What is Postpartum Depression and How do I Deal With it?

Medically Reviewed By: Chukwuma Chinaza Adaobi 

The months following the birth of a baby are ones of great adjustment. Changing body chemistry, lack of quality sleep and numerous other stressors lead many women to experience postpartum depression in the year following childbirth.

Sadly, inadequate information and understanding of the nature of postpartum depression, along with a pervasive stigma in our society about its exact cause, leave many women to suffer alone. Postpartum depression is a disease and is never the fault of the mother - nor is it an indication of their worthiness to be a mom.

Healing is available for postpartum depression, and no mother should feel shame for pursuing treatment for this medical condition. It is real, it is common, and it is treatable.

How Many People Experience Postpartum Depression?

Postpartum Depression is incredibly common. While some estimates cite postpartum depression statistics as high as 20% (one in five women), most experts agree that the frequency is around 15% (one in seven women).

When Does Postpartum Depression Occur?

Postpartum depression can happen at any time during the baby's first year of life - not just immediately after birth. In fact, postpartum depression tends to spike around the time the baby is five months.

What Are the Symptoms?

Most women experience some level of "baby blues" during the first two weeks after childbirth due primarily to the hormonal shifts that occur during that period. The primary symptom is an underlying feeling of sadness.

Postpartum depression, however, is marked by persistent feelings past the initial two-week mark, and the symptoms are much broader than simply "sadness." In fact, many women don't recognize that they may be suffering from postpartum depression simply because sadness isn't their primary symptom. Postpartum depression often doesn't look like people think it does. Symptoms often include:

• Anger, rage, or irritability
• Difficulty sleeping - even when exhausted
• Feeling "flat" - no strong feelings of either happiness or sadness
• Unexplained crying
• Extreme worrying or anxiousness
• Intrusive thoughts of serious harm or death coming to the baby
• Not feeling connected or loving toward the baby
• A general feeling of "this isn't what I expected it to be"

In more extreme cases (typically associated with postpartum psychosis), symptoms can include:

• Hallucinations
• Paranoia
• Thoughts of suicide or of harming the baby
• Confusion/disorientation

It's important to note that most high-profile media stories highlight women who suffer from postpartum psychosis, giving many sufferers the impression that if they are not experiencing these extreme symptoms, they're not experiencing postpartum depression.

It is simply not true. The truth is that postpartum depression symptoms occur on a spectrum, and a woman may only suffer a few of the above symptoms.

What Causes Postpartum Depression?

There isn't one single cause or predictor of postpartum depression, but rather it is caused by a combination of complex factors. Here are some of the culprits:

Hormones

Women make jokes and hear endless flippant remarks about "hormones," but the truth is that they are real and they are powerful. There are many physiological changes that occur during and after pregnancy, not the least of which are incredible fluctuations of hormones that cause very profound chemical changes in a woman's body. In many ways, these changes are miraculous. In other ways, they wreak havoc.

More specifically, the hormones estrogen and progesterone are significantly elevated during pregnancy, and then rapidly return to normal levels within 24 hours of childbirth. It is a huge adjustment for a woman's brain chemistry to adapt to, and the primary contributor to postpartum depression.

Lifestyle Factors

Some of the practical challenges of parenting a newborn exacerbate the hormonal effects, and the net result can be postpartum depression. These include:

• Lack of sleep
• The added stress of parenting a newborn
• Added challenges in the parental relationship
• Loss of flexibility/free time
• Lack of a good support system
• Lack of time to exercise
• Poor nutrition
• A strong desire or pressure to be the "perfect parent"/Type A personality

Social Factors

Teen moms and women who are in poverty have higher rates of postpartum depression. It's likely that the added stress experienced by these groups of women as they enter motherhood exacerbates the other factors and leads to their increased risk of postpartum depression.

Medical History and Genetics

Just as with traditional depression, there is a genetic component and women who have a family history of depression, or postpartum depression is at an elevated risk to struggle with the illness themselves. Similarly, women who have suffered from depression in the past have a higher likelihood of struggling post-birth, as well as women who experience premenstrual dysphoric disorder (PMDD) with their regular menstrual cycles. PMDD is an extreme form of PMS and an indicator of a woman's chemical brain response to hormonal fluctuations.

 

Struggles with fertility and difficulty conceiving also increase a woman's likelihood of experiencing postpartum depression. Finally, a traumatic or medically difficult birth experience is also a risk factor.

How Can I Deal with Postpartum Depression?

There are many things you can do to combat postpartum depression - it's not something you just have to suffer through. If you believe you are struggling, the first step is to speak with your doctor about your concerns. They will ask you more detailed questions to see if a diagnosis of postpartum depression is right for you.

Some women can combat their postpartum depression with simple lifestyle adjustments - other women need more comprehensive medical intervention. Regardless, it's important to remember that postpartum depression is, at its core, a chemical issue - and if you are not able to improve your symptoms without medical support, it is NOT a personal failure.

Postpartum depression is a complex relationship of multiple factors - and treatment for postpartum depression is equally complex. Here are some things you can do to combat the illness and return to wellness.

Develop Support

Be open about your struggle with postpartum depression with other mothers in your social circle. While you might have to battle the illness, you do not have to battle shame. Think about it - if as many as one in five women suffers from postpartum depression, the likelihood that you know women who have gone through it is incredibly high.

Make it a priority to spend time with friends and family. While it might not be possible to do all of the things you did pre-baby, gathering with others in a social setting is healthy. If you don't have a lot of friends who are mothers, contact your birthing hospital or your obstetrician and ask them about local parent/baby groups in the area. They are a great way to connect socially (and commiserate about the challenges of parenting a baby) with other moms.

You may also want to consider a local support group for women struggling with postpartum depression. These are very supportive, non-threatening groups that allow you to learn more about the illness, what it looks like in everyday life, and feel less alone in your struggle. They are also a wealth of information on local professional resources to help you. You don't need a diagnosis to attend - they welcome all new mothers. Ask your local hospital, doctor, or obstetrician for help finding one in your local area.

