Development of Body Image Dissatisfaction and Post-Partum Depression in Women

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A Historical and Cross-Cultural Analysis of the Development of Body Image Dissatisfaction and Post-Partum Depression in Women

 Pregnancy, childbirth, and beginning life with a new baby is often depicted as a magical time in a woman’s life: full of hope, new outfits, baby showers, and more.  Even some depictions that show a more realistic sleep deprived, stressed-filled life, often do not show the full picture.  Medical professionals and government officials alike have often failed to recognize the emotional toll that pregnancy can have on a woman’s body.  The truth is, recent studies have shown that up to 70-80% of women experience some form of body dissatisfaction post-partum (Couto).  Among the most serious of these cases are women diagnosed with post-partum depression.  While symptoms and intensity often vary from case to case, it can generally be described as an overwhelming feeling of despair and anxiety which, depending on its severity, could impact her ability to function within a normal environment, care for herself, and care for her family (Grogan).  The development of form of depression has its roots in almost every part of daily life, from a woman’s level of prenatal exercise to the type of media she is surrounded by (Couto).  This presents an issue however, because many pro-life arguments still allow for an abortion if the pregnancy poses severe risk to the mother.  If there is a high likelihood for the mother to develop this serious form of depression, however, is that also not maternal endangerment?  This essay will attempt to prove that post-partum depression and other forms of body dissatisfaction after pregnancy develop as a result of many factors, making it worth consideration amongst pro-life circles.  The development of body dissatisfaction and depression in post-partum women is a historic and cross-culturally important phenomenon that has ties to almost every aspect of a woman’s life in modern society; making this discussion incredible pertinent for young people, prenatal women and their families, and elected government officials alike. 

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 Body dissatisfaction can be defined as “a person’s negative thoughts and feelings about his or her body” (Grogan).  While it is an internal process, it can also be influenced and predicted by several external factors including a person’s history, psychology, and culture.  This is often measured by comparing a woman’s actual body size to the size she perceives her body to be.  (Grogan).  Most of these measurements in psychological studies tend to focus on college aged women, due to ease of access where most of this research is done.  One population that therefore usually goes understudied is post-partum women, or women in the first 6 weeks following childbirth.  In a recent statement from the World Health Organization: “the postnatal period is the most critical and yet the most neglected phrase in the lives of mothers and babies; most maternal and/or newborn deaths occur during this time period” (World Health Organization).  Many new mothers during this time period may experience what is commonly known as “baby blues” during the first few weeks post-partum, which includes less severe symptoms such as restlessness, mood swings, frequent crying, anxiety, difficulty sleeping beyond the normal loss of sleep with a new child (Tiggemann).  Some new mothers, up to 34.7% according to recent studies, “may experience a more severe, long lasting form of depression known as post-partum depression, or rarely, an extreme mood disorder called post-partum psychosis” (Cooper).  Post-partum depression may develop similarly to the common “baby blues”, but the symptoms are significantly more intense, and may begin to interfere with the mother’s ability to care for their child and handle other daily tasks.  These symptoms can include a depressed mood, severe mood swings, irritability, extreme anger, thoughts of harming others, and persistent thoughts of suicide (Walker).  Many factors have been proven to influence the development and severity of post-partum depression, most of which stemming from a woman’s social environment and mental health before pregnancy.  More recent evidence also points to genetic evidence independent of these factors.

