Mothers and pregnant women suffer high levels of mental health problems in South Africa
About one in three women in the country have experience depression and/or worry during pregnancy and the postpartum period up to one year after delivery.
For the first time, maternal mental health is now officially recognized in the country’s official plan for all matters related to pregnancy.
The fifth edition of Comprehensive Maternal and Perinatal Care Guidelines for South Africareleased by the health department in October 2024, now includes a chapter on mental health.
Doctors, nurses and midwives will now be able to assess for mental health conditions that may appear for the first time or become more severe during or after pregnancy.
These include anxiety, depression and post-traumatic stress disorder – common mental health conditions. They will have a clear approach to their management at primary care level and protocols for referral.
Maternal mental health disorders may have deep and lasting results and in mothers and infants if left untreated.
Mental health, mothers and babies
Mental health is closely related to adverse social and economic conditions. This means that the risk is greatest for women facing violence and trauma, poverty, discrimination, chronic physical health conditions and isolation.
Women living with these mental health problems face extreme distress and loss of quality of life. This limits their ability to connect to useful social networks and income-generating opportunities, further putting them at risk. marginalization, poverty and abuse.
Untreated, mental health conditions can cause premature birth and low birth weight and may intervene breastfeeding.
Children of women with mental health problems are also more likely to develop conditions such as retardation and poor mental health.
Financial cost and potential profit
Untreated maternal mental health disorders also have economic costs.
A 2022 study examined the lifetime costs of untreated maternal depression and anxiety for mothers and their newborn infants in South Africa.
Study shows that untreated depression and anxiety in mothers will cost an estimate of their lives R49 billion (US$2.8 billion) per year group of women and infants. These calculations included income losses, quality of life and public sector costs.
On the other hand, the economic returns to investment in addressing perinatal depression have been estimated to be the highest of all mental health conditions affecting the wider population R4.7 for every R1 spent.
Extremely treatable
Common mental health conditions are usually highly treatableespecially when diagnosed early and treated holistically.
There is also a growing body of global evidence that non-specialist providers it could make a real difference.
Community health workers and maternity health care workers, for example, could treat mild to moderate cases of these mental health conditions if they are adequately trained and supervised.
Read more: How hunger affects the mental health of pregnant mothers
Resources for providing services
The new guidelines lay the foundations for managing mental health conditions for women using maternity care services. But without the right resources, they won’t translate into effective care at the coalface clinic, and there’s a good chance they’ll remain a paper exercise.
Unfortunately, in South Africa, primary health care workers in maternal and child health services are inadequately skilled and supported for the provision of mental health services.
These healthcare workers often face an unmanageable patient load with limited time. In 2019, staffing levels (public and private sector combined) for obstetricians/gynaecologists were 36% lower from the proposed target for the country. For professional nurses and midwives, there was a Lack of 71%..
Mental health services are ill-equipped to handle the scale of the population’s needs and focus mainly on treating people with serious conditions such as schizophrenia and other psychotic disorders. For users of public health services who need mental health care, less than 1% receive some form of inpatient care and only around 7% receive outpatient care – meaning there is a treatment gap of over 90%.
For the few women who do access mental health support, many face rushed appointments or extremely long wait times.
A concerted and coordinated strategy
The guidelines mark an important milestone for women’s health, but their successful implementation requires strategic planning, adequate investment and coordinated efforts between the Ministry of Health, the Department of Social Development and non-governmental organizations.
Our main suggestions are:
Training: invest in improving and expanding existing training programs to equip maternity health workers with appropriate skills for primary mental health care.
Supervision and mentoring: establish strong clinical supervision and mentoring programs to support these workers in providing quality mental health care.
Enhanced health worker wellbeing: promoting health worker wellbeing within the work environment to mitigate burnout and improve patient care.
Establish and fund existing referral options for women in need of psychosocial support and/or specialist mental health care, while supporting non-governmental mental health organisations.
Strong governance, effective coordination and dedicated financial investment are essential to implement these strategies. The cost of inaction – both morally and financially – is very high.
Simone Honikman led the development of the mental health chapter in the new guidelines listed above. Donela Besada, senior scientist at the Medical Research Council, contributed to this article