Make Simple Lifestyle Adjustments

There are a few things you can do to try and combat postpartum depression on your own. These include:

• Ask a partner to take an overnight feeding (pump if you're nursing) to help you get a longer stretch of restorative sleep
• Schedule regular exercise
• Get outside in the sunshine and go on walks
• Pay attention to your nutrition; eat healthily
• Find ways to exercise regularly
• Eat a small piece of dark chocolate (yes, really!)

Seek Professional Help

Sometimes lifestyle adjustments don't help, or adequate social support is hard to come by. Counselling or talk therapy has been proven to be incredibly helpful in treating postpartum depression. A counsellor or therapist can not only help you work through the major lifestyle transition of adding a newborn to your family, but they can also walk alongside you and help you to find ways to implement some of the lifestyle changes listed above - because it can seem overwhelming to do it on your own.

A trained counsellor will help you identify the root causes of your negative feelings, give you guidance to process them effectively, and coach you on ways to improve those specific aspects of your life. And while there are many options available, the reality is that making time for appointments which caring for a newborn can be incredibly challenging. Navigating nursing and napping schedules, along with finding childcare, can make it feel nearly impossible to leave the house. Thankfully, there is quality and professional therapy available online to provide postpartum depression treatment, which is a perfect solution for a new mother to get the help she needs.

Medications are also available to help with postpartum depression. Your doctor can recommend and prescribe one that will work best in your situation, but even if you choose not to try medication make sure you keep them in the loop. Explain to your doctor that you feel you are experiencing signs of postpartum depression but would like to try non-medicated strategies to treat it before deciding whether you need medication. They will be able to tell you what symptoms to watch for to tell if your illness is getting worse and if you might need additional medical support.

The bottom line is you don't have to go through this alone. Postpartum depression is a common illness that can be treated in many ways. If you are struggling after the birth of a baby, seek help. Take action. Call your doctor. Contact a counsellor.

After all, this should be one of the most joyous times of your life. Don't let postpartum depression steal that from you. Take charge, and take it back.

What are the Natural Cures for Depression?

Depression is a word that has been used loosely in our world. It has been used during moments of grief, sadness, and unhappiness. At least once throughout your lifetime, you might experience down moments that may make you think you are depressed. In the real sense, you are only going through a phase of sadness and not depression. Depression is more profound than we may think. It is a mental health challenge that has gained more popularity in recent times than ever before. It could become a severe health condition that may affect a person’s work, relationships, family, and life.

Factors Supporting Depression

Just like several other illnesses related to mental health, depression is caused by a combination of factors. The World Health Organization mentioned that biological, psychological, and social factors are critical in developing depression. One or more of these factors could interact with an individual and result in depression. A fine interaction of all these factors can cause several levels of depression.

For example, a person who has gone through some hard moments in life, such as unemployment or the death of a loved one, may experience loneliness (a social factor), which could translate into severe depression. Also, psychological trauma due to the loss of a job, fraud, failure in school examinations, divorce, sexual violence, and other adverse life events can cause depression.

In some other cases, biological factors such as defective mood regulation by the brain, hormonal imbalance, certain debilitating health conditions, and disabilities have been found to support depression. Studies show that when the neurotransmitters in the brain go out of their natural and delicate balance, depression can occur.

Depression And The Various Types

The types of depression include Situational depression, Biological depression, Psychological depression, and Existential depression. It could also be classified as Major Depressive disorder, Persistent Depressive disorder, Seasonal Affective disorder, Bipolar disorder (manic depression), Psychotic depression, Premenstrual Dysphoric Disorder (PMDD), Perinatal depression (including antepartum and postpartum depression) and Atypical depression.

• Major depressive disorder is the most prevalent type. It is described as a depressed mood, loss of interest in favourite activities, significant weight changes, sleep troubles, reduced appetite, reduced energy, thoughts of worthlessness and suicide, indecisiveness, restlessness or reduced movement, etc. It is not an occasional depression that goes away. It occurs almost every day.
• Persistent Depressive disorder is also known as dysthymia. It is described as a chronic form of depression. It is characterized by continuous feelings of hopelessness and inadequacy, which may cause a loss of interest in day-to-day activities, causing reduced productivity in life matters.
• Seasonal Affective disorder is the type of depression associated with seasonal changes. For many people, it commences and ends around the same time year in, year out. It is more common during the fall and winter months but rarely in the spring or summer.
• Manic depression (bipolar disorder) makes that individual experience extreme moods. At a point in time, he/she is so happy and all over the place. The next minute could be so low because of depression. It is a mix of mania and depression.
• In Psychotic depression, such a person experiences depression in addition to psychotic symptoms such as delusions and hallucinations.
• Women with PMDD present with depression symptoms, excessive irritability, and/or anxiety before the period begins. This could occur about two weeks before the period and resolve some days after the period must have started. In the same vein, perinatal depression occurs in women. It refers to the depression in a woman before the birth of the baby or after delivery.
• Atypical depression implies that this depression type may not necessarily follow the principles of depression.

Symptoms Of Depression

Being sad about life’s situations may not necessarily mean you are depressed. Some people have all they need- love, family, materials, money, and all but still, get depressed. Depression: Major depressive disorder is a complicated form of depression. It is not just a mere change of mood. It is a medical condition presenting with several symptoms that affect emotion, physical appearance, behaviour, and cognitive functioning.

Emotional symptoms of depression include consistent and intense sadness for no obvious reason, feeling of worthlessness, loss of interest in previously pleasurable activities, suicidal thoughts, and lots of other dark thoughts. Physically, a person with depression may begin to experience low energy, slow speech, thinking, sleeplessness, too much sleep, weight changes, etc. Depression may make one experience reduced concentrating or focusing ability and indecisiveness. Going through depression could make one easily agitated, restless, eat more or less, and so much more.

Treatment For Depression

The treatment for depression includes every modality that can be employed to make an individual get better. The methods could be pharmacological, involving the use of medications or non-pharmacological, including therapy, lifestyle modification, or medical procedures. The primary modality used to treat depression is usually by the use of drugs. Here, we will consider the natural ways to go about managing depression.

