Postpartum depression affects millions of women but is neglected by health services in many countries.
Postpartum depression is estimated to affect more than one in ten women who have a baby – and it’s just one of many mood disorders a woman can experience during pregnancy or in the first year. after birth, known as the perinatal period.
However, these conditions, known as perinatal mood disorders, remain largely misunderstood by both the public and health care providers, experts say during a panel discussion hosted by the reporting team. on CNN’s “As Equals” genre. “.
Following a CNN story about a family’s tragic experience with postpartum depression, which had far-reaching repercussions, the “As Equals” team brought together an international group of people with experience and expertise in maternal mental health to discuss the prevalence of these disorders, their root causes, the challenges of their diagnosis and treatment, and, ultimately, potential solutions.
A “misunderstanding” of mental health in maternity
The conversation began with panelists saying that the number of women affected by perinatal mood disorders is likely well over one in 10, and unanimously agreed that the issue continues to be overlooked by health services. health around the world.
“There is still this widespread concept that mental health issues are a luxury,” said Simone Honikman, founder and director of the Perinatal Mental Health Project in Cape Town, South Africa.
Simone Honikman explained that a woman’s mental health affects not only her physical health but also that of her child, directly and indirectly, because when you have a mental health problem, you cannot seek other services. of health which are crucial for your health. mother or for the welfare of her child.
“There is a lack of appreciation that these mental health issues do, in fact, have a direct impact on physical health conditions and are very directly associated with a range of physical health issues, whether research services, health-seeking behavior, preterm birth, low birth weight, stunting, assistance with antiretroviral therapy or other forms of treatment,” Honikman said.
Kazione Kulisewa, consultant psychiatrist at Kamuzu University of Health Sciences in Malawi, agreed that mental health takes a back seat to other physical conditions, but explained that in countries like Malawi, where there are multiple competing health priorities for limited resources, it is even more difficult to insist on investing in maternal mental health care when rates of HIV and maternal mortality are so high. (In Malawi, an estimated 10% of women aged 15-49 were living with HIV in 2020, with the southern African country having one of the highest maternal mortality rates in the world, with 439 maternal deaths per 100,000 live births. In the United States, this number is 23.8 per 100,000).
Despite these challenges, Kulisewa pointed out, “mental health issues, when left untreated, cause a greater burden than some infectious diseases.”
The implications of this neglect on perinatal mood disorders are vast. A World Health Organization (WHO) study found that women with postpartum depression were twice as likely to suffer from depression four years later and were significantly more likely to suffer from a chronic condition. Studies have also shown links between the mental health of mothers and the health of their children.
“We don’t prepare women.”
For Jen Schwartz, CEO of Motherhood Understood, a US-based organization that connects and educates women about perinatal mental illness, the biggest concern is stigma and lack of awareness.
Schwartz herself suffered from severe postpartum depression and anxiety following the birth of her son nine years ago and recalls feeling uninformed, isolated and ashamed. She believes that by not educating and supporting women more openly about mental health issues during pregnancy and motherhood, “we are not preparing women to know what to look for and to know that something is wrong. not”.
“The consequences of that, I think, are huge,” Schwartz said, explaining that the resulting isolation leaves women unable to talk about how they feel. “You don’t talk and you suffer in silence,” Schwartz said.
Lack of knowledgeable professionals – at all levels
The experts also highlighted the lack of professionals in the sector, such as psychologists and perinatal therapists specialized in maternal mental health, but also midwives and antenatal care providers with knowledge in this area, so that they know what to look for. As an example, Kulisewa pointed out that there are only three perinatal psychiatrists in Malawi, which has a population of 19 million. CNN was unable to contact Malawi’s Ministry of Health to confirm this.
However, panel members also unanimously agreed that community organizations are also crucial.
Prabha Chandra’s team at India’s National Institute of Mental Health and Neuroscience worked with women and communities in Karnatika state to test various interventions with mothers, as well as talk to husbands and beauties. -mothers of what depression and anxiety are – once these relationships play a huge role in the well-being of new mothers in India.
Chandra stressed the need for culturally appropriate means of raising awareness about maternal mental health, such as simplified diagnostic methods and locally produced films and materials that take into account local sensitivities and communicate in an understandable way.
Need for systemic change
Having established the many challenges – limited resources, lack of trained personnel, consistent data collection across the world, competing public health needs, persistent stigma and shame, insufficient understanding of the scale and impact of the problem among both decision-makers than among the general population – the discussion turned to solutions – and solutions that could bring about systemic change.
A key part of the solution is to better integrate maternal mental health services into a country’s existing health infrastructure, such as antenatal services or child development programs. Many panelists said this integration would be essential so that funding or support for maternal mental health services is not dependent on political support and can survive changes in leadership that lead to shifts in public health priorities around the world.
This integration has been achieved in many high-income countries, said Jane Fisher, professor of global health at Monash University. “There is public recognition, but substantial investment was needed in public education, health care, vocational education and building interim services,” he said.
But it will take time to get there in low- and middle-income settings.
Another important solution proposed was the need to adapt the standard tool used worldwide for the analysis of mental health problems in the perinatal period, the Edinburgh Postnatal Depression Scale, created more than 30 years ago. year. The WHO says the scale should be used as a starting point rather than a means of diagnosis, and roundtable experts agreed, but said a universal test like this doesn’t work well in the practice.
“There is a great need for tools to be developed outside of the specific country context, using local idioms,” Honikman explained. She described the Edinburgh Scale as too long and complicated to be used by busy midwives who see thousands of women and think the languages used are inappropriate for the communities her team works with. As a result, they created their own shorter tracker in three local languages.
In terms of other solutions, others spoke of the need for greater mental health awareness and literacy among the public, policy makers and health care providers to have real impact and ultimately account, more funding and support.
Missed opportunities for prevention
A final point raised by Chandra and others was the possibility of prevention. If risk factors for maternal mental disorders are addressed by health systems early on, they may be able to prevent the onset of disorders. These risk factors include poverty, domestic violence and childhood trauma, and are likely to be higher in countries with lower gender equity index, such as India, a explained Chandra.
It is estimated that women who experience domestic violence during pregnancy are three times more likely to develop postpartum depression and studies show that the condition is two to four times more likely to occur in women living in poverty. .
“If you reduce domestic violence and reduce poverty in families, you can accomplish much more in terms of reducing mental health problems than a million psychiatrists will ever achieve,” said Alain Grégoire, co-founder of Global Maternal Mental Health Alliance.
Over the course of an hour and a half, the various experts spoke passionately about the needs of new mothers and expressed their frustration that more is not being done to address maternal mental health, given what is known. already about its prevalence and the necessary, often simple, steps that are needed to reduce it.
In conclusion, Schwartz reiterated a call that had been made earlier in the debate; simply pointing the finger at leaders who cared about the welfare of the children but perhaps saw the welfare of the mother as a lesser priority: “Caring for the mother and caring for the mental health of the mother [é] the best way to take care of your baby”.