Mental health and motherhood: South Africa now has treatment guidelines, the trick will be to make them work

Mothers and pregnant women suffer from high levels of mental health problems in South Africa

About one in three women in the country experience depression and/or anxiety during pregnancy and the postnatal period up to one year after the birth.

Mental health, mothers and babies

Mental health is strongly linked to adverse social and economic conditions. This means that the risk is greater for women who face violence and trauma, poverty, discrimination, chronic physical health conditions and isolation.

Untreated, mental health conditions can cause preterm birth and low birth weight and can interfere with breastfeeding.

Economic toll and potential gain

Untreated maternal mental health disorders also have economic costs.

A 2022 study looked at the lifetime costs of untreated maternal depression and anxiety for mothers and their newborn infants in South Africa.

Highly treatable

There is also a growing body of global evidence that non-specialist providers could make a real difference.

Resources to provide services

The new guidelines lay the foundation for the management of mental health conditions for women using maternity care services.

However, without the proper resources in place, they won’t translate into effective care at the clinical coalface and there is a high probability that they will remain a paper exercise.

A co-ordinated and concerted strategy

The guidelines mark a significant milestone for women’s health, but their successful implementation requires strategic planning, adequate investment, and coordinated efforts between the Department of Health, the Department of Social Development and nongovernmental organisations.

Our main suggestions are:

Training: invest in improving and expanding existing training programmes to equip maternity health workers with the proper skills for primary level mental healthcare.
Supervision and mentoring: establish robust clinical supervision and mentoring programmes to support these workers to provide quality mental healthcare.
Strengthened health worker wellbeing: promote health worker wellbeing within the work environment to mitigate burnout and improve patient care.
Creating and funding existing referral options for women in need of psychosocial support and/or specialised mental health care, while supporting mental health non-governmental organisations.

Strong governance, effective coordination and dedicated financial investment are essential to implementing these strategies.

The cost of inaction – both ethically and economically – is too high.

Conclusion

The guidelines on maternal mental health provide an opportunity to address this long-standing issue in South Africa. However, to turn this opportunity into reality, we need a concerted and coordinated effort from the Department of Health, the Department of Social Development, nongovernmental organisations and other stakeholders.