Resource Library

Summary

Mental health and psychosocial support (MHPSS) during the perinatal period is a global issue. This period is characterized by high risk of depression, anxiety, and somatic disorders – often referred to as common perinatal mental disorders (CPMDs) with one in six pregnant women and one in five postpartum women impacted by a mental health and psychosocial concern during pregnancy or in the first postnatal year.

Highlights

In humanitarian settings, these risks are often amplified by adversity and destabilizing factors including political instability, violence, loss, poverty, and migration. While MHPSS needs occur throughout the life course, the focus of this brief will be the perinatal period, as during this time, these illnesses can have severe, and even intergenerational effects, on maternal and newborn health (MNH) and development. The perinatal period is also a critical time when women are more frequently interfacing with health staff, allowing for more timely identification of mental health and psychosocial concerns and referral for appropriate support.

How to Use

Collaborating for Maternal Mental Wellbeing: Technical Brief on Perinatal Mental Health in Humanitarian Settings from the IAWG Maternal and Newborn Health Sub Working Group aims to provide an overview of MHPSS perinatal mental health in emergency response, present relevant resources, suggestions for improving collaboration and provision of perinatal mental health, examples of service delivery collaboration, and culminate with a call to action to progress momentum for peri­natal mental health.

Summary: This paper summarizes a WHO-led global initiative to develop and scale up a sexual, reproductive, maternal, newborn, child, and adolescent monitoring and evaluation framework for humanitarian settings. Researchers propose 17 maternal health indicators and 14 newborn health indicators aligned with global monitoring frameworks, split into core vs context-specific lists.

Highlights

• For maternal health, researchers identified seven core, six context-specific, and 4 service readiness indicators for humanitarian settings. 
• For newborn health, researchers identified seven core, five context-specific, and two service readiness indicators for humanitarian settings.

How to Use: Implementing agencies and partners can collaborate to scale up this agreed-upon set of SRMNCAH framework to enhance accountability and transparency in humanitarian settings. Through cross-sector coordination, stakeholders can improve existing data collection and reporting systems in humanitarian settings that are generally fragmented and inconsistent.

This resource, written by the IAWG Maternal and Newborn Health sub working group, outlines interventions implemented in stable settings that maternal and newborn health (MNH) providers and program managers in crisis-affected settings have identified as promising strategies for humanitarian settings. While respectful maternity care (RMC) is being incorporated in some humanitarian and fragile settings, more evidence around the implementation and effectiveness of these interventions for diverse populations including host communities, refugees, internally displaced persons, young mothers, and other vulnerable groups is needed. This brief can be used as a tool to improve and promote RMC in fragile and conflict-affected settings. 

To support countries in adapting their response to different COVID-19 scenarios, the World Health Organization (WHO) Department of Maternal, Newborn, Child and Adolescent Health and Ageing commissioned this scoping review of published and grey literature. The objective was to identify interventions implemented to maintain the provision and use of essential services for MNCAAH during disruptive events and to summarize lessons learned during these interventions. The review included outbreaks of Ebola virus disease (EVD), severe acute respiratory syndrome (SARS), Zika virus disease (ZVD), the ongoing COVID-19 pandemic, and natural disasters and humanitarian emergencies that caused disruption to services, transport and other activities.

A summary of USAID’s MOMENTUM Maternal Mental Health Technical Consultation and the way forward supporting the mental health of mothers in humanitarian and fragile settings.

The “Giving Voice to the Silent Burden: Maternal Mental Health Technical Consultation”, conducted in September 2021 and hosted by USAID’s MOMENTUM Country and Global Leadership (MCGL), in collaboration with the World Health Organization and United Nations Population Fund, was a pivotal three-day convening that brought together members of the maternal, newborn, child health, nutrition, humanitarian and fragile settings, and mental health communities to collaborate and inform the path forward for maternal mental health to ensure that pregnant and postpartum women, and their families, receive the respectful and nurturing care they need and deserve. Key discussions included an overview of the global burden of CPMDs and current evidence on effective interventions, country experiences introducing and scaling up maternal mental health programs, integrating mental health care into existing service delivery platforms, strengthening provider capacity to deliver maternal mental health care, and the role of community, civil society, and faith organizations in supporting mental health.

