The Aspiring Psychologist Podcast - Breastfeeding and Perinatal Mental Health: Challenges in South Asian Communities

Starting point is 00:00:00 Hi there, it's Marianne here. Before we dive into today's episode, I want to quickly let you know about something exciting that's happening right now. If you've ever wondered how to create income that works for you, rather than constantly trading your time for money, then you'll love the Race to Recurring Revenue Challenge with my business mentor, Lisa Johnson. This challenge is designed to help you build sustainable income streams. And whether you're an aspiring psychologist, a mental health professional, or in a completely different field,

Starting point is 00:00:32 the principles can work for you. There are also wonderful prizes to be won directly by Lisa herself. And if you join the challenge by my link, you can be in with a chance of winning a one-to-one hours coaching with me, Dr. Marianne Trent. Do you want to know more? Of course you do. Head to my link tree, Dr. Marianne Trent, or check out my social media channels, or send me a quick DM and I'll get you all the details. Right, let's get on with today's episode. Have you ever considered what additional challenges during breastfeeding and the perinatal

Starting point is 00:01:05 period might crop up for South Asian women? In this episode, Zainab Khan and I discuss the social, cultural and healthcare barriers these women face and discuss how we can provide better support for them and their families. Hope you find this so useful. Hi, welcome along. I am Dr. Marianne and it is lovely to have you here. If you haven't already caught the previous episode I did with Zainab, where we were looking more broadly at some of the additional mental and physical health factors that might be around for people with South Asian heritage, please do check that episode out as well,

Starting point is 00:01:46 or I will link it for you at the end of this episode too. I hope you will find this episode to be really illuminating. And if you do enjoy it, please do rate and review if listening on Apple Podcasts. If you are on Spotify, you can rate it. Please do drop me a comment, drop me a like, share it with your friends. Subscribe to the channel. It is the kindest thing you can do for any podcaster and it's entirely free. What is not to like there? Let's dive in and I'll look forward to catching up with you on the other side.

Starting point is 00:02:17 Hi, just want to welcome our guests for today, Zainab Khan. Hi, Zainab, welcome back. Hi, welcome. Thank you. Thanks for being here. Obviously, we were in the same outfit, so we've done it on the same day, but we figured that it was worth having a separate conversation about breastfeeding and how to kind of understand that within a South Asian context. And that's because you have done research into this area of your undergrad psychology degree haven't you? Yes so my undergrad dissertation was essentially an acceptability study on a breastfeeding workbook

Starting point is 00:02:54 that was used it was off the back of research done by my supervisor into the disparity between women of a high BMI and not reaching their breastfeeding goals despite obviously World Health Organization recommendations and such and yeah so it was like an intervention workbook that we were just trying to get an acceptability study done for however I decided to sort of branch off and specifically look at it from a South Asian perspective and get the acceptability from South Asian women in particular. Main reason for that was I know from my own family history and sort of cultural knowledge that for us breastfeeding is such a golden standard it's like the golden liquid it's so widely spoken about and within my own family breastfeeding is really

Starting point is 00:03:38 really highly encouraged so yeah I just thought it would be interesting to see well how would how would it be best to sort of attract their attention and sort of support them psychologically so yeah I recruited through online methods it was mainly through Instagram call outs with a family friend that runs like a baby class in Leicester and yeah so I sent them the workbook and they were being interviewed about their thoughts on on how they think that would have helped them through their own experiences. And there's a lot that came from it that I think is what really opened my tunnel into now really wanting to Amy Brown, who I interviewed for the podcast before. She does lots and lots of brilliant research into breastfeeding and the power of human milk and just feeding practices generally. But she's well worth looking out for to see if she's kind of branched in South Asian stuff as well but so an acceptability study that's where we're kind of checking that people like what we're about to launch into the world is it that it's doing what we hope it will do for different population yeah exactly that so it was literally just to get their thoughts on whether they think it's even worth doing do women I mean for me specifically I want to know with do the

