The racial and ethnic disparities around maternal health continue to run rampant in the US. It is estimated that 50-75 percent of new mothers experience baby blues and that 10-15 percent of those women will go on to develop a more severe case of postpartum depression. As a postpartum doula, I have seen how hard and isolating parenthood can be for new families. I constantly hear “I had no idea it would be like this.” With all the books and apps out there, new parents still need face-to-face community support and someone to guide them through one of life’s biggest transitions.
What is a postpartum doula?
A postpartum doula is someone who provides physical, emotional and evidence-based-informational support to new parents during the postpartum period. The postpartum period covers the 12-month period after the baby is born. While they are not medical providers, they fill a much-needed gap in a broken healthcare system. Postpartum doulas are trained to assist new parents with the overwhelming demands of parenthood, such as feeding issues, routines, bonding and sleep (for both baby and parents). Support is different for every family and doulas come from every background and have different areas of expertise. Many doulas are also trained lactation consultants. Postpartum doulas help replace “the village” that everyone tells you that you need but no one tells you how to obtain.
What a Doula Can Do for You:
Process your birth story
Feed support (chest feeding and formula feeding)
Sleep conditioning/guidance for shaping healthy sleep habits
Meal prep/Laundry (basic needs)
Teach newborn care (swaddling, bathtime, soothing techniques)
Telephone/text support
Explain normal newborn behavior
There are over a dozen training and certifying organizations for doulas. Currently, there is no U.S. regulation on birth or postpartum doulas, meaning you don’t have to take a training or certification to call yourself a doula. There are currently three states that have passed legislation for third party reimbursement for doulas services through Medicaid.
Alternatively, there are state-funded programs like the volunteer-run, NY Doula Project. Doula fees vary across the US in markets; for example, NYC postpartum doulas charge $35-60/hour based on experience and training.
When hiring a doula, it’s a great idea to interview several people and ask about training and certifications. You can also ask about adjacent services such as lactation, babywearing, infant massage and childbirth education. The site https://doulamatch.net/ has a comprehensive list of doulas in the U.S. and Canada. Welcoming a doula into your home during such a vulnerable time can seem stressful at first.
I always say to trust your gut and seek out someone with a personality that you want to be around and a specific skill set that you can benefit from. Word of mouth and recommendations from friends and your community are some of the best ways to find support!
Questions You Should Ask Your Potential Doula:
Are you trained/certified?
What are your COVID-19 pandemic protocols and precautions?
Are your immunizations up to date?
Do you have references we can call?
Do you have a backup in case of illness or emergency?
How can postpartum doulas help new parents experiencing postpartum anxiety or postpartum depression?
Postpartum care in the U.S. is underwhelming and disappointing. Most new parents are seen for the first time 4-6 weeks postpartum. During the COVID-19 pandemic, I have seen these appointments being pushed out by months. Mothers deserve better care. We aren’t meant to do this alone. Many new families are desperate for information and validation that they are doing it right, that everything is normal. This is where a postpartum doula comes in, this is the person you can call and text to see if something is par for the course. If you are wondering why your baby doesn’t want to be put down or if you are not sure if it’s gas or colic, you can reach out to your doula. You can go over all of your questions, challenges and fears. I always go back to the phrase “you don’t know, what you don’t know.” The unknown can cause so much anxiety and so much fear. Having a doula who can help ease those fears and prepare you for what to expect, what stages are coming next, what you can anticipate week to week is so valuable.
Postpartum doulas also connect you with local support groups, mental health professionals, pelvic floor therapists and lactation specialists who can round out your care team.
I have heard the first year postpartum described as the longest and shortest year of your life. When you look back on how fast your child’s first birthday rolls around at the same time wondering how you ever made it through the sleepless newborn stage or the teething stage. It’s overwhelming but such a milestone!
What is working with a doula like?
