By Wendell Roelf
For growing numbers of South African women, pregnancy is not something to celebrate - it is a desperate descent into depression and anxiety.
"In the South African setting we have a recipe for an epidemic of perinatal mental health problems," said Dr Simone Honikman, director of the Perinatal Mental Health Project at Liesbeeck midwife obstetric unit in Cape Town.
The pilot project offers free individual counselling with the aim of improving symptoms and preventing mental health problems from getting worse, and to prevent those at risk from developing perinatal mental health problems.
Honikman started the programme about three years ago after research showed up to 34 percent of women in Khayelitsha suffered from post-natal depression.
"This statistic blew me away... It is no longer exclusively found among the rich, stay-at-home white women," she said, contrasting the figure with the 10 percent to 18 percent prevalence of post-natal depression in developed countries.
Honikman said evidence showed that symptoms of depression found in post-natal women were manifest during their ante-natal (or during the pregnancy) stage as well, and the project aimed to "screen" women at risk.
Risk factors - such as lack of a supportive partner, teenage pregnancy, violence, poverty, HIV and Aids, physical or substance abuse - were endemic in the country and compounded the looming epidemic.
Honikman said women who were depressed or suffered from anxiety could, in extreme cases, physically hurt their children and themselves.
"Women may have difficulty in bonding with their babies and the consequence for the babies can be long-term. Studies showed babies were less likely to put on weight, didn't develop cognitively as well, and can also have mental health problems."
She said women with newborn babies were particularly vulnerable because they are physically tired, often isolated from their social circle and had to care for another person.
The pilot unit has screened 1 700 women, of whom about 25 percent qualified for counselling.
"Evaluations conducted on the pilot project indicate considerable success with the project receiving international recognition from the World Health Organisation."
Ntombomzi Mbovo, a mother of three from Khayelitsha, who benefited from the counselling, explained that during her third pregnancy she did not know she was depressed.
"I was not happy at work as a domestic worker in Rondebosch... my boss saw and asked what was wrong, but I didn't tell her because I didn't know."
Mbovo said when she just became pregnant in 2003 with her baby girl, her employer took her to the Liesbeeck unit. She continued with the sessions during pregnancy and after.
"It was my first time to speak to someone professional. I needed someone to listen to me... now I am fine, I can cope," she said, adding that with her second baby she struggled even to change a nappy.
But Mbovo felt her depression started when she became pregnant with her first child at the age of 15, and was not adequately supported by her family.
Honikman said the project was ready to expand, with the Western Cape government indicating a willingness to help with a sister unit at the Hanover Park and Heideveld midwife obstetrics units.
The long-term vision is for a mental health service to be accessible to all women having maternal care in the state sector.
Cynthia le Grange, a doctor of the provincial health department said plans were not yet finalised.
"We support the idea but the implementation is problematic at the moment," she said, adding that the department was wary of "creating expectations".
Another important benefit of the project was dealing with the frustrations of nursing staff - who find themselves in a sector that had a "dire need" of additional posts and who are "terribly underpaid", according to nursing union Denosa.
Reports have surfaced of nursing staff shouting, swearing and even hitting women, sometimes during labour.
"We have held numerous workshops where nursing staff discuss their own experiences of mothering and identify the needs and problems they had as patients. In this way we hope that empathy can be meaningfully explored, and we try to look at ways in which, by using simple tools, their work can be more rewarding," said Honikman.
Honikman said if nursing staff are expected to provide emotional support to their patients, they too required emotional support for the work they did and for personal difficulties in their lives. - Sapa
- This article was originally published on page 11 of Cape Times on May 31, 2005