Landscape Analysis Brief

This landscape analysis brief, published in October 2021 and developed by USAID’s MOMENTUM Country and Global Leadership (MCGL), describes the current state of perinatal mental health and the burden of common perinatal mental disorders for women, newborns, and families in low- and middle-income countries (LMICs). To date, mental health has lacked proper attention in the health sector in terms of funding and action. The perinatal period is associated with an elevated risk of mental health conditions – women with a history of a major postnatal depression had a 25% risk of a recurrence in a subsequent pregnancy,[4] and postnatal depression is a major risk factor for maternal death by suicide, accounting for 20% of mortality in the year after childbirth. [5] Perinatal mental health conditions have also been associated with adverse physical, emotional, and neurological development in newborns and children. [6] Studies from LMICs found that depressed mothers had a higher risk of preterm births and low-birthweight babies. [6] The presence of CPMDs in mothers also appears to increase the risk of stunting and wasting in children. [7] There also appears to be an association between CPMDs and the extent to which mothers seek immunization services or care for ill children. [8]

Key Findings

• Mental health remains underfunded and often ignored in the face of more visible physical health concerns. The global treatment gap for mental health disorders is estimated at nearly 90%.[1]
• CPMDs pose significant and lasting implications for women’s health and quality of life, and have been associated with adverse development in newborns and children.[2]
• Perinatal mental health needs to be better integrated across multiple health sectors and sectors outside of health, away from centralized institutions to the primary care and community level, and into health care provider education and practice.
• Future research should include findings from different contexts, avoid inappropriate generalization, generate more evidence for vulnerable populations, expand beyond postnatal depression, center on the expressed desires of women, and explore integrated approaches that improve both women’s and children’s health at scale.

The following sessions from the technical consultation highlighted select key and emerging evidence. Note that to view all consultation session recordings, including those listed here, you must register.

Highlighted Sessions

• Common Perinatal Mental Disorders: Current Evidence and Gaps. This panel discussion covered what evidence exists, and what we know works, from various perspectives, and identified areas for further research or implementation learning.

• We need to understand the many context-specific factors, including gender and family dynamics, social pressures, and localized knowledge and conceptualizations of mental health, that impact perinatal mental health.
• Measurement tools have been developed and validated in higher income settings, and the language used may not translate appropriately into other contexts.
• Targeted, low-intensity interventions delivered by non-specialists (supported by training and effective supportive supervisory systems) at the public health care level can reduce the treatment gap in LMICs.

• Evidence and Gaps for Women in Fragile and Crisis-Affected Contexts. In this session, speakers reviewed current evidence and reflected on gaps in approaches for addressing CPMDs in fragile and crisis-affected settings, including for displaced populations and those living in areas affected by conflict and complex emergencies. Participants and panelists explored how needs and service delivery platforms may vary across different types of settings and discussed priorities for strengthening maternal mental health programming.
  • Local terms for mental health conditions vary from country to country. We must understand local terms and engage local people to help, to provide effective treatment.
  • Sequential care, or treatment for one issue at a time, is problematic because many people are coping with multiple mental health-related issues. The Common Elements Treatment Approach treats conditions simultaneously and customizes the response by using different solutions for each condition a person may have.
  • Greater investment is needed in lay people who come from the communities they serve, and who are trained to respond to mental health issues, to sustain services.

• Overlapping Risks: Evidence and Gaps for Vulnerable Populations. This session reviewed the current state of evidence around perinatal mental health for vulnerable populations such as adolescents, women experiencing gender-based violence (GBV), minority populations and women living with HIV. Speakers discussed global initiatives, contextualized programming, and outstanding knowledge and program gaps. They drew lessons from diverse vulnerable populations and identified areas that must be addressed to better include and support these vulnerable women and girls.
  • Use youth as navigators and consider them key development partners to co-design mental health programs and contextualized approaches. Greater involvement of adolescents in program decision-making yields better results.
  • A research study in Ethiopia found significant marginalization exists among migrant workers, which have led to high levels of depression associated with violence and social isolation.
  • A research study on perinatal mental health in rural Rajasthan, found that women with co-morbidities, women experiencing IPV, and women from low-income families are vulnerable to poor well-being outcomes. In addition, there is a need for an integrated interventions that deal with mental health, GBV, and suicidal ideation.
  • There is a strong need to integrate men and boys, and the community, into mental health programs to ensure they are equal partners in improving women’s mental health.

