How social factors drive up suicide rates among pregnant women

We are reposting our article on maternal suicide on the occasion of #WorldSuicidePreventionDay2018

PMHP Blog

Source: The Conversation/ Perinatal Mental Health Project & Jason Bantjes

Pregnant women in South Africa who live in poor communities are more likely to consider or attempt suicide than the general population. That’s a key finding from a recent study we undertook at Hanover Park.

The research found 12% of pregnant women living in low-resource communities had thought of killing themselves during the previous month. In the same period, an additional 6% of pregnant women reported they had started to enact a suicide plan or attempted to end their lives. Rates of depression and anxiety were also found to be elevated among the pregnant women who took part in the study.

These findings mirror research about high rates of suicidal ideation and behaviour among pregnant women elsewhere in the world. A review of 17 studies in high- and low-income countries found the prevalence of suicidal ideation among pregnant and postpartum…

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Hanover Park: trauma and loss – mothers and children in need for mental health support

A recent article in the Daily Maverick emphasised the need for trauma counselling for women and children in the Cape Flats.

Our service site in Hanover Park serves the Greater Athlone health district, including parts of the Cape Flats, since 2012.

We continue to screen thousands of mothers and counsel about 200 per year at the Midwife Obstetric Unit.

Read more about our Hanover Park service here

Read the Daily Maverick article here

PMHP midyear reflection

Our August newsletter includes our latest publications and a shout-out to our fantastic volunteers!

Thank you to Ndivhudzannyi (Ndi) Mphephu, Sasha Roytowski, Rachel Field and Marni Riese for your valuable contributions, without which our work would not be possible!

Click the image below to read our newsletter or sign-up here!

Pregnant women suffer at hands of violent partners in South Africa

Republished article by Tanya Farber in Sunday Times (South Africa)

Many South Africa women‚ already in difficult situations‚ are experiencing violence during pregnancy at the hands of their intimate partners‚ a new study has found.

Of the 376 women who took part in the research‚ 15% had experienced intimate partner violence (IPV) during pregnancy‚ with forms of abuse ranging from sexual and physical to emotional and verbal.

This is against a backdrop of South Africa having intimate partner violence (among all women‚ not just those who are pregnant) which is “double that of the United States of America”‚ and which is as high as 71% in some communities.

The high level of violence during pregnancy in South Africa resulted from a combination of poverty-related factors.

Just published in the international BMC Women’s Health Journal‚ the study was carried out by a team from the University of Cape Town.

The sample was drawn from women attending antenatal services at a primary-level maternity facility in Cape Town.

The researchers found that the high level of violence during pregnancy resulted from a combination of poverty-related factors including food insecurity‚ mental ill-health‚ unemployment‚ unwanted pregnancies‚ and past experiences of abuse.

“In its most severe form‚ violence against pregnant women has been reported as a contributing cause of maternal deaths,” said researchers Sally Field‚ Michael Onah‚ Thandi van Heyningen and Simone Honikman.

It has also been associated with “inadequate uptake of antenatal care‚ with abused women being more likely to delay seeking pregnancy care and to attend fewer antenatal visits.”

For mothers and their unborn babies, results can include “low birth weight‚ foetal death by placental abruption‚ antepartum haemorrhage‚ foetal fracture‚ rupture of the uterus and premature labour”.

Also‚ they add that a “strong association” had been shown between thoughts of suicide and violence experienced by pregnant women.

They said that in South Africa‚ “high levels of violence occur within a context of multiple contributing social dynamics. These include prominent patriarchal norms where masculinity is associated with the defence of honour‚ harshness‚ and risk-taking.”

They added: “Poverty and gender inequalities contribute to the structural determinants of violence.

“Women in stable but unmarried relationships were more likely to have reported experiencing IPV than those who were married.”

Where to from here? The researchers said the study contributed towards a greater understanding of the risk profile for IPV among pregnant women in low-income settings.

 

This research and other PMHP findings are available open-source online!

