Maternal mental health in Nigeria: A silent pandemic

In May 2019, Nigeria Health Watch conducted a baseline investigation into the causes of maternal deaths in Nigeria. The specific aim of this sub-study was to investigate the mental health of pregnant women in Nigeria.

Women reported high levels of anxiety throughout pregnancy, with little to no support mechanisms or services available to them. God was often referred to as their only coping mechanism for worries and fears. In addition, women’s anxieties seemed to be particularly focused around labour and the fear of dying during labour. This was often exacerbated by reports and experiences of other women in their community dying during childbirth. 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 was the reality for many of the women interviewed.

Furthermore, where maternal deaths occurred in these communities (especially during labour), women generally lacked information on the causes of these deaths, which understandably generated further fears of labour. They also reported a lack of emotional and practical support during pregnancy (particularly from their partners). 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 (e.g., alcohol and substance abuse). These women also have an increased risk of obstetric complications and preterm labour and are less likely to seek and receive antenatal or postnatal care or adhere to prescribed health regimens. 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.

The findings of this baseline investigation therefore clearly make a case for routine perinatal psychosocial screening programs as part of a holistic perinatal care program in Nigeria, with clear and assertive perinatal treatment of maternal mental health. This plan should incorporate 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 antenatally and be counselled about pharmacological and other treatments during pregnancy.

Suggestions for a better and more sustainable maternal mental health care delivery in Nigeria

It is impossible to emphasise the importance of patient-centred maternal care. Women are often grappling with way too much during pregnancy 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, access to mental health care in Nigeria is limited. Improving access to care requires innovative approaches that deliver mental health interventions at the community level. One such innovative approach could be integrating mental health screening into existing community-based maternal health programmes targeted at pregnant women and their male partners.

Read also: Nigeria’s high maternal death rate, avoidable with skilled health professionals – Onyemelukwe

It is important to involve male partners in integrated mental services in maternity care because while health workers have a huge role to play, family relations are often mentioned as the strongest support systems by women who have had positive pregnancy experiences. Thus, male partners need to understand the psychological dynamics of pregnancy so they can provide knowledgeable support to their pregnant partners.

Another study explored the effectiveness of a church-based program that uses prayer sessions to recruit pregnant women into antenatal care early in their pregnancy, utilizes 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 huge gains to be had if religious houses can be co-opted to work with health workers and strengthen the psychological experience of pregnant women.

The government always has its role to play, refurbishment of health worker curriculum to become patient-centred and include strong maternal psychology components reside squarely in the policy and funding realm of Local, State and Federal Governments’ responsibilities. Policy and funding must drive these recommendations in a top bottom approach to complement the bottom-up behavioural change by health workers.

Ajala-Damisa & Oyebanji Obot are both programme managers at Nigeria Health Watch