Witness Testimony

I am a medical doctor who specializes in obstetrics and gynecology with a special interest in violence against women, women's mental health issues and pregnancy complications. I support ongoing research on how depression affects women and support furthering our understanding of why some women experience significant depression, some to the point of suicide, especially after pregnancy. I am a clinician who sees depressed women everyday in my practice, have co-authored clinical depression guidelines at the University of Michigan and have published research on depression and suicide after pregnancy.

Depression is generally viewed by the medical community like other diseases such as diabetes, hypertension and cancer. Theories explaining the cause of much of postpartum depression typically include changing hormone and brain receptor levels and thyroid disorders, to name a few, with research indicating that women at highest risk for depression after pregnancy are those who have been diagnosed with prior major depression and/or bipolar disorder, marital difficulties and a general lack of social support. About 10 to 15 percent of women experience mild to severe postpartum depression, which is clinically under-diagnosed.

In the past, research has failed to systematically incorporate an analysis of the effect of violence in women's lives as an important contributor to depression. Equally important, but routinely overlooked and ignored, is the data that homicide is a leading cause of pregnancy-associated death (the death of a woman from any cause while pregnant and during the year after pregnancy) and that suicide is also a significant cause of death.

Newer research has indicated that the risk of becoming an attempted or completed homicide victim was three times higher for abused women versus non-abused women during pregnancy and that black women have a three-fold increased risk as compared to white women. Other studies report higher rates of homicide among postpartum teenagers as compared to adult women.

This same research on homicide and suicide after pregnancy reveals that women who terminate their pregnancies, as compared to women delivering a term baby, are twice as likely to die from homicide and almost two to six times as likely to commit suicide. These associations were not seen in other forms of pregnancy loss. Violence histories are several-fold higher in these same women who seek termination of their pregnancies.

In addition, self-harm and psychiatric hospital admission because of suicide attempt is more common in women who terminate their pregnancies, while rates of suicide and suicide attempt are half or less for women with full term pregnancies compared to the general population.

The concentration on biology to the exclusion of culture and sexual and physical violence in examining differences in depression creates a misleading picture of risk factors and eventual outcomes. Studying depression while ignoring sexual and physical violence against women is like searching for a child hiding in a house without looking in the closets. In the same manner, research studying only depression after childbirth ignores the difficulties that millions of women in this country are faced with following pregnancy losses - depression after miscarriage, stillbirth and termination of pregnancy.

We must also focus considerable energy on the safety and mental health of women who terminate their pregnancies. Not doing so is to ignore an important area of women's mental health research. A number of studies note the association between the termination of pregnancy and either suicide or suicide attempt. This is an objective outcome which is seen only after termination of pregnancy rather than before and indicates either common risk factors for both choosing termination of pregnancy and attempting suicide such as depression or the harmful effects of termination of pregnancy on mental health.

Improving women's health must include improving mental health and physical and sexual safety. Therefore, improving our understanding of depression after pregnancy is imperative. We must look for the child in the closet.

(All research references available by request.)