Breaking the silence on maternal mental health

WHEN pregnancy related illnesses are being listed, mental health challenges that affect women during pregnancy and after delivery are most times not remembered or recognized, let alone given attention.

A state of complete physical, mental and social well-being is what the World Health Organization defines as health, and not merely the absence of disease or infirmity, but it’s quite unfortunate that mental health is most times missing in maternal health indicators.

In high-income countries, depression or mood disorders which is the most common mental disorder affects 10 per cent of pregnant women and 13 per cent of women who have given birth.

From the data available, the prevalence of common perinatal mental disorders (CPMDs) is as high as 33 per cent during pregnancy and 59 per cent after childbirth in low and mid income countries. Psychotic illnesses, to a large extent can be more detrimental, but only few suffer it.

According to Dr. Adebayo, a mental health expert, “The most common mental health problem after childbirth is what is commonly referred to as “baby blues.” This is a relatively milder form of emotional disturbance that happens to about 30 to 80 per cent of mothers, but it often will not significantly impair a mother’s ability to care for her child.”

The challenge with low and middle-income countries is that there are no statistics, so it’s difficult to put the issue of maternal mental health into proper perspective. Record keeping and use of data plays a vital role in working out strategies and interventions to fight maternal mortality caused by mental imbalance.

Low and middle-income countries attach a couple of limiting cultural beliefs to mental health challenges. In many African countries for instance, mental disorder is easily attached and attributed to spiritual forces.

Lagos based psychiatrist, Dr. Ayomide Adebayo explained in an interview that “although there is cultural recognition of maternal mental problems, they remain almost un-talked about that many who develop them think they’re the only ones, so there is a widespread perception that they are uncommon.”

And this brings a question to mind, how can an unacknowledged problem be solved? “The belief that mental illness is a spiritual problem encourages “treatment” from spiritualists, traditional healing centres and religious prayer houses, leading to avoidance of hospitals (until it is too late), which may be anything from unhelpful to actively dangerous” Adebayo elucidated.

Women who have low level of support, history of depression, unplanned pregnancy, and violence with their spouse are found to suffer postpartum depressive symptoms more.

According to The World Health Organization, the risk of CPMDs – Common Perinatal Mental Disorder is lower among women with higher access to better education; women who have paid employment; sexual and reproductive health services, and those who have supportive and non-critical or judgmental spouses and relatives.

There are multiple but unclear factors associated with common perinatal mental disorder among women living in low-income communities. Many women rarely term or see their depression or moodiness from a mental health perspective. So they see no reason seeking medical attention.

To better capture the experiences of women and design realistic health services to them through their personal experiences, a trained psychologist interviewed 22 postpartum women in Mexico to get an expression of how they’d describe the symptoms of their disorder and emotional reactions.

The findings revealed that women used words like useless, desperate, frozen, unable to manage nerves, emptiness, feeling extremely lonely despite having others around to describe their feelings.

According to the research conducted in Mexico, some women opened up that the feeling sometimes go beyond just feeling sad, it sometimes come with fear, anger, feeling stressed, and an intense feeling of worry, embarrassment and inadequacy about their capability to properly take care of their baby.

The survey reports a woman who said “When [the baby] was still inside me, I had talked to and played with her … but now, having her here, I didn’t know how to play or how to talk, I didn’t know what to do with her.”

According to the survey report by the Mexican psychiatrist, another woman related her experience with her husband saying: He would say to me, “You don’t take care of your appearance anymore, you look like a slob, you don’t get made up or do your hair, you don’t change your clothes.

I get home and find my wife like I left her in the morning.” Many women don’t have a clear idea why they feel the way they feel during pregnancy or after delivery, but they are conscious, though confused, about how they feel.

With this confusion and lack of information, they are left to battle the intense desire to ignore and suppress their feelings by diverting attention to the baby and other household chores.

When women do this, they are faced with the challenge of a deteriorating relationship with their spouses. And this remains a huge concern to them due to the seemingly feeling of rejection from partners most especially when partners don’t offer quality emotional support.

In place of seeking medical help, many women only seek advice from older women who most times encourage them to simply pay attention to their children. What a daunting task! Mental health challenges hamper women’s perinatal care attendance, it causes women to lose enthusiasm to adhere to medical prescription, and this could impact on the baby negatively in several ways.

Mental maternal health silence can actually be broken by introducing mental health screening and treatments during ANC -Anti-natal Care Clinics.

However, Adebayo was quick to point out that, “the idea that a woman with mental illness cannot breastfeed (for fear she might “infect” the child), is just another limiting fear as there is no such risk.” That said, the psychiatrist mentioned that “mothers with more severe mental disorders may indeed be unable to care for their children: if their judgment is impaired. But preventing a mother from caring for her child may only increase her distress.”

Suggesting a better approach, “let her care as much as she is able, with ready support at any time (in Africa, the presence of her own mother is often helpful here) — basically because mental illness is NOT transferrable. It isn’t something anyone, child or otherwise, can “catch” like an infection”, Adebayo reiterated.

Over time, some women get over their poor mental health, while many with chronic cases don’t. Women with such chronic disorders are more likely to have premature and low weight babies who later face challenges like stunting, poor cognitive and motor development amongst others.

For some other women, they succumb to suicide during pregnancy or the postpartum period. Unfortunately, death caused by suicide is often not included in maternal mortality despite that in some cases it counts for about 20-33% of maternal deaths.

Despite such an alarming figure, Dr. Adebayo is of the opinion that, “mental disorders only become a big deal when it is not faced as a big deal.

When it is taken seriously, yes, it becomes not so much a big deal.” The “No health without mental health” international call to action by the WHO needs to be emphasized and established across the globe.

Mental maternal health silence can actually be broken by introducing mental health screening and treatments during ANC -Anti-natal Care Clinics. Friends and family of pregnant women also need to offer empathy and listening ears, so woman can express their feelings, as this can increase chances for healthier motherhood.

*Lanre Olagunju blogs for the African Union on the Campaign on Accelerated Reduction of Maternal, Newborn and Child Mortality in Africa. He is @Lanre_Olagunju on Twitter