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Thought Leadership Series

Maternal Mental Health: A Reflection on World Mental Health Day 2021

Ifeyinwa Yusuf and Kenni Ndili (Lead Writers)

A woman’s body undergoes many changes through pregnancy, birth and postpartum that affect her in several ways. Until recently there was limited discussion around the psychological effects of pregnancy and childbirth on the mental health of women. According to the World Health Organisation, one in three to one in five women in developing countries, and about one in ten in developed countries, face significant mental health challenges during pregnancy and after childbirth. High rates of mental health challenges in pregnant women and mothers have been reported from many countries in Africa including Nigeria.
 
Ifeyinwa knows exactly what it feels like to experience a mental health illness while pregnant. In an excerpt from a blog published on Maternal Mental Health Day, she shared her experience, saying,

“Sometimes I felt happy about having a baby, but most times I felt sad. I was so forgetful; I cried a lot and was unable to concentrate at work. The mood swings continued after I had my baby. I often felt unhappy and was easily angered…By the time the naming ceremony came seven days after, I wished I could go somewhere to be by myself but could not. Added to this, at that same time my younger brother died, and this made my depression worse.

Image credit: Nigeria Health Watch

Three months later, I was still having the same ‘‘mood swings’’. I knew something was wrong, but I had no idea what it was, until my husband’s friend who is a medical doctor visited us and told us about Postpartum Depression. This made me see that it was not a mysterious problem, but rather it was an issue that is hardly discussed.”
 
Postpartum depression is a mental health illness women can experience after childbirth. The perinatal period is a particularly critical time to identify and address mental health concerns as this period is associated with high incidences of mental illness. The literature on perinatal mental health does not use a consistent definition for the perinatal period. This period generally commences with pregnancy but may be defined to extend up to two years after delivery. Common perinatal mental disorders (CPMDs), such as depression, anxiety disorders, and postpartum psychosis pose significant and lasting effects on women’s health and quality of life. Gender inequality — women’s status in families, communities, the health system, and society — is a key driver of CPMDs as well as a barrier to provision of and access to care and support.

Image credit: Nigeria Health Watch

Mental health care for all
October 10, 2021 was World Mental Health Day and the theme this year, ‘Mental Health in an unequal world’, emphasised the urgent need to close the huge gap in access to care for people with mental health problems around the world. This theme was inspired, in part, by the impact of the COVID-19 pandemic on mental health globally. The pandemic exposed glaring inequalities in access to mental health services that may have lasting consequences if not addressed with determined action.
 
The conversation about inequalities in mental health care cannot be complete without mentioning maternal mental health. The COVID-19 pandemic disrupted normal life, severely affecting vulnerable populations including pregnant women. Study findings suggested that increased risk perception about contracting COVID-19, reduced social support, increase in domestic violence, disruption of antenatal care, and economic consequences of COVID-19 mitigation strategies may have led to adverse maternal mental health outcomes. These have all had an effect on what is said to be a silent burden that has not yet received the political and programmatic attention it deserves from the global health community.

To better understand the current state of maternal mental health, USAID, UNFPA and WHO partnered to host a Maternal Mental Health technical consultation under the theme: “Giving A Voice to the Silent Burden” bringing together consultants in mental health and maternal health fields to talk about the unique inequities in access, services, and quality for women during the perinatal period, and about changing the status of perinatal mental health for women, their children, and communities.

Some recommendations made at the meeting are as follows:

  • Engage with communities to organise community-led interventions that can influence a paradigm shift in maternal mental health.
  • Recognise and address the gender-sensitive nature of the risks and consequences associated with maternal mental health issues.
  • Recognise that the community, social and cultural gender norms and the role of poverty and stigma are crucial to address mental health conditions in a sustainable and accessible way.
  • Resist the urge to use western tools and interventions and focus on locally developed interventions that have been generated by and for the communities that need the services.
Image credit: Nigeria Health Watch

Nigeria has no national psycho-social support intervention. The 2018–2022 National Strategic Health Development Plan did not make any provisions to address perinatal depression in women. Perinatal mental health has ramifications for a woman’s long-term mental and physical health, functioning, and quality of life. The country will benefit from implementing these recommendations starting with creating an enabling environment for maternal mental health by increasing awareness and ensuring that maternal mental health is included in the curriculum for health worker training.
 
Mental health screening should be incorporated in the maternal health care value chain as a core component all women must receive at the antenatal and postnatal care stages. Government and all stakeholders must ensure that maternal mental health is not dealt with in a silo but as part of the maternal health care value chain. Women’s rights are human rights, and every woman has the right to better quality maternal mental health care.

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