A commonly held myth is that the perinatal period — the period of time immediately before and after childbirth — is a naturally fulfilling phase in a woman’s life and consequently it’s abnormal to be depressed. 

Perinatal depression is known to affect as many as one in seven women but is, in fact, often overlooked or misdiagnosed even by experts. While research on perinatal mental health in India has witnessed a rise in recent years, important evidence gaps remain. 

“In India, more knowledge is there about postpartum depression which happens after one year of delivery. Perinatal depression isn’t even included in psychologist textbooks. Often counselors themselves cannot recognize the condition,” Priti Sridhar, CEO, Mariwala Health Initiative tells India Today.

“Perinatal mental health in India is not developed extremely well. Even though we know the problem is present and its impact on the pregnancy outcomes, as well as infant development, mother-infant dyad and family,” echoes Dr. Prabha S. Chandra,  a senior professor of psychiatry and in-charge of Perinatal Psychiatry Services, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, in a video presentation in 2019. 

Dr. Chandra has been instrumental in setting up the first dedicated prenatal psychiatric service in a public health setting, including a mother-baby inpatient psychiatric unit.

Perinatal mental health (PMH) problems include a range of mood and anxiety symptoms – this could be depression and guilt, loss of energy, restlessness and extreme irritability – during pregnancy or up to one year postpartum. The cause, however, could be a combination of genetic and environmental factors. The good news is, perinatal depression can be treated.

Then, there is postpartum depression (PPD), or what we call a more severe, postpartum psychosis. A 2018 World Health Organization (WHO) report mentions that PPD is a globally prevalent non-psychotic, depressive disorder that is known to affect about 22% of new mothers in India. There are quite a few women who undergo a phase called the ‘postpartum blues’, which is likely to last up to two weeks after the delivery, typically.

A WHO report further states  that in developing countries, pregnant women – about 15.6% during pregnancy and 19,8% after childbirth – experience a mental health disorder, depression being the most common.

If we delve further, it is estimated that one in five new mothers have postpartum depression or psychosis in India. The reality is that despite the surge in empirical studies on postpartum depression in India, there is a lack of robust systematic evidence that looks not only at the comprehensive burden of postpartum depression, but also its associated risk factors.

On its part, the government had introduced the Mental Health Care Act, 2017, which mandates mother-infant joint care when a mum is admitted for mental illness. However, there is a need to push innovative implementation and translational research to generate knowledge to further strengthen maternal mental healthcare systems. 

As the country is experiencing a steady drop in maternal mortality, we hope that the focus of care in the future will move in the direction of reducing maternal morbidity – and this includes maternal mental health disorders.

Maternal mental health: Impact of covid-19

The challenges posed by Covid-19 hinder and threaten the progress made in this sector, point out experts. In fact, the pandemic has also put a pause to the essential primary healthcare services for women resulting. This has resulted in increased healthcare disparities as per the initial results obtained by the National Family Health Survey round 5 (NFHS). 

Clinical Psychologist Dr. Prerna Kohli, Founder, Mindtree.in states that this has led to a variety of research and ongoing projects on improving maternal nutrition, and the effect of Covid-19 immunization, among others. There’s also the launch of a free course by the Indian government in an attempt to keep receivers and providers of maternal care educated. “Covid-19 has put a severe burden on the healthcare system of India, which has also brought us to the brink of healthcare collapse, thus pointing out the flaws in the healthcare system,” she says.

According to her, we need more human resources, infrastructure, higher and easier accessibility of healthcare, especially in rural as well as urban areas. “We must also be able to curate affordable services.”

There have also been reports of increased unplanned and accidental pregnancies as well as unwanted abortions in 2020. “This also points to increased demand for maternal healthcare services needed in the country, especially in the context of maternal mental health. Better budgeting and strict implementation of the aforementioned plans along with timely delivery of them is essential to overcome the problems that pose a threat to maternal mental health and healthcare in general,” adds Dr. Kohli.

Maternal mental health: Help at hand

In 2018, the White Swan Foundation for Mental Health, a not-for-profit organization, launched an eBook for expectant mothers on maternal mental health that highlights how to deal with postpartum depression and when to seek medical help for a mental health issue during pregnancy. 

The ground reality

The fact that the recent budget underscores the National Tele Mental Health Program points to the recognition of mental health challenges that have come to the fore during Covid-19 pandemic. However, if we look into the numbers, then the National Mental Health Programs (NMHP)  has received an allocation of Rs 40 crore. This number has remained the same since 2019-20. A lack of adequate support for mental health on priority has resulted in the allotted budget being largely underspent.

Mental health disorders in pregnancy and after childbirth are estimated to be twice as common in developing countries as they are in developed nations.

For instance, as per a 2021 WHO study, 10% to 15% of women in industrialized countries and 20% to 40% of women in developing countries suffer from depression during pregnancy or the postpartum period. The need of the hour is to prioritize maternal mental health.

It is only then that we will be anywhere close to achieving the United Nations Sustainable Development Goals by 2030. That’s some food for thought, indeed.

Those seeking medical expert guidance can reach out to NIMHANS’ perinatal psychiatric national helpline (81057 11277). Similarly, The Doula Collective Postpartum Support Initiative also extends the help of a free support group. The Green Oak Initiative: Chiguru perinatal mental health initiative can be contacted on 99726 65268/ 8042 40411.