Starting point is 00:05:00 South Asian women feel like this workbook is necessary would their own sort of peers appreciate a workbook to sort of support them reaching their breastfeeding goals I think a lot of the original research into why women don't a woman of a high BMI don't reach their breastfeeding goals does come down to sort of mind over matter not being being stigmatized or not feeling competent enough so I think that was the main push behind needing such a workbook but actually my interviews almost went very south away from the workbook and so much was brought up with regards to culturally the sort of difficulties that women have that regardless of their BMI that South Asian women have when it comes to breastfeeding and actually reaching their breastfeeding goals and even something as simple as clothing so obviously for

Starting point is 00:05:44 South Asians traditional wear can be quite heavy it can be quite complex and very much not the most breastfeeding friendly outfits I think almost the narrative of you need to attend these events and you need to wear this sort of attire really puts a lot of women off breastfeeding or they give up early because they have so many of these weddings and events to go to that they turn to bottle feeding even if that's not internally what they want to do or even at family functions if it's not appropriate to breastfeed in front of male counterparts and things like that very much discouraging than our culture of breastfeeding publicly there really needs to be more to sort of highlight those sort of psychological thought process behind doing engaging in breastfeeding especially when it comes to I guess the public breastfeeding whilst the workbook that we showed had a whole section

Starting point is 00:06:29 on it the almost the narrative behind the actual workbook when it came to public breastfeeding was not so much assimilated to why women of South Asian descent don't engage in public breastfeeding I think for them it came down to a lot of cultural stigma and also stigma around doing it in front of males and and and it has to be done hidden and I think yeah it was interesting to kind of hear from their perspective of things they wish they had received when it came to their own experiences especially when it came to things associated with their weight being told they're not good enough by family or being told that because they're overweight you know their breast not good enough I mean that's quite similar to what the general narrative is for white Caucasian women as well from the research.

Starting point is 00:07:10 But I think it was more deep rooted for South Asians in regards to their culture in particular, which I think was different. Yeah, so interesting. And I guess there's not necessarily a biological reason why somebody with a higher BMI can't produce breast milk. And I think certainly Professor Amy Brown's research seems to suggest that it's only 2% of women who can't produce enough milk to sustain their own yield. That's what the evidence tells us. But thinking about my experiences of having been a breastfeeding mother to both of my children, certainly in the early days when you're establishing feeding and when they're establishing feeding and when

Starting point is 00:07:45 they are cluster feeding, which is really, really exhausting for mum actually, because you're getting almost, it feels like constant feeding. That is involving a lot of either top-off time or clever one-up, one-down outfit choices. And cultural dress may not always make that possible, especially when out and about. And it is really challenging, establishing breastfeeding, especially if you're being undermined by people around you. It's really, really difficult. You need somebody who, you don't always need somebody who gets why

Starting point is 00:08:27 it's important to you, but it sure does help if someone is willing to bring you a pint of water as soon as you sit down to feed. Because if someone is trying to undermine you and constantly saying, oh, you know, perhaps they'd sleep better with formula or perhaps, you know, I would actually really like to feed them, you know, I'm going to feed them a bottle. That can affect a mother's mental health. It can affect how she's able to produce milk in future. Like it's a really big deal. Yeah, exactly. And I think speaking about South Asia in particular, I know that there was a huge brand that went into India years and years and years ago and introduced formula milk which was incentivized by free formula milk and things like that and it really really perpetuated this cycle that's really gone down tradition to tradition because it was linked so heavily

Starting point is 00:09:18 their advertising was linked so heavily to well if you use formula you can do the housework you can get on with the chores you can look after your other children you can pass the baby from family member to family member it was really tying into certain cultural niches that it has I know it sustains such a long-standing tradition now within cultures that I actually wasn't aware of until I did this research just given that within my own family circle they've all been everyone's breastfed, it's very much spoken about, but after doing my dissertation, it really highlights to me, actually, almost the narrative

Starting point is 00:09:49 slightly switched within South Asians, a lot of, actually, why don't we try formula, because it does mean that you can, because we're such family,

Starting point is 00:09:57 family orientated people, we have such large families, typically, it has been perpetuated a lot, that actually, if you do use formula, you know, you can just hand the baby