Natural Cure For Depression

Natural methods are effective in managing depression. This is not to say that counselling sessions or drugs are not good enough. We are looking at ways to boost our mood and improve our overall health state. There are a couple of them, and we will consider each one.

• First off, relaxation is a way to manage depression. Relaxation helps you unwind, and that will improve your mood altogether. Relaxation would help you to sleep well.
• Exercise regularly. Talking walks, yoga, or other forms of movements or workouts raise the dopamine level in the brain, which subsequently lifts one’s mood. Avoid strenuous exercises like running that could wear you out quickly.
• Do something you love to do. You can avoid being alone or lose interest in previously pleasurable activities. Instead, you can work at it to make it feel like fun again. Go to the beach, read a book, go for dinner, do some baking, etc. With time, you will love your favourite activities again.
• Accept responsibilities. Depression may want you to go into isolation and move away from responsibilities at work and at home. However, doing your office work or house chores may provide you little time to brood over worrying thoughts.
• Draw up a routine. For some reason, depression could take away your well-structured daily plans. Setting a daily routine of the things you will like to do each day and sticking to it can help manage depression.
• Talk to someone. Seeking help is never a sign of weakness, and this is usually underestimated. Talking to someone can go a long way in recovering from depressive moments. At BetterHelp, professionals are well seasoned to help with such trying moments.
• Have a support group. Meeting people and sharing your experience may help in your way to recovery. Having a trusted person to share your difficult time with is a good way to heal quickly.

Consequences Of Depression

When depression is left unattended, it could get worse. It is a serious mental health problem and should be managed as such. There is a higher chance that an individual with depression may get addicted to drugs. Such persons can also become less effective at work or school, ruin their relationships, have sleep disorders, and so much more.

The worst of it all is that depression can lead to suicide. Depression is a leading cause of suicide worldwide. However, depression is treatable.

Conclusion

Depression is fast becoming a common mental health disorder across all age groups. It can get better with adequate care and attention. If it is not, the effects of depression on the affected person are far-reaching. Therefore, depression should be treated carefully, managed promptly, and properly.

Practical Ways to Cope With Anxiety

 Whether you are dealing with ordinary day-to-day anxiety that comes with life’s responsibilities or you are struggling with one of the many different types of anxiety disorders out there, learning how to cope with these feelings can be very challenging on your own. In this article, you will learn about some different ways you can find relief to start managing stress and anxiety and improve your mental health.

Improve Your Time Management Skills

Many people become stressed and anxious because they feel that they only have so little time to do what they need to do each day.

Although people’s schedules can indeed become jam-packed with tasks and responsibilities, by carefully examining how you carry them out, you might realize that you’re not utilizing your time efficiently. Perhaps you’re not prioritizing the most important things, or you’re procrastinating, and it seems like you don’t have enough time, leading you to push yourself.

How we utilize our time can change how we feel throughout the entire day. For example, going to bed earlier and leaving ahead of schedule for work can help you avoid traffic and worry about running late.

Learning to manage your time better will take some time to fully get the hang of, but you can start implementing various techniques today. For instance, you can write out and schedule everything that needs to get done each day and start making priorities.

You’ll probably find that you haven’t been making the best use of your time before. Still, once you learn how to manage your time better, you’ll feel less stressed, anxious, and pressured to get things done at the last minute, and most likely, you’ll have some more time to do other things that you like and spend time with the people you care about which can then benefit your mental health.

Find Time For Yourself

While it might be difficult to arrange some time to do things around a busy schedule, your mental health must pursue activities that you enjoy.

Hobbies can come in many different forms, and whether you like things such as art, music, playing games, cooking, and many more, there is a good chance you’ve already established some interests before.

If you haven’t been able to find the time for them, it’s important to try to do so by managing your time, which was discussed in the previous section.

Some people who are stressed or anxious can also become depressed because they can’t figure out how to make time for their hobbies; however, depression can make people lose interest in the things that they used to enjoy as well.

If this sounds like you, you can also use this time to rediscover yourself and try to find new hobbies and activities that catch your interest. You may find something that sticks with you and provides you with some fulfilment and excitement that you could have been missing out on.

This kind of positivity can also be just what you need to help you learn how to relax and cope with the challenges of everyday life, such as work, school, family, and relationships.

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Diet & Exercise

The impact that diet has on a person’s mood often goes underestimated, and many people don’t realize what their food is doing to their mind and body behind the scenes.

One example of this is bad comfort foods processed foods that are full of unhealthy fats, simple carbs and sugars, and excessive calories. Many people who are stressed, anxious, or depressed will use these kinds of foods to cope because it makes them feel good; however, their effect is temporary, and the energy that comes with comfort foods quickly comes crashing down.

Luckily, a healthy, balanced diet can help provide you with energy levels that can be sustained throughout the day and boost your mood more consistently.

Additionally, you will also want to pay attention and moderate your caffeine and alcohol consumption. While it’s perfectly normal and acceptable to have a cup of coffee or tea to start your day or wind down with a drink after a long day, they could be contributing to your anxiety levels or make them worse. You also might be more dependent on these chemicals than you realize; even though they are legal and widely used, they are still drugs, and they can affect your mental health.

Exercise is also important, and it can complement any healthy diet. Getting an adequate amount of physical activity can have tremendous positive benefits not just for your physical health but your mental health as well.

Exercise releases naturally-occurring chemicals in the body known as endorphins, which can make you feel great during and after a workout, but staying committed to a routine can have similar benefits as hobbies.

Physical activity of your choice can eventually become a hobby as well, and it can help keep you motivated and can give you goals to shoot for and stay focused on. Reaching these goals can boost your esteem and have a positive benefit for your mental health in both the short and long term.

Breathing Exercises & The Relaxation Response

If we become chronically stressed and anxious, it’s common for people to “forget” how to breathe properly. The fight-or-flight response that happens when we are in a state that we feel is stressful or dangerous, such as in anxiety and panic attacks, quickens our heart rates as well as the speed and depth in which we breathe. The breaths tend to be shallower, and this means that your body isn’t getting enough oxygen flowing, which it needs to relax. People get used to breathing like this, and it may be a contributor to why generalized anxiety disorders are on the rise.