Every family’s needs are unique. Some families want support during the day and typically that would be a 4-6 shift where the doula would come in and chat with you about challenges and goals, teach a skill such as swaddling, tummy time or bath time. The doula can then fix a meal for the new parents and tend to the baby to allow parents to nap or shower. Doulas with lactation training can also spend day shifts helping parents with their breastfeeding relationship. Many families choose to use a postpartum doula overnight. Overnight shifts are typically 8-10 hours a night. Overnight shifts allow parents to catch up on much-needed sleep. Overnight doulas will watch over newborns while parents sleep, bring the baby in to nurse or handle bottle feedings. They can also help throw coffee on and prep a meal for the next day. There is so much value in both day shifts and overnights. Many choose to utilize a combination of the two. There is no time limit on how long you can have a postpartum doula, but I typically work with families during the first 6 months. Many families opt for support several days a week and some choose just one week of care as soon as they are home from the hospital.
A question to the community: What was your postpartum experience? What do you wish you had more info on? If you are expecting, how are you creating a support system?
If you or your loved one is experiencing signs of postpartum anxiety, depression or psychosis please reach out to your healthcare provider.
Valentine’s Day is here, and my calendar is fully booked on February 14th. It’s not what you think. My calendar is fully booked with therapy clients who will most definitely be reflecting on their singlehood this year. And so will I. Most of them are just like me — single South Asian Americans, between the ages of 22-40 who come from moderately conservative cultures. The adult children of immigrants, who had arranged marriages, wondering when we will ever find “the one,” and why we won’t settle.
I’m a therapist in therapy, and I’ve had a lot of family trauma and baggage to unpack with my therapist. Through my training and personal therapy journey, I learned to question a lot of the things that I’ve been told about marriage and relationships.
At the same time, it’s not easy. No one wants to be lonely. Brené Brown talks about how detrimental loneliness can be for humans in “Braving the Wilderness.” We all want to belong to someone or something bigger. And there is a difference between being lonely, without intimate companionship, and being alone in our experiences. As we get older, everyone we know in our age group is on a different life trajectory, and we start to feel both alone and lonely.
We straddle the line between two cultures — the one that we were born and raised in, and the one our parents and family tried to teach us. Many of us might live double lives. But being single is not an anomaly. In fact, according to the Pew Research Center, about 31% of adults in America are single. About 32% of American women, between ages 18-29, and 29% of women, 50-64, are single. This means that roughly about a third of American women are single, regardless of age or developmental stage.
Results vary by sexual identity and race. 56% of adults who identify as lesbian, gay, or bisexual, between the ages of 18-29, are single, compared to 29% of their straight counterparts. Black adults are more likely to be single than White or Hispanic adults. However, no statistics included Asian Americans. Some studies show we are more likely to get married due to strong values placed on marriage in Asian cultures, and less likely to get divorced. There is also a huge stigma against divorce. For Asian American women, there is a cultural pressure to not only get married, but stay married.
For many South Asian Americans who are first or second-generation, we have no blueprint for the modern world of dating. A lot of us don’t know what a healthy dating experience, let alone a marriage, is supposed to look like if it is even at all possible. In the South Asian diaspora, marriage is taken very seriously, but counter-intuitively; we are not given the opportunity to spend time on making the decision — we are expected to decide very quickly. For most of us, who are children of immigrants, our parents more than likely had an arranged marriage — that was a decision made by our grandparents, aunts and uncles. And the wedding and engagement happened fairly quickly. That is our blueprint
There are many mixed messages about how to approach marriage and dating. Many of us were told to not start dating until after we graduate from college and get a full-time job, which left a lot of us with very little dating experience, and then, Poof! We’re magically just supposed to settle down. There are many desi people who stay single because they know they have issues to work on. A lot of us are aware of how messages about marriage and dating in our communities are sometimes not realistic, if at times rooted in colorism, internalized colonialism, patriarchal and misogynistic values,and racism.