Starting point is 00:10:04 off to grandma, or to aunties and uncles and while you get on with the housework and I think when it comes to then trying to implement psychological interventions or workbooks or anything that can sort of change the narrative around your breastfeeding behaviors and your approach to breastfeeding if the healthcare providers have that knowledge in mind or they just kind of do the almost preparatory work of what is going on for that coach in particular first before we create any sort of intervention I think they'll have a lot more efficacy and in how they kind of work I think again it also ties in with not necessarily all healthcare providers because you do get obviously some very good ones but I think the research that I've looked into anyway there is a huge disparity between the general perinatal support whether that's

Starting point is 00:10:50 psychological or practical medical help that South Asian women get in comparison to their white Caucasian counterparts so I think if systemically you've got healthcare providers that don't actually want to do the the kind of groundwork of understanding that culture's issues and problems, you're never going to kind of bridge the gap and increase those breastfeeding rates or increase any of the positive behaviours that should happen postnatally or even perinatally as well. And I, you know, whoever I'm supporting as a new mum, I'll always think, actually, we don't necessarily need them to come around and feed the baby. But if they're coming around, perhaps they could clean the bathroom whilst they're using it. Perhaps they could do the cleaning. Would that fly as an intervention

Starting point is 00:11:36 for South Asian cultures? Or would that be frowned upon if I asked my auntie to clean my bathroom when she came around? Yeah, traditionally very frowned upon. I think it's very, it's almost women's bills are held to such a high standard which kind of works in a positive and negative light in some ways I think it's quite a common misconception that obviously women in my culture for example are like quite oppressed or they're not seen as as valuable individuals but I mean coming from like a religious point of view for me like religiously women and my within my family women are held to such a high standard in terms of they are the most valuable members of the community because of how much they have to enjoy whether it's childbirth and being a parent

Starting point is 00:12:15 and so on so forth but I think sometimes that can be taken the wrong way where it's because so much is expected of them that's when sort of the psychological impact of just certain things like traumatic births which statistically South Asians have a very high experience of traumatic birth I think there was a it was Owen Mitchell that did a the first ever South Asian perinatal conference recently and I was reading the report of that and it was all about traumatic births and how statistics aren't being published about the high numbers of traumatic births experienced by South Asians but if people and not just healthcare providers but even family members and friends within the community aren't aware of the psychological impact of even just a normal birth let alone traumatic birth

Starting point is 00:12:57 they're so overlooked then that they're just expected to do a lot of the housework and things so I think it's a lot of it is there just has to be balance I think I think it's quite common within western culture to almost discredit cultural practices where they encourage sort of these very traditional gender roles or they see it as oppressive and the woman has to be submissive and it's not a good thing I think it ties back to what I've said in the previous episode with you where you have to see it from a culturally appropriate point of view where for us it's not a bad thing to be a domesticated person or a domesticated woman it's not a bad thing to be the one doing the cleaning but there also has to be a level of support from other people so yeah I mean if if it was in encouraged that you know when someone's a new mum let's help

Starting point is 00:13:39 out a little bit more with the housework that would be great but I think introducing that within the culture isn't as easy as just saying well why don't you ask your auntie next time to come like when she comes over to do the cleaning I think that's the big difference okay I really liked what you said in the previous episode about the parallels between the World Health Organization take on breastfeeding and the Quran could you tell us a bit more about that yeah so essentially word for word what you see in the WHO is written word for word what you see in the who is written word for word in regards to how many months they recommend breastfeeding the benefits of breast

Starting point is 00:14:10 meat it's literally written word for word um in the ground as it is on the who website as well for me that was highlighted by i knew that anyway going into this research but i did notice across the interviews i did a lot of them did bring up they just happened to all be Muslim that I spoke to just by chance and they all in the way they were talking about their experiences of perinatal mental health and things like that they all brought in sort of a religious influence and sort of the maybe the comfort they found in prayer or turning to religious leaders and things like that and where they were getting their source of information and for me that highlights almost a need for healthcare providers and services to almost bring religion into it where it's appropriate because I