    In 2012, The National Institutes of Health conducted a literary review of 25 research articles exploring the role genetics plays in the development of post-partum depression (PPD) (Shapiro).  They aimed to determine which genes and polymorphisms were associated with PPD.  A total of 6 genes were studied, with some showing more promise than others.  For example, the 5HTT gene polymorphism showed variable results.  Most studies showed an association between this gene and PPD at the 8-week mark, but upon further statistical investigation, these results were determined to be insignificant because they were dependent on the evaluation time point.  Another gene analyzed by this report was the TPH gene, which, when it contained the T27224C polymorphism, created a higher comorbidity of depression and anxiety.  A further risk analysis into this gene showed that the expression of the “C” allele showed a strong protective effect for depression and anxiety.  This means that when an individual has this C allele, they become “protected” from the effects of depression and anxiety, and are statistically less likely t develop these.  This proves, therefore, that the TPH gene plays an important role in the development of depression as a whole, which has possibly transference to the development of post-partum depression.  A third gene this paper investigated focused on the C677T polymorphism on the gene that codes for the enzyme methylenetetrahydrofolate reductase.   This enzyme is important for the direction of various folate species to aid in DNA synthesis or to homocysteine remethylation.  When this C677T polymorphism is present, it was proven to play a significant role in the development of non-gestational-related depression, but not for the development of peripartum depression.  While this does not explicitly describe post-partum depression, it provides support for an interesting point related to this area of study.  This study chose to focus only on peripartum and non-gestational-related depression, so there exist possible applications to post-partum depression with further study and analysis.  Overall, these results show that there exists a link between genetics, gene mutations, and the development of post-partum depression.  What is important now to consider is the fact that while genetics may offer some support for the development of post-partum depression, factors such as a woman’s culture, psychology, and history may offer a more complete and reliable overview. 

 One important perspective to consider, and the first of these factors, is the historical point of view.  Postnatal mental illness has always existed, despite its level of understanding in society.  Hippocrates, an ancient Greek physician, in the fourth century B.C. proposed that bodily discharge expelled after giving birth could travel to the brain and cause agitation which he termed “puerperal fever”.  Some have speculated that he was discussing septicemia or infection, but none the less he was making a postnatal mental health analysis by attempting to describe possible health conditions that may arise after a woman gives birth.  Until the mid-20th century, postnatal psychiatric difficulties escaped the notice of medical professionals and lay-people, but the symptoms did not.  Transcending family generations are often frightening stories of mothers with these difficulties, including having her husband tie her arms behind her to keep her from violently scratching and tearing the skin on her body or having to lock the windows to keep her from throwing her child out the window.   It was not until 1968 that The Diagnostic and Statistical Manual of Mental Disorders, often considered the “holy grail” for diagnosing mental disorders, even briefly alluded to mental health issues one might experience after giving birth.  It was not mentioned by name specifically until DSM-V when a section under Major Depressive Disorder had a specifier titled “with peripartum onset”, which is defined as the most recent episode occurring during pregnancy as well as in the first four week following pregnancy (O’Hara).  This official recognition of depression during pregnancy represented a significant step forward, however, it still did not include, and would not include until 1995, the period of suffering that often occurs within the first year after childbirth.  Overall, postnatal mental illness is not a new phenomenon and it is not newly-recognized, however, simply few too many people have been genuinely interested in the well-being of mothers and have recognized its potential consequences. 

 New versions of the DSM are significant in that it acknowledges the co-existing symptoms of anxiety and panic, symptoms that often accompany the development of peripartum depression.  “Fifty percent of ‘postpartum’ major depressive episodes actually begin prior to delivery.  Thus, these episodes are referred to collectively as peripartum episodes.  Women with peripartum major depressive episodes often have severe anxiety and even panic attacks” (O’Hara).  In contrast, unfortunately, while the definition for postpartum depression has been significantly extended since its inclusion in the DSM in the 1960s, there is considerable disappointment because the time frame was not extended for this disorder as well.  There is hope for increasing public research, but with the current political climate that has often stifled scientific research, specifically in the fields of mental health and pregnancy, it is clear that any changes to the DSM in this area will take many years to accomplish. 