Dating is uncertain because you can’t control whether or not someone wants to date you, let alone if someone wants a relationship with you. And sometimes that has nothing to do with you and everything to do with that person’s preferences or baggage. But is it possible you have some baggage too?
Staying single because of personal baggage is not uncommon for South Asian American millennials. Because of this, many of us believe that something must be “wrong” with us, especially when people ask why we’re still single and unmarried. While we should address underlying issues for why we’re still single, that doesn’t mean anything is necessarily “wrong” with us.
As a licensed therapist, I see many single South Asians Americans who believe that something must be wrong with them because they’ve never been in a relationship before, or because they’re not in a serious relationship yet. If you’re one of these people, I want you to consider:
Who taught you how to date?
Who taught you how to socialize with other genders?
When were you allowed to date?
How often were you allowed to socialize with other genders?
What is your model of a healthy marriage or relationship?
Who taught you free will and how to exercise choice?
How were affection and romance modeled for you?
When we unpack the answers to these questions, we start to realize that there are actually very good reasons for why we’re still single.
If there are that many South Asian Americans who are afraid of dating because they don’t want to repeat toxic relationship patterns, that means that many of us are…meant for each other. So why can’t we find each other?
Our parents had an easier time finding each other because they lived in a homogenous society. My parents came from a community where everyone was of the same or similar Malayalee-Indian background and the same religion. My parents hope that I can find someone from our culture, but they forget that we live in a heterogeneous society, where finding someone who is South Asian, let alone of our specific culture, background, community, and religion, is few and far between. There is pressure on many South Asian Americans to find someone within their specific communities. Not to mention that meeting someone through a mutual connection doesn’t necessarily mean they’re a good fit for you. It makes it feel like our options are limited.
This creates a ‘scarcity mindset.’ Scarcity mindset is the belief that there aren’t enough resources or opportunities out there. When you feel there aren’t enough singles within your community that you can meet, it can cause you to become hyper-fixated on these limited ‘resources’ and even heighten anxiety. And to some extent, there is some truth to that fear — some of my clients are joining dating apps to meet South Asians out-of-state. As the people around you start to settle down, you might start to feel the pressure of settling down quickly to “catch up.” You may have tried to go on a bunch of dates or entertain the idea of certain people in your community, but they eventually fizzle out, fall flat, or end in rejection. You might start to feel discouraged. This kind of pressure can result in:
Avoiding dating in the culture or dating altogether to prevent being hurt or feeling rejected, or having to confront the social anxieties of meeting new people and being open and vulnerable.
Latching on to the idea of someone we meet, working too hard to impress them early on, and attempting to force chemistry to guarantee an outcome (marriage).
When you feel this kind of pressure, you might underestimate or overestimate how to interact with potential partners. This pressure might come from messages you’ve heard in your community that you’ve internalized. For instance, if you’ve heard someone say, “we don’t get divorced in our culture,” you might start to believe that divorce is the worst possible outcome. That might put pressure on you to find the “perfect” partner in order to prevent divorce, but the future of your marriage is not something that you can guarantee. Another example — if you hear your parents tell you to “just compromise,” you might start to believe that your expectations are not realistic; therefore, that’s why you’re not married or in a relationship yet. You might start to lower your expectations and get attached to any potential partner in the hopes that you can guarantee a relationship, but changing who you are does not necessarily mean you’ll attract what you want.
How we approach dating, especially when under this cultural pressure, can have an impact on how we bond emotionally with people. One theory based on psychological research, called Attachment Theory and Styles, describes patterns of how we create and maintain emotional bonds with others and where we fall on the attachment style spectrum or circle. Cultural pressure to settle down and marry someone from your specific culture or community can influence how we date and why, but it prevents us from being mindful and enjoying the process of dating. Your attachment style might be the result of your family dynamics, your parents’ style of emotional connection, and cultural messages you’ve been taught about what a relationship or marriage “should” be like. For example, if you’re under cultural pressure to get married quickly to appease your family, you might develop an anxious attachment style because it triggers thoughts and behaviors that fall under that category. If you question the cultural pressure, you might associate marriage with negative connotations. You might push away dating and marriage and act in the way of an avoidant attachment. Your attachment style is not genetic or something you are born with. It is a pattern of behavior that is about how you relate with others, especially in relationships. It can change over time and vary based on your anxiety or the person you’re seeing. If you want to learn more about attachment style, seeking a therapist is a good resource.
