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!

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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 #perinatal period is associated w/adverse obstetric outcomes. If you are pregnant & experiencing #domesticviolence our guide provides information on where to go and who to contact if you need support https://lght.ly/33djjh3 

#maternalMHmatters #Listen2Mothers

 

 

We need sustainable solutions to deal with mental health treatment gap

On World Mental Health Day many have thought about mental health status in their countries and the treatment gaps all over the world.

Our blog focuses on articles and statistics around mental health care and in particular around maternal mental health care globally and in low- and middle-income countries.

“Mental health matters because it affects everyone”

“Around 30% of women in low-income countries and 10-15% in high-income countries have a significant mental health problem during pregnancy and after childbirth. And yet most of these women never get diagnosed or receive any treatment” Maternal Mental Health-Global Challenge

“South Africa needs sustainable solutions to deal with its mental health treatment gap, delegates heard at a roundtable discussion ahead of World Mental Health Day (WMHD) – “Economy, Equality and Access to Mental Health Services” Close the mental health treatment gap

“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 affect 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.” How hunger affects the mental health of pregnant mothers

Image: Robin Hammond

“Lack of food security is driving depression, anxiety and suicidal behaviour in poor communities” How hunger erodes mental health

“From OCD to suicide and depression, these numbers will alarm you.” (South Africa focus) 10 Mental Health stats South Africa

“South African children may be affected by a myriad of traumas. According to the South African Journal of Psychiatry, children and adolescents can suffer from post-traumatic stress disorder (PTSD) after being exposed to a range of traumatic events.” Here’s how the Sesame Street’s Muppets help kids

“Crisis issue needs to be priority among developing nations” Mental health treatment a human right

“World Mental Health Day: the need for conversations on the subject in India is as strong as ever, because despite a start, not enough of them are taking place.” A poignant series of films relates the stories of people who fought and won

Sick link between hunger and mental health – linking food insecurity and mental health.

“Future actions should focus on better identification of people in vulnerable situations who may require specific support including people experiencing mental distress, early intervention and culturally appropriate mental health training for all frontline staff.” Mental health is not the problem, it’s the solution

“Children whose mothers are depressed during pregnancy have a small increased risk of depression in adulthood, according to a UK study.” Depression risk ‘starts in the womb’

“What more needs to be done to make mental health care a reality for people worldwide.” Making mental health a cultural priority

“Mental health needs a new narrative. citiesRISE is a global platform committed to transforming the state of mental health policy and practice in cities and beyond to meet the mental health needs of populations across the world.” citiesRISE new website

 

Making a case for the integration of mental health screening into HIV care

Source: Journal of Interpersonal Violence

Screening for Traumatic Experiences and Mental Health Distress Among Women in HIV Care in Cape Town, South Africa

“Traumatic events can negatively affect clinical outcomes among HIV positive women, particularly when those events result in ongoing psychological distress. Consequently, there have been calls to integrate screening and treatment of traumatic experiences and associated mental health disorders into HIV care. In South Africa, screening for traumatic experiences and mental health is not a routine part of HIV care. […]

Participants [of this study] almost unanimously agreed that it would be appropriate and acceptable to screen all women in the clinic setting for trauma and mental health symptoms. […]

The high prevalence of traumatic experiences and psychological distress in this study highlights an urgent need to integrate screening into routine HIV care. The study provides evidence of the acceptability of screening for trauma and mental health symptoms among HIV positive women, at the critical points of care engagement when they are initiating ART or have defaulted on ART. In addition, there is need to link women screened to interventions and services, as part of trauma informed HIV care.”

Full text available on Sage Journals

 

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?

 

Do you have a safety plan in place for you and your baby should anything go wrong?

Find out more about all this important information in our Violence against Women leaflet

Looking for more information for new mothers? Check out our resource pages.

Breaking the link between gender-based and intimate partner violence and HIV

Intimate partner violence (IPV) during or before pregnancy is associated with many adverse health outcomes.

Pregnancy-related complications or poor infant health outcomes can arise from direct trauma as well as physiological effects of stress, both of which impact maternal health and fetal growth and development.

Antenatal care can be a key entry point within the health system for many women, particularly in low-resource settings. Interventions to identify violence during pregnancy and offer women support and counselling may reduce the occurrence of violence and mitigate its consequences.

This research will provide much-needed evidence on whether a short counselling intervention delivered by nurses is efficacious and feasible in low-resource settings that have a high prevalence of IPV and HIV.

Source: BMC Health Services ResearchBMC series

Follow the project: BioMed Central

Perinatal depression and anxiety: Let’s talk about moms and dads in Africa

In low- and middle-income countries (LMICs), competing health priorities, civil conflict, and a lack of political will mean that expenditure on mental health is a fraction of that needed to meet the mental health care needs of the population.

For mothers, this treatment gap is most notable in regions where health agendas focus on maternal mortality indicators.

Source: Essentials of Global Mental Health

Who is at risk of perinatal mental health disorder?

