A positive birth experience is not a luxury, but a necessity, said Hedieh Mehrtash, consultant for the Department of Sexual and Reproductive Health and Research at the World Health Organization (WHO), at a panel during the Maternal Mental Health Technical Consultation hosted by the United States Agency for International Development’s (USAID) MOMENTUM Country and Global Leadership, in collaboration with WHO and the United Nations Population Fund.
Much is still unknown about the connections between respectful maternity care and maternal mental health outcomes, said Patience Afulani, Assistant Professor at the University of California, San Francisco. Nevertheless, existing research indicates that women who have negative birth experiences are at higher risk of developing post-traumatic stress disorder, postpartum depression, and other perinatal mental health issues. “When women are treated in a way that is responsive to their needs, their preferences, and values; when providers are compassionate and respectful and supportive, a woman feels engaged in their care,” she said. “They feel satisfied. They feel valued. They feel empowered, which promotes positive emotional health.”
There is a complex “cyclic relationship” between respectful maternity care and maternal mental health, said Afulani. For example, due to provider discrimination, women with pre-existing mental health issues may be more likely to have negative birth experiences. Negative birth experiences may also deter women from seeking care in the future, making it less likely that mental health issues will be properly identified and addressed, she said.
Although supporting mothers and parents is incredibly important, “caring for the carers” is also essential, said Mary Ellen Stanton, Senior Maternal Newborn Health Advisor at USAID. Partially due to provider burnout, health care workers often lack the role models, skills, and resources needed to provide the highest standard of respectful care, said Charity Ndwiga, Program Officer III in the Reproductive and Maternal Health Program at the Population Council. When providers are burnt out, they are less able to communicate with and listen to patients. This damages the patient-provider relationship and can worsen health outcomes. In light of this reality, interventions need to target both mothers and providers, said Ndwiga.
Developing measurement tools is a crucial next step, said the panelists. Concerns about the impact of respectful maternity care on maternal mental health outcomes are widespread but evidence remains fairly anecdotal, said Dr. Mary Sando, Chief Executive Officer of the Africa Academy of Public Health. More research will help stakeholders “name and frame” the problem and determine its extent. This knowledge can then be used to develop solutions and inform implementation strategies, she said. For this to happen, research tools need to be consolidated, validated, and standardized, said Mehrtash. Tools must also be critically examined based on the context in which they are being employed, especially given that most mental health instruments were developed in high-income countries and are now being imported to low- and middle-income settings, said Afulani.
Nevertheless, this pursuit of further evidence does not preclude present action, said Afulani. We cannot wait until we have perfect measurement tools in place before beginning to think about the mechanisms driving provider stress and poor maternal outcomes, she said. Instead, stakeholders must recognize the ways in which research and advocacy can support each other and pursue the two in tandem, said Stanton. “Women will tell their stories, while the research provides a growing body of evidence about what works in different environments. That will encourage policymakers and healthcare providers and society at large to tackle these problems with skill, compassion, and respect.”