Regardless of what your attachment style is, it can prevent you from being patient, truly vulnerable, and having quality dates or quality relationships. It might keep you in unhealthy dating situations or relationships too long out of fear that you won’t find anyone else “in time.” You might be jumping to conclusions about what should happen next when you date someone. When you really like someone, you might be asking, “What if things go wrong?” But what if things go right?
Valentine’s Day has never been something special for me, and while it would be nice to be in a relationship, I’m not going to let the cultural pressure of what I’m “supposed” to do, as a South Asian American single woman, dictate my life. I have my reasons for being single, and it’s no one’s business but mine (and my therapist’s). If someone in my family or my culture doesn’t approve of my singlehood, then I sincerely hope they’re awake at night thinking about why I’m single. What they think of my life is none of my business. At the same time, I’m not going to shut myself off completely from dating and relationships. Dating will be on my terms. While rejection hurts, I have accepted that people will come and go and I wouldn’t want someone to feel forced or obligated to stay with me if they have emotionally left the relationship. Ultimately, I’m looking for someone who will fit the lifestyle I already have, but if I don’t find my life partner, I’m okay being with myself too.
You don’t have to follow your parents’ blueprint to marriage and relationships. You’re allowed to follow your own. If we adopt an abundance mindset, a mindset of knowing that there are enough resources for everyone and accepting what resources are available to us — along with practicing healthy relationship habits — we might develop better, more satisfying relationships. There are enough single South Asian Americans out there who would love to be with you. Stand firm in who you are and what you want, and be open to what comes your way.
Mental health in the South Asian community has long been stigmatized, and South Asian individuals who experience psychological issues might feel hesitant to express their concerns due to the shame they may encounter. Nevertheless, while there has been progress made in studying and openly discussing South Asian mental health, several topics remain in need of further examination; these include studying the relationship between mental health and gender, specifically the role of masculinity on mental health outcomes.
What is South Asian masculinity?
Masculinity and mental health have come under greater scrutiny by researchers, particularly as traditional masculinity is often cited as the reason why men are less willing to reach out for support regarding psychological issues. However, the influence of masculine norms on well-being has been insufficiently viewed through an intersectional lens and is understudied within South Asian mental health. From a South Asian context, traditional masculinity can include focusing on material success while displaying suppressed emotionality, which can be manifested through anger or practicing other harmful behaviors.
In order to understand its influence, it is critical to examine the impact of traditional paradigms of masculinity across the diaspora. For instance, some traits associated with traditional masculinity among South Asian men include displaying control over others. A Sri-Lanka-based study found that most male participants “associated manhood with dominance…” A Forbes India article asserted how boys in India are “taught to … apply themselves to the task of growing up to be a strong, unwavering support system for their families,” which in turn forces them to be silent about topics that may make them seem weak. This pattern of behavior becomes manifested in a particularly harmful way because boys grow up with the inability to handle their emotions or formulate healthy coping strategies during challenging circumstances.
These norms can have drastic implications and harm other community members. For instance, a focus group conducted among Nepali men found that failure to deliver for their household economically as breadwinners eventually resulted in heated disputes, which escalated and led them to engage in domestic violence. The presence of domestic violence can also be observed through media stories on the pervasiveness of gender-based harm within South Asian communities, as seen in the murder of Sania Khan.
Traditional masculinity also hides the wounds that South Asian men may be battling within themselves. One paper asserts that for a sizable number of Indian men, “…sadness and despair find a distorted manifestation in destructive behaviors that deny their emotional pain to themselves and to others.” Thus, performing conventionally masculine behaviors can mask deeper mental health issues.
