Main course

More specific factors include:

• Isolation

  Migrating (forcibly or by choice) often results in new mothers having little to no social support, leading to feelings of loneliness and isolation (Ballantyne et al., 2013; O'Mahony & Donnelly, 2010; Wittkowski et al., 2017). Many women arrive to their migration destination alone and sustain pregnancies on their own. Additionally, mothers who do not come alone may experience conflict with their husbands, lack necessary supports (as fathers may need to work long hours) and lack knowledge of depression. They are also often solely responsible for child-related issues, which may not be seen as a man's role (Wittkowski et al., 2017).

• Violence

  Research has shown that the rates of intimate partner violence (IPV) during pregnancy are higher and it could have detrimental effects on the mother and the newborn. In addition, new migrants may face social and material issues such as deprivation and poverty, dangerous housing and unemployment or underemployment (Picot & Hou, 2019); Wittkowski et al., 2017). Violence of any type (IPV or by strangers) during pregnancy is a strong indicator of prenatal depression in immigrant women (Miszkurka et al., 2012b).

• Gender roles

  Some researchers assert that cultural factors among some immigrant and refugee women, as with women in general, may be associated with the increased rates of depression during pregnancy. This includes views around traditional gender roles, adherence to childbirth rituals, and cultural beliefs and values around depression (O'Mahony & Donnelly, 2010; Wittkowksi et al., 2017). As in many families, migrant or not, women may have multiple roles expected of them as mother and wife, with often uneven responsibilities and an expectation that they can cope with caring for their children, husbands and households (Ibid.).

• Cultural rituals

  Some cultures may perform expected rituals and practices around childbirth to ensure the future health of the baby. These rituals and practices may be difficult to adhere to in Western cultures (Wittkowski et al., 2017). As mentioned earlier, these rituals may act as a risk factor; however, if performed, these rituals and practices may help alleviate factors of postpartum depression (O'Mahony & Donnelly, 2010). The most common rituals are resting for a period of time after giving birth, observing a diet and other restrictions, and receiving support from the extended family. These rituals have been found to help the woman's perceived support and feeling that her needs are being met (Bina, 2008).

• Privacy

  Depression during pregnancy is not always recognized or it is minimized in order to prevent damaging the image others may have of how “strong” a mother is (Wittkowski et al., 2017). Some cultures also have codes of privacy in which talking about concerns or issues is seen as a sign of weakness or may make it worse (Ibid.).