Category Archives: End Stigma
In response to Daily Maverick article: “Antidepressants during pregnancy linked to autism in kids: study”
We would like to take the opportunity to raise caution with regard to the article published in The Daily Maverick titled “Antidepressants during pregnancy linked to autism in kids: study” on 20 July 2017
“Single studies like this need to be interpreted with great caution. Risk does not mean an inevitable outcome. Furthermore, an association does not necessarily mean cause. An association may reflect a causal link between autism and severe depression or the association may reflect a causal link between the medication and autism.
The global evidence is increasingly showing that the risk of untreated depression or anxiety perinatally on the foetus and infant, are likely to outweigh the risks of antidepressants on offspring outcomes. Balancing the risks is an important part of the decision to treat with antidepressants or not. This decision needs to be individualized and made collaboratively, as part of the consultation between the woman and her practitioner.”
Dr Simone Honikman, Perinatal Mental Health Project (PMHP)
The article is published here
Further information on antidepressant use during pregnancy in our Issue Brief
Perinatal depression and anxiety are serious mental health problems and are among the leading causes of maternal morbidity and mortality worldwide!
Pregnant women are at higher risk for suicidal ideation and behaviours compared to the general population.
Suicide has been identified as one of the major contributors to the global mortality burden and there is a growing concern over the increase in suicidal ideation and behaviour among pregnant women.
Studies in low- and middle-income countries put the rate of maternal death due to suicide at somewhere between 0.65% and 3.55%. In such cases, risk factors include poverty, lack of support, lack of trust in health systems and coexisting mental illnesses.
Suicidal thoughts experienced during pregnancy can continue beyond the initial postpartum period, affecting the well-being of both mother and child.
More about pregnancy and suicidal ideation in our infographic
The negative cycle of mental ill-health and poverty is particularly relevant for women and their infants during the perinatal period. During this time, major life transitions render women more vulnerable to mental illness from social, economic and gender-based perspectives.
Those with the most need for mental health support, have the least access. Overburdened maternal and mental health services have not been able to address adequately this significant unmet need. There have been limited attempts at a programmatic level, to integrate mental health care within maternal care services.
The perinatal period, where women are accessing health services for their obstetric care, presents a unique opportunity to intervene in the event of mental distress. Preventive work involving screening and counselling may have far-reaching impact for women, their offspring and future generations.
Mental health care is a notoriously neglected area – even more so in “healthy” pregnant and postnatal women. The focus on the physical to the detriment of the emotional is particularly felt now against the backdrop of HIV and AIDS. The public health service has been unable to address the mental health needs of women from poorer communities – neither within maternity services nor within mental health services. This is despite a wide body of evidence showing that distress in the mother may have long-lasting physical, cognitive and emotional effects on her children.
The PMHP aims to integrate mental health service routinely, within the primary maternal care environment.
Based at selected government MoU facilities in Cape Town, we offer counselling and support services focused on the emotional wellbeing of pregnant women with a strong focus on postnatal and clinical depression.
The importance of parental mental health as a determinant of infant and child outcomes is increasingly acknowledged. Yet, there is limited information regarding paternal mental health during the perinatal period. The aim of this review is to summarise existing clinical research regarding paternal mental health in the perinatal period in various contexts, and its possible impact on infant development.
Men are at increased risk of mental health problems during the transition to fatherhood, as well as during the perinatal period. Paternal mental health during the perinatal period has been shown to impact on their child’s emotional and behavioural development. However, research addressing the needs of fathers with mental illness and the impact of their illness on their infant and family has been limited.
A paradigm shift is required, from a focus on women following childbirth and women with pre-existing psychiatric disorders to a broader family perspective with the focus firmly on parent-infant relationships. This paradigm shift needs to involve greater research into the fathering role and paternal mental illness during the perinatal period, including further studies into risk factors, impact on the family system, and the most appropriate form of intervention and service provision.
The full research review is available on Wiley Online Library
In our resource library, you can find information for future fathers in four different languages
“As we celebrate International Day of Action for Women’s Health on May 28, we reflect on the physical, emotional and psychosocial dimensions of women’s health as well as the reasons to support girls’ and women’s health throughout the lifecycle.