Bringing mental health of mothers into the spotlight in Africa

In most societies, mothers are the primary providers of care to young children. This is a demanding task and the mental health of a mother is not only essential to her well-being, but that of her child’s physical health, nutrition and psychological well-being. However, most child development programmes do not adequately address maternal mental health.

Recent research has shown that about 20% of mothers in developing countries experience some form of mental health problems during or after childbirth. The United Nation’s Secretary-General António Guterres has recently acknowledged that the issue of mental health remains a largely neglected issue and announced the UN’s commitment to “working with partners to promote full mental health and well-being for all”.

Moreover, professionals in the field are pointing out that the mental health of mothers is critical to the success of the UN Sustainable Development Goals on health, nutrition and gender equality (SDG 3, 2 and 5).

In South Africa, the rate of pregnant and postnatal mothers suffering from common mental disorders (depression and/or anxiety) can reach up to one in three. Many of them are poor, come from disadvantaged communities and face many obstacles in accessing services and care.

Across Africa, the majority of women experiencing challenges to their mental health during the perinatal period (pregnancy and up to one year after the birth) are also exposed to gender-based violence, economic and gender inequalities, physical illnesses (including HIV), complications of childbirth and the stresses of childcare. Suicide has been identified as one of the leading causes of maternal death worldwide.

Unfortunately, health care systems in most African countries are not equipped to deal with the complex health and social challenges faced by most mothers. With competing physical health priorities and constrained resources, mental health care remains seriously neglected.

To challenge the status-quo and to improve the mental health of mothers in Africa, a group of individuals and organisations are working together in the newly established African Alliance for Maternal Mental Health (AAMMH).

AAMMH believes that a multi-sectoral approach is needed to tackle the causes of poor maternal mental health in Africa. The alliance calls for the integration of existing evidence-based interventions for the detection, prevention and treatment of maternal mental health problems into reproductive and child health programmes, supported by mental health services with specialist expertise.

This call for action is very close to the PMHP’s mission to develop and advocate for accessible maternal mental health care that can be delivered effectively in low-resource settings. We have thus become involved with the Global Alliance for Maternal Mental Health (GAMMH) over the past year since its formation and are now a proud founding partner of its first regional off-shoot, the AAMMH.

Together with colleagues in Malawi, we have been preparing for the upcoming launch on the 19 June in Lilongwe, Malawi. Prior to the launch, we will conduct a training workshop with health care providers and managers in maternal, mental and child health. On the launch day itself, we will be delivering a keynote address sharing the experience of the PMHP and will also be conducting a workshop towards establishing strategies for working partnerships across sectors for maternal mental health.

We hope our experience and work in South Africa, and in other low and middle-income countries, will contribute to the development and growth of this pan-African advocacy initiative. At the same time, we look forward to collaborating and learning from advocates, practitioners, trainers and researchers across Africa to strengthen the work we do in South Africa.

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The African Alliance for Maternal Mental Health (AAMMH) is part of the Global Alliance of Maternal Mental Health and works in close collaboration with the Marcé Society African Regional Group.

AAMMH will be officially launched in Lilongwe, Malawi on 19 June 2018. You can follow the event by using the hashtag #AAMMH #GAMMH

Read more about aims and objectives of the AAMMH here.

Good News in June

During the first half of 2018, we have produced a training video on Empathic Engagement Skills, published a number of research papers and have been busy all around.

Read our latest newsletter or subscribe to get the latest developments straight into your inbox.

(no worries, we are only sending a newsletter every couple of months!)


Click on the image to read the June newsletter 

Addressing the Maternal Mental Health Diagnosis Gap through screening tools

Source: Maternal Health Task Force blog

Diagnosis gap in Low- and Middle-Income Countries (LMICs)

Despite contributing significantly to maternal deaths and unproductive life years, common perinatal mental disorders (CPMD) often go undetected among women in low-resource regions. This can mean that up to 80% of women remain untreated in such settings. Resource-constrained primary care centers, high patient volumes, lack of recognition by health workers as well as increased task shifting to semi-skilled health workers contribute to this treatment gap. In order to encourage timely identification of CPMD among mothers followed by referrals, antenatal care provision centers are a promising platform in LMICs due to the high level of touchpoints between expectant women and health systems. In South Africa, for example, a mother’s contact rate with any antenatal care facilities is quite high at approximately 91%. […]

Empathic engagement training

Lead author Thandi van Heyningen shares insight into progress and next steps for improving maternal mental health in low-resource settings:

“Where health system resources are scarce, one way of improving detection and improving access to treatment, is to integrate these services into existing, routine, primary health care services using a stepped care approach. Improving detection through routine antenatal screening may provide a vital first step, however there is a need to generate further evidence on the feasibility and acceptability of existing screening tools for use in such settings, and by non-specialist health care workers.”

