The mental health of pregnant women can be affected by a range of factors, including partner violence and unemployment. But one of the key drivers that adversely affects a pregnant woman's mental health is food insecurity. Being food insecure is when someone doesn't have food or has the wrong kinds of food.
We set out to explore the factors that affected common mental health problems in pregnant women. These included intimate partner violence, unemployment and food insecurity. We found that women who don't get enough to eat when they are pregnant face a high risk of developing mental illnesses like depression and anxiety during pregnancy and after giving birth. And they are likely to have suicidal thoughts during this time too.
The South African Government provides social grants to mothers who meet certain low-income criteria after the birth of their babies. But, based on our findings, we would argue that women should be eligible for poverty alleviation support while they are pregnant. This would benefit them physically and emotionally. Research from a range of developing countries shows that providing pregnancy support grants benefits mothers and their children.
Based on these findings, and our own research, our view is that mental well-being and food security policies should be rolled out together as part of an antenatal care package for women. This is important because managing the mental health of mothers' can help children develop better.
Pressures of poverty
In South Africa more than 40% of the population lives below the poverty line. This means that many families in poor communities don't have enough to eat, or don't have access to healthy food.
Often the food they buy doesn't last the entire month which means that they skip meals or eat less food because there isn't money for more. Recent statistics show that two in every ten South African families run out of money for food before the end of the month.
Hanover Park has high rates of unemployment, alcohol and substance abuse, physical and sexual violence, child abuse and neglect.
Our research found that almost half the pregnant women attending the Hanover Park Midwife Obstetric Unit were food insecure.
In the group of nearly 400 pregnant women, about 22% were depressed while 23% had an anxiety disorder; about 10% of women had both common mental disorders. Moderate to high risk levels of suicidal thoughts or behaviours were present in 18%. Being food insecure more than doubled the chance of a pregnant women developing depression or an anxiety disorder and was very strongly associated with previously having attempted suicide.
We also found that many women who had had their second, third or fourth child and lived in families with minimal income felt overwhelmed and hopeless at the prospect of bringing another child into the world.
There are both short and long-term consequences of untreated mental illness in pregnant mothers.
Women with mental illness may find it challenging to use optimally existing services, including health services. Untreated depression in pregnancy has also been shown to be linked to premature birth and low birth weight.
After giving birth, mothers may have difficulty caring for themselves or their babies. Pregnancy is a critical window of development for a baby. When women develop mental health problems during pregnancy and after birth it may affect this window. If a new mother isn't able to connect emotionally with her baby, in some cases neglect, or even hostility towards the baby can follow. Breastfeeding may also be affected.
These all matter for the healthy development of a child. If they're deprived of these inputs they can, in the longer term, develop social, emotional and behavioural problems.
Solving the problem
The first big challenge is that public health and social service systems need to be revamped. Public health systems are aimed at decreasing maternal mortality rates. They're equipped to help pregnant women deal with challenges such as HIV, massive blood loss or high blood pressure. But mental disorders, which occurs in 20-40% of pregnant women living in poor communities, often go unattended.
Our view is that common mental health problems should be detected and managed in routine maternity care settings. Non-specialist care providers, who have been properly trained and supervised, could use brief screening tools to detect problems and provide onsite counselling to women who need it.
But helping mothers cope with mental illness also needs government intervention to ensure that they don't go hungry. This may be addressed by a social grant that begins in the antenatal period. This is only likely to have a meaningful impact if it has all components - the social, the physical and the mental.
Dr Zulfa Abrahams receives funding from Harry Crossley Foundation.
Simone Honikman works for the Perinatal Mental Health Project in the Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town. She receives funding from several philanthropic organisations and the Department for International Development, UK.