Representative image. AFP
Maternal mental health refers to the mental health of pregnant people or people within a few weeks or months after giving birth. Despite research suggesting that the psychosocial well-being of individuals and their children is important, recognition of maternal mental health has not been high on the health agendas of many low- and middle-income countries (LMICs). Although there are no reliable national data on maternal mental health, the The WHO estimates that one in three to one in five people during pregnancy or childbirth in low- and middle-income countries have a significant mental health problem, compared to one in ten people in low-income countries. and medium.
While discussion of postpartum mental health dominates maternal mental health discourse, there is documentation that India has a high rate of perinatal (during pregnancy and childbirth) mental health problems. Perinatal mental health problems tend to have serious repercussions on maternal and fetal health, leading to low birth weight, anemia, and eventually infant nutrition and growth retardation. However, there are knowledge gaps in India regarding these mental health issues and any screening for mental health issues, if any, is done postpartum.
According to the NCRB Report for 2021, 18,588 women in the age group 18 to 30 years died by suicide. Of these, ‘marriage-related problems’ (particularly those related to dowry) and ‘impotence/infertility’ were found to be the leading causes of these suicide deaths. Despite such numbers of suicide deaths of young women and the root causes and repressive cultural factors and stigma around marriage and infertility, there is limited conversation about it within government and civil society.
Maternal mental health in India is characterized by an increased number of young women giving birth (at least 7.9 per cent of women aged 15-19 have started having children, Source: 2011 Census). India has a third of the total number of married girls in the world, causing girls to miss out on education and future sources of income. Other important issues include limited access to contraception and family planning, unplanned pregnancies, intimate partner violence (IPV) (1 in 3 women in India experiences IPV), lack of support from birth families and economic dependence on the conjugal family. These stressors are compounded by son preference, lack of adequate nutrition during pregnancy, health problems such as anemia (NHFS 2020 revealed that a third of all Indian women suffer from anemia) and lack of access to reliable antenatal care.
Maternal mental health has been further exacerbated by the COVID pandemic in India. Already overburdened health systems were unable to provide the full range of reproductive and mental health services, limiting and disrupting access to abortion, contraception and prenatal care.
In accordance with prevailing social norms in various parts of India, pregnant women normally go to their natal families for childbirth and the immediate postpartum period, but strict lockdown prevented them from doing so, contributing to the mental anguish. Gender norms, unpaid work, lack of partner support, and childcare burden all play a role in mental distress among women of reproductive age in India. Data during the COVID-19 pandemic revealed that women experienced all of these stressors, along with job losses, pay cuts, and uncertain employment prospects.
Maternal mental health requires multiple intervention strategies, beginning with medical curriculum revision to train and sensitize obstetricians and gynecologists on maternal mental health for perinatal and postpartum issues. Although NIMHANS has recently started a prenatal mental health certificate course for health workers, this limits the acquisition of such knowledge to the initiative of the individual, while including it in the general MBBS curriculum will allow all future health workers to health are aware of the problem. and provide better references.
Second, the Ayushman Bharat Program Health and Wellness centers list mental health services as one of the 12 services they will provide. There is a need to have tools available to community health officers (CHOs) so that they can identify pregnant and new mothers experiencing mental health problems and provide them with basic counseling support.
Third, there is a need to create community programs that provide a safe space for people to talk about problems they experience during and after pregnancy, where they can learn from and support each other. Such programs are based on the existing knowledge of people in the community, are contextual and use local resources.
Ekjut, a community organization working in Jharkhand, demonstrated one such approach more than a decade ago, using participatory learning and action (PLA) tools, which are a collection of methods to enable and empower participants to discuss and take action. on topics of interest. common importance and concern. The intervention involved regular meetings with facilitators from the community itself, where information was shared on pregnancy, childbirth and care-seeking practices through games and stories. Case studies of the local context were shared and community members discussed the problems and what strategies could be used to address them. A research study on this project showed that forming and facilitating women’s groups reduced neonatal mortality rates and a reduction in moderate depression at the third year. The Ekjut study has ample lessons to draw from: that there is merit in linking maternal mental health services with physical health. This will help women easily access mental health services without facing stigma.
At the macroeconomic and implementation level, the way forward to universalize maternal mental health care and improve access to reliable and affordable services is to integrate the mental health component with programs and schemes to reduce maternal and infant mortality. There is also a need to include maternal mental health data in the National Family Health Surveys and other data related to women’s health in India. Better data collection and quality primary research on specific maternal mental health issues, both on their causes and on service models that have worked, can be important for advocacy and intervention design.
Lastly, maternal mental health in India needs to be viewed from a perspective where reproductive rights are also integrated into the conversation about maternal mental health. A reproductive justice lens takes the conversation beyond just rights, to accessible services. For example, what are the factors that prevent certain groups of women from accessing their rights or services? This is due to structural factors such as caste, religion, disability that prevent access to quality health services. Inaccessibility to reliable health services during pregnancy, childbirth and the postpartum period contributes to mental anguish.
The author is executive director of the Mariwala Health Initiative. Views are personal.
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