Read the full paper “Comparison of mental health screening tools for detecting antenatal depression and anxiety disorders in South African women” in the MHTF-PLOS collection on NCDs and maternal health

How social factors drive up suicide rates among pregnant women

Source: The Conversation/ Perinatal Mental Health Project & Jason Bantjes

Pregnant women in South Africa who live in poor communities are more likely to consider or attempt suicide than the general population. That’s a key finding from a recent study we undertook at Hanover Park.

The research found 12% of pregnant women living in low-resource communities had thought of killing themselves during the previous month. In the same period, an additional 6% of pregnant women reported they had started to enact a suicide plan or attempted to end their lives. Rates of depression and anxiety were also found to be elevated among the pregnant women who took part in the study.

These findings mirror research about high rates of suicidal ideation and behaviour among pregnant women elsewhere in the world. A review of 17 studies in high- and low-income countries found the prevalence of suicidal ideation among pregnant and postpartum women ranged from 5% to 18%. Rates were higher among pregnant women living in low-income countries.

Our study’s most-significant finding was that more than half of the pregnant women who were at risk of suicide did not have a diagnosable depressive or anxiety disorder. Their suicide risk was also associated with lower socioeconomic status, food insecurity, intimate partner violence and a lack of social support.

This suggests suicidal ideation among pregnant women is about more than mental illness. Past studies suggest suicide and mental illness are strongly linked. Pregnant women who are depressed or have problems with anxiety are more likely to experience thoughts of death and engage in suicidal behaviour compared with other pregnant women.

But our research shows social and economic context may be a much more important contributor to suicide risk than previously thought.

Pernicious impact of adversity

The findings show the pernicious impact of socioeconomic adversity, interpersonal violence and lack of social support on pregnant women’s wellbeing.

We found pregnant women who are the victims of intimate partner violence are twice as likely to engage in suicidal behaviour compared to other pregnant women. Those who experience food insecurity – either they go hungry regularly or they have considerable trouble feeding themselves and their families – are almost four times more likely to report suicidal behaviour.

Pregnant women who are not in a relationship are also more likely than other pregnant women to experience suicidal thoughts and attempt suicide. And we found suicide risk decreases as pregnant women experience more social support.

These findings add to the growing body of evidence showing that sociocultural and economic factors are important risk factors for suicide. Suicidal ideation and behaviour are not simply a symptom of mental illness. Suicide can be a reaction to living in a particular context or facing stressful circumstances.

So, our research supports the idea that suicide risk should be assessed independently of – and in addition to – depression and anxiety among pregnant women.

Broader focus needed

This is an important nuance. Suicide prevention initiatives have traditionally focused narrowly on identifying and treating psychiatric illness. Our findings suggest they should more broadly include interventions that tackle socioeconomic factors and adversity.

Interventions that focus exclusively on psychiatric determinants of suicidal behaviour are unlikely to be effective. This is especially true in low-resource settings. Contributing factors include a scarcity of mental health resources and factors that adversely affect people’s lives.

More work still needs to be done to identify effective suicide prevention interventions for pregnant women living in adverse conditions. This requires more collaboration between different sectors. Policymakers also need to tackle social ills and find ways to increase the level of support for pregnant women and mothers of young babies.

How hunger affects the mental health of pregnant mothers

Source: The Conversation/ Perinatal Mental Health Project

The mental health of pregnant women can be affected by a range of factors, including partner violence and unemployment. But one of the key drivers that adversely affects a pregnant woman’s mental health is food insecurity. Being food insecure is when someone doesn’t have food or has the wrong kinds of food.