Deep breathing exercises can be done anytime and anywhere when you are feeling anxious, and one of the simplest and most straightforward techniques is to take long, deep breaths, and slowly let the air fill up your abdomen. Once this happens, you can then gradually release this air through your lips or your nose, whichever your preference is.

Despite being so simple, deep breathing and eliciting the relaxation response is scientifically proven to have a positive physiological response; however, such techniques, especially ones used in yoga and meditation, have been around for centuries. [1]

A more modern form of meditation, known as Transcendental Meditation, provided the basis for the establishment of what would be known as The Relaxation Response. Coined by the Harvard doctor Herbert Benson, it was found that deep breathing in a quiet and comfortable environment while not paying any mind to any distracting thoughts but finding a focus word could reduce your heart rate and blood pressure.

Benson described the Relaxation Response as being the opposite of the fight-or-flight response that can be very problematic and taking some time to sit down and breathe for 10 to 20 minutes a couple of times a day can reduce stress and anxiety and help you develop a calmer mind.

Try Therapy

When things get tough and overwhelming, you don’t need to try to deal with things all on your own. Stress and anxiety are among the most common reasons why people seek help, and more than half of all healthcare visits are related to these issues.

Counselling and therapy are extremely effective for a person’s mental health because they teach individuals the skills they need to cope with their emotions and the problems that they currently face as well as the ones that will arise in the future.

If you’ve been struggling with anxiety disorders of any kind for a long period, therapy is also highly recommended to treat those as well. One of the most popular and empirically-supported treatments for anxiety, along with other mental health disorders like depression and bipolar disorder, is cognitive-behavioural therapy (CBT).

Essentially, CBT works by changing the way you think and respond to the things that bother you, and in turn, this changes how you feel. By identifying and addressing the negative thinking patterns in your life, you can change them into positive ones, and this can allow you to have a more fulfilling life. Because of this, CBT works on countless mental health issues, not just anxiety.

Finding a therapist who knows how to treat anxiety is more accessible than ever, and at BetterHelp, you can connect to licensed professionals who can help you through the issues that you are facing.

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BetterHelp’s online therapy services are also convenient and affordable, and this helps you have a stress-free experience where you can focus on improving, rather than worrying about travelling and working around a busy schedule and trying to fit therapy in. Scheduling a session with a mental health professional is easy and flexible; all you need is access to the internet through your computer, tablet, or mobile device.

Conclusion

Anxiety can be overwhelming, but thankfully with the tools and techniques available to you, like the ones discussed in this article, along with the assistance of others, it doesn’t need to be a permanent state of mind, and your mental health can improve. You can find ways to deal with stress and anxiety in both the short and long term, and by doing so, you can focus on living a happier and healthier lifestyle that fulfils you.

References

1. Zaccaro, A., Piarulli, A., Laurino, M., Garbella, E., Menicucci, D., Neri, B., & Gemignani, A. (2018). How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physiological Correlates of Slow Breathing. Frontiers in Human Neuroscience, 12. doi:10.3389/fnhum.2018.00353
2. American Psychological Association. (2010, October). The power of the relaxation response. Retrieved from https://www.apa.org/monitor/2008/10/relaxation

Understanding the Reality of Male Sexual Abuse

While everyone may experience the issues mentioned in this article, please note that as part of our initiative responding to the APA Guidelines for Psychological Practice with Boys and Men (2018), these articles will focus on how these topics affect men and boys. We use “men” to refer to people who identify as men.

Warning: This article discusses sexual abuse and child abuse. The National Domestic Violence Hotline: 1-800-799-SAFE (7233), the Childhelp National Abuse Hotline: 1-800-4-A-CHILD (1-800-422-4453), and the National Sexual assault Hotline: 1-800-656-HOPE (4673) can all be reached 24/7.

In our society, sexual abuse and violence towards men are often overlooked and neglected. This is a real problem many boys and men have faced and face on a day-to-day basis. How can we further understand and prevent this reality?

What Is Sexual Abuse?

Sexual abuse is described as unwanted sexual activity, with perpetrators often using force and coercion when the individual doesn’t give consent. Sexual abuse is common between people who know each other and strangers alike.

What Happens When You Are Sexually Abused?

Anyone can experience sexual abuse and can have many debilitating symptoms in both children and adults.

Signs Of Sexual Abuse In Children

Signs and symptoms of sexual abuse in children fall into three categories: physical, behavioral, and emotional.

Physical: Physical signs of abuse in children can take the form of bruises, bleeding, and even sexually transmitted infections.

Behavioral: Children can manifest different behavioral problems such as engaging in sexual activities, wetting the bed, excessive shyness, especially around removing clothes, and avoiding certain adults.

Emotional: Children who have been abused can begin to discuss sexually explicit topics, regressing to early childhood behaviours such as sucking their thumbs, having vivid nightmares, and showing signs of anxiety.

Sexual Abuse In Adults

College-age and older adults can experience sexual abuse and violence as well. The perpetrators can be trusted adults, peers, or even strangers. Young adults can find it especially hard to open up and communicate about their abuse, so it is crucial to look for the warning signs early.

• Rapid weight loss or weight gain
• Unexplained and poorly explained bruises or scars
• Excessive drinking or drug use
• Withdrawal from friends and family
• Emotional issues such as depression, anxiety, or suicidal thoughts
• Changes in personal hygiene and self-care
• A sudden decline in school or work performance
• Panic attacks
• Self-harm

What Is Sexual Violence?

Sexual violence is a term that encompasses all crimes like sexual assault, rape, and sexual abuse. Terms vary from state to state, but this is a general overview.

• Sexual Assault
• Child Sexual Abuse
• Sexual Assault Of Men And Boys
• Incest
• Drug Facilitated Sexual Assault

Sexual violence can take on other forms that can be overlooked. It is crucial to look out for the warning signs, be knowledgeable, and be open about your experience. Some of the other forms of sexual violence include:

Stalking: “Stalking is a pattern of repeated and unwanted attention, harassment, contact, or any other course of conduct directed at a specific person that would cause a reasonable person to feel fear,” according to the Department of Justice.