Since its inclusion in the DSM, increases psychological research has been done in order to determine the causes of post-partum depression.  Based on this research, 3 emerging factors have arisen that have proven to influence the development of post-partum depression.  The first of these is the mother’s amount of exercise post-partum.  Research has shown that exercise release endorphins, a group of hormones secreted within the brain that activate the body’s opiate receptors- causing an analgesic effect, so increased exercise may help combat the development of PPD, and even lessen its effects if it does develop.  Another factor could be a mother’s decision, or lack thereof, to breastfeed.  Breastfeeding is often seen as a feminine, maternal duty amongst societies, so an inability to do so, for the baby’s or mother’s health, may contribute to the development of PPD.  If a woman is unable to fulfill this functional capability, she may be more likely to feel detached from her child, worsening the effects of PPD.  For women with depressive symptomatology in the early postpartum period, they may be at an increased risk for negative infant-feeding outcomes including decreased breastfeeding duration, increased breastfeeding difficulties, and decreased levels of breastfeeding self-efficacy.  There is also beginning evidence to suggest that depressed women may be less likely to initiate breastfeeding and do so exclusively.  Currently, there is little research for women who choose not breastfeed on their own accord, due to its rarity.  A third factor could be a mother’s mental health before pregnancy.  Recent studies have shown that women with depression or premenstrual dysphoric disorder may have a higher likelihood developing PPD.

The last major factor proven to have some impact on the development of post-partum depression is the woman’s culture and society in which she lives.  For example, studies have long shown that married women are less likely to develop PPD than unmarried women, explained by the fact that married women have a sense of constant support from their partners, and may just experience “baby blues”.  This is supported by studies that claim that women in marital conflict have an increased likelihood of developing PPD due to their increased stress levels and tendency to blame their child.  Recent studies have hypothesized a more complez relationship between marital distress and depression and invoked the constructs of stress and coping resources.  For example, several researchers have suggested that a supportive marital relationship may serve as a buffer against the depression that can result from experiencing stressors such as the birth of the child.  Given these data and theoretical perspectives, it is clear that the marital relationships, perceived stress, coping resources, and dysfunctional cognitions of postpartum depressed women warrant further examination.  Similar stresses impact those single women living alone who may feel as if the world is against them in their fight to raise her child.  A recent cross-cultural analysis of post-partum depression showed that cross culturally, there are similarities amongst women from similarly developed countries.  In 1st world countries, for example, increased media presence and societal pressures have resulted in increased levels of body dissatisfaction and PPD in these areas.  This is comparable to the rates in 3rd world countries where these pressures are not as prevalent, and PPD and body dissatisfaction rates are decreased as a result.  It is also worth discussing, however, that women in 3rd world countries have decreased access to medical attention and would therefore have underdiagnosed levels of PPD, despite how common it actually it.  Another factor may be cultural pressures that are more common in 2nd and 3rd world countries.  In some cultures, discussing mental health is frowned upon and therefore women may feel ashamed to discuss their mental health and seek attention if necessary.

Post-partum depression and other forms of body dissatisfaction after pregnancy pose a serious risk to mother and baby.  There is significant evidence spanning all the way back to the 4th century BC as well as cross-cultural evidence to prove that this form of depression is not a localized or rare occurrence: it is a serious event that can wreak havoc on a woman’s life and family.  For women in “first-world” societies, the danger may be even greater due to the increased influence of media and the cultural imposition placed upon her by her family.  Seemingly mundane factors such as exercise and the marital status of the mother may also play a role. If this is the case, there is sufficient evidence to support the development of this form of depression as maternal endangerment, and gives more support for pro-choice arguments to a woman’s right to choose.  The truth is, up to 80% of woman report feelings of body dissatisfaction after birth, making this topic an important one to discuss with women before they decide to start their families.  It is also worth discussion amongst young audiences and male audiences so they can be well equipped to support women in their life going through this period of time in their lives.   

Works Cited

Boscaglia, Nadia, Helen Skouteris, and Eleanor H. Wertheim. “Changes in body image satisfaction during pregnancy: A comparison of high exercising and low exercising              women.” Australian and New Zealand Journal of Obstetrics and Gynaecology 43.1              (2003): 41-45.

Cooper, Peter J., et al. “Post-Partum Depression and the Mother-Infant Relationship in a South

African Peri-Urban Settlement.” British Journal of Psychiatry, vol. 175, no. 6, 1999, pp.

554–558.