Repercussions of South Asian masculinity on mental health
Because of the pressure to adhere to such strict standards of conduct, traditional masculinity has significant, greater repercussions for mental health and well-being. For instance, because of the narrow ability of men to compartmentalize their feelings, this restrictive emotionality can result in an inability for others to recognize their mental health issues, thus failing to target the deeper causes of men’s behavior. Furthermore, men themselves might engage in fewer help-seeking behaviors. This is also further complicated due to gaps in culturally competent services that can serve South Asian men when they do utilize support systems.
Additional social forces experienced by South Asian men might explain mental health outcomes, particularly when considering the role of immigration. Among South Asian American men in the United States, one study noted that “a lower social position” within their community was linked to higher distress, indicating how critical it was for first-generation men to be leaders and actively participate in their ethnic community’s organizations. Thus, social expectations of men within South Asian communities influenced their well-being, as did their social status and relative power.
What we can do to change the status quo on South Asian masculinity and mental health
In order to ensure that men in South Asian cultures can embrace their mental health, it is important to formulate a prudent, welcoming paradigm that encourages greater help-seeking behaviors. Greater attention to this topic can also contribute to theories on feminist and sociocultural therapeutic frameworks, which both offer the following includes suggested remedies:
Challenging gender stereotypes and encouraging mental health care as a means to discuss issues about well-being
It is imperative to encourage South Asian men to show more emotion, thus changing the existing narrative and social pressure they face to limit the expression of their feelings. Fortunately, there is a platform, known as @BrownManTherapy, that posts content about the struggles South Asian men experience. Furthermore, therapy ought to be recommended as a means to deal with mental health concerns, which should be combined with support from the community.
More South Asian male clinicians
In addition to instituting changes in community norms, there needs to be more diverse representation in the mental health field. In doing so, there will be greater platforms to have conversations about the negative repercussions of traditional masculinity that are unique to South Asian men. Furthermore, it is critical to challenge the social stigma that mental health is a female-dominated profession or that seeking therapy is emasculating.
More research studies examining cross-cultural differences in masculinity across South Asian cultures
The connection between masculinity and mental health ought to be investigated much further. Studies should particularly assess masculinity within non-white contexts in order to examine the standards of manhood across several communities and truly understand the unique stressors men face across different cultural backgrounds.
While the connection between South Asian masculinity and mental health is not discussed among psychology professionals, it is critical to study the association since it plays a role in South Asian gender inequities and in mental health behaviors among South Asian men. More broadly, given the prevalence of intimate partner violence within the Asian American and Pacific Islander communities and the role of patriarchal norms in inflicting this harm, it is now more important than ever to reimagine expectations surrounding men’s behavior.
By further examining the problems caused by adherence to traditionally masculine norms and implementing certain solutions, these ideas can be challenged and dismantled to create a progressive and more inclusive model of manhood. Above all, identifying and eradicating toxic ideas rooted in traditional South Asian masculinity will lead to liberation for all people.
Paritosh Joshi is a graduate student in Clinical Psychology at Teachers College, Columbia University. His background includes a Master of … Read more ›
February 28, 2023February 28, 2023 4min readBy Sara Qadeer
Hi! I am Sara and I am a mom to a beautiful, neurodivergent child. This piece explores some challenges of parenting an atypical child in a typical world.
It is a sunny day in the summer of 2020 and I am trying to enjoy the only entertainment that has finally been “allowed” by our province. Parks. Sunshine was always free; scarce but free. I have eyes on my daughter, running and somersaulting, with that untethered quality they say she gets from me, while socializing with two girls her age from a distance.
All of a sudden, the distance called ‘social’ gets smaller and as I run and call out in vain my child has the kid in a tight and loving but forbidden hug. I understand that pandemic or no pandemic, physical space is a basic right but for my daughter, it falls under the ‘but why?’ category.
