Recently I was invited as a guest speaker at one of the Rotaract clubs of Rotary District 9211. The topic for that month in the district was maternal health so the opportunity was well-aligned with the sensitization we do at Malketha Maternal services. After clarification of all the logistics of the talk, I settled to prepare what I would say and how I would best express my point. I ran my presentation by a colleague and her first question was “What is Maternal Mental health?” I went on to explain what it was. Her question reminded me of someone who once said Maternal mental health is for “abalalu abazala abaana”, loosely translated to “mad women that have children”. At the time that remark was made, I laughed it off.
Later on, as this question was asked over and over each time I talked about maternal mental health, it ceased to be funny; it was confirmation of an information gap and stereotypes surrounding the topic/issue that needed to be addressed.
In 2011 in England, Martin Knapp and colleagues at PSSRU LSE carried out a broad-scope analysis on the economics of mental health promotion and prevention initiatives for the Department of Health. This work looked at the cost-effectiveness of more than a dozen interventions, from post-natal depression and anti-violent projects in schools, to workplace screening and suicide prevention. The study was commissioned by the Labor government and followed through by the Coalition. It had a big impact in England, being heavily cited in the subsequent national Mental Health Strategy in 2011. The results have been used for various targeted strategies such as suicide prevention and early intervention to reduce the risk of diabetes for people with depression. Overall, PSSRU helped raise awareness in other countries of the importance of the economics of mental health as a discipline.
After a quick explanation about Maternal mental health, my colleague’s next question was “But does it stop me from going to work and taking care of my family?” What she really was asking was is it a serious condition? Can’t I live with it? Is it the kind of health issue that you can see a doctor about? Does it affect my life in any evident way? Is it going to cost me money? Is it a priority?
Existing literature also indicates that healthier women and their children contribute to more productive and better-educated societies. Studies carried out document extensive literature confirming that women’s health is tied to long-term productivity: the development and economic performance of nations depends, in part, upon how each country protects and promotes the health of women. Providing opportunities for deliberate family planning; healthy mothers before, during, and after childbirth, and the health and productivity of subsequent generations can catalyze a cycle of positive societal development. In a country like Uganda where a large percentage of families are headed by single mothers, it is more than necessary to promote the health of these mothers.
For me and for Malketha Maternal services, what stands out the most is that the mental health of a mother can affect the health of subsequent generations. It’s not about the one individual, but about even the many that will come with and after her. A study found that grandmother’s stature and mother’s birth weight were the strongest predictors of the mother’s stature, which in turn has implications for the birth weight of their children. Currie and Moretti found that low maternal birth weight is associated with low birth weight among offspring, even among mothers who are sisters and therefore exposed to similar genetic material and environment.
While the evidence is mixed and relatively dependent on context, it’s not a secret that Maternal mental health and disorders affect the production of future human capital through increased risk of poor child health, including neonatal mortality, low birth weight, later stunting, and diarrheal disease. Although the evidence is mixed when it comes to common mental disorders, it is clearer when looking at severe mental disorders, like psychosis and schizophrenia. Offspring of mothers with these diseases have higher morbidity and mortality, suggesting a possible dose-dependent response to accumulation of risk that affects child development. The extent to which societies and cultures have different coping mechanisms and social support to look after the child when a mother (or father) falls ill will probably affect how much maternal mental health affects child health and well-being. To put it in simple terms, it’s a farmer watering their garden. Anything that affects the farmer affects the garden, the subsequent yield, the profit and the subsequent planting season.
Photo credit: NHS
My answer to my colleague’s question was not two paragraphs of research statistics. It was a simple yes. Yes it can stop you from going to work and taking care of your family. Yes it is a serious condition. Yes, you may live with it but it would affect not just you and your productivity but even that of generations to come after you. Yes it is the kind of health issue that people do see doctors about. It may not affect you in the way that measles does, but it’s equally critical.