Common mental disorders during pregnancy and in the first year after birth are associated with certain risk factors. These include poverty, migration, extreme stress, exposure to violence (domestic, sexual and gender-based), previous history of mental disorders, alcohol and other drug use as well as low social support.

– Migration
– Violence and abuse
– Alcohol and drug use

In South Africa, there is a very high prevalence of adolescent pregnancies with 39% of 15- to 19-year old girls being pregnant at least once. When adolescent mothers suffer from depression, the likelihood of a subsequent teenage pregnancy nearly doubles.

– Teenage pregnancy
– HIV/AIDS

How to address maternal mental illness among economically disadvantaged parents? 

Integration of services!

Mothers in many settings are using maternal and child health services as well as social services. Thus, detection and access will increase if maternal health screening and services are integrated into these public care platforms.

How to implement a maternal mental health intervention in low-resource settings?

We are sharing our lessons learned in this learning brief. 

We have also developed a Service Development Guidelines which demonstrates how to develop a mental health intervention at your facility, even with limited resources.

Find more free & open access resources for professionals on our website

And what about dads?

Postnatal depression can affect dads too. Find out about common concerns for new dads and discover helpful tips on how they can become more involved. We compiled a leaflet with information that could help you be better prepared for what is happening. The leaflets are available in

English • isiXhosa • Afrikaans • French

Domestic violence during pregnancy

Domestic violence is any physical, sexual, psychological or economic abuse that takes place between people who are sharing, or have recently shared a home.

In Africa, there is more violence against women than on any other continent. Three women are killed by their partners in South Africa every day, thats twice as many women than in the United States of America. Violence during pregnancy has negative effects for both the mother and the child. Abused women are more likely to delay getting pregnancy care and to attend fewer antenatal visits.

Our recent research study looked at pregnant women who experience domestic violence in Hanover Park, Cape Town. We looked at the profile of women who reported domestic violence and what factors in their lives were associated with this abuse.

We found that women who were experiencing domestic violence were more likely than those without domestic violence to:

– have a current mental health problem like depression, anxiety, suicidal thoughts or behaviours, alcohol or drug abuse

– have had past mental health problems
– have experienced past abuse
– not feel supported by their partner
– not likely feel pleased about being pregnant
– more likely experience food insecurity and not have a job

Out of this study with developed a learning brief which targets any service providers who interact with vulnerable women and children, especially those service providers who work with pregnant women. Such services providers can arise from nongovernmental organisations (NGOs) or civil society organisations and may be healthcare providers or social service providers.
Find this and more on our resources for professionals pages.

Suicide risks among pregnant women and new mothers

To mark World Suicide Prevention Day we’d like to focus on suicidal thoughts during the perinatal period

Mothers’ emotional needs can go undetected during the perinatal period where there is much attention on the baby and women often face multiple difficulties. Studies have shown that women at risk for suicide may be easier identified, by increasing screening of expectant and new mothers for major depression and conflicts with intimate partners. Thus care providers and family may be able to detect symptoms and signs of suicidal thoughts and possibly prevent further distress or the development of suicidal behaviour.

Symptoms and warning signs include 

– Talk of suicide or dying “If I died, would you miss me?” or “It would be better if I were not here or dead.”
– Depressive symptoms, including feelings of guilt, hopelessness or no sense of the future.
– Feeling isolated or wanting to be alone “No one understands me”.
– Obsessive thinking – thinking ‘too much’, especially about harming oneself or dying
– Giving things away (clothes, expensive gifts), “When I am gone, I want you to have this.”

Our recently produced Issue Brief deals with some of the risk factors and unearths some of the myths surrounding suicide during and after pregnancy.

Read this and other Issue Briefs on our website

#WSPD16 will be commemorated on 10 September
Join the conversation on Twitter with the hashtag #WSPD16

Defeating the enemy within – intimate partner violence in South Africa

Abuse at the hands of one’s partner is rife across the world. And even though South Africa has the highest levels of this type of violence, healthcare providers are not trained to deal with it and it is still regarded as a taboo subject.

Image: Graeme Arendse

In South Africa, shocking statistics reveal that:

– half of all women killed are slain by their intimate partners
– this is the highest femicide rate in the world
– more than 50% of women report experiencing intimate partner violence, often during pregnancy
– 20% of women surveyed in antenatal clinics in Soweto reported sexual violence by an intimate partner
– 68% reported psychological abuse and
– more than a third of girls report having been sexually violated and
– 45% of children have witnessed their mothers being beaten

Now, the World Psychiatric Association has created the first comprehensive position paper and curriculum that can be used by institutes globally to try to combat intimate partner violence.

Simone Honikman, director of the Perinatal Mental Health Project (PMHP) in Cape Town, has hailed the new open-source curriculum, saying it will be very useful in South Africa. “I think this is an excellent resource for capacity building that may be easily adapted for our local setting. Over the years of working with health and social development workers of all types, we at the PMHP, have been struck by the need for improved access to accessible, competency-based training on addressing intimate partner violence and sexual violence.”

Read the full article by Tanya Farber in the Times Live here

 

Related resources: Intimate Partner Violence (IPV) in South Africa: How to break the vicious cycle