Any mental illness present during pregnancy or the first 12 months after birth is considered a ‘perinatal mental illness’, regardless of whether the person has experienced the illness before.
Globally, 15 to 20 per cent of women experience a perinatal mental health condition, said Sarah Barnes.
At a recent event, the Maternal Health Initiative project Director was held in partnership with the United Nations Population Fund (U.N.F.P.A.U.N.F.P.A.) on mental health support for mothers in the perinatal period.
Women are more likely to develop anxiety or depression in the year after giving birth than in any other time in their lives, with suicide and overdose the leading causes of death in the first year postpartum.
Untreated perinatal depression and anxiety in mothers can lead to intergenerational consequences such as an increased range of cognitive, psychological, and developmental disturbances in children.
Sadly, some 75 per cent of women suffering from a perinatal mental health condition never receive the care they need, she said.
The pandemic has added tremendous stress for people all over the world. According to a recent Lancet study, it is responsible for an estimated 53 million more cases of major depressive disorder and 76 million more cases of anxiety disorder across 204 countries and territories—with women and young people most affected.
“The compounded stress for pregnant people during the pandemic cannot be overstated,” said Barnes.
Invisible Enemy
Maternal mental health was often omitted from conversations and clinical treatments surrounding maternal health, said Tafadzwa Meki, Founder of Someone Always Listens To You (S.A.L.T.S.A.L.T. Africa)Â in Zimbabwe.
People dealing with perinatal mental health conditions often report feelings of guilt, shame, and worthlessness, said Chowdhary. Because birthing people may be at their most vulnerable when reaching out for help, they need to be seen and heard, said Kay Matthews, Founder of the Shades of Blue Project in the United States. Individualized postnatal care is crucial for maternal mental health care, even for those who experience pregnancy and infant loss.
“We must be inclusive of all birth stories no matter the outcome,” said Matthews. Leading with compassion in every interaction includes acknowledgement, respect, and asking what the woman needs, she said.
Community-oriented Support System
“Statistics are great, but what are our solutions?” said Matthews. Community-driven approaches to providing perinatal mental health care is the way forward for the world, said Jane Fisher, Finkel Professor of Global Public Health and Professor of Women’s Health, Monash University, Australia. Community-based solutions are available.
However, many people who need these interventions are not aware of them, said Matthews.
Practitioners should work alongside the community and focus their approaches around the needs of that community because the community frames the services offered, said Matthews.
Intentionality with how care was provided to communities and pregnant people is crucial for retention, she said. “Our mission is to change the way women of color are currently being diagnosed and treated after giving birth and experiencing any adverse maternal mental health outcome,” she said. Social support should be coupled with mental health services for pregnant people to meet immediate basic needs for the family so the pregnant person can focus on their mental health, said Matthews.
Mbuya Nyamukuta, a maternal mental health model in Zimbabwe, centres on community support mechanisms, relying on grandmothers and midwives to form care networks for pregnant people, said Meki. Mbuya means “grandmother”, and Nyamukuta translates to a local term for “midwife.” She said that the model has helped reduce maternal mortality, increased awareness of maternal health, and reduced neonatal and infant mortality. Adopting such Afrocentric mental health solutions for Afrocentric mental health-related issues is vital, said Meki.
Practical Solutions
In the maternal mental health space, solutions are in demand. Service delivery clinicians need pragmatic approaches for the pregnant people in front of them right now, said Pandora Hardiman, Chief Nurse and Midwife of Jhpiego. Maternal healthcare workers also need support as they may be dealing with grief and loss due to their work, she said. Translating research into practical techniques so that non-specialist caregivers, such as grandmothers and aunties, can provide mental health support to pregnant people is critical, said Hardiman. Trauma-tapping, a holistic technique that involves physical tapping on one’s body while simultaneously sharing traumatic experiences, has been successful with survivors of gender-based violence and displacement from war. This technique can be applied to pregnant people everywhere, she said.
Evidence-based interventions for prevention and treatment for perinatal mental health conditions are also readily available, said Chowdhary. “The WHO intervention guide has simple algorithms that can be used to train non-specialists to assess and manage a range of mental health conditions,” she said. It can also be used to train healthcare providers working in maternal and child health services. The WHO Thinking Healthy cognitive-behavioural manual assists healthcare providers with psychosocial treatments for pregnant people, offering a cost-effective and community health inclusive approach, said Chowdhary.
We cannot formulate programs for women and leave out men, said Meki. It is essential that our perinatal mental health efforts involve co-parents, including babies’ fathers, said Fisher. She said that practical, inclusive educational tutorials for men on bathing and soothing a baby coupled with empathy and psychological support have led to mental health benefits for the entire family.
The INSPIRE method is another successful approach to improve maternal mental health.
