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 …
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Source: When our eyes met – WMMH Day
There are clear economic and societal arguments for investing in mental health interventions for women during pregnancy and immediately after birth.
This report examines the economic case for investing in early interventions that reflect best practice in England. Best practices that can and should be transferable to a cost-benefit analysis for perinatal mental health care in Low- and Middle Income Countries.
The second in a series of blogs by Dr Robert Nettleton, Education Advisor, Institute of Health Visiting, on his travels to Cape Town, South Africa through his Florence Nightingale Foundation Travel Scholarship 2017. He met our director, Simone Honikman, and our clinical team at Mowbray Maternity Hospital:
“The connection between a ‘trauma-informed’ approach and infant and perinatal mental health was obvious from my visit to the Perinatal Mental Health Project team at Mowbray Maternity Hospital, led by Simone Honikman.
There is an ‘epidemic of mental distress among women living in adversity’. Alongside wealth, there are extensive townships or informal settlements that are a legacy of the apartheid era in which, for example, 50% of women are HIV positive and levels of domestic, gender-based and sexual violence are high, as is poverty. Providing for accessible front-line assessment of mental health distress is a priority, through providing training to a range of workers and also within the community through ‘social connectors’ (I’ll learn about this more next week).
A challenge that resonated for me was about promoting quality and consistency in a fragmented system where there is also a heavy reliance on separate NPOs (not-for-profits) as providers of services.
Two key learnings for me were:
- The importance of what Simone calls ‘self-care’ – what we might call supervision with a substantial restorative component. I met, briefly, Charlotte who provides counselling out of a cubby-hole of an office in a maternity hospital. Her heart was bigger than her office! Maintaining resilience is something that we know is important, and the ‘Sollihull Approach’, while not rolled out in Cape Town, was something that colleagues recognised as applicable.
- The dilemma of seeking to deliver a quality service within a very low-resource environment. This resonated with me as we face resource pressures in the UK. We discussed and reflected on what would be the essential elements of a service (the ‘active ingredients’ or ‘programme mechanisms’) and what could be delegated or substituted without placing effectiveness at risk. The ability to form effective empathic relationships is one of those essential elements common to both South Africa and the UK, as is support and supervision.”
Misconceptions regarding maternal depression are obstacles to the integration of mental health initiatives in Maternal and Child Health (MCH) programmes.
The myths about maternal mental health include the beliefs that: maternal depression is rare, not relevant to MCH programmes, can only be treated by specialists, and its incorporation into MCH programmes is difficult.
Fact is that: Maternal Depression is the second-leading cause of disease burden in women worldwide, following infections and parasitic diseases
In the second article of a five-part series providing a global perspective on integrating mental health, Atif Rahman and colleagues argue that integrating maternal mental health care will help advance maternal and child health.
This can be achieved by collaboration between policy makers in mental health and those in MCH for action that will advance maternal and child health status. And by linking strategies to improve maternal mental health to broader development goals, including poverty reduction and gender empowerment.
Inspiring African innovations: Perinatal Mental Health Project, South Africa [#WHD2017 Africa Blog Series]
To commemorate International Youth Day we advocate for better mental health for vulnerable teenagers
Across the world, developing countries are making progress in tackling the HIV epidemic. According to UNAIDS, in 2012 South Africa registered more than 450,000 new HIV infections, a significant drop from the 640,000 new infections registered in 2001. They’ve achieved this radical progress through the provision of antiretroviral therapy (ART) to more than 2.4 million people.
The ‘New Beast’: Mental Illness Among People Living with HIV
In South Africa, 38% of people living with HIV have a common mental health disorder. This is more than triple the incidence of mental health conditions for the general South African population. What’s shocking is that in this era of ART, increased advocacy, and knowledge of the condition, there has not been a decrease in prevalence of mental illness in people living with HIV, but a two-fold increase.
Depression, anxiety and other mental health disorders are of particular concern in patients with HIV because they can lead to:
• Poor treatment adherence
• Lower CD4 counts
• Increased viral load
• A greater chance of developing drug-resistant strains of HIV
Source: Mental Health Innovation Network
HIV and Maternal Mental illness
The enormous emotional strain of living with HIV, including its social and financial consequences, makes women vulnerable to depression and anxiety. On the other hand, those women with mental illness are more vulnerable to becoming HIV positive. A depressed woman is less likely to be able to negotiate safe sex due to low self-esteem, a sense of hopelessness or financial dependency.
Women at risk
• HIV+ mothers are particularly vulnerable to mental illness during and after pregnancy
• Mental illness affects how women use maternity, child health services and HIV services
• Mental illness has been found to have negative impacts on how HIV+ women adhere to their own and their child’s HIV treatment
• Mental health support and social support for HIV+ mothers is vital for the general health of women, their babies and families
Read more on the subject in our Issue Brief
Teenage pregnancy and mental illness
Approximately 30% of teenagers in South Africa report ‘ever having been pregnant’, the majority, unplanned. The likelihood of a subsequent teenage pregnancy nearly doubles when adolescent mothers suffer from depression.
Adolescents at risk
• Adolescents who become pregnant are more likely to have relationships that are coercive and abusive
• They are more likely to have had a forced first sexual experience, or physical or sexual abuse, and tend to experience a loss of support from family, friends or school
• They are also more likely to engage in high risk sexual behaviour or be using substances and alcohol
• Adolescent and young pregnant women are at increased risk of mother-to-child transmission of HIV
Read more on the subject in our Issue Brief
“In a single year ending in March 2015 more than seventeen thousand people were murdered in South Africa. This is higher than some countries at war. Around 600 000 other violent crimes were reported, including attempted murder, rape, robbery and assault.”
The authors are making the case for improved antenatal support for pregnant women living in adversity to reduce violence and gang formation.
World Maternal Mental Health Day
May 4, 2016
Maternal Mental Health Matters
Increasing awareness will drive social change with a goal toward improving the quality of care for women experiencing all types of perinatal mood and anxiety disorder (PMADs), and reducing the stigma of maternal mental illness.
Organisations from around the world are leading efforts to raise awareness about maternal mental health through a collective social media push and in-country events.
We are a proud member of the initiatives Task Force, which includes organisations from the UK, US, Canada, Turkey, Australia, Argentina, Malta, New Zealand, Spain, Germany and of course South Africa.
You can follow the first ever global #WorldMMHDay on Twitter with the hashtag #MaternalMHmatters.
Join the movement and become a global partner.
“For any family, emotional wellbeing matters. When it comes to mental health the perinatal period can be a challenging time. Adjusting to life with a new baby is hard, but for some families the transition to parenthood is complicated by depression, anxiety, OCD, PTSD or psychosis. The impact on families can be devastating, especially if they are unable to access support. Coping day to day becomes hard, relationships can become strained, caring for their new baby overwhelming…
Does perinatal mental health matter? Yes it does. We can make a difference. By working together, by listening to the experiences of those affected by perinatal mental health and by campaigning for awareness, training, and specialist perinatal services we can help families get the support and treatment they need.”
Take this call to action and join our campaign for a global maternal mental health day. Follow the campaign in the run up to the 4 May and become a global partner because #maternalMHmatters