Originally published in the NewVision newspaper
In 2019, I met a young mother living in the slums of Kampala. She had dropped out of school due to the pregnancy and had been raped by the child’s father and his friend while pregnant. She was depressed and thought her prospects for a good future for her and her baby were non-existent. This young mother wanted to kill herself and be relieved from suffering.
Maternal Mental Health (MMH) conditions refer to a variety of mental health challenges that women suffer during pregnancy and in the first year after birth. These include depression, psychosis, anxiety, amongst others. It is estimated that 1 in every 5 women in low income countries like Uganda experiences MMH conditions. Many of these are hidden, with women not seeking for help.
Causes of MMH conditions include domestic violence, financial problems, biological issues or other trauma especially amidst limited social support from partners or immediate family. Poor MMH affects women, their babies and families, leading to higher risks of pregnancy complications, poor birth outcomes, poor nourishment and growth of the baby, less bonding with the mother, and it has been noted as a cause of suicide.
While this crisis has received more attention in high income settings, this has not been the case for low income countries, where cases are reportedly more. In 2021, a study amongst 2,652 pregnant women in eastern Uganda reported 5.8% as depressed (Nakku et al 2021). Another in south western Uganda found that midwives were not well trained in identifying and managing MMH challenges (Nakidde et al. 2023).
In this article I focus on depression. While conducting research on various aspects of maternal and newborn health, we frequently encountered mothers who were evidently depressed. Major categories included those who had premature births and were struggling with the associated strain of looking after a small and sickly baby, whose survival was uncertain. This was often amidst high pile up of medical bills and potential loss of a job during the long hospital stay. In rural areas, some of these mothers were alone in hospital, thus no social support.
Another deeply troubled group we came across in health facilities and communities were those who had suffered a miscarriage, stillbirth or lost a newborn baby. Expectedly, they were depressed and struggling to cope with the loss, with many not receiving any form of professional counselling. Infact, some had suicidal thoughts, just like the third group, who are the teenage mothers.
These teenagers that have had to become mothers early are particularly vulnerable in terms of mental health. They have multiple stressors, for instance dropping out of school, defilement, being abandoned by their families but also the father of the child, lack of money, an uncertain future and a general inability to cope with motherhood. Many teenage mothers I interacted with residing in the informal settlements (slum areas) of Kampala were depressed and anxious. Those who come for antenatal care sometimes have to walk long distances without food due to lack of money, thus attending irregularly and worsening chances of their baby’s survival.
Unfortunately, communities often react negatively when a mother or pregnant woman is depressed and for instance refuses to breastfeed or look after the baby, calling her spoilt or ungrateful. This is partly
because we do not know the signs of MMH conditions. We also tend to criminalize those who abandon babies, referring to them as evil and other such terms, instead of first understanding their state of mind and finding out what support they need.
It is prudent that we pay attention to the mental health of mothers and pregnant women in Uganda. Fortunately, many of these conditions are mild or moderate and can be easily prevented or handled. I suggest that as a nation and community, we need to have more awareness around maternal mental health conditions. These discussions should also happen within the family. We need to be able to identify these scenarios and understand what support the mothers need and where to refer them for appropriate care.
Additionally, health workers need to be taught about identifying these challenges, especially for groups that are already vulnerable. The World Health Organisation recommended that maternal mental health is integrated in maternal and child services, and this should be done in Uganda as well, including screening, care and referral as needed. Institutions like Uganda Police that handle cases of abandoned children or attempted murders by mothers also need knowledge and skills in handling these special challenges. Otherwise, mothers, babies and the country shall continue to suffer the physical, emotional and financial effects of maternal mental health conditions.
Dr. Doris K. Kwesiga