It is a registered fact that many Nigerian women go through pregnancy with high level of anxiety, and with little to no support mechanisms available to them. Often, these women only refer God as their only coping mechanism for worries during pregnancies.
This prompted the Nigeria Health Watch, in May 2019, to conduct a baseline investigation into the causes of maternal deaths. The specific aim of this sub-study was to investigate the mental health of pregnant women in Nigeria.
Besides, women’s anxieties seemed to be particularly focused on labour and the fear of dying during childbirth. This was often exacerbated by reports and experiences of other women in their neighbourhood dying during childbirth.
This plan should integrate early antenatal and postnatal psychosocial assessment with ongoing mental health monitoring across all maternity and postnatal settings
Giving birth at home or in a community space, with little to no professional healthcare equipment or personnel, as well as long and often dangerous travel to potential medical facilities were the reality for many of the women interviewed.
Furthermore, where maternal deaths occurred in these communities, especially during labour, women generally lacked detailed information on the causes of these deaths, which understandably generated further fears of childbirth in them during pregnancy.
According to the report, we discovered that a lack of emotional and practical support during pregnancy from their spouses is another point of concern to these women. It was apparent that women’s mental health and emotional experiences are not addressed in any antenatal or postnatal care.
However, mental health problems such as anxiety disorders during pregnancy and after childbirth are no trivial conditions.
Pregnant women or mothers with mental health problems often have poor physical health and may have persistent high-risk behaviours, for instance, alcohol and substance abuse.
These women also have an increased risk of obstetric complications and pre-term labour and are less likely to seek and receive antenatal or postnatal care or adhere to prescribed health plans.
Mental health problems in pregnant women and mothers can thus lead to increased maternal mortality, both through adversely affecting physical health needs as well as more indirectly through suicide, with suicide being one of the leading indirect causes of maternal death in developed countries.
Therefore, we advocate for routine perinatal psychosocial screening programmes as part of a holistic perinatal care programme in Nigeria, with the clear and assertive perinatal treatment of maternal mental health.
This plan should integrate early antenatal and postnatal psychosocial assessment with ongoing mental health monitoring across all maternity and postnatal settings.
Women with mental health problems should be offered a mental health assessment antenatal and be counselled about pharmacological and other treatments during pregnancy.
Furthermore, there should be in place a better and more sustainable maternal mental health care delivery across all hospitals, and health centres in the country.
The importance of patient-centred maternal care cannot be over-emphasised, and the behaviour of health workers should not be anywhere on their list of worries.
Health workers are often seen to be only concerned about the clinical success of delivery and often neglect the psychological roller-coaster pregnant women experience.
Although the prevalence of mental health challenges in Nigeria is comparable to most developed countries, but access to mental health care in Nigeria is limited.
Nevertheless, we plead the authorities concerned to improve access to care, which requires innovative approaches that deliver mental health interventions at the community level.
One of such innovative approaches could be to integrate mental health screening into existing community-based maternal health programmes targeted at pregnant women and their male partners.
We believe that it is important to involve male partners in integrated mental services in maternity care because while health workers have a huge role to play, relations are often mentioned as the strongest support systems by women who have had positive pregnancy experiences.
Hence, male partners need to understand the psychological dynamics of pregnancy so they can provide learned support to their pregnant partners.
Another way could be to explore the effectiveness of a church-based programme that uses prayer sessions to recruit pregnant women into antenatal care early in their pregnancy, utilises baby shower activities to deliver multiple health interventions including health education and integrated laboratory testing, and baby receptions to follow up with the women and link them to continuing care after delivery.
This is an innovative case of not throwing the baby out with the bath water. Religious houses and beliefs have long been implicated in being the root cause of many poor health-seeking behaviours due to the strong impact faith has on many people, Nigeria inclusive.
Imagine the massive gains possible if religious houses can be co-opted to work with health workers and strengthen the psychological experience of pregnant women.
We strongly believe here that the government at all levels has roles to play in achieving this goal through improvement of health worker curriculum to become patient-centred and include strong maternal psychology components to reside squarely in the policy and funding realm of local, state, and Federal Government’s responsibilities.
Policy and funding must drive these goals in a top-bottom approach to complement the bottom-up behavioural change by health workers.