Sexual Harassment: Sexual harassment can include unwelcome sexual advances, requests for sexual favours, and other verbal or physical sexual harassment in the work environment or learning space.

Sexual Exploitation: Sexual exploitation can include unwanted sexual conduct of any kind between a professional and the individual seeking their services. These professionals can consist of and aren’t limited to police officers, doctors, lawyers, religious leaders, and professors.

How Do Men Face Sexual Abuse And Violence?

As mentioned earlier, anyone can experience sexual abuse or violence. Men and boys face unique problems and challenges due to social attitudes and stereotypes regarding masculinity.

It is a common stereotype that men can’t be survivors of sexual abuse or violence. The topic of sexual violence towards men isn’t something you hear often. Oftentimes people believe men should be able to fight off an attacker, or that they can’t be forced into sexual acts. This stigma can lead male survivors to feel even more at odds with their experience and prevent them from seeking support.

Men and boys who have survived sexual assault can experience the same effects as survivors of other forms of abuse and trauma. Men who have experienced and survived sexual assault as adults can feel a sense of shame or self-doubt. Men can also have a more challenging time understanding their situation if they got an erection or ejaculate during the encounter. Ejaculation and erections do not suggest you wanted, invited or enjoyed the assault. This isn’t an all-encompassing list, but these are some of the shared experiences by both young and adult male survivors:

• Feeling “less of a man” or feeling like you lost control of your own body
• Difficulty sleeping, feeling on edge or being unable to relax
• Concerns or questions about sexual orientation
• PTSD, anxiety, depression, eating disorders, and flashbacks
• Withdrawal from relationships and social isolation
• Fears of judgment or disbelief

Keep in mind that if you faced sexual assault or violence, it is never your fault. You are not alone in your experience or “less of a man” because of it. You are a survivor, and that makes you strong in its own right.

Most first-time survivors experience intimate partner sexual violence before 25, most commonly before the age of 18. Survey data has also found about 1 in 3 men will experience some form of sexual violence from a partner.

It’s also important to note that even though sexual violence is portrayed as mainly involving female survivors, there is a high rate of male survivors. 3 out of 33 studies show male victimization rates of more than 57%. This shows that contrary to popular belief, men and boys are just as likely to experience sexual violence.

How Gender Stereotypes Affect Male Survivors

Through gender stereotypes and gender role socialization, men are put into the sexually dominant role. This gender role socialization implies men are sexual opportunists and should “make the first move.” There is also the belief that men are always willing to engage in sexual activity.

This belief and stereotype can cause men to feel guilty for refusing sexual advances. The “sexual opportunist” frame can imply that men cannot experience negative consequences of sexual violence. Male survivors may also report fewer negative feelings to maintain this social script and their self-image. Evidence suggests that sexual violence can be even more traumatizing for men, given the sex-role stereotypes. Men can feel “unmasculine” and suffer from a fundamental identity crisis.

What Is The Meaning Of Male Violence?

Male violence relates to violent acts that are disproportionately or exclusively committed against men and boys. These violent acts don’t necessarily have to be sexual in nature.

Even though it is presented in society that women are at a higher risk of violent crimes, this isn’t necessarily the case. 2.5 percent of men 15 or older reported experiencing a violent crime versus 1.7 percent of women. Another study showed out of over 215,000 homicides, 77% of the victims were males. As a male, you may not have been raised to believe this, but it is the unfortunate reality we face today.

Women are often warned about sexual and physical violence, and men are often expected to just hold their own. This reinforces the idea that men cannot or are unlikely to be victims of sexual and physical violence. When men do face these experiences, it can be challenging for them to get help.

If you have faced any sexual or physical violence, do not feel ashamed or be afraid to speak up. Your experience is real, and you can receive the support and guidance you need to handle it accordingly.

Seek Outside Support

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No one should be subject to violence. Know that as a man, you deserve to be free of this pain. This is a real problem, and you are not alone or at fault. Check out

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COUNTERFEIT AND SUBSTANDARD ANTIMALARIAL DRUGS

Meta assessment by Chukwuma Chinaza Adaobi

What are counterfeit and substandard antimalarial drugs, and why are they important to public health?

Counterfeit (fake) and substandard antimalarial drugs may contain no active ingredients, less than the required amount of active ingredients, or ingredients not described on the package label. Manufacturers of counterfeit drugs tend to copy more expensive brands of drugs and make them look like brand-name drugs. They may also repackage expired products and substitute a later expiration date, or they may package another drug or alternative substance as if it were an active product. Substandard drugs are made by manufacturers trying to avoid costly quality control and good manufacturing practices; these can result from deliberate or unintended lapses in the manufacturing process. These medicines may have too little or too many active ingredients and may not be absorbed properly by the body. If they are taken to treat an illness like malaria, they may be incompletely effective or altogether useless. A counterfeit or substandard treatment can prolong illness and increase the risk of severe disease or death. If substandard medicines are widely used, they can also select for drug-resistant parasites.

Where can they be found?

They can be found anywhere, but they are especially prevalent in developing countries lacking effective drug regulatory agencies as well as resources required to effectively evaluate drug quality or enforce drug quality regulations.

What types of antimalarial drug quality issues can be found?

• Drugs with too little, too much, or absolutely no active ingredient, due to intentional fraud or poor manufacturing and quality control practice.
• A tablet’s inability to release drug, due to poor formulation techniques.
• The chemical breakdown of drugs is caused by storage conditions, especially in warm, humid climates.
• Contamination with other substances due to poor manufacturing procedures.
• Incomplete, inaccurate or misleading packaging and labelling.

How can I avoid buying counterfeit or substandard antimalarial drugs to prevent malaria when I travel to an area with malaria transmission?

• Buy the antimalarial drugs you need in your home country and keep the original packaging.
• Write down the drug’s generic and brand names as well as the name of the manufacturer so in case you run out, you can look for the correct product.
• If you need to purchase medicine in the country you are visiting, inspect and compare the packaging of the medicine available for sale in that country with the original. Many times poor-quality printing or paper indicates a counterfeited product.
• Be suspicious of tablets that have a peculiar odour, taste, or colour, or ones that are extremely brittle. Ill-defined imprints on the tablet may indicate a counterfeit.

