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Disrespect and abuse (D&A) during facility-based childbirth

Source: Maternal Health Task Force

Researchers Share Lessons Learned From Measuring the Prevalence of Disrespect and Abuse

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By: Sarah Hodin, Project Coordinator II, Women and Health Initiative, Harvard T.H. Chan School of Public Health

Disrespect and abuse (D&A) during facility-based childbirth has been identified as a widespread problem, but just how commonly it happens is not well understood. Several studies have attempted to measure the prevalence of D&A during childbirth in health facilities across the globe, resulting in a wide range of estimates. Given that variations in reported prevalence may be at least in part the result of differences in definitions, measurement tools and data collection methods, comparing the extent of D&A across diverse settings remains challenging.

In order to better understand the trade-offs related to various methods for measuring the prevalence of D&A, the Maternal Health Task Force (MHTF)’s Rima Jolivet and Harvard Chan doctoral student David Sando conducted a systematic literature review to find all of the studies that have attempted to measure D&A during childbirth in health facilities. They then collaborated with the authors of these studies to compare methods and offer lessons learned.

The following five studies were included in the review:

The prevalence estimates in these five studies ranged from 15% to 98%. Given that all of these studies were conducted in low-resource settings in sub-Saharan Africa with similar maternal health delivery systems, the wide variation was likely due at least in part to differences in the way that researchers chose study sites and participants, defined D&A and collected data from participants.

Recommendations for future studies

The authors offered recommendations for researchers conducting studies that involve measuring the prevalence of D&A in order to maximize reliability, validity and comparability of results:

  1. Study site and population: Ensuring that there are no systematic differences in the study sample compared to the target population is important.
  2. Inclusion criteria: All women receiving maternity care in the study facility should have equal chance of being included regardless of their pregnancy outcomes. Stratified analyses can be used to examine different sub-groups of interest.
  3. Standardization vs. localization: Standardization of measurement across different study populations would ensure comparability of findings between studies, but ensuring valid measures that capture the constructs of D&A as perceived and experienced in the local context is also key. It is therefore important to acknowledge the tension between standardization and localization in developing instruments to measure the prevalence of D&A. Use of standard categories could help maximize comparability, while some leeway may be needed for context-specific operationalization of those categories.
  4. Environment: When possible, conducting interviews with women in a safe, neutral setting outside of the health facility where they may have experienced D&A can help participants feel more comfortable and open.
  5. Timing: In contrast to the typical understanding of recall deteriorating over time, in this context, women’s self-reports of D&A may be more accurate when solicited after they have had some time to process their experiences. More research is needed in this area.
  6. Data collection methods: Direct observation is generally regarded as the gold standard for measuring observable phenomena in prevalence studies. However, if the outcome of interest is women’s experiences of care, using women’s self-reports–ideally collected using patient-developed or patient-validated measures and participatory research techniques—is a better method.

Are you working on measuring the prevalence of disrespect and abuse during facility-based childbirth? We want to hear from you!

Read the full open access paper, “Methods used in prevalence studies of disrespect and abuse during facility based childbirth: Lessons learned.”

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Poverty and mental illness

Poverty and mental health

A review to inform the Joseph Rowntree Foundation’s Anti-Poverty Strategy

“Poverty increases the risk of mental health problems and can be both a causal factor and a consequence of mental ill health. Mental health is shaped by the wide-ranging characteristics (including inequalities) of the social, economic and physical environments in which people live. Successfully supporting the mental health and wellbeing of people living in poverty, and reducing the number of people with mental health problems experiencing poverty, require engagement with this complexity. […]

Although mental health problems can affect anyone at any time, they are not equally distributed and prevalence varies across social groups.”

Although this policy review is based on UK data it is relevant for everybody working in the mental health sector

 

 

Mental health and new care models – The King’s Fund lessons from the vanguards

Emerging evidence suggests that integrated approaches to mental health can help to support improved performance across the wider health system.

Key findings

  • Knowledge and skills around psychology and mental health are important features of integrated care, whatever the client group.
  • Despite this, the level of priority given to mental health in the development of new models of care has not always been sufficiently high.
  • Some areas report that new models of care have made it easier for local professionals to obtain informal advice from mental health professionals without making a referral, creating a more seamless experience for patients.
  • Working closely with voluntary sector organisations has allowed integrated care teams in some vanguard sites to better support the mental health and wellbeing of people with complex needs.

Policy implications

  • Testing the mental health components of existing vanguard sites must be a central part of the evaluation strategy for the new care models.
  • Other local areas rolling out multispecialty community providers, primary and acute care systems and related care models should go further than the vanguard sites in four key areas:
    • complex needs: enabling local integrated care teams to draw on and incorporate mental health expertise to support people with complex care needs
    • long-term care: equipping primary care teams to address the wide range of mental health needs in general practice (including among people presenting primarily with physical symptoms)
    • urgent care: strengthening mental health support for people using A&E departments and other forms of emergency care
    • whole-population health: placing greater emphasis on promoting positive mental wellbeing in the population, in particular among children and young people, and during and after pregnancy.
  • All sustainability and transformation plans should set out ambitious but credible plans for improving mental health and integrating mental health into new models of care.

Source: The King’s Fund

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.

Reflections from Cape Town, South Africa by Dr Robert Nettleton

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:

  1. 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.
  1. 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.”

Source: Reflections from Cape Town, South Africa – week 2 – IHV

Every $1 invested in mental health yields $4 of value

Mental disorders affect up to 450 million people worldwide, and depression alone is one of the leading causes of disability. Stigma, inadequate funding, and poor healthcare systems prevent people from accessing much-needed treatment.


Photo: Basic Needs

This in turn has serious economic consequences, costing the global economy some US$2.5 trillion per year, an amount that is expected to increase to US$6 trillion by 2030. Yet funding for critical interventions remains scarce. Mental health is allocated less than two percent of health spending in most low- and middle-income countries.

Without action now, the social and economic impact of mental illness in the coming years will be huge.

A recent study found that every $1 invested in #mentalhealth yields $4 of value.

Source: Skoll World Forum

Mental Health First Aid: A beginner’s guide to being on happy pills

In this latest #DignityInMind campaign blogpost, Kate gives us an insight into her relationship to anti-depressants.

I popped my first anti-depressants ten years ago, and I count myself lucky that in all the years since, no-one has ever given me a hard time about being on medication for my mental state. Frankly, if anyone did, I wouldn’t care.

People (not me obviously) find it hard to talk about, and even harder to find help for. My oversharing, it seems, might be a public service.

happy-pills

Source: World Mental Health Month – #DignityInMind

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