Mental Health: The Missing Piece in Maternal Health
Kathryn Millar is the publication coordinator and technical writer at the Maternal Health Task Force at the Harvard T.H. Chan School of Public Health where she manages the MHTF blog and is the curator of the MHTF Buzz. She is also the project manager for the MHTF’s partnership with The Wilson Center and UNFPA on advancing the dialogue on maternal health.
The World Health Organization defines health as “a complete state of physical, mental and social well-being, and not merely the absence of disease or infirmity.” Yet, mental health is often absent in maternal health programs, indicators and research. This leaves mental health a neglected pillar of maternal health care, resulting in poor health outcomes along the continuum of care. Mental health is not only an aspect of maternal health, but inherently linked to all facets of a woman's health.
First associated with pregnancy in 1858 by Louis-Victor Marcé, maternal mental health was not formally evaluated or recognized until 1964 when Paffenberger first described psychosis in the postpartum period and 1968 when Pitt first recognized and described postpartum depression.1 Since then, the study and understanding of the relationship between pregnancy and mental health has grown into a discipline of its own, yet we have a lot of progress to make in both research and clinical care of maternal mental health, especially in low-resource settings.
Today, mental health disorders, most commonly depression or anxiety, occur in 10% of pregnant women and 13% of women who have given birth. However, these rates are representative of only high-income countries. A dearth of maternal mental health research in low- and middle-income countries (LMICs) has made it difficult to assess disease prevalence and understand the complex factors that affect prevention and treatment of these disorders in this vulnerable population.
What we do know is that 85% of LMICs have no data on maternal mental health and as of 2012 there were only 34 studies in LMICs on mental health in the postpartum period. From the few studies from LMICs, we know that low-socioeconomic status, intimate partner violence (IPV), poor quality intimate partner and family relationships, poor reproductive health status and a history of mental health problems predisposes women for mental health disorders throughout pregnancy. Education, employment, structured direct care of the woman and an affectionate intimate partner relationship all protect the woman in this setting from mental health disturbances.2 In order to address the great inequalities in maternal mental health in LMICs, it is critical that researchers and program implementers bolster the evidence base and translate what we know works in high-income settings to interventions that are appropriate for low-income settings.
But maternal mental health is more than just the prevention and treatment of a disorder. Suicide during pregnancy and beyond is not often accounted for in maternal mortality even though in some areas it can account for 20-33% of maternal deaths.3-4 Also, mental health disturbances affect a woman’s ability to seek perinatal care and adhere to pregnancy care plans, such as daily iodine supplements, affecting both her health and the health of her baby.
The relationship between a woman’s mental health status and the health of her newborn extends into early childhood and beyond. Women with maternal mental health disorders are more likely to have a premature and low birth weight baby who then faces poor cognitive and motor development, stunting and behavioral and emotional problems.
To explore the knowledge gaps that remain and current and past successful approaches in maternal mental health, The Maternal Health Task Force, the Mental Health Innovation Network at the London School of Hygiene and Tropical Medicine and Dr. Jane Fisher of Monash University are partnering to host the blog series "Mental Health: The Missing Piece in Maternal Health".
Questions and topics for potential guest posts:
- Addressing risks, research and programs in LMICs: What unique risks does a woman face in regards to her mental health in LMICs? What are the research priorities for the maternal health community? How do we translate what we know about maternal mental health into low-resource settings? What are the inequities in maternal mental health disorders between women in LMICs and high income countries?
- Measurement: Currently the measurement of maternal mental health indicators are nearly absent in policy, programs and national frameworks. Do you have an experience of success in implementing maternal mental health indicators? How would the prevalence and treatment of maternal mental health change if measurement was improved? Would support for maternal mental health improve if suicide was considered a part of maternal mortality? What should we be measuring and which indicators are valid and reliable?
- Stigma and Gender: How does stigma affect the identification, prevention and treatment of maternal mental health disorders? How do stigma and gender inequalities work together against preventing and treating these disorders? Do pregnant women face unique barriers that other women or men do not face? Do we have to use psychiatric language when we talk about maternal mental health? Is there other language we can use that decreases stigma?
- Maternal mental health and the life course: How do early childhood experience, like sexual abuse, and IPV affect the maternal mental health? How does taking a life course approach to maternal mental health change where we focus our attention for prevention? How do maternal mental health disorders affect not only a newborn, but other children and family members? How does a family’s expectations of and relationship with the mother affect her risk for mental health disorders?
- Maternal mental health in the context of overall health: How can respectful and responsive care impact a woman’s mental health? How does a woman’s biological health affect her risk for mental health disorders and vice versa? How do maternal mental health disorders affect a woman’s ability to seek and receive appropriate care?
- Strategies for reducing and treating maternal mental health disorders: Which strategies have you found effective in the prevention, support and treatment of maternal mental health disorders? How have you made these strategies context appropriate in low-resource settings?
You may also feel free to suggest your own topic to our editors.
General guidelines for guest blog posts:
- Please include the author name, title, and photo
- Goal: Guest posts should raise questions, discuss lessons learned, analyze programs, describe research, offer recommendations, share resources, or offer critical insight.
- Audience: The audience for this series is health and development professionals working in maternal and newborn health around the world, primarily in resource-constrained settings
- Tone: Conversational. Doesn’t need to meet professional publication standards
- Feel free to choose your own style or approach. Q/A as well as lists (eg. top ten lessons) can often be effective ways of organizing blog posts.
- Length: 400-600 words
- No institutional promotion
- Please include links to sources such as websites and/or publications
- May also include photos and videos, please include a caption and a credit for the photo
To contribute a post to this series, please contact Katie Millar at firstname.lastname@example.org.
Submissions to this series will be reviewed and accepted on a rolling basis, but preference will be given to posts received by June 1st, 2015.
Main Image: © 2014 Jonathan Torgovnik/Reportage by Getty Images, used under the Creative Commons Attribution-NonCommercial 4.0 International license: http://creativecommons.org/licenses/by-nc/4.0
- Fisher, J., Herrman, H., Cabral de Mello, M. & Chandra, P.S. (2013). Women’s Mental Health. In Global Mental Health (Chapter 16).
- Fisher, J., Cabral de Mello, M., Patel, V., Rahman, A., Tran, T., Holton, S., & Holmes, W. (2012). Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review. Bulletin of the World Health Organization, 90, 139–149G.
- Lal et al, 1995
- Granja et al, 2002