The quality of commercially available drugs varies greatly in malaria-endemic countries:

• The amount of the active ingredient can vary due to a lack of regulations and poor quality control practices.
• Some pills may release very little if any drug due to poor formulation techniques.
• Chemical break-down of some drugs can occur due to poor storage conditions, especially in warm and humid tropical climates.
• Some drugs may be contaminated with other substances.
• Counterfeiters may also obtain expired drugs and repackage them with false or missing expiration dates.

What are countries with malaria transmission doing about this problem?

With help from the Global Fund to Fight HIV/ AIDS, Tuberculosis and Malaria, the U.S. Agency for International Development, the U.S. Pharmacopeia (USP), and CDC, countries are improving their capacity to monitor the appearance of counterfeit drugs and to execute their regulatory functions.

How is CDC (or CDC and its partners) addressing this issue?

CDC is currently collaborating with the London School of Hygiene and Tropical Medicine and the Georgia Institute of Technology on a project surveying and evaluating the quality of ACTs in Africa. CDC is also working with the U.S. Food and Drug Administration and Georgia Institute of Technology to evaluate new techniques to quickly identify counterfeit medicines. We are also assisting our collaborators in Kenya, Tanzania, the Lao People’s Democratic Republic and Burma by collecting samples and performing chemical analysis of suspect pharmaceuticals.

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INTERMITTENT PREVENTIVE TREATMENT OF MALARIA FOR PREGNANT WOMEN (IPTP)

Meta assessment by Chukwuma Chinaza Adaobi

Why Pregnant Women Are Especially at Risk

Adults who have survived repeated malaria infections throughout their lifetimes may become partially immune to severe or fatal malaria. However, because of the changes in women’s immune systems during pregnancy and the presence of a new organ (the placenta) with new places for parasites to bind, pregnant women lose some of their immunity to malaria infection.

Malaria infection during pregnancy can have adverse effects on both mother and fetus, including maternal anaemia, fetal loss, premature delivery, intrauterine growth retardation, and delivery of low birth-weight infants (<2500 g or <5.5 pounds), a risk factor for death.

It is a particular problem for women in their first and second pregnancies and for women who are HIV-positive. 

Adverse Effects Vary by Transmission Level

The problems that malaria infection causes differ somewhat by the type of malaria transmission area: stable (high) or unstable (low) transmission.

• In high transmission areas, women have developed immunity that generally prevents severe disease, however, parasites specifically targets the placenta, leading to increased risk during pregnancy gained a level of immunity to malaria that wanes somewhat during pregnancy. Malaria infection is more likely to contribute to maternal anaemia and delivery of low birth-weight infants (<2500 g or <5.5 pounds). It is a particular problem for women in their first and second pregnancies, for younger women, and for women who are HIV-positive.
• In low transmission areas, women generally have developed no immunity to malaria. Malaria infection is more likely to result in severe malaria disease, maternal anaemia, premature delivery, or fetal loss.

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The true death toll of COVID-19 Estimating global excess mortality

Meta assessment by Chukwuma Chinaza Adaobi

On 30 January 2020 COVID-19 was declared a Public Health Emergency of International Concern (PHEIC) with an official death toll of 171. By 31 December 2020, this figure stood at 1 813 188. Yet preliminary estimates suggest the total number of global deaths attributable to the COVID-19 pandemic in 2020 is at least 3 million, representing 1.2 million more deaths than officially reported.

With the latest COVID-19 deaths reported to WHO now exceeding 3.3 million, based on the excess mortality estimates produced for 2020, we are likely facing a significant undercount of total deaths directly and indirectly attributed to COVID-19.

COVID-19 deaths are a key indicator to track the evolution of the pandemic. However, many countries still lack functioning civil registration and vital statistics systems with the capacity to provide accurate, complete and timely data on births, deaths and causes of death. A recent assessment of health information systems capacity in 133 countries found that the percentage of registered deaths ranged from 98% in the European region to only 10% in the African region.

Countries also use different processes to test and report COVID-19 deaths, making comparisons difficult. To overcome these challenges, many countries have turned to excess mortality as a more accurate measure of the true impact of the pandemic.

Excess mortality is defined as the difference in the total number of deaths in a crisis compared to those expected under normal conditions. COVID-19 excess mortality accounts for both the total number of deaths directly attributed to the virus as well as the indirect impact, such as disruption to essential health services or travel disruptions.

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Yellow Fever – Nigeria

 Meta assessment by Chukwuma Chinaza Adaobi

Since September 2017, yellow fever cases have been reported across several states in Nigeria. From 1 January to 31 August 2021, a total of 1,312 suspected cases were reported in 367 Local Government Areas (LGAs) across 36 States and the Federal Capital Territory (FCT).

A total of 45 blood samples were sent to the Institut Pasteur in Dakar (IPD) and 31 samples tested positive by the Plaque reduction neutralization test (PRNT). Of these 31 PRNT positive cases, twelve cases had a history of yellow fever vaccination. Two deaths were reported among the remaining 19 non-vaccinated PRNT positive cases (Case fatality ratio: 11%). These 19 PRNT positive cases were reported from Enugu (seven cases), Anambra (three cases), Benue (three cases), Delta (two cases), Oyo (two cases) Niger (one case) and Osun (one case) State. Investigations into the PRNT-positive cases are ongoing.

Nigeria has documented gaps in population immunity against yellow fever.  According to WHO-UNICEF 2020 estimates, the national immunization coverage for yellow fever was 54% in 2020 which is below the threshold of 80% necessary to protect against outbreaks. In the nine states reporting PRNT positive cases, the routine immunization coverage declined between 2018 and 2020 and was below 80% in 2020.  These states include Anambra, Benue, Delta, Enugu, Imo, Niger, Ondo, Osun and Oyo. Six states reported coverage below 50% (Anambra, Delta, Enugu, Imo, Osun, and Oyo states).

