Community, culture and the first year of motherhood

I moved to Japan six months pregnant, when my husband’s job brought him to Tokyo. My plan was to continue my work as a journalist. I also hoped that the new setting might add even more adventure to our new journey into parenthood.

The morning after my son was born, though, it occurred to me that the move might have been a terrible mistake. Motherhood is thrilling but also confounding, especially in a foreign country. Thousands of miles from the comfort of my family and now with a new baby, I was filled with a deep longing for home. In the months that followed, I felt completely overwhelmed. New parenthood confronts you with endless micro-questions – from whether to co-sleep, to when to introduce solids, and even whether babies should wear socks – and the answers vary by culture.

Still, there were advantages to becoming a parent there: unlike in the USA, where I was born and raised, the government in Japan covers the cost of delivery and childcare from birth, as encouraging people to have more children is a centrepiece of its long-term economic plan.

I became curious about how other countries handle the sensitive and important work of supporting new parents, and began to do reporting for what would become my book Four Mothers: An intimate journey through the first year of parenthood in four countries.^[1] It follows women from the USA, Japan, Kenya and Finland, who all had babies around New Year 2022, through their first year of motherhood.

I was struck by how many similarities there are in traditional systems of care for new mothers – but also by how quickly those traditions are fading, and how countries are struggling to put in place alternative systems for all.

Networks of family and friends are unravelling

After giving birth in Nagano, first-time parent Tsukasa adheres to the centuries-old practice of satogaeri shussan, returning to her parents’ house to recover for the first postpartum month. Her mother prepares nutritious food and encourages her to follow kampo, the Japanese version of traditional Chinese medicine. It holds that cold can slow recovery, so Tsukasa stays inside, drinks warm tea and refrains from even washing her hair. “I don’t want to get chilled because I need to look after the baby,” she explains. The only time she leaves the house is to take her new daughter Rota to the hospital for a checkup.

Friends visit, but mostly, she rests next to Rota on a futon, following the oral tradition that “exerting yourself after giving birth will haunt you for the rest of your life”. Then at the one-month mark, she and her mother jubilantly put away the futon in a ceremonial event called “raising the floor” that marks the end of her confinement. Tsukasa and Rota return to their own home in Tokyo.

I learned that this traditional Japanese system of care is remarkably similar to the traditions in Kenya, halfway around the globe. Asande Bonyo is now 91 years old. She tells me that when she gave birth, in the middle of the 20th century, women from her Luo community brought food and gifts, and took over her farm work. “Those were very good days,” she smiles; “you would be cooked for and would just eat.” She recalls filling up on fish and arrowroot, a starchy vegetable thought to have medicinal properties. The traditional postpartum rest period was 40 days, at which point Bonyo celebrated with a ritual bath, similar to the Japanese practice of “raising the floor”. The practice also exists in cultures around the world including Greece and Latin America, where the postpartum recovery period is known as cuarantena.

Now, though, things are changing. In Japan, Tsukasa’s experience is becoming less common: women often live further from their home towns and have children later in life, when their parents are less able to help. In Kenya, too, many new mothers no longer have the same kind of support.

Chelsea is a new mother in Nairobi, Kenya, who belongs to the same Luo community as Bonyo. As she feeds her newborn daughter Ada one rainy afternoon, she realises she herself hasn’t eaten all day but there’s barely any food in the flat. She has no network of friends who routinely bring food – she will have to go to the shops herself. But she will also have to take Ada, which makes it so much harder to carry groceries, and she worries about exposing such a young baby to crowds.

Most days, Chelsea doesn’t venture outside her flat – but, unlike for Tsukasa, this postpartum confinement is not a positive experience. Chelsea sees her old friends only when their posts pop up on social media. “Sometimes it can be hard because maybe you see them having fun and you’re like, why are they not visiting any more? But it’s okay,” she says, her voice breaking. There is a long pause. “They’re just busy with their lives and I don’t get to see them as much because maybe I’d need to go out of the house, but I’m mostly with the baby.”

Cultural shifts and their impact on mental health support

Chelsea worries about whether Ada is gaining enough weight. She worries that Ada is congested – is it her fault, because she did not dress her warmly enough? She worries that Ada’s navel isn’t healing properly. “Anxiety is like a switch I can’t turn off,” Chelsea says.

The Luo traditionally relied on people called Jocho, or soothers, to help members of the community in emotional distress, including women suffering from what would now be described as postpartum depression. “If somebody experienced a bad moment, Jocho would be deployed so there would always be someone there who knew how to help, and they might even stay for months,” says William Janak, a mental health counsellor in Nairobi. He says the work of the Jocho could be described in Western terms as psychotherapy.

Today, there are few Jocho left. Chelsea has no equivalent figure to soothe her anxiety. There are only around a hundred licensed psychiatrists in all of Kenya – nowhere near enough, when an estimated one in four Kenyan girls struggles with mental health challenges.

In Finland, Anna – who gave birth around the same time as Tsukasa and Chelsea – receives mental health support as part of her regular care through the public health system. Ahead of her due date, Anna attends a session with a public health nurse who encourages her to reflect on her own childhood and consider what she might want to do differently, a powerful exercise meant to break intergenerational trauma. Then, after she has the baby and runs into trouble breastfeeding, a public health nurse tells her not to worry too much about supplementing with formula. Take care of yourself so you can take care of the child, she tells Anna gently; as long as he’s growing, it’s fine. It’s part of a Finnish philosophy that reducing maternal stress is also beneficial for the baby.

In Japan, Tsukasa also has a hard time breastfeeding. The hospital had advised her to try to nurse her child as much as possible to keep up her milk supply, but – unlike Anna – she does not have ongoing reassurance and reinforcement from a public health nurse. Instead, she gets into an explosive fight with her mother, who thinks she should give up on breastfeeding and switch to formula. “You had formula as a baby,” her mother tells her, “and it was fine.”