Couto, Tiago Castro, et al. “Postpartum depression: A systematic review of the genetics

involved.” World Journal of Psychiatry 5.1 (2015): 103.

Grogan, Sarah. Body Image: Understanding Body Dissatisfaction in Men, Women and Children.

3rd ed., Routledge, 2017.

Marks, Maureen, et al. “How does marriage protect women with histories of affective disorder              from post‐partum relapse?.” British Journal of Medical Psychology.  69.4 (1996): 329.

“Palmer’s Cocoa Butter”. YouTube, uploaded by Space City, 8 Feb 2016. 

Shapiro, Gabriel D., William D. Fraser, and Jean R. Séguin. “Emerging risk factors for

postpartum depression: serotonin transporter genotype and omega-3 fatty acid

status.” The Canadian Journal of Psychiatry 57.11 (2012): 704-712

Strang, Victoria R., and Patricia L. Sullivan. “Body image attitudes during pregnancy and the              postpartum period.” Journal of Obstetric, Gynecologic, & Neonatal Nursing 14.4              (1985):              332-337.

Tiggemann, Marika. “Body image across the adult life span: Stability and change.” Body image 1.1 (2004): 29-41.

Tiggemann, Marika, and Belinda McGill. “The role of social comparison in the effect of magazine advertisements on women’s mood and body dissatisfaction.” Journal of Socialand Clinical Psychology 23.1 (2004): 23-44.

Walker, Lorraine O., and Jeanne Freeland‐Graves. “Lifestyle factors related to postpartum              weight gain and body image in bottle‐and breastfeeding women.” Journal of Obstetric,Gynecologic, & Neonatal Nursing 27.2 (1998): 151-160.

Walker, Lorraine, et al. “Relationships between body image and depressive symptoms during              postpartum in ethnically diverse, low income women.” Women & Health 36.3 (2002):              101-121.

World Health Organization, United Nations Population Fund, and Key Centre for Women’s

Health in Society. Mental health aspects of women’s reproductive health: a global review

of the literature. World Health Organization, 2009.

A Historical and Cross-Cultural Analysis of the Development of Body Image Dissatisfaction and Post-Partum Depression in Women

 Pregnancy, childbirth, and beginning life with a new baby is often depicted as a magical time in a woman’s life: full of hope, new outfits, baby showers, and more.  Even some depictions that show a more realistic sleep deprived, stressed-filled life, often do not show the full picture.  Medical professionals and government officials alike have often failed to recognize the emotional toll that pregnancy can have on a woman’s body.  The truth is, recent studies have shown that up to 70-80% of women experience some form of body dissatisfaction post-partum (Couto).  Among the most serious of these cases are women diagnosed with post-partum depression.  While symptoms and intensity often vary from case to case, it can generally be described as an overwhelming feeling of despair and anxiety which, depending on its severity, could impact her ability to function within a normal environment, care for herself, and care for her family (Grogan).  The development of form of depression has its roots in almost every part of daily life, from a woman’s level of prenatal exercise to the type of media she is surrounded by (Couto).  This presents an issue however, because many pro-life arguments still allow for an abortion if the pregnancy poses severe risk to the mother.  If there is a high likelihood for the mother to develop this serious form of depression, however, is that also not maternal endangerment?  This essay will attempt to prove that post-partum depression and other forms of body dissatisfaction after pregnancy develop as a result of many factors, making it worth consideration amongst pro-life circles.  The development of body dissatisfaction and depression in post-partum women is a historic and cross-culturally important phenomenon that has ties to almost every aspect of a woman’s life in modern society; making this discussion incredible pertinent for young people, prenatal women and their families, and elected government officials alike. 