Between 2019 and 2020, preventive mass vaccination campaigns were conducted in six (all LGAs) of the nine states. Coverage was reported to be high (>90%) in Delta and the Ondo States but lower (<80%) in Anambra, Benue, Niger, Osun and the Oyo States. Additionally, in Enugu State, nine out of 17 LGAs organized reactive mass vaccination campaigns in 2020, while in Imo State, mass vaccination activities have not been organized in recent years.

In addition, yellow fever surveillance is sub-optimal. Not all suspected cases are documented, presumptive positive cases are not always investigated, and investigations of confirmed cases and confirmatory testing results are delayed. Additionally, vaccination status which is critical for interpretation of laboratory results and case confirmation may not be reported as part of the investigation. 

Public health response

Yellow fever response activities are coordinated by Nigeria Center for Disease Control through a multi-agency Yellow Fever Technical Working Group. The current response includes the following:

• Distributed yellow fever preparedness and response guidelines to all states;
• Commenced yellow fever IgM testing for the South-East and South-South geopolitical zones at University of Nigeria Teaching Hospital Enugu and University of Benin Teaching Hospital Benin City, respectively;
• Additional yellow fever Information, Education and Communication materials have been printed for dissemination;
• Ongoing development of yellow fever training manual for the training of healthcare workers on yellow fever identification, management, documentation, and reporting;
• Ongoing daily media monitoring across social and traditional media platforms to detect yellow fever related signals.
• Weekly monitoring and analysis of surveillance data across the country to guide response activities;
• Monitoring the effective use of Surveillance and Outbreak Response Management System (SORMAS) in all affected states to improve real-time reporting;
• Supporting National Primary Health Care Development Agency in the planning meetings for yellow fever preventive mass vaccination campaign for Quarter 4 (November 2021 in Abia, Ebonyi, Imo, Taraba and selected wards and LGAs in the Borno States;
• Coordination of sample collection and transportation from affected states to the national testing laboratories and regular testing of yellow fever samples in all the testing laboratories. Additionally, ensuring availability of reagents and consumables in all testing laboratories;
• Engaging with state epidemiologists for weekly updates is planned.

WHO risk assessment

Nigeria is a high-risk country for yellow fever and is recognized as a high priority country to the global Eliminate Yellow Fever Epidemics (EYE) Strategy. The re-emergence of yellow fever in September 2017 in Nigeria has been marked by outbreaks over a wide geographical area. A combination of vaccination and vector control strategies is the most important means of preventing infection. Yellow fever is endemic in Nigeria and, due to suboptimal immunization coverage in most states and nationwide, the risk of spread is high. Entomological investigations have confirmed the presence of the vectors, Aedes aegypti and Aedes africanus in several states across the country.

Given the low routine immunization coverage, coupled with the poor performance of reactive mass immunization activities, indicate an ongoing risk in susceptible populations and thus, a risk of serious public health impact.

To address the risk, the country has engaged in a multi-year plan to complete preventive mass vaccination campaigns targeting all eligible persons aged 9 months to 44-year-old, supported through the EYE and global partners. Since 2017, a total of 22 of 36 states including FCT have completed these campaigns. National and State public health authorities are currently responding to several concurrent outbreaks (COVID-19 pandemic, Lassa fever, and a widespread cholera epidemic), which are straining the available limited resources, especially human resources to conduct investigations and response activities. Additionally, the recent relaxation of COVID-19 measures could increase population mobility and the potential risk for spreading yellow fever to urban areas. 

WHO advice

Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes and has the potential to spread rapidly and cause serious public health impacts. The disease is preventable using a single dose of the yellow fever vaccine, which provides immunity for life. Although there is no specific treatment, supportive care to treat dehydration, respiratory failure and fever and antibiotic treatment for associated bacterial infections can reduce mortality and is recommended. Viraemic cases should stay under mosquito nets during the day to limit the risk of spread to others through bites of mosquitoes.

Routine yellow fever vaccination was introduced to Nigeria’s Expanded Programme on Immunization in 2004. However, due to sub-optimal yellow fever vaccination coverage, population immunity in most areas around the country remains below herd immunity thresholds (≥80%). The EYE Strategy was launched in Nigeria in 2018, yet its implementation at the national and sub-national levels remains low. Preventive campaigns for yellow fever are being implemented in Nigeria in six phases. The target is to accelerate and complete these vaccination campaigns nationwide by 2024.

As yellow fever is endemic in Nigeria, it is a priority country for the EYE strategy. Accelerated phased vaccination campaigns are planned to cover the entire country by 2024. Vaccination is the primary intervention for the prevention and control of yellow fever. In urban centres, targeted vector control measures are also helpful to interrupt transmission. WHO and partners will continue to support local authorities to implement these interventions to control the current outbreak.

WHO recommends vaccination against yellow fever for all international travellers from 9 months of age going to Nigeria. Nigeria requires a yellow fever vaccination certificate for all travellers aged 9 months or over as a condition of entry.

Yellow fever vaccines recommended by WHO are safe, highly effective and provide life-long protection against infection. In accordance with the IHR (2005), the validity of the international certificate of vaccination against yellow fever extends to the life of the person vaccinated with a WHO-approved vaccine. A booster dose of the approved yellow fever vaccine cannot be required of international travellers as a condition of entry.

WHO encourage its Member States to take all actions necessary to keep travellers well informed of risks and preventive measures including vaccination. Travellers should also be made aware of yellow fever symptoms and signs and instructed to seek rapid medical advice when presenting signs. Viraemic returning travellers may pose a risk for the establishment of local cycles of yellow fever transmission in areas where the competent vector is present.

The areas at risk for yellow fever transmission and the related recommendations for vaccination of international travellers were updated by WHO on 1 July 2020 and are available on the WHO International Travel and Health website.

WHO does not recommend any restrictions on travel or trade to Nigeria based on the information available on this outbreak.

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HOW DO VACCINES WORK?

How do vaccines work?

Meta assessment by Chukwuma Chinaza Adaobi

This article is part of a series of explainers on vaccine development and distribution. Learn more about vaccines – from how they work and how they’re made to ensuring safety and equitable access – in WHO’s Vaccines Explained series.

Germs are all around us, both in our environment and in our bodies. When a person is susceptible and they encounter a harmful organism, it can lead to disease and death.

