Maternal mental health poses threat to women, development

She is only three months old, but in her short life, baby Emmy has hardly experienced the love of a mother. Not that her mother died, nor is it because her mother dumped her after birth.

Emmy is at Malawian Girls (Magi) Care Centre in Blantyre because her mother suffered a mental health disorder soon after giving birth. The mother has since been confined to Zomba Mental Hospital, Malawi’s main referral hospital for mental illness, for treatment.

Baby Emmy’s mother suffers from what is known as common perinatal mental health disorders (PCMD), which  affect as much as 20 percent of women during pregnancy and after giving birth in developing countries, according to the World Health Organisation (WHO).

The WHO published a review of studies on common perinatal mental disorders in women in low- and lower-middle-income countries that showed an average of nearly 16 percent of pregnant women had PCMD and nearly 20 percent were affected in the year after giving birth.

Locally, a 2008 study at Thyolo District Hospital found that of 519 mothers with infants, nearly 30 percent had some form of mental disorder.

The study, which concluded that CPMDs are prevalent in rural Malawi, identified poverty, lack of support, HIV, witchcraft and child illness as causes of worry in the perinatal period, which led to “altered mental states”.

“The symptoms of which are consistent with the concept of common perinatal mental disorder,” reads part of the study.

Sister Ruth Malote, who is in-charge of Emmy and other children at Magi Care Centre, says they got Emmy on February 18 this year after being contacted by Thyolo District Social Welfare office.

“The baby was taken to the district social welfare office by Thyolo Police who found her mother roaming the streets because of her mental condition,” says Malote.

She says, judging by how frail and unkempt the baby was, the mother and child had been on the streets for several days when they were picked up by police.

“The baby refused the milk bottle as she was not used to it. It is a miracle that she survived,” Malote says.

The national programme manager for non-communicable diseases and mental health in the Ministry of Health, Dr Beatrice Mwagomba, told The Nation in an e-mail that PCMDs impair not only the women themselves but their infants and their families as well.

“Infants are dependent on their mothers for breastfeeding, physical care and social interaction. As such, for a mother affected by PCMD, her infant’s development is compromised, especially if the mother becomes insensitive or unresponsive to the infant’s needs,” says Mwagomba.

She added that studies have shown that maternal depression is associated with higher rates of malnutrition and stunting, infectious illnesses, hospital admissions and lower birth weight as well as reduced immunisation among infants.

And in Malawi, where culturally baby care is a woman’s responsibility, PCMDs leave families with the added responsibility of caring for the affected woman and her infant.

“Due to lack of knowledge on the cause and that the problem is treatable, some families resort to witchdoctors for solution, and others leave the mother to wander about, which is very sad,” Mwagomba said.

Not surprisingly, as Mwagomba says, women with  mental  health problems are often stigmatised due to the behaviours and are, therefor,e less likely to receive antenatal, perinatal and postnatal care.

“While some women recover from the PCMD over time, others end up with chronic mental health problems,” she said.

But is Malawi doing enough to raise awareness and treat women with such conditions?

Dorothy Ngoma, a nurse and midwife who is also president of the National Organisation of Nurses and Midwives of Malawi, says Malawi is doing its best in terms of general  maternal health care but limited resources are affecting the delivery of quality health care.

“The midwife-to-patient ratio in Malawi is way below required levels. As such, midwives tend to focus on the physical aspect when providing services to pregnant women, neglecting the mental side,” says Ngoma.

She said this is why cases such as that of Emmy’s mother are not identified until the illness gets out of hand.

“Our midwives in this country are trained to look into mental health when providing maternal care. They know some women suffer depression after delivery. It happens due to hormonal disturbances that occur in the woman’s body after giving birth,” Ngoma said. “However, they are usually overworked and do not have enough time to examine the mental issues.”

Malawi has one midwife for every 272 patients, far higher than the recommended midwife-to-patient ratio of 1 to 5, Lennie Kamwendo, a registered midwife and board member of White Ribbon Alliance for Safe Motherhood, told The Nation in September 2014.

Mwagomba said the proposed Sustainable Development Goals (SDGs) that are expected to replace the Millennium Development Goals include a target on the promotion of mental health and well-being.

“Maternal health problems affect the whole family, hence impinging on the family’s productivity,” Mwagomba said. “If development agendas can include prevention of maternal mental health problems from all angles, women and their families can contribute significantly to the societal and national development.”

She says the WHO’s Global Action Plan for mental health notes that there is no health without mental health.

“A mentally healthy person can make sound decisions in all aspects of life. Women would not only make such sound decisions for their lives but also for the infants and children under their care,” explains Mwagomba.

As noted by the Woodrow Wilson International Centre for Scholars in Washington D.C., addressing PCMD remains conspicuous by its absence in large-scale maternal health programmes globally.

But with about 30 percent of pregnant women experiencing PCMDs, Malawi cannot afford to ignore this problem.

Mwagomba says the starting point is having a functional mental health policy that covers mental health care provision at all levels.

“A comprehensive revised mental health policy has already been developed but it is still in draft form, awaiting finalisation and endorsement,” she says.

Acknowledging that a policy alone is not enough to change the situation, Mwagomba concurs with Ngoma that there is need for resources to win this battle, saying without resources, achieving good mental health and wellness for women will remain far-fetched.

Ngoma calls on government to deploy more health workers in health facilities in rural areas, where over 70 percent of the Malawi population lives.

“I wish we had enough resources to train community midwives in psychiatric health and deploy them to every health care centre in the country,” says Ngoma. “In the absence of that this problem will remain unsolved”.