This is one of the key findings of our study, conducted in an impoverished community in Cape Town which is also regarded as one of the most violent in South Africa.

We set out to explore the factors that affected common mental health problems in pregnant women. These included intimate partner violence, unemployment and food insecurity. We found that women who don’t get enough to eat when they are pregnant face a high risk of developing mental illnesses like depression and anxiety during pregnancy and after giving birth. And they are likely to have suicidal thoughts during this time too.

Several studies have analysed antenatal depression and shown that there are higher rates of depression among mothers-to-be in low socio-economic settings.

The South African Government provides social grants to mothers who meet certain low-income criteria after the birth of their babies. But, based on our findings, we would argue that women should be eligible for poverty alleviation support while they are pregnant. This would benefit them physically and emotionally. Research from a range of developing countries shows that providing pregnancy support grants benefits mothers and their children.

Based on these findings, and our own research, our view is that mental well-being and food security policies should be rolled out together as part of an antenatal care package for women. This is important because managing the mental health of mothers’ can help children develop better.

Pressures of poverty

In South Africa more than 40% of the population lives below the poverty line. This means that many families in poor communities don’t have enough to eat, or don’t have access to healthy food.

Often the food they buy doesn’t last the entire month which means that they skip meals or eat less food because there isn’t money for more. Recent statistics show that two in every ten South African families run out of money for food before the end of the month.

Hanover Park has high rates of unemployment, alcohol and substance abuse, physical and sexual violence, child abuse and neglect.

Our research found that almost half the pregnant women attending the Hanover Park Midwife Obstetric Unit were food insecure.

In the group of nearly 400 pregnant women, about 22% were depressed while 23% had an anxiety disorder; about 10% of women had both common mental disorders. Moderate to high risk levels of suicidal thoughts or behaviours were present in 18%. Being food insecure more than doubled the chance of a pregnant women developing depression or an anxiety disorder and was very strongly associated with previously having attempted suicide.

We also found that many women who had had their second, third or fourth child and lived in families with minimal income felt overwhelmed and hopeless at the prospect of bringing another child into the world.

The consequences

There are both short and long-term consequences of untreated mental illness in pregnant mothers.

Women with mental illness may find it challenging to use optimally existing services, including health services. Untreated depression in pregnancy has also been shown to be linked to premature birth and low birth weight.

After giving birth, mothers may have difficulty caring for themselves or their babies. Pregnancy is a critical window of development for a baby. When women develop mental health problems during pregnancy and after birth it may affect this window. If a new mother isn’t able to connect emotionally with her baby, in some cases neglect, or even hostility towards the baby can follow. Breastfeeding may also be affected.

These all matter for the healthy development of a child. If they’re deprived of these inputs they can, in the longer term, develop social, emotional and behavioural problems.

Solving the problem

The first big challenge is that public health and social service systems need to be revamped. Public health systems are aimed at decreasing maternal mortality rates. They’re equipped to help pregnant women deal with challenges such as HIV, massive blood loss or high blood pressure. But mental disorders, which occurs in 20-40% of pregnant women living in poor communities, often go unattended.

Our view is that common mental health problems should be detected and managed in routine maternity care settings. Non-specialist care providers, who have been properly trained and supervised, could use brief screening tools to detect problems and provide onsite counselling to women who need it.

But helping mothers cope with mental illness also needs government intervention to ensure that they don’t go hungry. This may be addressed by a social grant that begins in the antenatal period. This is only likely to have a meaningful impact if it has all components – the social, the physical and the mental.

Domestic Violence against Women during and after pregnancy

Women are particularly vulnerable to domestic abuse during and after their pregnancy. 

Protect yourself and your baby – help is available!

It is important to know what kinds of behaviour is considered domestic abuse – it is not only physical or sexual harm. Did you know that domestic abuse can happen between any persons sharing a household – not only at the hands of your partner?

Domestic violence in period is associated w/adverse obstetric outcomes. If you are pregnant & experiencing our guide provides information on where to go and who to contact if you need support

 

 

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