Maternal Mental Health: A South African Story
By the Perinatal Mental Health Project
Common mental health problems, such as depression and anxiety, that occur during pregnancy and in the year after child birth are highly prevalent globally. In developing countries, the rates are much higher than in high income settings. Women and girls who live in poverty and who experience violence are particularly vulnerable. In South Africa, about 1 in 3 women will experience depression or anxiety during or after their pregnancy.
Poor maternal mental health not only has adverse effects on mothers, but may negatively impact their children. Mental health problems in mothers is linked to maternal and infant mortality. Poor maternal mental health jeopardises the development of the foetus resulting in premature births and low birth weight infants. Social, behavioural and emotional development of children is also affected by the mental health of the mother. Many of these effects may be buffered by the presence of another supportive and well adult caregiver for the child. However, many mothers in resource scarce settings are socially and emotionally isolated.
In South Africa, more than 40% of the population lives below the poverty line. Recent statistics show that two in every ten South African families run out of money for food before the end of the month.
The Perinatal Mental Health Project (PMHP) provides a maternal mental health service in Hanover Park, an area with high rates of unemployment, alcohol and substance abuse, physical and sexual violence, child abuse and neglect. Recent research from the PMHP shows that 42% of pregnant women attending the antenatal clinic were food insecure, with 21% diagnosed with depression. Food insecurity was also associated with suicidal behaviour.
One of the women seen by a PMHP counsellor is Carol.
Here she tells her story:
It’s very hard… it’s… sometimes I feel I can explode because I am alone. while I was pregnant, … one of the sisters [nursing staff] approached me and asked me to complete a form. I didn’t know what it was about, and then after completing the form and answering all the questions they scored my points and then they told me that I needed to see a counsellor. I was always a person that would tell myself, when I was younger, I want to get married, and you know, buy a house and then start a family. But then I got involved with the wrong guy… ’.
The day I told him [that I was pregnant], over the phone actually and I never saw him again. He never saw me pregnant, he never saw the baby. Thinking of why did I get involved with him, how could I be so stupid, you know. I punished myself a lot.
I’m the sort of friend, no one sees my sensitive side, or no one knows what I was going through. So I didn’t want them to know, you know, and talking to someone I didn’t know [the counsellor] was actually a good thing because I knew no one would look at me, she wouldn’t judge me.
I felt much better that it was someone that I didn’t know.
All those hurts, feelings inside, you know, it’s not a good thing. It just made me an unhappy person and I didn’t want to be an unhappy mother actually. I just thought to myself, when I talk to the counsellor I don’t know how but I felt much better.
Last year the PMHP screened more than 1300 pregnant women at the Hanover Park midwife obstetric unit for mental health problems and for risk factors. Out of those, over 200 women, like Carol, took up the offer of free, on-site counselling.
The PMHP’s aim is to ensure that all pregnant women, particularly women from disadvantaged communities, have access to quality mental health services routinely integrated in to all public services for mothers.
The PMHP research agenda arises from real world service design and health systems problems that have emerged over 16 years in the field. We then translate the scientific evidence to engage collaboratively with local and international policy makers and programme managers. We develop a range of open access resource materials and build capacity among health and social development workers to provide empathic support for pregnant women and new mothers.
Find out more about the PMHP on their website: https://pmhp.za.org/