POSTPARTUM DEPRESSION AMONG NIGERIAN WOMEN IN URBAN REGION: PREVALENCE AND ASSOCIATED FACOTRS

CHAPTER ONE INTRODUCTION 1.1 Background to the Study Pregnancy is a complex physiological and psychological process that entails a multitude of physical, hormonal, emotional, and social changes in a woman's life. It marks the beginning of a profound biological transformation where the woman’s body undergoes gestational changes in preparation for childbirth. These changes, although natural, often present physical discomforts such as nausea, fatigue, weight gain, and hormonal fluctuations that can strain a woman’s mental and emotional well-being (Fisher et al., 2012). As the pregnancy advances, the anticipation of motherhood may also be accompanied by anxiety about labor, changes in familial roles, and adjustments in interpersonal relationships. The period following childbirth—postpartum—is particularly critical. During this time, women are expected to rapidly adapt to new responsibilities, cope with disrupted sleep cycles, and respond to the demands of an infant while managing their own recovery from childbirth. These overlapping stressors, compounded by sociocultural expectations and limited psychosocial support, may precipitate mental health challenges, including postpartum depression (PPD). This condition has become increasingly recognized as a major public health issue, especially in low- and middle-income countries where mental health services are scarce or underutilized (World Health Organization [WHO], 2023). Postpartum depression is a mood disorder that occurs within the first year following childbirth, characterized by persistent sadness, loss of interest, fatigue, feelings of guilt, anxiety, and in severe cases, thoughts of self-harm or harming the infant. According to O’Hara and McCabe (2013), PPD is “a non-psychotic depressive episode that begins in or extends into the postpartum period, typically within four weeks after delivery.” Similarly, Beck (2002) defines PPD as “a distinct clinical entity marked by a cluster of affective, behavioral, and somatic symptoms that significantly impair a mother's ability to function.” These definitions underscore the seriousness of PPD as more than transient "baby blues," with potential long-term consequences if unaddressed. Globally, the prevalence of PPD ranges between 10% and 20%, with significant variation based on geographical, cultural, and socio-economic contexts (Shorey et al., 2018). In low- and middle-income countries, including sub-Saharan Africa, the burden is notably higher. A meta-analysis by Gelaye et al. (2016) estimated the pooled prevalence of PPD in Africa at 20.8%, highlighting intimate partner violence, poor social support, and unplanned pregnancy as key contributing factors. Nigeria is not exempt from this reality. Numerous studies across Nigerian states report PPD prevalence ranging from 20% to over 40% (Abiodun et al., 2021; Mohammed et al., 2025). This wide range is reflective of regional disparities in healthcare access, cultural beliefs, and socioeconomic conditions. In Lagos State, Nigeria’s most urbanized and populous state, the challenge of maternal mental health is pronounced due to the intersection of urban stress, high population density, and economic disparity. Lagos represents a unique context where both high-income women with professional careers and low-income women in informal settlements coexist. Despite the availability of tertiary health facilities, awareness and screening for postpartum depression remain inadequate. While previous studies have examined the predictors of PPD in parts of southeastern and northern Nigeria (Anosike et al., 2023; Mohammed et al., 2025), there is a paucity of evidence specific to urban megacities like Lagos, particularly regarding how sociodemographic and obstetric variables influence PPD across socioeconomic strata. This study is therefore hinged on the need to investigate the prevalence and associated factors of postpartum depression among women in Lagos State, bridging the regional gap in empirical literature and supporting mental health interventions in maternal care. By examining both psychological and socio-cultural predictors of PPD, the study aims to contribute to a more inclusive and evidence-based framework for maternal health policy in Nigeria. 