Starting point is 00:14:56 think again just in the world we live in they're always seen as quite taboo topics or you don't bring religion into things or you don't but I think for a lot of these services especially ones that aren't educated in England or in western cultures or that haven't ever engaged with any education providers at all if they've migrated from abroad or anything like that for them they might turn to religious books for their almost education and I think if there was some knowledge of that from you know psychological providers service providers I think it's not necessarily a bad thing I think you'd was some knowledge of that from you know psychological providers service providers I think it's not necessarily a bad thing I think you'd get a lot more reach and a lot more response I just thought it was very interesting to be honest yeah even just to know to ask the question

Starting point is 00:15:35 is there anything in your faith or your culture or your you know your cultural and religious books that talks about this that might be you know explaining some of what we're seeing right now but I seem to remember working with women in the past who really they recognized that they weren't ready to stop breastfeeding their child and that the baby the child wasn't ready to stop but I seem to remember there was some understanding that it was to stop by two years of age. Does that ring a bell for you, Zainab? Yeah, I think the actual, I should really know this off by heart given that I did research into it, but the WHO recommendation, I know that it's exclusive breastfeeding up to six months

Starting point is 00:16:17 and then it's supposed to be introduced alongside obviously solids up to two years. So yeah, you're right in saying that yeah but it's i guess speaking as a mother who did feed both of our children past two years one was 25 months and one i had to put a line under it at two years and 10 months it's it's it's kind of at least two years is how i remember the guidance but that is uh i think in, in certain South Asian cultures, it's seen as you mustn't go beyond that. It becomes inappropriate or not OK. But of course, what we know, the woman who has breastfed, is that it's a very individual relationship between you and that child. And, you know, trying to stop for an external reason rather than a reason that is about you or about that baby choosing to make that stop.

Starting point is 00:17:16 So it's said there's only two times where you should stop breastfeeding and that's if it doesn't work for you or it doesn't work for baby but of course having separate guidance around do not continue beyond two years can can add lots of elements of guilt shame and regret and blame and and very difficult kind of mental processes that are there yeah you're absolutely right i mean i mean going back to religious scriptures it mirrors it's only a guidance it's not that you have to suffer two years. But I think culturally, a lot of it comes into, I think, I mean, the intervention that we were looking at, there was so much talk about, you know, talk about your body is like, get your breasts out, like, explore and things like that. I think one thing that I discussed a lot with the interviewees was it's not culturally appropriate to get your breasts out. Exposing body parts is not a thing that we do. with the interviewees was it's not culturally appropriate to get your breasts out exposing body parts is not a thing that we do even talking about it within the work with your husband

Starting point is 00:18:10 not also very much encouraged like the exploratory side of things that you know what positions like for you and so on and so forth just even something as small as that wasn't very much encouraged because of cultural shame and stigma almost I guess you could call it I think again I don't think it's necessarily should be seen as a bad thing I just think again it's just a cultural preference that we especially if you come from a Muslim background or typically any religious background within South Asia it's that you you maintain your modesty and things like that especially when it comes to your male counterparts or family members or friends and I think yeah so when it comes to obviously going past certain ages you're right

Starting point is 00:18:49 it does come down to I guess the stigma around oh that's a bit inappropriate to look at for whatever reason that's I don't know where that idea has even come from but it just I think from the like research and healthcare provider point of, it shouldn't be about questioning where has that come from. More so, it's there. It's not going to disappear. Because a lot of these cultural issues or cultural beliefs, they stem from generations ago. It's not something you can change overnight.

