Blog Archives

MMH campaign summary and other news from the PMHP

Want to know how the Maternal Mental Health awareness campaign went this year?

Or want to check out our latest resources and developments in and around the PMHP?

Read our latest newsletter here

Let’s talk about mental health of pregnant teenagers

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

[#WMMHday Blog Series #4] “Falling Over the Edge”

This post is crossposted on the WMMHday campaign site by  Liz Shane

In the summer of 2013, my life was going great. I’d married my high-school sweetheart two years earlier and we had just moved into to an amazing rental house with our dog. It seemed like the perfect time to expand our family and I soon became pregnant with our first child. While I was initially ecstatic about the pregnancy, several weeks later, I started experiencing some very troubling symptoms.

I had a history of episodic anxiety and depression, usually centered around major life transitions, but this was something far beyond anything I had experienced in the past. I remember sitting in my office one day when I started to feel completely and utterly terrified, even though nothing was objectively wrong. I felt like crying all the time, could not focus on my work, and there was nothing that anyone could say or do to alleviate my anxiety. […]

Source: Falling Over the Edge – WMMH Day

[#WMMHday Blog Series #3] “Coming Up for Air”

This post is crossposted by Kathy Schommer

I feel like I’m drowning.” It was 7:00 a.m. on a weekday morning and my husband had just left for work. I was already sobbing on the phone to my mother, 1,800 miles away in North Dakota.

My then seven-month-old twin girls were bouncing away in their ExerSaucers. “I feel like I am treading water and trying so hard to keep my head up, but I keep sinking further down,” I cried to my mom. ”I’m trying to come up for air, but I feel like I can’t catch my breath.” […]

Source: Coming Up for Air – WMMH Day

A brief, valid mental health screen for mothers living in adversity

The PMHP identified a major obstacle to providing mental health care: the relevant mental health screening tool validated for our setting

The high prevalence of maternal depression in South Africa requires that maternal mental health screening, performed routinely and on-site, be logistically feasible and responsive to the local risk factors which may influence mental distress. To address this gap, we have developed a brief 5-question screening tool to identify symptoms of depression, anxiety and suicidal ideation.  

The study was based at our Hanover Park site. Women attending the maternity service were screened, offered counselling if required and referred to social support services where appropriate. Screening included the PMHP’s risk factor assessment, as well as several other risk and mood screens which are being assessed against a diagnostic gold standard. The most robust screening items were identified for inclusion in a valid, responsive and pragmatic new tool which may be used in limited-resource settings.

Overview of the Hanover Park maternal mental health screening study

Looking beyond depression

Call for greater global focus on improving quality of mental health care for women in the perinatal phase

Researchers and healthcare services have focused on depression, particularly postnatal depression, but a growing evidence base has accrued on the importance of other primary and comorbid disorders, particularly bipolar disorder, anxiety disorders (post-trauma stress, obsessive-compulsive, panic and generalized anxiety disorders), psychosis, eating disorders and personality disorder in both the antenatal and postnatal period.

The World Psychiatric Association urges all health care professionals and policy makers to improve pregnancy outcomes, reduce maternal and infant morbidity and mortality, improve care of the infant and enhance the mother infant relationship.

The WPA calls for all health professionals and other care providers to look beyond depression and also focus on other symptoms of anxiety, PTSD, somatic symptoms (as potential indicators for depression) and psychotic disorders. Women with severe mental illnesses need to be recognised as a high risk group requiring co-ordinated obstetric, paediatric and mental health care.

Read the full statement by the World Psychiatric Association (WPA)

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.

SAsouthAfrica

– 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

EnglishisiXhosa • Afrikaans • French

Women’s voices report on maternal mental health

Women’s Voices – Maternal Mental Health

The Royal College of Obstetricians and Gynaecologists (RCOG), supported by the Maternal Mental Health Alliance (MMHA), have published a survey Women’s Voices – Maternal Mental Health which highlights the urgent need to improve maternal mental health-care.

The survey of over 2,300 women who had given birth in the last five years in the UK, explores their experiences of perinatal mental health problems, engagement with healthcare professionals and the quality of care they received.  It reveals the impact of low rates of specialist referral, long waits, as well as lack of consensus over medication and little support for their partners.

The results present a stark picture of how services are letting down some of the most vulnerable women in our society, and provides key recommendations for healthcare professionals, managers, providers, commissioners and policy-makers.

Key findings

– Women reported experiencing low rates of referral, long waits, regional variation of care, a lack of continuity of care, misunderstanding and stigma

– The mental health of women’s partners is also often neglected by healthcare professionals and services

Source: RCOG survey women’s voices

Download the RCOG survey

Download the RCOG infographic

Maternal Depression: A Hidden Burden in Developing Countries

The most common mental health condition to affect perinatal women and mothers worldwide are depression and anxiety.

These illnesses impact thoughts, feelings and behaviours.

Routine antenatal and postpartum health services provide an opportunity for heightened and psychologically informed mental health care. Even in the poorest countries, there is some provision for antenatal, perinatal, postpartum, and infant health care and other primary health care services.

Interventions to improve maternal mental health and related child survival, health and development can be integrated into these existing services.

Source: Maternal Depression: A Hidden Burden in Developing Countries

At the PMHP service delivery sites, we provide routine screening for pregnant women and girls for depression and anxiety at the first antenatal visit. If they show signs or are at risk of depression or anxiety, free on-site psychosocial counselling, follow-up and case management is provided by our trained counsellors for up to one-year post delivery.

The PMHP model is based on a stepped care approach, which means that referrals are made to psychiatric services when necessary

Learn more about our integrated, stepped-care, collaborative service model, implemented through task sharing.

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