Meet the Nollywood women breaking silence on postnatal depression

• Postnatal depression rates in Africa exceed global average
• Condition is under-reported and access to care limited
• Nigerian filmmaker seeks to lift veil on taboo subject

LAGOS - Nigerian director Sarah Kwaji was always unsettled by how mental health issues were ignored by Nollywood, Nigeria's prolific movie industry.

So when she got the opportunity to produce her first film in 2023, Kwaji decided to document a Nigerian mother's struggles with depression.

The result, "Out in the Darkness," was released in Nigeria in July.

Kwaji was told not to expect commercial success, but her goal was to raise awareness. And she has.    

"Many families have called me to share their personal experiences with their relatives and how it affected their lives, and that is why I made it," Kwaji said.

Nigeria is home to Africa's biggest film industry, but mental health is not often explored in Nollywood films, which are best known for dramatic, moralistic tales of good versus evil.

Postnatal depression is also rarely discussed on television or off-screen by Nigerians.

Kwaji said she thought it was important to use the medium of film to push for better mental health support for struggling mothers.

"There's a strong cultural belief that motherhood comes naturally and that women in Africa don't experience depression because they have family support," Kwaji told Context at her home in Lagos.

"I think we need to change those narratives."

Globally, about 17% to 19% of women experience depression after having a baby. In Africa, the rates are higher, averaging between 20% and 25%, with experts blaming poor access to diagnosis and treatment.

Studies carried out in South Africa show the rate climbs to nearly half of mothers who are living with HIV, in poverty or in rural communities.

'No one noticed'

Postnatal depression, a severe mood disorder that sets in either immediately or months after childbirth, is dangerous when untreated and undiagnosed in new mothers.

Although postpartum depression is more common in Africa than in many other regions, mental health advocates warn it is rarely acknowledged because of stigma and deep-rooted cultural beliefs.

The silence - combined with a shortage of mental health services - leaves countless women at risk of suicide or causing harm to their babies.

Nigerian mental health campaigner Ayo Ayeni told Context that mental health had never been a priority in healthcare systems in Africa.

In Nigeria, for example, where more women die during childbirth than anywhere else in the world, Ayeni said most government funding goes into saving mothers' lives during delivery rather than training health workers to spot or treat depression.

"We are literally fighting for the lives of our mothers, and rightly so. But this comes at an opportunity cost to maternal mental health," Ayeni who runs Lagos-based Haven Advocacy, a helpline for mothers.

Including mental health checks into routine antenatal and postnatal visits can help health providers detect warning signs.

Nigerian gynaecologist Samuel Adebayo says postnatal depression often stems from severe psychological stress or trauma during pregnancy.

When those pressures persist after birth, they can, in extreme cases, lead to suicide or even infanticide, he said.

"There have been instances where mothers took their own lives right in the hospital after delivery because they didn't get help before they had the baby," Adebayo said.

The sudden decline in hormone levels after delivery also increases the risk of depressive episodes, according to some studies.

Even when African women recognise the issue and seek help, mental health services are thin on the ground.

According to the World Health Organization, Africa has fewer than one mental health worker for every 100,000 people.

Nigerian actress Anne Njemanze said it took many years to get professional help after she began having suicidal thoughts following the birth of her first daughter when she was aged 20.

"I was treated for malaria and typhoid, but no one noticed what was happening in my mind," she said. "It took years before a psychologist finally told me I had been living with depression."

Frontline workers

Ayeni says frontline health workers and midwives must be trained to recognise the signs of depression and not dismiss it as "baby blues" or stress.

"A woman is not likely to say, 'I'm depressed'. She will say things like 'I don't feel like myself,' 'I am overwhelmed,' 'I am not a good mom,' 'I am not coping,' 'I feel irritable,' or 'I feel alone,'" said Ayeni.

For health services to address such concerns, the government should lead the way on raising awareness, said Kwaji.

"We want actionable measures that require health workers to follow up with new mothers and not just dismiss these symptoms as stress," she said.

But Njemanze says mothers must ultimately advocate for themselves, regardless of the pushback they may face.

"The worst thing people will say is that you're crazy or that you have gone mad. But you have to look out for yourself and the baby."

(Bukola Adebayo; Editing by Clár Ní Chonghaile and Ayla Jean Yackley.)