The postpartum period, often referred to as the "fourth trimester," is a critical phase marked by profound physical, emotional and psychological changes for new mothers. While the birth of a child is often celebrated as a time of joy, it is also a period of heightened vulnerability, requiring comprehensive postnatal care (PNC) to ensure the well-being of both the mother and the newborn. Effective postnatal care encompasses not only physical recovery—including hygiene management, nutritional replenishment and breastfeeding support—but also emotional and psychological health, areas that are frequently overlooked in mainstream maternal healthcare services [1-3].
Postpartum depression (PPD) represents one of the most significant, yet often underdiagnosed, mental health challenges during this period, affecting an estimated 10-20% of new mothers globally. Symptoms such as persistent sadness, anxiety, irritability and feelings of inadequacy can severely impact maternal functioning, infant care and long-term family dynamics. Despite its prevalence, awareness regarding PPD and emotional well-being in the postpartum period remains limited, particularly in socio-cultural settings where mental health is stigmatized or misunderstood [4,5].
In India, the traditional focus of postnatal care has largely centered around physical health, with comparatively less attention given to psychological support, emotional resilience and informed nutritional practices. In urban environments like Delhi, where rapid lifestyle transitions, nuclear family structures and work-life pressures dominate, the lack of structured postnatal support systems further exacerbates maternal vulnerability. The compounded neglect of mental health needs, poor postnatal hygiene practices and nutritional deficiencies can significantly hinder recovery and increase the risk of long-term morbidity for new mothers [6,7].
Understanding the level of awareness about comprehensive postnatal care—including the recognition of postpartum depression, hygienic practices, optimal nutrition and the necessity of emotional support—is crucial to addressing the existing gaps in maternal healthcare. Despite growing international emphasis on holistic postnatal care, there remains a paucity of data exploring these issues within the Indian urban context.
This study aims to evaluate the awareness of postnatal care and mental health among new mothers in Delhi, with particular focus on postpartum depression, hygiene, nutrition and emotional support systems. By identifying knowledge gaps and prevailing misconceptions, the findings intend to inform targeted educational initiatives, guide policy development and ultimately promote a more integrated, mother-centered approach to postnatal healthcare.
A descriptive, cross-sectional online survey was conducted to assess awareness about postnatal care practices and mental health, particularly focusing on postpartum depression, hygiene, nutrition and emotional support among new mothers residing in Delhi.
The study targeted new mothers residing in Delhi who had delivered a live infant within the previous twelve months. Eligible participants were women aged 18 to 40 years, able to comprehend Hindi or English, with access to the internet and willing to provide informed electronic consent.
The data collection period spanned three months, from January to March 2025.
Assuming a 50% prevalence of adequate postnatal care awareness, with a 95% confidence interval and a 5% margin of error, the calculated minimum sample size was 384 participants. To compensate for potential incomplete responses, a final target of 420 participants was set.
Participants were recruited using a convenience sampling method by sharing the survey link widely across digital platforms, including WhatsApp parenting groups, Facebook maternal health forums, Instagram communities and local online networks catering to new mothers in Delhi.
Inclusion Criteria
Women aged 18-40 years
Residents of Delhi
Delivered a child within the past 12 months
Ability to read and understand Hindi or English
Access to a smartphone, computer, or tablet with internet connectivity
Willingness to provide informed digital consent
Exclusion Criteria
Mothers currently hospitalized for severe postnatal complications
Mothers with a history of diagnosed psychiatric illness unrelated to postpartum depression
Participants unwilling or unable to complete the online questionnaire
A structured, pre-validated questionnaire was developed and hosted using Google Forms. The questionnaire was bilingual (Hindi and English) and divided into four sections:
Socio-Demographic Information: Age, education, occupation, family type (nuclear/joint) and healthcare access
Postnatal Physical Health and Hygiene: Questions covering hygiene practices, breastfeeding support, postpartum wound care and nutritional habits
Mental Health and Emotional Well-being: Assessment of knowledge regarding postpartum depression, recognition of symptoms, emotional support needs and healthcare-seeking behavior
Sources of Information and Barriers: Exploration of the sources from which participants obtained postnatal care information and perceived barriers to accessing healthcare
The questionnaire was pilot-tested among 30 mothers to ensure clarity, cultural relevance and technical functionality before final dissemination.
