Note – content below is from an email update, May 2016
Mental health has recently returned to the fore following a series of debates concerning the prominence, or lack of, given to it in the SDGs. How can we ensure that it is given adequate priority in low and middle income countries (LMIC) given the global scale and impact of the problem, the lack of resources and the evidence for the effectiveness of prevention and treatment interventions?
In this fourth informal update HEART shares recent publications and discussions relating to the challenges of getting maternal mental health (MMH) on the agenda.
#1) Knowing the data on prevalence and determinants: systematic reviews published in the Bulletin of the World Health Organization allow a comparison of the prevalence and determinants of common perinatal mental disorders between women giving birth in different country contexts. A 2012 systematic review showed the prevalence of these disorders in women from LMICs to be 15.6% in pregnant women and 19.8% in women who had recently given birth. In comparison, a 2011 systematic review showed that approximately 10% of pregnant women and 13% of those who have given birth in high income countries were affected by a mental disorder.
Furthermore, evidence from specific countries illustrates the depth of the problem in local contexts. In South Africa, for example, a recent Maternal Health Task Force (MHTF) blog entry reports that 47% of pregnant women and 34% of post-natal women in low-income settings experience maternal depression.
#2) Recognising the wider impacts: MMH problems often have a much wider impact than on the individual woman’s health alone. Studies, including from India and Pakistan, have linked MMH to reduced quality of caregiving, to diarrhoeal diseases; to poor infant growth and child nutrition; and to poor child development; as well as to other consequences including breakdown in family relationships, stigmatisation, social isolation and inability to contribute to household activities, both social and economic.
#3) Establishing the financial burden: In 2014 the Centre for Mental Health in the UK calculated that the total economic and social long-term cost of perinatal mental health problems were about £8.1 billion for each one-year cohort of births in the UK. However, there is limited evidence of the economic cost in LMICs. One 2002 study in South concluded that “Addressing mental illness is integral to achieving development goals and, in short, it costs South Africa more to not treat maternal mental illness than to treat it”.
#4) Reinvigorating the debate: Despite the high prevalence and high impact on maternal and child wellbeing and survival and on macro level social and development outcomes, very few countries have developed a programmatic response. There has been a recent reinvigoration of the challenges of maternal mental health as a result of new studies and activities including: a discussion in 2015 on Integrating Mental Health into Maternal Health Programs (hosted by MHTF and the Wilson Center); a blog series Mental health: the missing piece in maternal health (by MHTF in collaboration with the Mental Health Innovation Network and Dr. Jane Fisher); the Joining up care in maternal mental health event, held on 4 March 2016 by the UK Royal College of Obstetricians and Gynaecologists.
Finally, a series of awareness raising events took place on 4th May 2016 to mark the first dedicated World Maternal Mental Health Day. This included sessions on improving the quality of perinatal mental health services, and discussions on areas such as male involvement and the impact of culture.
#5) Browsing additional resources:
- WHO objectives and resources for MMH, from The WHO’s Mental Health department
- An overview presentation of MMH issues and terminology, from Johns Hopkins Bloomberg School of Public Health
- Resources and evidence on MMH, from the Perinatal Mental Health Project (PMHP) in South Africa
- A key issues video (from PMHP) outlining key challenges as explained by mothers and practitioners in South Africa
- Advocacy guidance materials, from the ‘Everyone’s Business’ (UK) campaign and guidance
- Open access e-learning on Perinatal Mental Health, from e-learning for Healthcare
Please note: The resources highlighted above are just a selection of recent initiatives / publications – HEART does not endorse those mentioned.