Today, to mark World Maternal Mental Health Day, Grazia and the Maternal Mental Health Alliance (MMHA) are launching a new campaign to improve women’s access to mental health care during and post pregnancy. We’re asking the government to implement mandatory mental health check-ups as part of every prenatal and antenatal appointment.
Mental health problems are the most common complication of pregnancy and the postnatal period (affecting 1 in 5) and yet there is far less investment and attention compared to physical conditions like gestational diabetes (1 in 20) and pre-eclampsia (1-5 in 100). It’s also estimated that at least 1 in 5 women worldwide experience some sort of perinatal mood and anxiety disorder, and 7 in 10 women hide or downplay their symptoms. Suicide continues to be the leading cause of direct maternal death between 6 weeks and 12 months after birth, and accounts for a staggering 39% of maternal deaths. The rate of maternal death in the UK has risen by 15% in 10 years, with Black women 3.7 times more likely to die from pregnancy or childbirth compared to white women.
For Abigail Reynolds, a mother of two, mental illness plagued her life as a new mum, at one point causing her to experience suicidal ideation. ‘I developed an eating disorder after my first son was born,’ Abigail tells Grazia. ‘I was struggling with low self-esteem and was also very aware of having put on a fair amount of weight since having my baby. I found the first year of being a mum pretty stressful and isolating. I lost a lot of confidence and felt extremely lonely and anxious.’
I felt like I deserved to die, I was terrified something would happen to the baby.
Abigail Reynolds
Despite losing her periods as a result of her eating disorder, Abigail conceived again three years later and was terrified by how her mental illness might impact her growing baby. ‘I felt like the worst mother in the world; like I was completely undeserving of this miraculous little creature growing inside me, that I was starving this innocent being and risking its life because I was too selfish to eat and rest. I felt that I deserved to die, and I was terrified that something would happen to the baby.’
Abigail opened up to her midwife about her mental health struggles at every appointment, but never received support. ‘She always just measured my bump and said, “Well, the baby’s growing fine so you’re obviously managing to eat enough”. This wasn’t down to anything she did wrong as an individual, but simply down to the fact that due to a lack of education and awareness, eating disorders simply aren’t on the radar of the vast majority of perinatal professionals.’
And at six months pregnant when she opened up to a consultant who would perform her C-section, she firmly asked for help for an eating disorder. ‘The consultant’s response was, “You know you need to eat for the baby. You just need to park the eating disorder till after the baby’s born”, as though this devastating mental illness was just some sort of lifestyle fad.’
Abigail’s suicidal thoughts escalated, and at eight months she asked her GP for help and was referred to eating disorder services. She received community-based treatment, and her son was born healthy, but afterwards she required inpatient treatment at a mother and baby unit. Even in the unit, nurses admitted they had never worked with someone with an eating disorder. ‘Despite eating disorders having the highest mortality rate of any mental illness, and around 13% of new and expectant mums screening positive for disordered eating or an eating disorder, there was simply zero training, awareness or understanding of what an eating disorder really involved. It wasn’t fair on me as a patient or on these incredible professionals who are so committed and dedicated to trying to give women the best possible support,’ Abigail says.
Her story paints a bleak picture of maternal mental health care in the UK. In the last 10 years, thanks to national investment and commitment, there has been welcome progress in the availability of specialist perinatal mental health services for women with the most severe and complex issues. However, there is currently no routinely-funded provision for women with more common maternal mental health problems such as depression and anxiety. These more common conditions can have a devastating impact on the lives of women and their families.
‘When we say maternal mental health must be discussed at every appointment, we mean every appointment,’ says MMHA President, perinatal psychiatrist Dr Alain Gregoire. ‘Mum might not feel comfortable sharing how she really feels the first, second or third time. That's OK but we have to keep asking the question. The more we do, the more we normalise the conversation and the safer new and expectant mums will feel to speak openly....and we are then all contributing to reducing the harmful stigma and discrimination that surrounds mental health problems.’
‘Every contact a healthcare professional has with a new or expecting mum is a chance to sensitively ask about their mental health and make sure the 1 in 5 who need it get compassionate, potentially lifesaving support,’ Karen Middleton, Head of Policy, and Campaigns at the MMHA adds. ‘But health and social care services must be empowered and equipped to do so. What this means in practice is education and training for all midwives and health visitors, better integration of mental health care into those services, and urgently addressing the workforce gaps. This isn't a nice to have, it is essential. The human and economic consequences of failing to support mothers are too great.’
Clotilde Rebecca Abe, co-founder of Five X More, adds that the racial disparity in maternal care makes prioritising this issue the difference between life and death. 'Black women are four times more likely to die during pregnancy, birth and in the six week period after birth than white women,' she says. 'All women should be having post-natal checks ten days after they give birth. If women are not getting these checks, it can have fatal consequences. Suicide is one of the number one mental health killers in pregnancy so it is very important that we have proper checks that actually work. Not just asking "How are you?" but really reading the woman's body language and the words that she is using - truly understanding how she is and how she feels instead of asking her how she feels while looking at a computer, which happens too often. Cutting corners costs lives.'
We think mental health check-ins should be as standard as taking blood pressure. If you want to support Grazia and MMHA’s new campaign, we’ve written a template letter here that you can download, edit and send to your local MP asking them to support a policy change. To contact your local MP, visit WriteToThem.
As part of the campaign, mums are also posting about their mental health experience on Instagram, which you can see on Grazia’s parenting platform @TheJuggle, @GraziaUK, or @MMHA. If you want to get involved, tag us in your post with the hashtag #MMHAdvocacyDay.