With Sustainable Development Goal (SDG) 5 calling for an end to all forms of discrimination against all women and girls everywhere, the elimination of all violence against women and girls and universal access to sexual and reproductive health and rights by 2030, now is the time to draw attention to the many elements of and impediments to women’s health and rights […]
It’s Teen Pregnancy Prevention Month in some parts of the world
We want to emphasise that sex-education can prevent teenage pregnancy, but let’s not forget a teen mom is not only struggling with the normal issues of being a teenager, yet another part is facing the responsibilities of an adult!
Teenage pregnancy rates in South Africa are high, with around 30% of teenagers in the country reporting ever having been pregnant. According to the 2015 annual school survey, over 15,000 pupils fell pregnant during the academic year. This is nearly triple the worldwide rate of pregnancy in teenagers.
The psychological impact of pregnancy on teenagers is pronounced; adolescents are twice as likely as adults to experience postpartum depression. Another concern is the lack of education, with only about a third of pregnant girls in South Africa going on to finish their schooling. Incomplete education and lack of skills make it difficult for these young women to find work in order to support themselves and their children.
There are a number of physical ramifications to teenage pregnancy – unsafe abortions, for example, can cause injury or death. As a whole, complications during pregnancy and birth are the second leading cause of death for adolescent girls worldwide. But it’s not only them that face serious risks during this period – their babies also have a much higher risk of dying than those born to older mothers.
One way of decreasing the risks to both mother and child is by making skilled antenatal, childbirth and postnatal care available in a safe, teen-friendly environment. This should include counselling with the intent of providing emotional support, mobilising potential resources, and teaching important information about childcare.
Further readings: Pregnancy – a guide for teens
A guide to pregnancy, giving birth, and life as a mom for teens
Written by: Meagan Dill, PMHP volunteer
Alcohol and other drugs (AOD) use among pregnant women is associated with poor health outcomes for mothers and children.
Research has found that South Africa has one of the highest prevalence rates for Fetal Alcohol Spectrum Disorders (FASD) in the world. Alcohol, crack/cocaine, heroin and methamphetamine are the most abused substances in South Africa, with alcohol abuse being the most significant problem.
Maternal mental distress and AOD use in pregnancy often result in a cycle of dependency.
BUT, there are new the cross-cutting approaches that can maximize engagement and positive outcomes while mitigating potential harms.
Mothers who take alcohol and other substances during pregnancy often don’t attend antenatal clinic because they fear judgement by healthcare workers. If a mother does attend it’s important to keep her in the system by making a special effort to create a positive relationship with her, through empathic communication. You can encourage her to return to the clinic more frequently than other mothers, affirm the things she is doing well and help her to make informed choices.
Healthcare workers are better able to mitigate harm if the mother is retained in the system!
For more information see our Issue Brief on Alcohol and other drug use in pregnancy
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.
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.
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.
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
Guest blog post by Dyane Harwood – originally submitted to WMMHday Blog
Bipolar disorder, postpartum depression, and postpartum psychosis have made media headlines over the past couple years. Katie Holmes stars as a lovestruck poet with bipolar disorder in the film “Touched With Fire.” The British hit television show “EastEnders” featured a postpartum psychosis storyline that gained national attention. In a landmark decision, the U.S. Preventative Task Force called for screening for depression during and after pregnancy.
While the greater awareness of postpartum mood disorders is promising, postpartum bipolar disorder, the mood disorder I was diagnosed with, is virtually unheard of. Postpartum bipolar is also known as bipolar, peripartum onset, and it’s arguably the least known of the six postpartum mood and anxiety disorders. It might seem unimportant to publicize an obscure mood disorder, but every mom’s postpartum experience counts. Many medical professionals are unaware that postpartum bipolar exists. Some postpartum and bipolar organizations are unfamiliar with postpartum bipolar or they’re unclear about its definition. When I was pregnant, my obstetrician didn’t question me about my mental health or my family’s mental health history. My father had bipolar disorder, but before and during my pregnancy I didn’t show any signs of mental illness.
