The international INTERSECT study covered women who had recently given birth in 31 countries. It found that almost one in four (an average of 23.3%) rate their birth as a psychological trauma, and roughly 7% develop post-traumatic stress disorder (PTSD) - a condition in which a person is haunted by intrusive memories of the event, avoids reminders of it and is constantly on edge. The results were published in The British Journal of Psychiatry.
A birth was considered traumatic if, during it, the woman was certain that she or her child would suffer serious injury or die. Participants completed a standardized 29-question questionnaire - the City Birth Trauma Scale, developed to assess symptoms according to the criteria of the DSM-5 diagnostic manual (the fifth edition of the handbook of mental disorders).
The study covered countries with different income levels - from Germany and Norway to Malawi and Pakistan. The survey was conducted from April 2021 to January 2024, mainly through routine maternity care services, and also through social media in Norway and Slovenia.
The spread of the estimates turned out to be very wide. The share of women calling their birth traumatic ranged from 7% in the United Arab Emirates to 69% in Malawi. High rates were also recorded in Chile (49%), Nepal (41%), Saudi Arabia (40%), and Spain and Turkey (35% each). The prevalence of birth-related PTSD itself averaged 6.7% - from 1% in Israel to 36% in Malawi and 33% in Saudi Arabia.
Importantly, traumatic births do not always lead to full PTSD. For example, in Saudi Arabia 86% of women who called their birth traumatic met all the criteria for the disorder, whereas in Chile only 17% did, and in Nepal 22%.
In addition, many mothers suffer from individual symptoms without reaching the diagnostic threshold. On average, 44.5% of women reported that memories of their birth cause them emotional distress, and 34.1% said these experiences interfere with daily life. The authors stress that such subclinical symptoms (individual manifestations without the full set of criteria) are more widespread than was thought and also require attention.
The researchers acknowledge limitations. Women were recruited through specific clinics rather than national registries, so the samples do not necessarily reflect the situation in a country as a whole. In addition, the data are based on self-reports rather than clinical interviews - the gold standard of psychiatric diagnosis. Pandemic restrictions in maternity wards and different methods of conducting the survey could also have affected comparisons between countries.
Nevertheless, the authors conclude that postpartum mental health requires systematic attention. They call for a trauma-informed approach in obstetrics - one in which medical staff regularly identify signs of birth trauma and offer support tailored to cultural characteristics. A second stage of data collection is already under way and is expected to cover about 30 more countries.