 Body dissatisfaction can be defined as “a person’s negative thoughts and feelings about his or her body” (Grogan).  While it is an internal process, it can also be influenced and predicted by several external factors including a person’s history, psychology, and culture.  This is often measured by comparing a woman’s actual body size to the size she perceives her body to be.  (Grogan).  Most of these measurements in psychological studies tend to focus on college aged women, due to ease of access where most of this research is done.  One population that therefore usually goes understudied is post-partum women, or women in the first 6 weeks following childbirth.  In a recent statement from the World Health Organization: “the postnatal period is the most critical and yet the most neglected phrase in the lives of mothers and babies; most maternal and/or newborn deaths occur during this time period” (World Health Organization).  Many new mothers during this time period may experience what is commonly known as “baby blues” during the first few weeks post-partum, which includes less severe symptoms such as restlessness, mood swings, frequent crying, anxiety, difficulty sleeping beyond the normal loss of sleep with a new child (Tiggemann).  Some new mothers, up to 34.7% according to recent studies, “may experience a more severe, long lasting form of depression known as post-partum depression, or rarely, an extreme mood disorder called post-partum psychosis” (Cooper).  Post-partum depression may develop similarly to the common “baby blues”, but the symptoms are significantly more intense, and may begin to interfere with the mother’s ability to care for their child and handle other daily tasks.  These symptoms can include a depressed mood, severe mood swings, irritability, extreme anger, thoughts of harming others, and persistent thoughts of suicide (Walker).  Many factors have been proven to influence the development and severity of post-partum depression, most of which stemming from a woman’s social environment and mental health before pregnancy.  More recent evidence also points to genetic evidence independent of these factors.

    In 2012, The National Institutes of Health conducted a literary review of 25 research articles exploring the role genetics plays in the development of post-partum depression (PPD) (Shapiro).  They aimed to determine which genes and polymorphisms were associated with PPD.  A total of 6 genes were studied, with some showing more promise than others.  For example, the 5HTT gene polymorphism showed variable results.  Most studies showed an association between this gene and PPD at the 8-week mark, but upon further statistical investigation, these results were determined to be insignificant because they were dependent on the evaluation time point.  Another gene analyzed by this report was the TPH gene, which, when it contained the T27224C polymorphism, created a higher comorbidity of depression and anxiety.  A further risk analysis into this gene showed that the expression of the “C” allele showed a strong protective effect for depression and anxiety.  This means that when an individual has this C allele, they become “protected” from the effects of depression and anxiety, and are statistically less likely t develop these.  This proves, therefore, that the TPH gene plays an important role in the development of depression as a whole, which has possibly transference to the development of post-partum depression.  A third gene this paper investigated focused on the C677T polymorphism on the gene that codes for the enzyme methylenetetrahydrofolate reductase.   This enzyme is important for the direction of various folate species to aid in DNA synthesis or to homocysteine remethylation.  When this C677T polymorphism is present, it was proven to play a significant role in the development of non-gestational-related depression, but not for the development of peripartum depression.  While this does not explicitly describe post-partum depression, it provides support for an interesting point related to this area of study.  This study chose to focus only on peripartum and non-gestational-related depression, so there exist possible applications to post-partum depression with further study and analysis.  Overall, these results show that there exists a link between genetics, gene mutations, and the development of post-partum depression.  What is important now to consider is the fact that while genetics may offer some support for the development of post-partum depression, factors such as a woman’s culture, psychology, and history may offer a more complete and reliable overview. 

 One important perspective to consider, and the first of these factors, is the historical point of view.  Postnatal mental illness has always existed, despite its level of understanding in society.  Hippocrates, an ancient Greek physician, in the fourth century B.C. proposed that bodily discharge expelled after giving birth could travel to the brain and cause agitation which he termed “puerperal fever”.  Some have speculated that he was discussing septicemia or infection, but none the less he was making a postnatal mental health analysis by attempting to describe possible health conditions that may arise after a woman gives birth.  Until the mid-20th century, postnatal psychiatric difficulties escaped the notice of medical professionals and lay-people, but the symptoms did not.  Transcending family generations are often frightening stories of mothers with these difficulties, including having her husband tie her arms behind her to keep her from violently scratching and tearing the skin on her body or having to lock the windows to keep her from throwing her child out the window.   It was not until 1968 that The Diagnostic and Statistical Manual of Mental Disorders, often considered the “holy grail” for diagnosing mental disorders, even briefly alluded to mental health issues one might experience after giving birth.  It was not mentioned by name specifically until DSM-V when a section under Major Depressive Disorder had a specifier titled “with peripartum onset”, which is defined as the most recent episode occurring during pregnancy as well as in the first four week following pregnancy (O’Hara).  This official recognition of depression during pregnancy represented a significant step forward, however, it still did not include, and would not include until 1995, the period of suffering that often occurs within the first year after childbirth.  Overall, postnatal mental illness is not a new phenomenon and it is not newly-recognized, however, simply few too many people have been genuinely interested in the well-being of mothers and have recognized its potential consequences. 

