A progress report was to be submitted to the Ministry of Health at the end of September. Zilpauša says that so far there has been only one remote meeting and one face-to-face meeting on the matter.
"I see it as the Saeima has given the task to the ministries to fully implement this initiative, but it is not being implemented at all," comments the author of the initiative.
The "MammaMammai.eu" foundation, which has been granted the status of a public benefit organization, surveyed 300 women about the fulfillment of existing rules that are supposed to ensure regular, standardized check-ups by medical professionals on the progress new mothers are making. Among other things, the survey revealed that about 70% of respondents did not know about postpartum depression and its prevention.
"On paper, we have that support, but in reality, it is not there - I don't understand," said Zilpauša.
However, some progress is being made. Research started this summer by the Department of Psychiatry and Narcology of Riga Stradiņš University (RSU) in cooperation with the Riga Maternity Hospital. This is the most ambitious study to date to determine the prevalence and risk factors of postpartum depression, involving women who visit a gynecologist at the Maternity Hospital in the fourth to sixth week after giving birth.
"At that moment, these women are approached, our fellow gynecologists fill out a screening tool, and those women who show even the slightest signs of depression or anxiety are asked if they agree to a psychiatrist's interview," explained Professor Elmārs Rancāns, head of the Department of Psychiatry and Narcology at RSU.
During the interview, the psychiatrist assesses whether the woman has depression and finds out its causes. Later, researchers will gather risk factors for postpartum depression and develop a depression assessment scale, a tool that can be used to assess a woman's health.
"And then, if a woman has a certain number of points, then some kind of help is needed, and this is very essential, and it has not been done so far," emphasized Rancāns.
Rancāns estimates that around 10%-15% of new mothers in Latvia suffer from postpartum depression. SPKC data show that last year there were 14,270 births in Latvia. So postpartum depression could have affected from 1,427 to 2,140 women.
"What we see is that women are very busy and very focused on the child during that period, they have little time to think about themselves. There are even women who we diagnose or register with postpartum depression or severe anxiety who do not always want to seek help," Rancāns said.
In the field of psychiatry, there is priority given to women with postpartum depression, but only if they they sign up themselves or are referred by their family doctor.
"For us in Latvia, it is not that help is not available, but it is distributed, not synchronized and not centered around women," said the professor.
The University wants to develop and implement a more woman-centered system of aid with better pregnancy management and information for medics and mothers alike. But it won't happen this year or next year. The Ministry of Health is also developing a pilot project for midwives to make post-birth visits to mothers to assess their situation and offer support.
