Supporting Women with Mental Ill-Health During Pregnancy and After Birth: Lessons From SA, University of Cape Town

Anxiety and sadness are prevalent mental disorders among women in low- and middle-income nations during pregnancy and the first year following childbirth. According to Associate Professor Simone Honikman of the University of Cape Town (UCT), the frequency is roughly 20% and is higher in marginalised women.

These illnesses have crippling effects on earning money, caring for others, and obtaining medical care if left untreated. They also cause extreme misery. Domestic violence is more likely to affect women who have mental health issues. They are more likely to experience unwanted pregnancies, food insecurity, and HIV infection.

A recent survey of the maternal mental health landscape in low- and middle-income countries was released by the US development organisation USAID Momentum. The study identified societal factors that contribute to poor mental health throughout pregnancy and after delivery. These include various forms of violence, gender injustice, and poverty.

The negative social and economic elements that have an impact on women are reflected in maternal mental health disorders. Furthermore, the physical, emotional, and neurological development of infants and children may be impacted by the mental health of the mother.

The entire society must respond to this public health emergency. We wrote a call to action with a group of international colleagues that included seven suggestions to address the problems identified in the USAID report.

We suggest the following to enhance maternal mental health:

·       establishing international benchmarks and goals

·       Modifications to government policy and explicit budgetary allocations

·       incorporating maternal mental health care into the frameworks of the current health system

·       Making use of research to improve existing interventions

·       enhancing already-existing strengths at the local level

·       Any solution should target social and economic risk factors.

·       reducing stigma associated with mental illness.

Our research on maternal mental health in low- and middle-income nations, including South Africa, served as the foundation for these suggestions. There is still much to be done in the nation. But it has advanced significantly.

Risk Factors

A closer examination of the USAID analysis's data reveals that women who have prevalent prenatal mental illnesses deal with a variety of other health problems. These include having obstetric difficulties and not having access to enough nutrients. Many people experience social isolation and find it difficult to go to their regular doctor's appointments.

Stigma may be experienced by pregnant women with mental health problems. On the other side, when women experience poverty, different types of persecution, or humanitarian disasters, their chances of having poorer maternal mental health outcomes increase.

Pregnant teenagers had up to three times the rate of perinatal mental illness as older women does, according to numerous research from low- and middle-income nations.

Lessons from the situation in South Africa

Many women in South Africa are exposed to these risk factors. There is a wide range in the prevalence of depression and anxiety throughout pregnancy and the first year following delivery, from 16 to 47 percent. The risk of suicide is significant for about 10% of women during this time. Most of these women don't get the treatment or assistance they require. The COVID-19 epidemic has exacerbated the problem. Food insecurity, social isolation, abuse against women, and poverty have all increased. There is a need for a maternity income assistance grant as a result of the connections between hunger and poor mental health in pregnant women.

There is a chance to incorporate mental healthcare into these platforms because maternal and child health services are widely used. But there are difficulties. Here, we'll focus on three:

1. Staffing levels are not optimised. Health professionals who are not specialists lack the expertise and confidence to deliver mental treatment. They struggle with severe mental health issues, such as burnout and compassion fatigue.

2. A lack of accountability: Health information systems do not contain pertinent indicators, and providers and programmes are not regularly monitored and evaluated. The staff is unclear about their actual responsibilities.

3. No special funding is provided for maternal mental health care.

But during the previous 10 to 15 years, there has been progress:

·       Local research has produced insightful findings. According to studies, specialised lay healthcare workers can provide mental healthcare in the community or in settings as part of a stepped-care system where professional service providers are available as needed, as opposed to generalist lay healthcare workers. However, when training and supervision are insufficient, their impact is minimal.

·       The detection and management of common mental health issues should be integrated into platforms for sexual and reproductive health services, according to the Mental Health Policy Action Framework 2013-2020. This document is currently being updated.

·       A new module on respectful maternity care and empathic engagement has been added to the National Department of Health curriculum for training maternity care providers.

·       A locally created mental health screening tool was approved and is now included in the Maternity Case Records on a nationwide level.

·       The Standard Treatment Guidelines (hospital level) of the National Department of Health now provide particular information for people with different mental health issues as well as thorough antidepressant prescribing recommendations for women who are pregnant or nursing. There is now a chapter on psychosocial care in the revised COVID-19 Clinical and Operational Guideline for Mothers, New-borns, and Children.

·       Respectful maternity care and mental health issues are integrated across various policy domains in the new South African Maternal, Perinatal, and Neonatal Health Policy.

·       The National Department of Health's Mental Health Investment Case recently assessed a return on investment of 4.7 for perinatal depression therapies. In other words, for every R1 spent, R4,70 (or $0.29) can be saved through improved production, better health, and lower healthcare costs. If the effects on early childhood development were taken into account, this return would probably be substantially higher.

Moving forward

Even though there are obstacles to change, there are also chances to build on the advancements made thus far, as we have attempted to demonstrate in our call to action.

Evidence, policy, and recommendations on maternal mental health must be put into practise in South Africa and throughout the rest of the world. Women, children, and communities will continue to suffer if we don't. If we do nothing, it will cost us more.