By Emma Harries
Social Connectedness Fellow 2017
Gender plays a vital role in determining mental health and illness, with women being more likely to suffer from common mental disorders such as depression and anxiety.[i] For instance, unipolar depression, which is predicted to be the second leading cause of global disability burden by 2020, is twice as common in women.[ii] Tackling the pervasiveness of mental health issues in both men and women is incredibly important, but special attention should be paid to these gender differences. That women are more likely to suffer from common mental disorders implies their children may be more susceptible as well.
It is common for women to experience mental health problems during pregnancy and after childbirth, as women worldwide suffer from perinatal mental illness. In high-income countries (HICs), the nature, prevalence and determinants of mental health issues among women during pregnancy, and in the year after giving birth, have been comprehensively studied. In HIC’s, about 10% of pregnant women and 13% of women who have just given birth struggle with mental disorders, mainly depression or anxiety.[iii] This research represents significant advances in the study of maternal mental health in recent years, as perinatal mental disorders used to be minimized as the ‘baby blues’, and postnatal anxiety written off as something with which a ‘nervous mother’ contends.
However, much less is known about maternal mental health in impoverished countries. Until recently, very little attention has been given to any mental health issue in lower income countries (LICs and LMICs). This is largely due to the extraordinarily low number of therapists — less than 1 for every 100,000 people — as well as limited availability of medication.[iv] And when it comes to maternal health in LICs, preventing pregnancy-related deaths continues to be the top priority.[v]
But less attention towards maternal mental health problems in lower income countries does not imply a lesser prevalence. In fact, in all the LICs and LMICs that report data on maternal mental health, “pregnant women and women who have recently given birth experience non-psychotic mental health conditions at substantially higher rates than the 10% in pregnancy and 13% postnatally reported in high-income countries.”[vi] These differences are sizable: in poor countries, nearly 17% of pregnant women and 20% of women who have recently given birth experience common perinatal mental disorders.[vii]
Not only are maternal mental health problems detrimental to a woman’s well-being, but they also impact her child’s development. When a mother is experiencing poor mental health, she is less responsive to her infant’s needs and less likely to breastfeed – actions that may carry grave consequences. In HICs, maternal mental health issues are associated with poor outcomes in childrens’ psychological development, intellectual competence, and psychosocial functioning.[viii] And in LMICs, the impact on infants extends far beyond psycho-social factors; the effects are “independent of the influence of poverty, malnutrition and chronic social adversity.”[ix] In these countries, maternal mental health issues are associated with higher rates of malnutrition and stunting, diarrhoeal diseases, infectious illnesses, hospital admissions, lower birth weight and reduced immunizations.[x] In short, poor maternal mental health places immense burden on individuals, family members, and society.
The World Health Organization argues that “reducing the overrepresentation of women who are depressed would contribute significantly to lessening the global burden of disability caused by psychological disorders.”[xi] Thus, it is critical that we address women’s mental health issues, and improving maternal mental health is a worthy place to start.
One of the best preventative measures against maternal mental illness is social support. Studies have shown that having close ties, and being emotionally supported, protects against illness and premature death.[xii] Larger and more supportive networks are associated with lower stress, increased personal well-being, and greater personal self-efficacy,[xiii] all of which help prevent or cope with depression and anxiety. Moreover, “social relationships can mitigate postpartum depression, reduce parenting stress, and improve maternal well-being.”[xiv]
Thus, special attention should be given to decreasing social isolation and bolstering social connectedness for mothers. Strong social connections have also been found to have a ‘rippling effect,’ thereby improving parent-child relations and child developmental outcomes.[xv] After all, humans have a need to belong, and fulfilling this need has a profound impact for mother, for child, and for all humankind.
[i] “Gender and women’s mental health.” The World Health Organization. Accessed July 6, 2017. http://www.who.int/mental_health/prevention/genderwomen/en/.
[iii] Rahman, A., J. Fisher, P. Bower, S. Luchters, T. Tran, M. T. Yasamy, S. Saxena, and W. Waheed. “Interventions for common perinatal mental disorders in women in low- and middle-income countries: a systematic review and meta-analysis.” Bulletin of the World Health Organization. August 01, 2013. https://www.ncbi.nlm.nih.gov/pubmed/23940407.
[iv] Anderson, Mark and Achilleas Galatsidas. “Mental healthcare 50 times more accessible in wealthy countries.” The Guardian. July 20, 2015. https://www.theguardian.com/global-development/datablog/2015/jul/20/mental-healthcare-world-health-organisation.
[v] Fisher, Jane, Meena Cabral De Mello, Vikram Patel, Atif Rahman, Thach Tran, Sara Holton, and Wendy Holmes. “Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review.” Bulletin of the World Health Organization 90, no. 2 (2011). http://researchonline.lshtm.ac.uk/20658/1/BLT.11.091850.pdf.
[ix] Rahman, A., J. Fisher, P. Bower, S. Luchters, T. Tran, M. T. Yasamy, S. Saxena, and W. Waheed. “Interventions for common perinatal mental disorders in women in low- and middle-income countries: a systematic review and meta-analysis.” Bulletin of the World Health Organization. August 01, 2013. https://www.ncbi.nlm.nih.gov/pubmed/23940407.
[x] Fisher, Jane, Meena Cabral De Mello, Vikram Patel, Atif Rahman, Thach Tran, Sara Holton, and Wendy Holmes. “Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review.” Bulletin of the World Health Organization 90, no. 2 (2011). http://researchonline.lshtm.ac.uk/20658/1/BLT.11.091850.pdf.
[xi] Gender and women’s mental health.” The World Health Organization. Accessed July 6, 2017. http://www.who.int/mental_health/prevention/genderwomen/en/.
[xii] Balaji, Alexandra B., Angelika H. Claussen, D. Camille Smith, Susanna N. Visser, Melody Johnson Morales, and Ruth Perou. “Social Support Networks and Maternal Mental Health and Well-Being.” Journal of Womens Health 16, no. 10 (2007): 1386-396. http://online.liebertpub.com.proxy3.library.mcgill.ca/doi/pdf/10.1089/jwh.2007.CDC10.