Although much of the attention to the health risks for women just before and after childbirth has focused on physical well-being, Rebecca Levine, senior maternal health adviser with the U.S. Agency for International Development (USAID), observed that we may be missing a key piece of the picture.
“Many are unaware that common perinatal mental health disorders – such as anxiety and depression – are the leading complication of pregnancy and childbirth around the world,” Levine said at a recent event hosted by MOMENTUM. USAID’s Country and Global Leadership on Global Resources for Perinatal Mental Health (PMH). She added that USAID recognizes that healthy women and families are the cornerstone of a sustainable and prosperous society; and USAID has decided to play a key role internationally in making perinatal mental health a strategic priority for increased focus and investment in the years to come.
Leaders and experts shared a global theory of change on PMH developed through collaboration and synthesis of existing data at the event. This work was a key part of broader efforts to support the destigmatization of broader perinatal mental health and help build an evidence base for large-scale interventions, Levine said.
A widespread problem
Jane Fisher, professor of global health at Monash University, offered a detailed view of the commonalities of perinatal mental health conditions like depression, anxiety and post-traumatic stress disorder, all of which can impact daily operation. She noted that in high-income countries, one in ten pregnant women experience these conditions, and added that estimates of the same figures in low- and middle-income countries are much higher. “The prevalence increases as the socioeconomic status of the country decreases, and the highest prevalence is found in countries affected by humanitarian conflict as well as poverty,” Fischer said.
What is being done to address the perinatal mental health of women in these countries? Many programs have had positive results for mothers and their children, but the challenge is scaling and sustaining them, said Shanon McNab, senior technical advisor at MOMENTUM Country and Global Leadership. The broader perinatal mental health crisis, she continued, meant that “there was a call to do something in a more collective and collaborative way.”
More than 700 global stakeholders presented a collaborative vision at the first-ever Technical Consultation on PMH in 2021. Building on the work of this consultation, the Perinatal Mental Health Theory of Change was developed using a “human-centered design process,” said Rohan Patankar, Senior Design Researcher at Quicksand. The process involved a review of the existing evidence landscape, he continued, with a series of workshops and multiple rounds of consultations with experts to arrive at the PMH’s final theory of change.
How it works
The PMH Theory of Change is a multilevel model. Beginning at the individual level, the model ripples outward to consider the role of interpersonal relationships, the community, the service delivery ecosystem, and the political landscape, with each layer comprising specific interventions and outcomes. “This [model] will provide guidance to organizations, teams and individuals working in these environments,” said Aditya Prakash, Principal Design Researcher at Quicksand.
An example of how a tiered approach benefits PMH programs is the Society for Pre-Post-Natal Services (SPANS) approach to perinatal mental health in Zimbabwe. “We are aware that there is a great lack of maternal mental health care providers,” said Linos Muvhu, therapist and founder of the Afrocentric International Conference on Maternal Mental Health in Africa (ICAMMHA). “It is critical that we link perinatal mental health interventions to social determinants,” said Laura Fitzgerald, Senior Technical Advisor at MOMENTUM Country and Global Leadership. The SPANS program addresses this issue through multi-level interventions such as community awareness, education and training, screening and prevention, and advocacy to better support PMH in Zimbabwe.
The PMH Theory of Change has other clear advantages as well. It provides a high-quality synthesis of the evidence and provides a clear way to plan those policies, Fisher said. The collaborative aspect of the model is also beneficial and will be put forward to address PMH.
“There’s so much rich experience and expertise on a global scale in this space,” Levine said. “We have to learn from each other. We have to listen to each other. Now is not the time to think that we have all the answers and that there is a magic bullet to address perinatal mental health. It is a complex problem, which requires complex answers.
Sources: Healthy Newborn Network, JAMA Network Open, London School of Hygiene & Tropical Medicine, Maternal Mental Health Leadership Alliance, Mental Health Innovation Network, Momentum Country and Global Leadership, USAID
Photo credit: Nefisa, a farmer who lives in the Oromia region of Ethiopia, smiling with her healthy husband and child, Courtesy of Flickr user USAID Africa.
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