The role of traditional confinement practices in determining postpartum depression in women in Chinese cultures: a systematic review of the English language evidence.

BACKGROUND: The Chinese postpartum custom of "confinement" or "doing-the-month" involves formalised social support and recognition of the status of motherhood and has been presumed in anthropological literature to protect mothers of newborns from postpartum depression. The aim of this review was to examine systematically the evidence about the relationship between confinement practices and postpartum depression in Chinese cultures.
METHODS: A systematic search of the English-language literature.
RESULTS: Sixteen studies met inclusion criteria. It was found that the role of confinement in postpartum depression is complex: eight studies concluded that it had a protective role; four that it increased risk of postpartum mood disturbance and four studies had inconclusive findings. Aspects of the confinement practice that could contribute to or fail to protect against postpartum depression include the generally diminished social support in contemporary society, conflict with a mother-in-law and the tension experienced by modern women as they work to balance traditional with contemporary values. LIMITATIONS: Methodological differences limit meaningful comparisons between the reviewed studies and generalizations from them.
CONCLUSIONS: There is little consistent evidence that confinement practices reduce postpartum depression in Chinese cultures. Specific components of confinement practices might reduce psychological distress in Chinese mothers of newborns, but these cannot be discerned from the existing evidence. Confinement cannot be presumed to be available to, welcomed by or effective for all Chinese women or to be a substitute for health service provision.