A 2017 study found that Finnish postpartum mothers reported significantly higher rates of subjective wellbeing than Japanese mothers.^[2] “Finnish mothers got more support from maternal and child health clinics, and I think that support was good for them,” explains Tuovi Hakulinen, head of research at the Finnish Institute for Health and Welfare and one of the study’s authors. She says Finland’s health system offers professional, evidence informed guidance that can be preferable to traditional modes of care passed down from grandparents. Still, the Japanese model does offer generational continuity and encourages family involvement.

Finding support when there is a care gap

Aware of the drawbacks of relying on grandparental guidance and care, Japan has been introducing new ways to offer professional support to new mothers. Since 2019, for example, all Japanese women are guaranteed access to facilities where midwives provide round-the-clock care, and guidance on how to breastfeed and look after babies. Women can come immediately after delivery or later in the year – perhaps when infants start getting fussy at around 3 months old – and stay up to a week for free, or at a heavily subsidised rate.

“If it’s not possible for family members to do the caregiving, we’ll make arrangements so the new mother can receive support elsewhere, including from public institutions,” says Tomomi Yamamoto, director of nursing at Tokyo’s Seibo Hospital.

Sarah, a new mother in Utah, also lives close to a “confinement hotel”, based on the Asian system of postpartum care. Unlike Japan’s public centres, though, the US version is private and luxurious: at the Utah Postpartum Retreat in downtown Salt Lake City, new mothers receive both lactation services and in-room pedicures. “Through endless pampering, personalised meals, sumptuous accommodations, and expert support, we aim to empower parents to embrace their postpartum journey,” its website reads. The cost is over a thousand dollars a night.

Unable to afford the retreat, Sarah considers hiring a post-natal doula but learns that this service is also prohibitively expensive. There are also some limited public programmes to help low-income families during the postpartum period but Sarah’s income as a teacher, combined with her husband’s as an Amazon delivery driver, makes them ineligible. “If only they’d help middle-class families that may also be struggling but don’t qualify,” Sarah says.

A mother also needs her partner and peers around her

In Finland, fathers’ roles are now central to family policy discussion. Tuovi Hakulinen is working on a pilot programme that provides expectant fathers with the same pre-birth counselling as mothers receive. Nurses also offer parenting advice; Hakulinen says many fathers receive advice better from a professional than from a spouse – just as mothers might receive advice better from a professional than from their ownmothers.

The need to get fathers more involved in their children’s upbringing is even greater in Japan, where women do six times more housework than men – the highest ratio of any OECD nation. Surveys show that young Japanese men are keen to break free from the caricatures of Japanese masculinity – like the so-called nure-ochiba, the man who devotes his life to a company, then retires and finds that he has no friends or hobbies and has become a “wet leaf” stuck to his wife’s shoe. However, it is not always easy to find a new path.

Tsukasa had hoped her husband, Kaz, would be more available to help with their baby, Rota. Kaz himself had wanted to be more involved than his own father, a brain surgeon, who in Kaz’s recollection never did laundry. Kaz took a less traditional career path, working as a composer for successful pop bands. However, his work is demanding and he feels pressure to provide financially. He is entitled to one year of parental leave but didn’t take any. Kaz and Tsukasa have slipped into stereotypical patterns at home, with Tsukasa doing the bulk of the caregiving.

However, Tsukasa finds another source of support thanks to a “mothers salon” at a local community centre – an example of the kind of programmes that Japan funds to help new parents build their own support networks. She strikes up a conversation with another new mother whose son was born at the same time as Rota, and soon they’re making plans for lunch. Tsukasa and the other mothers all have a year’s guaranteed paid leave, and spend a lot of time together. Tsukasa finds that she values the kind of enthusiastic conversations about childrearing that you can only have with other new parents whose babies are the same age.

Sarah in the USA, by contrast, is mostly alone. Her husband Brian gets no paid time off from his job. Notably, if he worked in a management position at Amazon rather than as a delivery driver, he would be entitled to six weeks’ paid leave. It shows how unequal employer-based benefits can be.

In Kenya, men are entitled to two weeks’ paid paternity leave but Chelsea’s boyfriend is increasingly absent from her life since their baby was born and so she too has to navigate the postpartum period alone – without public counselling sessions as Anna had, or community centres like the one where Tsukasa met other mothers.

It takes a community to care for new mothers

“Debriefing with other new mothers is crucial to psychological wellbeing,” says Aurélie Athan, a clinical psychologist and faculty member at Columbia University’s Teachers College. “It’s similar to what trauma victims require, they need to process what’s happened to them.”

In Utah, Sarah goes back to work after three months of partially paid leave – less than Tsukasa, Anna or Chelsea, but more than many American women. She grows increasingly exhausted from trying to balance her professional responsibilities as a teacher with overnight feeding and pumping. She feels morose, as if the colour has drained from her life. She brings her concerns to her healthcare provider and leaves with a prescription for the antidepressant Prozac.

“In America,” Sarah reflects, “we praise moms for giving everything for their children. And that’s a problem because then we feel like we aren’t good moms if we don’t.”

For me, writing my book about the experiences of fellow mothers Sarah, Chelsea, Anna and Tsukasa was a way to process my own rocky entry into motherhood. I learned that it takes a community, and concerted effort, not only to raise a child but to support a mother. Our  postpartum traditions across countries and cultures recognised what new mothers need: adequate time to recover; nutritious food; consistent social interaction and guidance; relief from domestic and professional work; and a joyful reintegration into society. The roadmap exists, passed down from generations of mothers who faced the same biological reality that women around the world do today. We should not squander that inheritance.