Don't Forget About Perinatal Mental Health

Recently, at the United Nations Summit on Millennium Development Goals (MDGs), Secretary Gereral Ban Ki-moon acknowledged that "the world has failed to invest enough in the health of women, adolescent girls, newborns, infants, and children. As a result, millions of preventable deaths occur each year, and we have made less progress on MDG five, improving maternal health, than any other." In response, the international community pledged $40 billion to the effort.

Bravo! Now let's hope that perinatal mental health gets its share of the pie.

Perinatal mental illness, a known commodity in the United States, is also widespread in the developing world. For example, one-third of all South African women who give birth will experience some form of depression or anxiety during or shortly after pregnancy. Without treatment, a mental illness can have devastating consequences that include problems with fetal brain development, non-completion of immunizations, higher rates of infectious illness, poor nutrition, gastro-intestinal problems, growth retardation and infant mortality. It also makes the mother more vulnerable to HIV infection, substance abuse, loss of employment and suicide.

Experts believe that increased perinatal depression is often a function of a negative cycle in which poverty and mental illness feed off one another. The cycle is manifested in housing problems, social drift, exclusion, lack of access to a social safety net and violence/trauma. The Perinatal Mental Health Project of South Africa, which provides counseling for women at-risk and advocates for increased resources to combat perinatal mental illness, has found that 69 percent of all women seeking the organization's counseling have an unsupportive partner and 39 percent have an unsupportive family.

On a recent visit to South Africa, I had the opportunity to meet Dr. Simine Honikman, the founder of PMHP. And I can attest without reservation that PMHP should serve as a model in the fight against infant and maternal mortality. The organization has found that pregnancy represents the optimal time to screen for risk factors because it is during this period that at-risk women are most likely to access health services. In addition to providing screening and counseling services, PMHP also trains healthcare providers to destigmatize mental illness in the communities they serve.

PMHP has screened more than 8,000 women while providing counseling to more than 1,200 and psychiatric services to more than 100. And each year, receptiveness to counseling grows. In 2009, the percentage of women who declined counseling services dropped from 11 percent to four percent and there was a nine percent increase in the overall number of women who received services. It is a pilot project that, if brought to scale, could have widespread impact in South Africa and could be replicated in other developing nations. This involves conducting more research on effectiveness and on the potential impact of a larger scale effort; developing "short-screening" tools for low resource clinics; partnering with the public sector and increasing the ranks of dedicated mental health workers who can maintain a constant on-site presence in order to maximize the fleeting opportunities to engage women.

One of the best pieces of advice I've ever received is to listen closely because opportunity knocks softly. Few people realize the impact of perinatal mental health and its role in infant and maternal mortality. But Dr. Honikman and her colleagues can't knock any louder. Hopefully, the United Nations will soon hear them.