Perinatal depression: Why it’s in the spotlight

May marks Maternal Mental Health Month, with the aim to raise awareness around the fact that many women struggle with perinatal mental health challenges, and to share resources for support. And this month, the Perinatal Mental Health Project (PMHP) at the University of Cape Town (UCT) is shining a spotlight on the issue.

The term perinatal refers to the period of pregnancy and the first year after giving birth, and in South Africa, one in three women suffer from it. “Perinatal depression is common, and so is anxiety and post-traumatic stress disorder,” said Associate Professor Simone Honikman, the founder and director of PMHP, which is based in the Centre for Public Mental Health in the Department of Psychiatry and Mental Health at UCT. “The prevalence here is about double that in higher-income countries, and marginalised women are affected the most.”

Honikman added: “Perinatal depression and other common maternal mental health disorders are highly treatable when detected early. However, they often go unrecognised and untreated, with many women simply being left to push through as best they can. This can lead to serious consequences for both the woman and her baby.”

“There is a very real need for high-quality, integrated mental health services within maternity care.”

Available information shows that with appropriate care, women can be supported to optimise challenging circumstances and navigate a way forward. However, access to treatment is a key challenge, particularly for the most vulnerable women living in low-income communities. Data shows in 2019, just 5% of the country’s total public health budget was allocated to mental health expenditure. Of the population without private medical insurance who needed mental health care, less than 0.9% received inpatient mental health care, and only 7.8% received outpatient mental health care.

Holistic maternal care

“There are also economic impacts. In South Africa, the lifetime costs of untreated maternal depression and anxiety alone add up to R51.8 billion per annual group of pregnant women and their infants,” Honikman explained. “There is a very real need for high-quality, integrated mental health services within maternity care.”

All parents dealing with perinatal mental health challenges are encouraged to seek support. Globally, the World Health Organization (WHO) has called for mental health care to be integrated into maternal and child health services through a recently published guide. In South Africa, this is reflected in the new National Maternity Care Guidelines, which are pending formal sign-off from the minister of health. These guidelines provide evidence-based and practical approaches for maternity care workers to provide mental health as part of holistic maternal care. Honikman and her team at PMHP played a core role in the creation of both these guidelines.