1.2 Statement of the Problem Postpartum depression constitutes a growing public health concern that transcends socioeconomic status. Among low-income Nigerian women, particularly those residing in densely populated urban slums or rural areas, the risk of PPD is exacerbated by financial insecurity, poor living conditions, food insecurity, and limited access to healthcare services. Women in these settings are less likely to receive antenatal and postnatal care, including mental health screenings, increasing their vulnerability to undetected and untreated depression. For instance, Mohammed et al. (2025) found that over 43% of postpartum women in northern Nigeria exhibited depressive symptoms, largely due to lack of family support and chronic poverty. Conversely, high-income women are not immune. In more affluent areas of Lagos, women may face pressure to resume professional responsibilities quickly after childbirth, often with insufficient postpartum support. Studies suggest that career-related stress, perfectionist tendencies, and absence of extended family networks contribute to emotional exhaustion and depression (Afolabi et al., 2022). Thus, while economic factors differ, the psychological burden of postpartum depression cuts across income levels. Moreover, rural-urban disparities further complicate the narrative. Urban centers like Lagos, while better equipped in terms of infrastructure, may be characterized by anonymity and weakened communal support systems. In contrast, rural areas may offer stronger social networks but limited access to specialized maternal care. These contextual variations underscore the necessity for region-specific studies. Despite Lagos’s centrality to Nigeria’s healthcare system, limited empirical research has explored how urban complexities influence the prevalence and predictors of PPD. This gap in localized knowledge impedes the design of culturally appropriate and evidence-based mental health interventions for new mothers in the state. 1.3 Objectives of the Study The main objective of this study is to assess the prevalence and associated factors of postpartum depression among Nigerian women in Lagos State. Specific objectives are to: 1. Determine the prevalence rate of postpartum depression among women attending postnatal clinics in Lagos State. 2. Identify sociodemographic factors associated with postpartum depression in the study population. 3. Examine obstetric and psychosocial predictors contributing to postpartum depression. 4. Evaluate the relationship between postpartum depression and maternal-infant outcomes. 1.4 Research Questions 1. What is the prevalence of postpartum depression among women in Lagos State 2. What sociodemographic characteristics are associated with postpartum depression in the study area? 3. Which obstetric and psychosocial factors significantly predict postpartum depression? 4. How does postpartum depression affect maternal well-being and infant care practices? 1.5 Research Hypotheses 1. There is a significant relationship between sociodemographic characteristics and the prevalence of postpartum depression among women in Lagos State. 2. Obstetric and psychosocial factors significantly predict the occurrence of postpartum depression among postpartum women. 1.6 Significance of the Study This study will contribute meaningfully to academic literature by expanding the evidence base on maternal mental health within urban Nigerian contexts. Its findings will enrich scholarly discourse on the intersection of sociocultural, economic, and medical factors influencing postpartum depression, particularly in Lagos State. For health professionals and policymakers, the study offers empirical data necessary for designing targeted mental health interventions. It advocates for the integration of routine screening for postpartum depression into maternal healthcare services in Lagos and similar urban settings. At the societal level, this research underscores the importance of maternal mental health as foundational to child development and family well-being. By identifying risk factors, the study encourages community-based support systems and mental health education that can mitigate the long-term consequences of untreated postpartum depression. 1.7 Scope of the Study This study is geographically delimited to Lagos State, Nigeria, focusing on women attending selected postnatal clinics within both public and private healthcare facilities. It aims to capture a representative sample across different socio-economic strata within the state. The study variables include the dependent variable—postpartum depression—and independent variables such as age, parity, mode of delivery, partner support, income level, exposure to violence, and access to healthcare. The target population comprises women within one year postpartum period who have recently attended postnatal care services in Lagos. 1.8 Operational Definition of Terms Postpartum Depression (PPD): A mood disorder occurring within one year after childbirth, marked by sadness, anxiety, and fatigue that interfere with a mother's ability to care for herself or her baby. Sociodemographic Factors: Characteristics such as age, education, marital status, employment, and income level that influence the risk of PPD. Obstetric Factors: Pregnancy and childbirth-related variables such as parity, delivery method, complications, and history of miscarriage. Psychosocial Support: Emotional, informational, and practical assistance received from family, partners, or the community during and after pregnancy. Maternal-Infant Outcomes: The overall health, bonding, and caregiving practices between the mother and child, influenced by maternal mental well-being. Prevalence: The proportion of individuals in a population who exhibit symptoms of postpartum depression at a specific time period.