The body has many ways of defending itself against pathogens (disease-causing organisms). Skin, mucus, and cilia (microscopic hairs that move debris away from the lungs) all work as physical barriers to prevent pathogens from entering the body in the first place. 

When a pathogen does infect the body, our body’s defences, called the immune system, are triggered and the pathogen is attacked and destroyed or overcome.

The body's natural response

A pathogen is a bacterium, virus, parasite or fungus that can cause disease within the body. Each pathogen is made up of several subparts, usually unique to that specific pathogen and the disease it causes. The subpart of a pathogen that causes the formation of antibodies is called an antigen. The antibodies produced in response to the pathogen’s antigen are an important part of the immune system. You can consider antibodies as the soldiers in your body’s defence system. Each antibody, or soldier, in our system, is trained to recognize one specific antigen. We have thousands of different antibodies in our bodies. When the human body is exposed to an antigen for the first time, it takes time for the immune system to respond and produce antibodies specific to that antigen. 

In the meantime, the person is susceptible to becoming ill. 

Once the antigen-specific antibodies are produced, they work with the rest of the immune system to destroy the pathogen and stop the disease. Antibodies to one pathogen generally don’t protect against another pathogen except when two pathogens are very similar to each other, like cousins. Once the body produces antibodies in its primary response to an antigen, it also creates antibody-producing memory cells, which remain alive even after the pathogen is defeated by the antibodies. If the body is exposed to the same pathogen more than once, the antibody response is much faster and more effective than the first time around because the memory cells are at the ready to pump out antibodies against that antigen.

This means that if the person is exposed to the dangerous pathogen in the future, their immune system will be able to respond immediately, protecting against disease. 

How vaccines help

Vaccines contain weakened or inactive parts of a particular organism (antigen) that trigger an immune response within the body. Newer vaccines contain the blueprint for producing antigens rather than the antigen itself. Regardless of whether the vaccine is made up of the antigen itself or the blueprint so that the body will produce the antigen, this weakened version will not cause the disease in the person receiving the vaccine, but it will prompt their immune system to respond much as it would have on its first reaction to the actual pathogen.

Some vaccines require multiple doses, given weeks or months apart. This is sometimes needed to allow for the production of long-lived antibodies and the development of memory cells. In this way, the body is trained to fight the specific disease-causing organism, building up the memory of the pathogen so as to rapidly fight it if and when exposed in the future.

Herd immunity

When someone is vaccinated, they are very likely to be protected against the targeted disease. But not everyone can be vaccinated. People with underlying health conditions that weaken their immune systems (such as cancer or HIV) or who have severe allergies to some vaccine components may not be able to get vaccinated with certain vaccines. These people can still be protected if they live in and amongst others who are vaccinated. When a lot of people in a community are vaccinated the pathogen has a hard time circulating because most of the people it encounters are immune. So the more that others are vaccinated, the less likely people who are unable to be protected by vaccines are at risk of even being exposed to harmful pathogens. This is called herd immunity.

This is especially important for those people who not only can’t be vaccinated but may be more susceptible to the diseases we vaccinate against. No single vaccine provides 100% protection, and herd immunity does not provide full protection to those who cannot safely be vaccinated. But with herd immunity, these people will have substantial protection, thanks to those around them being vaccinated.

Vaccinating not only protects yourself but also protects those in the community who are unable to be vaccinated. If you are able to, get vaccinated.

Throughout history, humans have successfully developed vaccines for a number of life-threatening diseases, including meningitis, tetanus, measles and wild poliovirus.

In the early 1900s, polio was a worldwide disease, paralysing hundreds of thousands of people every year. By 1950, two effective vaccines against the disease had been developed. But vaccination in some parts of the world was still not common enough to stop the spread of polio, particularly in Africa. In the 1980s, a united worldwide effort to eradicate polio from the planet began. Over many years and several decades, polio vaccination, using routine immunization visits and mass vaccination campaigns, has taken place in all continents. Millions of people, mostly children, have been vaccinated and in August 2020, the African continent was certified wild poliovirus free, joining all other parts of the world except Pakistan and Afghanistan, where polio has not yet been eradicated.

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AT 74, SHE "BALANCES" HER TYPE 2 DIABETES. THIS IS HER STORY...

Meta assessment by Chukwuma Chinaza Adaobi

Today, we talked to Carol, a 74-year-old woman who reversed her diabetes. She tells us how...

"Hello, this is Carol.

I had been suffering from type 2 diabetes for several years.

My weight had increased; I often felt tired and had to inject myself several times a day to monitor my blood sugar.

Not exactly a dream life.

But the saddest thing for me was when I had to turn down the cake for my grandchildren's birthday party, and they would ask me, "but grandma, why don't you eat like us?"

It broke my heart...

Not to mention the stress of going to see my doctor. Every time, he would scare me by telling me about the complications of diabetes: heart disease, amputation...or even going blind!

The worst part, I think, was the food. Nothing tasted good anymore, and I often felt like eating cardboard.

But with time, I resigned myself to it. After all, there are several diabetics in my family, so I figured it was my fate.

Yet one day, an excellent friend sent me a video. She told me that diabetes could be stopped naturally.

Of course, I was sceptical...Why hadn't my doctor told me about it if it was true?

But after all, I had nothing to lose, so I watched this video.

And I must say I was astonished!

Inside, I learned that an American doctor from a prestigious university had found a natural and effective way to normalize blood sugar levels, using what he calls a "forgotten method".

And his patients manage to get rid of their diabetes in almost 100% of the cases.

So I followed the recommendations of this video without much hope.

I didn't see much change during the first days, but I decided to continue anyway.

And after a few weeks, my blood sugar started to normalize: I felt less tight in my pants and had more energy.

After a few more days, I even received compliments from my husband. He told me that I looked "good". Now that's good news!

After a month, I had a routine appointment with my doctor. Well, he was "shocked" (his words) by my blood sugar numbers. I was at 103 when I went to see him, at 9:30 in the morning.

Since then, I've been alive again. No more prickles in my fingers, no more stress during meals.

And I even allowed myself some chocolate cake for my grandson's birthday. He was so happy.

 

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