• Interventions Addressing CPMDs through the Continuum of Perinatal Care: Evidence and Gaps. This session presented evidence from a variety of interventions in one South Asian, one Southeast Asian and two African countries, that address the needs of women during and after pregnancy. Speakers touched on when and how women were screened for CPMDs, linkages with appropriate care, post-intervention follow up, and intervention outcomes. Speakers discussed care provided at community and facility levels by trained community health workers, peer counselors, and nurses/midwives.
  • Mental health programs have historically been siloed and difficult to scale. Systems-wide change is needed.
  • Support systems are critical for maternal mental health interventions. Community health workers, midwives, and other healthcare workers need support systems to effectively task shift and scale programs for their own mental health.
  • Maternal mental health requires significant advocacy to reduce shame and stigma, for policy-change and scale-up, and for resource mobilization and financing.

About the Series

The Self-Care Learning and Discovery Series, held June 24-August 27, 2021 was a highly interactive, virtual forum where participants exchanged and incubated ideas, experiences, and solutions on a variety of self-care topics. Hosted by White Ribbon Alliance (WRA) on behalf of the Self-Care Trailblazer Group (SCTG), the Self-Care Learning and Discovery Series presented new knowledge, elevated self-care solutions, forged connections across issues and geographies, and much more! The series was open to all interested self-care stakeholders, including advocates, health providers, government representatives, implementers, journalists, community leaders, academia, product developers, feminists, youth champions, and more. There was no fee to participate.  

Sessions

The Self-Care Learning and Discovery Series included 16 virtual sessions, organized by diverse partners from around the world, that explored a different self-care topic. Each session featured examples and discussions of self-care evidence, advocacy, and practice through interactive panels, participatory dialogues, and more. All sessions are available in English, French, and Spanish and include English closed captioning. 

Please continue to visit the Self-Care Learning and Discovery Series platform to access self-care session recordings and resources that can be easily downloaded and shared at no cost. 

These seven knowledge-to-action briefs support partners to carry forward the PMNCH Call to Action on COVID-19, which aims to increase investment and policy support to mitigate the devastating effects of the COVID-19 pandemic on the health of women, children and adolescents, and the societies and economies that support them. The knowledge-to-action briefs synthesize relevant evidence to the COVID-19 Call to Action, focusing on:

1. key impacts of COVID-19
2. policies and mitigation strategies
3. strategic gaps in knowledge and action, including in humanitarian and fragile settings. 

A comment on “Impact of COVID-19 on maternal and child health” in Lancet Global Health

The Roadmap to Accelerate Progress for Every Newborn in Humanitarian Settings seeks to address newborn heath across these diverse contexts, with recommendations that can be applied generally, but can also be relevant to some specific contexts more than others.

This roadmap was developed with input from more than 80 individuals, led by a Steering Committee with a strong stake in improving maternal and newborn health in humanitarian contexts including non-governmental, UN, academic, and donor agencies. A multi-sectoral experts meeting was held in February 2019 to validate the critical needs, challenges, and opportunities highlighted in this roadmap for newborn health in humanitarian settings.

The result of a collaborative and consultative process engaging hundreds of representatives from United Nations agencies and non-governmental organizations that make up the Inter-Agency Working Group on Reproductive Health in Crises (IAWG). Based on guidelines issued by normative bodies, particularly those of the World Health Organization, the 2018 IAFM incorporates specific evidence from, or examples about, the application and adaptation of global SRH or human rights standards in humanitarian settings. The 2018 IAFM reflects the wide application of the manual’s principles and technical content beyond refugee situations, extending its use into diverse crises, including conflict zones and natural disasters. 

This Field Guide is a companion to the Inter-agency Field Manual on Sexual and Reproductive Health in Humanitarian Settings (2018), providing information related specifically to newborn care during the neonatal period (days 0-28). The interim Field Guide was originally published in 2015. After field-testing in two humanitarian crises (South Sudan and Somalia) and soliciting extensive feedback from practitioners, it was revised in 2017 and published in January 2018. The Field Guide has been designed as an enhancement to national
strategies and programs aimed at improving the lives of newborns and their mothers, and to strategies such as the Every Newborn Action ABOUTNewborn Health in Humanitarian Settings: Field Guide 9 Plan (ENAP).1 We encourage its use in advocacy and strengthening efforts of existing country programs for newborn care, regardless of whether such programs were developed in response to humanitarian crises or as permanent systems during times of stability. The Field Guide can also be used for the development of the neonatal component of national emergency preparedness and response plans. Our ultimate aim is to improve the survival and wellbeing of newborns in humanitarian settings.