The next 15 minutes are spent apologizing to an exasperated mother asking me why my kid was not taught the dangers of COVID-19 and personal space. She is four, I tell her, she just got excited. At some point, I zone out and just let her say her piece. Some of it is in a language I have never heard before, complete with hand gestures and melodrama as if it was not a preschooler but Bigfoot.
Maybe later I will do the thing we all do; oh, I should have said that. Maybe I won’t. This is not the first time my kid has drawn public attention and it is not the last.
Six months later, we received a diagnosis for Autism Spectrum Disorder (ASD). After the reaction time (read stress eating and ugly crying) ended, we began our journey of raising an atypical child in a world that insists on the typical.
Textbook wise, neurodivergence includes Autism, ADHD, Asperger’s Syndrome, Dyslexia, Dyscalculia, OCD, hyperlexia and Tourette Syndrome.
I could write a book on my journey as a mom raising a child who is neurodivergent (ND). I will in due time and the first chapter would be, “Fighting for inclusion in a world insisting on exclusion.” If you ask any parent with a neurodivergent kid, they will tell you that it is not finances or the fear of the future bringing them down, it is just people. But that’s been the case since the dawn of time anyway.
If you are someone who is kind and inclusive but are confused by the jargon, read on for some guidance that will make you an ever-favorite ally and, well basically, just decent. It is just basic decency after all to be inclusive and kind.
If you have a kid on the spectrum for ASD or ADHD or any other neurodivergence in your social circle, the first step is to not stop being friends with their parents. Yes, that happens. Parents can get super isolated and alienated because their kid is a certain way. Give ND families a chance to breathe. Invite them to BBQs, ask them what their kid will eat, encourage your kids to include them — the whole nine yards.
There will be meltdowns, at birthday parties, at the mall, in restaurants. Sometimes the best thing to do is to look the other way. Ask the right questions. Rather than asking “what happened?” or “why are they doing this?”simply say “how can I help?” Maybe you can help with another sibling or give the child some space.
Do not equate a sensory meltdown or otherwise to a parenting failure or a lack of discipline. ND parents face a lot of judgment on those grounds. That is one of the top reasons they scoop up their kids and leave before dinner is even served.
The biggest challenge in our community is acceptance. There is a dire need to accept that around 30 percent of our population is neurodivergent. This includes adults and undiagnosed individuals. You and I might not even know if we are atypical, the world is just getting to know this word and what it entails. As for the South Asian community, neurodivergence is practically stigmatized and seen as ‘spoilt’ child behavior or ‘mom spending too much time at work, on social media, Netflix, sewing, knitting, kayaking…’ The list goes on.
It is 2022 and we are all trying to make space for people at our tables. This includes people who might not look or act or perceive the world like us. As a parent I have fears that all parents have, but somehow those fears have been heightened to exponential limits ever since my kid’s diagnosis came through.
How is she doing? Did someone bully her? Does she have friends? Is she included in activities? What if she says something silly and they laugh at her? What happens when she is older? Will she go to college? I should not be thinking that. I want to think about how much she is learning at school, what game they played today, what she and her friends talk about and all other typical mom things.
Except I am not a typical mom. And that is okay.
My child has wonder; she has innocence. I see things from her lens and her computation of the world is unique. The biggest misconception people have is of intelligence. A child with autism finds difficulty in processing social cues (like sarcasm) but otherwise they are as smart as you and me, if not more. Probably more.
Some days are hard but not all days are hard, and not every moment of that rough day is difficult. We, parents of ND children, do not keep obsessing over the fact that our kids are atypical; we binge watch the same shows, we have hobbies and interests and date nights and ‘me-time.’ Some days are magical and the most important thing for people to know is that Autism families are not looking for pity parties, just kindness and inclusion with a healthy sprinkle of understanding— an understanding of the atypical in a world only rooting for the typical.