The Google Forms survey link was distributed digitally via social media platforms, parenting communities and healthcare-related online groups. An introductory section in the form detailed the study objectives, assured participants of confidentiality and included an electronic consent checkbox, which participants had to select before proceeding.
Only one response per participant was allowed to maintain data integrity and no personal identifiers were collected, ensuring complete anonymity.
Responses to knowledge and awareness questions were scored, with one point assigned for each correct answer. Overall awareness levels were categorized as follows:
Very Good Awareness: ≥80% correct answers
Good Awareness: 60-79% correct answers
Fair Awareness: 40-59% correct answers
Poor Awareness: <40% correct answers
Separate analyses were conducted for physical health awareness and mental health awareness scores.
Survey responses were exported from Google Forms into Microsoft Excel and analyzed using IBM SPSS version 26.0. Descriptive statistics were used to summarize demographic variables and awareness levels.
Informed digital consent was obtained from all participants prior to survey participation. Participation was entirely voluntary and confidentiality and anonymity were maintained throughout the study process.
The socio-demographic profile of the 420 participants revealed that the largest proportion of respondents were between 26-30 years of age (41.4%), followed by 18-25 years (22.9%), 31-35 years (20.9%) and 36-40 years (14.8%). Educationally, most participants had attained undergraduate degrees (36.4%) or secondary school education (33.8%), while a smaller proportion
held postgraduate degrees (18.3%). A minority reported only primary education (8.6%) or no formal education (2.9%). In terms of occupation, homemakers constituted the largest group (43.8%), followed by private sector employees (24.3%), self-employed women (12.9%), students or unemployed women (10.4%) and government sector employees (8.6%). Regarding family structure, a majority of participants (64.8%) lived in nuclear families, while 35.2% resided in joint family settings (Table 1).
Awareness and knowledge levels regarding postnatal care and mental health among participants were encouraging across several indicators. A high proportion of respondents correctly recognized the importance of hygiene after delivery (85.2%), the need for nutritional replenishment (80.0%) and the benefits of emotional support (74.3%). Awareness regarding postpartum depression (PPD) symptoms (69.5%), its impact if left untreated (64.5%) and the importance of professional counseling (75.2%) was moderate but notable. Furthermore, 82.9% acknowledged the importance of breastfeeding support and 86.0% correctly identified the recommendation for exclusive breastfeeding for six months. Awareness about the timing of postnatal check-ups (6 weeks) was correct among 66.4% of respondents and 81.2% recognized that poor postpartum hygiene could increase infections in infants. Despite these positive findings, gaps remained in recognizing early signs of postpartum infection (67.6%) and in fully understanding the symptoms of severe PPD, including suicidal thoughts (63.3%). Overall, the findings suggest that while foundational awareness was good, targeted education addressing mental health and infection recognition is needed (Table 2).
