Diversity in formal religious practice is acknowledged and respected in western medical practice. Popular religious practice, particularly when directed towards healing, is often viewed doubtfully, if not rejected by western medicine. Formal religious practice tends to a mother and child’s metaphysical needs, but popular religious ritual provides comfort and relief of their emotional and physical needs. An immigrant woman may have access to her formal religious rituals, but not to her accustomed popular rituals in the 40 days following birth, and the absence of those popular religious rituals may put her at increased risk for postpartum depression.

Women recently immigrated into western countries have up to 10 times the incidence of postpartum depression in comparison to their peers in their native non-western countries and in comparison to women acculturated to the west (Bashiri and Spielvogel, 1999). New mothers in non-western cultures display few symptoms of postpartum depression; some sociologists believe that the women may be so well supported by their postpartum rituals within their countries of origin this affective disorder is nearly eliminated (Stern and Kruckman, 1983). Other studies demonstrate that the physical and emotional stresses following childbirth are well identified and managed by ritual in the indigenous community, so that the experience of depression is minimized (Pillsbury, 1978). Immigrant women’s lack of access to their postpartum rituals in their host country has been proposed as a cause of this elevation in psychiatric morbidity (Lee et al, 1998; Moon Park and Dimigen 1995). In North Africa, women who feel they are suffering from postnatal illness seek help from a traditional healer rather than from a physician (Cox, 1983), and such preference is common in other countries. The women feel that their needs for postpartum reorientation and support are better met by popular religious ritual rather than formal religion or western medical practice. When they are immigrants into a western country, the formal religion may be available, but performance of appropriate popular religious rituals for childbirth may be impossible do to lack of knowledgeable practitioners and implements for performance.

Western Medical and Popular Religious Ritual Approaches to Birth and Postpartum Depression

Western doctors understand that their patients are religiously and ethnically diverse, but they are selective about which religious/medical actions they are willing to tolerate or perform. Western neonatal practice is willing to perform male circumcision, but not female circumcision. A priest may be admitted into a hospital setting to bless a child, but a large group of women loudly trilling a zgrit^[3] to bless a child (Westermarck 1926, II, 375) might be unwelcome. A woman may be able to order kosher or vegetarian food for her hospital stay, but not exotic foods required by popular religious ritual in her country of origin. Women in obstetric wards receive flowers from a florist, but are usually discouraged from decorating their bedposts with traditional textiles to deter evil spirits, as only sterilized bedding and autoclaved instruments are permitted. An obstetrical room will be cleansed with antibacterial spray, but anti-smoking regulations may be interpreted to prohibit cleansing censing with gum-sandarach, which rural Moroccan women believe to excite fear in malevolent spirits (Westermarck 1926, II, 382). A woman going into surgery is required to remove all jewelry, even if that includes amulets and talismans that she feels are crucial to insure a safe delivery. Western physicians often mistake henna for skin disease, and may dismiss other traditional postnatal rituals as unhygienic or medically useless. If performance of postnatal rituals can be demonstrated to significantly reduce maternal psychiatric morbidity incidence in immigrant women, they are NOT medically useless! In addition, there is concern that selective serotonin reuptake inhibitors prescribed by physicians to depressed mothers are found in their breast milk. The long-term effect of antidepressants consumed by infants through breast milk has not been assessed for possible side effects, though it is noted to cause sleep disturbance (Schmidt, Olesen, Jensen, 2000). A mother may be asked to choose between breastfeeding and depression if a western doctor offers her only SSRIs to assist her postpartum depression. If performance of traditional postpartum rituals could reduce depression to levels achieved with medication, such a choice might be avoided.