 New versions of the DSM are significant in that it acknowledges the co-existing symptoms of anxiety and panic, symptoms that often accompany the development of peripartum depression.  “Fifty percent of ‘postpartum’ major depressive episodes actually begin prior to delivery.  Thus, these episodes are referred to collectively as peripartum episodes.  Women with peripartum major depressive episodes often have severe anxiety and even panic attacks” (O’Hara).  In contrast, unfortunately, while the definition for postpartum depression has been significantly extended since its inclusion in the DSM in the 1960s, there is considerable disappointment because the time frame was not extended for this disorder as well.  There is hope for increasing public research, but with the current political climate that has often stifled scientific research, specifically in the fields of mental health and pregnancy, it is clear that any changes to the DSM in this area will take many years to accomplish. 

Since its inclusion in the DSM, increases psychological research has been done in order to determine the causes of post-partum depression.  Based on this research, 3 emerging factors have arisen that have proven to influence the development of post-partum depression.  The first of these is the mother’s amount of exercise post-partum.  Research has shown that exercise release endorphins, a group of hormones secreted within the brain that activate the body’s opiate receptors- causing an analgesic effect, so increased exercise may help combat the development of PPD, and even lessen its effects if it does develop.  Another factor could be a mother’s decision, or lack thereof, to breastfeed.  Breastfeeding is often seen as a feminine, maternal duty amongst societies, so an inability to do so, for the baby’s or mother’s health, may contribute to the development of PPD.  If a woman is unable to fulfill this functional capability, she may be more likely to feel detached from her child, worsening the effects of PPD.  For women with depressive symptomatology in the early postpartum period, they may be at an increased risk for negative infant-feeding outcomes including decreased breastfeeding duration, increased breastfeeding difficulties, and decreased levels of breastfeeding self-efficacy.  There is also beginning evidence to suggest that depressed women may be less likely to initiate breastfeeding and do so exclusively.  Currently, there is little research for women who choose not breastfeed on their own accord, due to its rarity.  A third factor could be a mother’s mental health before pregnancy.  Recent studies have shown that women with depression or premenstrual dysphoric disorder may have a higher likelihood developing PPD.

The last major factor proven to have some impact on the development of post-partum depression is the woman’s culture and society in which she lives.  For example, studies have long shown that married women are less likely to develop PPD than unmarried women, explained by the fact that married women have a sense of constant support from their partners, and may just experience “baby blues”.  This is supported by studies that claim that women in marital conflict have an increased likelihood of developing PPD due to their increased stress levels and tendency to blame their child.  Recent studies have hypothesized a more complez relationship between marital distress and depression and invoked the constructs of stress and coping resources.  For example, several researchers have suggested that a supportive marital relationship may serve as a buffer against the depression that can result from experiencing stressors such as the birth of the child.  Given these data and theoretical perspectives, it is clear that the marital relationships, perceived stress, coping resources, and dysfunctional cognitions of postpartum depressed women warrant further examination.  Similar stresses impact those single women living alone who may feel as if the world is against them in their fight to raise her child.  A recent cross-cultural analysis of post-partum depression showed that cross culturally, there are similarities amongst women from similarly developed countries.  In 1st world countries, for example, increased media presence and societal pressures have resulted in increased levels of body dissatisfaction and PPD in these areas.  This is comparable to the rates in 3rd world countries where these pressures are not as prevalent, and PPD and body dissatisfaction rates are decreased as a result.  It is also worth discussing, however, that women in 3rd world countries have decreased access to medical attention and would therefore have underdiagnosed levels of PPD, despite how common it actually it.  Another factor may be cultural pressures that are more common in 2nd and 3rd world countries.  In some cultures, discussing mental health is frowned upon and therefore women may feel ashamed to discuss their mental health and seek attention if necessary.

