For growing numbers of South African women, pregnancy is not something to celebrate — it is a desperate descent into depression and anxiety.
”In the South African setting, we have a recipe for an epidemic of perinatal mental health problems,” said Dr Simone Honikman, director of the Perinatal Mental Health Project at Liesbeeck midwife obstetric unit.
The pilot project offers free individual counselling to pregnant women, with the aim of improving symptoms and preventing mental health problems from getting worse.
Another aim is to prevent those at risk from developing perinatal mental health problems.
Honikman started the programme about three years ago after research found that up to 34% of women in Khayelitsha, Cape Town, suffered from post-natal depression.
”This statistic blew me away … It is no longer exclusively found among the rich, stay-at-home white women,” she said, contrasting the figure with the 10% to 18% prevalence in developed countries.
Honikman said one in three women in informal and low-income settlements such as Khayelitsha suffers from post-natal depression.
She said evidence shows that symptoms of depression found in post-natal women are manifest during their ante-natal (during the pregnancy) stage as well, and the project aims to ”screen” women at risk.
Risk factors — such as lack of a supportive partner, teenage pregnancy, violence, poverty, HIV/Aids, physical or substance abuse — are endemic in the country and compound the looming epidemic.
Honikman said women who are depressed or suffer from anxiety could, in extreme cases, physically hurt their children and themselves.
”Women may have difficulty in bonding with their babies, and the consequence for the babies can be long-term. Studies also showed babies were less likely to put on weight, didn’t develop cognitively as well, and can also have mental health problems.”
She said women with newborn babies are particularly vulnerable to depression, because they are physically tired, usually isolated from their social circle and have to care for another person full-time.
The pilot unit has screened 1 700 women, of whom about 25% qualified for counselling.
”Evaluations conducted on the pilot project indicate considerable success with the project receiving international recognition from the World Health Organisation.”
‘I needed someone to listen to me’
A mother of three from Khayelitsha, who benefited from the counselling, said that during her third pregnancy she did not know she was depressed.
”I was not happy at work [as a domestic worker in Rondebosch] … my boss saw and asked what was wrong, but I didn’t tell her because I didn’t know,” said Ntombomzi Mbovo.
She said when she became pregnant in 2003 with her baby girl, her employer took her to the Liesbeeck unit.
Mbovo went to several sessions during and after her pregnancy.
”It was my first time to speak to someone [professional]. I needed someone to listen to me … now I am fine, I can cope,” said Mbovo, adding that with her second baby she struggled even to change a nappy.
Mbovo felt her depression started when she fell pregnant with her first child at the age of 15, and was not adequately supported by her family.
Honikman said the project is ready to expand, with the Western Cape government indicating a willingness to help with a sister unit at the Hanover Park and Heideveld midwife obstetrics units.
The long-term vision is for a mental health service to be accessible to all women having maternal care in the state sector.
Dr Cynthia le Grange of the provincial health department said plans are not yet finalised.
”We support the idea, but the implementation is problematic at the moment,” she said, adding that the department is wary of ”creating expectations”.
Another interesting benefit of the project is dealing with the frustrations of nursing staff — who find themselves in a sector that has a ”dire need” of additional posts and who themselves are ”terribly underpaid”, according to nursing union Denosa.
Reports have surfaced of nursing staff shouting, swearing at and even hitting women, sometimes during labour.
”We have held numerous workshops where nursing staff discuss their own personal experiences of mothering and identify the needs and problems they had as patients. In this way, we hope that empathy can be meaningfully explored, and we try to look at ways in which, by using simple tools, their work can be more rewarding,” said Honikman.
Honikman said if nursing staff are expected to provide emotional support to their patients, they too required emotional support for the work they do and for personal difficulties in their lives. — Sapa