The classification of participants’ knowledge scores demonstrated that 41.9% of the mothers had a "Good" level of awareness (60-79%) and 34.8% achieved a "Very Good" awareness level (≥80%), indicating that over three-fourths of the sample possessed substantial understanding regarding postnatal care and mental
Table 1: Socio-demographic characteristics of participants
Variable | Category | Frequency (n) | Percentage (%) |
Age Group (Years) | 18-25 | 96 | 22.9% |
26-30 | 174 | 41.4% | |
31-35 | 88 | 20.9% | |
36-40 | 62 | 14.8% | |
Education Level | No formal education | 12 | 2.9% |
Primary education | 36 | 8.6% | |
Secondary education | 142 | 33.8% | |
Undergraduate degree | 153 | 36.4% | |
Postgraduate degree | 77 | 18.3% | |
Occupation | Homemaker | 184 | 43.8% |
Employed (Private Sector) | 102 | 24.3% | |
Employed (Government Sector) | 36 | 8.6% | |
Self-employed | 54 | 12.9% | |
Student/Unemployed | 44 | 10.4% | |
Family Type | Nuclear family | 272 | 64.8% |
Joint family | 148 | 35.2% |
Table 2: Awareness and knowledge regarding postnatal care and mental health
No. | Question | Options | Correct Responses (n) | Percentage (%) |
1 | Importance of hygiene post-delivery | a) Pain management, b) Infection prevention, c) Diet control, d) Exercise improvement | 358 | 85.2% |
2 | Recognition of postpartum depression symptoms | a) Fever, b) Sadness and withdrawal, c) Vomiting, d) Increased appetite | 292 | 69.5% |
3 | Need for nutritional replenishment after childbirth | a) Yes, b) No, c) Only during breastfeeding, d) Only after 6 months | 336 | 80.0% |
4 | Early signs of postpartum infection | a) Mood swings, b) Hair loss, c) Fever and foul-smelling discharge, d) Appetite increase | 284 | 67.6% |
5 | Benefits of emotional support in recovery | a) Reduces risk of depression, b) Causes weakness, c) Lowers milk supply, d) Causes hormonal imbalance | 312 | 74.3% |
6 | Impact of untreated postpartum depression | a) Improves on its own, b) Enhances bonding, c) Affects baby’s development, d) Increases appetite | 271 | 64.5% |
7 | Importance of breastfeeding support | a) Decreases immunity, b) Delays bonding, c) Encourages successful breastfeeding, d) Causes overfeeding | 348 | 82.9% |
8 | Role of family support in maternal mental health | a) Negligible effect, b) Causes stress, c) Promotes recovery, d) Only financial | 306 | 72.9% |
9 | Recognition that PPD requires medical attention | a) Yes, b) No, c) Only if severe, d) Only after six months | 286 | 68.1% |
10 | Awareness about balanced diet post-delivery | a) Avoid proteins, b) Rich in iron and vitamins, c) High sugar diet, d) Starvation diet | 339 | 80.7% |
11 | Recommended timing of postnatal check-up | a) 3 months, b) 6 weeks, c) 1 year, d) After next pregnancy | 279 | 66.4% |
12 | Hygiene practices to prevent wound infection | a) Regular cleaning and dry area, b) Avoid touching stitches, c) Exercise early, d) Ignore bleeding | 346 | 82.4% |
13 | Understanding emotional fluctuations postpartum | a) Indication of psychosis, b) Normal hormonal changes, c) Permanent depression, d) Physical exhaustion only | 314 | 74.8% |
14 | Exclusive breastfeeding recommendation | a) 1 month, b) 3 months, c) 6 months, d) 9 months | 361 | 86.0% |
15 | Nutrition impact on emotional health | a) No impact, b) Strong positive link, c) Causes anxiety, d) Only affects hair growth | 278 | 66.2% |
16 | Symptoms of severe postpartum depression | a) Night sweats, b) Muscle cramps, c) Suicidal thoughts, d) Excessive thirst | 266 | 63.3% |
17 | Sources of emotional support | a) Only online blogs, b) Family, friends, healthcare providers, c) Exercise clubs, d) Television | 288 | 68.6% |
18 | Importance of professional counseling | a) Not necessary, b) Helps early recovery, c) Worsens symptoms, d) Only for psychosis | 316 | 75.2% |
19 | Impact of poor postpartum hygiene on infant | a) None, b) Mental delay, c) Increased infections, d) Skin glow | 341 | 81.2% |
20 | Common barrier to seeking help for PPD | a) Weather, b) Stigma and lack of awareness, c) High cost, d) Lack of transport | 271 | 64.5% |
Table 3: Knowledge score classification
Knowledge Category | Score Range | Frequency (n) | Percentage (%) |
Very Good Awareness | ≥80% | 146 | 34.8% |
Good Awareness | 60-79% | 176 | 41.9% |
Fair Awareness | 40-59% | 74 | 17.6% |
Poor Awareness | <40% | 24 | 5.7% |
health. However, 17.6% of participants exhibited "Fair" knowledge (40-59%) and a smaller segment (5.7%) displayed "Poor" knowledge (<40%), underscoring the existence of a notable subgroup that could benefit from targeted awareness interventions to improve their understanding and promote better health-seeking behaviors during the postpartum period (Table 3).