Post-partum depression and other forms of body dissatisfaction after pregnancy pose a serious risk to mother and baby.  There is significant evidence spanning all the way back to the 4th century BC as well as cross-cultural evidence to prove that this form of depression is not a localized or rare occurrence: it is a serious event that can wreak havoc on a woman’s life and family.  For women in “first-world” societies, the danger may be even greater due to the increased influence of media and the cultural imposition placed upon her by her family.  Seemingly mundane factors such as exercise and the marital status of the mother may also play a role. If this is the case, there is sufficient evidence to support the development of this form of depression as maternal endangerment, and gives more support for pro-choice arguments to a woman’s right to choose.  The truth is, up to 80% of woman report feelings of body dissatisfaction after birth, making this topic an important one to discuss with women before they decide to start their families.  It is also worth discussion amongst young audiences and male audiences so they can be well equipped to support women in their life going through this period of time in their lives.   

Works Cited

Boscaglia, Nadia, Helen Skouteris, and Eleanor H. Wertheim. “Changes in body image satisfaction during pregnancy: A comparison of high exercising and low exercising              women.” Australian and New Zealand Journal of Obstetrics and Gynaecology 43.1              (2003): 41-45.

Cooper, Peter J., et al. “Post-Partum Depression and the Mother-Infant Relationship in a South

African Peri-Urban Settlement.” British Journal of Psychiatry, vol. 175, no. 6, 1999, pp.

554–558.

Couto, Tiago Castro, et al. “Postpartum depression: A systematic review of the genetics

involved.” World Journal of Psychiatry 5.1 (2015): 103.

Grogan, Sarah. Body Image: Understanding Body Dissatisfaction in Men, Women and Children.

3rd ed., Routledge, 2017.

Marks, Maureen, et al. “How does marriage protect women with histories of affective disorder              from post‐partum relapse?.” British Journal of Medical Psychology.  69.4 (1996): 329.

“Palmer’s Cocoa Butter”. YouTube, uploaded by Space City, 8 Feb 2016. 

Shapiro, Gabriel D., William D. Fraser, and Jean R. Séguin. “Emerging risk factors for

postpartum depression: serotonin transporter genotype and omega-3 fatty acid

status.” The Canadian Journal of Psychiatry 57.11 (2012): 704-712

Strang, Victoria R., and Patricia L. Sullivan. “Body image attitudes during pregnancy and the              postpartum period.” Journal of Obstetric, Gynecologic, & Neonatal Nursing 14.4              (1985):              332-337.

Tiggemann, Marika. “Body image across the adult life span: Stability and change.” Body image 1.1 (2004): 29-41.

Tiggemann, Marika, and Belinda McGill. “The role of social comparison in the effect of magazine advertisements on women’s mood and body dissatisfaction.” Journal of Socialand Clinical Psychology 23.1 (2004): 23-44.

Walker, Lorraine O., and Jeanne Freeland‐Graves. “Lifestyle factors related to postpartum              weight gain and body image in bottle‐and breastfeeding women.” Journal of Obstetric,Gynecologic, & Neonatal Nursing 27.2 (1998): 151-160.

Walker, Lorraine, et al. “Relationships between body image and depressive symptoms during              postpartum in ethnically diverse, low income women.” Women & Health 36.3 (2002):              101-121.

World Health Organization, United Nations Population Fund, and Key Centre for Women’s

Health in Society. Mental health aspects of women’s reproductive health: a global review

of the literature. World Health Organization, 2009.

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