Globally, 15 to 20 percent of women experience a perinatal mental health condition, said Sarah Barnes, Project Director of the Maternal Health Initiative at a recent event, held in partnership with the United Nations Population Fund (UNFPA), 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. “And yet, the prevention, early recognition, and treatment of perinatal mental health conditions is a challenge for many, if not most, healthcare systems across the world,” said Barnes.

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, said Neerja Chowdhary, Technical Officer, Department of Mental Health and Substance Use, World Health Organization (WHO). Sadly, some 75 percent 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. 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, according to a recent Lancet study. “The compounded stress for pregnant people during the pandemic cannot be overstated,” said Barnes.

Invisible Enemy

Maternal mental health is often omitted from conversations and clinical treatments surrounding maternal health, said Tafadzwa Meki, Founder of Someone Always Listens To You (S.A.L.T Africa) in Zimbabwe.  Many preventable causes of maternal mental health conditions could be prevented if mental health were included in maternal health assessments, and people weren’t left to fight “the unseen battle” of poor mental health, she said.

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 they are 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. When she lost an infant eight years ago, pregnancy loss and maternal mental health were not often discussed together, she said. However, she still experienced a postpartum period following her loss, as well as postpartum depression and anxiety. 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 community frames the services offered, said Matthews. Intentionality with how care is 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 basic immediate 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, centers on community support mechanisms, relying on grandmothers and midwives to form networks of care for pregnant people, said Meki. Mbuya means “grandmother” and Nyamukuta translates to a local term for “midwife.”  The model has helped reduce maternal mortality, increased awareness of maternal health, and reduced neonatal and infant mortality, she said. 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 Hardtman, Chief Nurse and Midwife of Jhpiego. Maternal healthcare workers also need support as they may be dealing with grief and loss as a result of 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 Hardtman. 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 behavioral 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 absolutely essential that our efforts surrounding perinatal mental health involve co-parents, including babies’ fathers, said Fisher.  Practical inclusive educational tutorials for men on how to bathe and soothe a baby coupled with empathy and psychological support have led to mental health benefits for the entire family, she said.

The INSPIRE method is another successful approach to improve maternal mental health. The INSPIRE method (Involve Others; Nourishment & Exercise; Spirituality & Prayer; Patience, Identify & Initiate Change; Rest & Relaxation; and Each Day is a New Day to Start Again), was designed to help someone who experienced loss or someone with a living birth with all the different elements of the birthing experience, said Matthews. Maternal mental healthcare must be a collective effort by community leaders and healthcare providers doing the best they can, she said.

Read More:

• Good maternal mental health depends on respectful maternity care
• Many factors affect maternal mental health in Nairobi, Kenya
• How to tackle the COVID-19 maternal mental health crisis