This study explored the awareness of postnatal care and mental health among new mothers in Delhi, focusing particularly on postpartum depression (PPD), hygiene practices, nutrition and emotional support needs during the postpartum period. The findings shed light on both encouraging trends and significant knowledge gaps that warrant attention to optimize maternal health outcomes in an urban Indian context.
The socio-demographic profile of the participants indicated a relatively educated population, with the majority having completed at least secondary or undergraduate education. A large proportion of participants belonged to the economically active age group (26-30 years) and most lived in nuclear families, reflecting contemporary urban family structures in metropolitan areas like Delhi. These demographics are crucial, as previous research has demonstrated a positive correlation between educational attainment and health-seeking behavior among postpartum women [4,5]. Despite the relatively high educational level, this study revealed that knowledge gaps persist, particularly in areas relating to emotional health and the early identification of mental health issues.
In terms of awareness, the results are promising with over 75% of respondents demonstrating either "Good" or "Very Good" knowledge regarding postnatal care and mental health. High levels of awareness were noted for hygiene practices post-delivery (85.2%), the importance of nutritional replenishment (80.0%), breastfeeding support (82.9%) and the benefits of emotional support (74.3%). These findings align with global initiatives that emphasize physical recovery and breastfeeding as core components of postnatal care [6,7]. Encouragingly, most mothers were also aware of the recommended exclusive breastfeeding duration (86.0%) and the critical timing for the first postnatal check-up (six weeks postpartum, recognized by 66.4% of respondents).
However, a deeper examination reveals persistent shortcomings in mental health awareness. While 69.5% of respondents were able to recognize symptoms of postpartum depression, fewer participants could accurately identify severe symptoms like suicidal thoughts (63.3%) or appreciate the critical need for professional counseling (75.2%). Alarmingly, nearly one-third of the respondents lacked full understanding that untreated postpartum depression can adversely affect infant development. These gaps are concerning, given the well-documented consequences of unrecognized and untreated postpartum depression, including impaired mother-infant bonding, delayed cognitive development in children and increased maternal morbidity [4,5].
The study also highlighted the central role of emotional support systems in maternal recovery. A significant number of participants recognized that family and healthcare support promotes emotional recovery (72.9%). Nevertheless, barriers such as stigma, lack of awareness and misconceptions surrounding mental health services remain prevalent, as indicated by the moderate recognition (64.5%) of stigma as a primary barrier to seeking help for PPD. These findings are consistent with previous Indian studies where mental health stigma and cultural
expectations about maternal self-sacrifice often discourage new mothers from openly discussing emotional struggles [5-7].
Another important observation was the strong understanding of hygiene practices post-delivery (82.4%) and the link between maternal hygiene and infant health (81.2%). This is a crucial finding, as poor hygiene can predispose both mothers and newborns to infections, contributing to maternal and neonatal morbidity.
Despite these strengths, certain limitations of the study must be acknowledged. The online nature of the survey may have introduced selection bias, favoring digitally literate, urban and relatively better-educated women, thereby limiting the generalizability of the findings to more marginalized or rural populations. In addition, self-reported data may be subject to response bias, with participants potentially providing socially desirable answers rather than reflecting true knowledge or practices.
Nonetheless, this study provides valuable insights and highlights the urgent need for integrated postnatal care models that go beyond physical recovery and address mental health proactively. Targeted educational interventions, community-based support programs and the incorporation of mental health screening into routine postnatal visits are necessary to bridge the gaps identified. Moreover, leveraging digital platforms for maternal health education—given their evident reach and influence in urban settings—can be an effective strategy to disseminate accurate information and normalize mental health discussions among new mothers.
In conclusion, while awareness regarding basic aspects of postnatal physical care among new mothers in Delhi is commendable, substantial efforts are still required to elevate mental health literacy, dismantle stigma and promote timely healthcare-seeking behavior. Holistic, mother-centered approaches must become an integral part of postnatal care frameworks to ensure the health, dignity and emotional well-being of women navigating the transformative journey of motherhood.
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