Starting point is 00:19:17 You can't tackle almost where it's come from. I think that's a lot of the focus when it comes to research. Well, where's this shame coming from? Let's tackle the where. I think it needs to just be that it's there anyway assume it's there and deal with it in that way instead I think almost giving them just an alternative point of view a lot of South Asian women stopping exactly two years because of that shame that comes after all this yeah and I think I know even myself as I was talking just then about how long I'd fed my children for, I had this kind of internal critic like, oh, should you be saying

Starting point is 00:19:51 this? Should you be publicly telling people that you'd fed for this length of time? And will people think that you're judging them or slighting them if they didn't feed for that. It's really hard, but I'm proud to have fed my children. It was not easy. It was incredibly difficult. Both of them had tongue ties as well, but having a child is not easy. And for me, that was just something that I was adamant that I was going to make work. And thankfully, I wasn't one of the two percent of women that couldn't produce enough milk you know there are medical reasons why some people can't do that and there's sometimes personal preference reasons and when it comes to kind of trauma and abuse obviously there's this absolutely complicates whether someone feels they want to or

Starting point is 00:20:41 can breastfeed but I guess it's what we said before, like in the first episode, like if you can see it, you can be it. You know, if you've heard Dr. Marianne Trent talking about having breastfed her children beyond two years, maybe that thing makes you think, well, I can work. I can go back to work. I went back to work with both babies a year of age. And I expressed, you know, I think this is just, we need to be getting better at asking people for their story, for what matters to them, for what external and internal factors might be perpetuating some of these difficulties, all these struggles, these challenges. You know, we should be empowering people, ourselves, people in our team, people above us, people below us to have these conversations.

Starting point is 00:21:27 And I guess it's really difficult, especially as a white British woman. I don't want to get things wrong. I don't want to be making't know. We cannot be an expert in everything. Podcasts like this help to illuminate areas that we might not even have considered before. But really, the person themselves is always going to be the expert on themselves, aren't they? Yes. I think that literally sums up perfectly. I think it is. The big thing that I'm so interested in is, I think where it's almost going wrong is at the baseline. I think, especially for South Asian women, given that culturally they can be quite stereotypically seen as, you know, submissive characters or they don't get their voices heard I think that's where

Starting point is 00:22:30 as a researcher or as a healthcare provider a clinical psychologist you really have to be the one that does empower them to speak and I think it goes down to being exploratory and just curious I think at the start of meeting a client if you're asking them almost give me everything about your life story so I can understand would do us a lot more good than it does harm than if we were to ask something and maybe trot on the wrong foot slightly and get something wrong that we don't understand I think that's better to do almost than if you just don't ask and you just assume that they fit the sort of same narrative that we've seen for countless years I think especially when it comes to sort of perinatal mental health I think going forward for South Asians like my biggest thing is I want to be the representation for as a clinician or as a researcher to almost like be the like the bridging gap between I think the

Starting point is 00:23:24 big thing that we spoke about even in the previous episode is just representation if you can have some representation somewhere in a service that understands or that can just show that I think like what you said before with if you can see it you can believe it if you can see yourself almost a representation of yourself within your healthcare provisions you're more likely to want to engage and you're more likely to believe what's being said than if it's someone that doesn't emulate the same beliefs or even look the same as you thank you so much please could you let us know where people can kind of connect with you and learn more about your research i would probably

Starting point is 00:23:59 say linkedin is the best place to go for that um it's just my name, Zainab Khan, and you'll find me. Thank you so much for helping illuminate our listeners and our watchers about this really important issue. Thanks for your time. Thank you so much, Avowee. It's been really, really, really good to speak on the podcast today. Oh, thank you. Thank you so much once again to Zainab for her time in speaking with me. What has this brought up for you?

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Starting point is 00:25:22 If you're looking to become a psychologist, then let this be your guide. Thank you so much for being part of my world. With Dr. Marianne Trent My name's Jana and I'm a trainee psychological well-being practitioner. I read the Clinical Psychologist Collective book. I found it really interesting about all the different stories and how people got to become a clinical psychologist. It just amazed me how many different routes there are to get there and there's no perfect way to become one and this kind of filled me with confidence that no I'm not doing it wrong and put less pressure on myself. So if you're feeling a bit uneasy about becoming a clinical psychologist I'd definitely recommend this just to put yourself at ease and everything will be okay

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The Aspiring Psychologist Podcast - Breastfeeding and Perinatal Mental Health: Challenges in South Asian Communities

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