When I went into labor, my life changed overnight. We went to the hospital and I stayed up all night in pain. When my daughter Marilla was born the next day, I became hypomanic. I was exuberant and talkative (both signs of hypomania), but I appeared relatively normal. My baby attracted most of the attention, and no one noticed that I was in trouble. Exhausted, I sensed something was off, but I kept my fearful feelings inside. Within forty-eight hours I had hypergraphia, a rare condition in which one compulsively writes. I wrote at every opportunity, even during breastfeeding, when I should’ve been resting and focusing on my baby. I could barely sleep as my mania escalated, and poor Marilla didn’t gain enough weight because I didn’t breastfeed her sufficiently. A month postpartum, I knew I was manic; after all, I had witnessed mania in my father. I frantically searched the internet about postpartum mania, but my search only yielded postpartum psychosis statistics. During Marilla’s six-week checkup, her observant pediatrician heard my racing voice and pressurized speech (both behaviors are symptoms of bipolar disorder) and blurted out “Dyane, I think you’re manic!” I burst into tears. While I felt ashamed, I was relieved that he realized what was happening. It was clear I needed hospitalization, but leaving my newborn was agonizing. I admitted myself into a hospital’s psychiatric unit where I was diagnosed with postpartum bipolar disorder. After years of hospitalizations, medication trials, and electroconvulsive (ECT) therapy, I’m stable and doing well. While bipolar disorder ravages many relationships, my husband and I have stayed together, in part, thanks to the guidance of counselors and psychiatrists. Life will always be a challenge, but my two daughters inspire me to take care of myself.
While chances of postpartum bipolar are low, it can affect any mother. Obstetrician and Perinatal Mental Health Lead Dr. Raja Gangopadhyay of West Hertfordshire Hospitals NHS Trust, UK, explains, “The risk of developing new-onset severe mental illness is higher in early post-childbirth period than any other time in women’s life. Family history, pre-existing mental health conditions, traumatic birth experience and sleep deprivation could be potential risk factors. Bipolar illness can present for the first time during this period. Accurate diagnosis is the key to the recovery.” Confusion abounds regarding postpartum bipolar and postpartum psychosis. While the two conditions can present together, postpartum bipolar isn’t always accompanied by postpartum psychosis. Perinatal psychologist Shoshana Bennett Ph.D., co-author of the bestselling classic “Beyond the Blues: A Guide to Understanding and Treating Prenatal and Postpartum Depression and Anxiety\” says, “Many women I’ve worked with had been previously misdiagnosed with postpartum depression. I always make a point of discussing this during my presentations. In addition, postpartum bipolar disorder deserves its own category separate from postpartum psychosis.” Mental health screening during pregnancy would be of immense value to every mom. Women with a family history of bipolar disorder could be observed postpartum, and if symptoms manifested they’d be treated immediately. It’s imperative that doctors and other caregivers assess women not only for postpartum depression but also bipolar symptoms. Everyone who lives with a stigmatized illness deserves a chance to find support and empathy from others who understand her experience. Through connecting with those who can relate to our mood disorder, we may not find a magic cure, but virtual support can be profoundly helpful.
Postpartum Support International created online support groups in English and Spanish led by trained facilitators, while the Postpartum Progress website offers moms a private forum to interact with one another. I’ve never personally met another mom who has postpartum bipolar and I yearn to do so. If you or someone you know is or might be suffering from postpartum bipolar disorder please reach out to me at my blog www.proudlybipolar.wordpress.com — I’d love to hear from you!
This post is crossposted By Analía Sierra
When our eyes met
At first everything was new, I did not know what to expect. I got at the end of those nine months without enough information but with all the excitement and expectation that would be the most important moment of my life.
I had many fears, and they all were reason for my hospitalization- I have always been a healthy woman and have never been in a similar situation- My concern about that was big, I have never liked the idea of going through a surgery and this was the closest I was going to be to a surgery room … In my mind I had the old phrases , which grandmothers and mothers say, “You will forget everything, … it is a special moment and such a joy when you deliver your child all pains stops” … When the moment arrived, everything went slowly. They were long 11 hour of waiting … waiting for something I wasn’t sure what or who, if the anesthetist, the obstetrician or my child deigns to leave …
Analía’s blog is also available Spanish
Make your voice heard!
Tell your story to help raise awareness for maternal mental health issues so that more women will get treatment and fewer will suffer. Submit your blog here
Source: When our eyes met – WMMH Day