Enforced isolation in the wake of the COVID-19 pandemic has compounded already high rates of perinatal depression and anxiety among many new and young mothers in low- and middle-income communities. But the recently launched platform Messages for Mothers (M4M) by the Perinatal Mental Health Project (PMHP) , based at the University of Cape Town’s (UCT) Alan J Flisher Centre for Public Mental Health in the Department of Psychiatry and Mental Health, is changing that.
PMHP, which was established in 2002, provides mental health services to pregnant and postnatal women.
M4M is a one-stop online resource developed in response to COVID-19 and the lack of targeted messaging for vulnerable mothers who are concerned for their children, families and themselves, said PMHP director, Associate Professor Simone Honikman.
In creating M4M, the PMHP teamed up with other organisations that work closely with mothers and have resources and experience in supporting mothers. These are Embrace, Flourish, Grow Great and Side by Side.
Many of the women they are targeting also face overcrowding, gender-based violence and food insecurity. On the M4M website, these women can find immediate help and information in three main areas: maternal and mental health, physical health, and parenting in the pandemic.
The platform curates simple content that answers common questions like “Must I wear a mask? Will I get a child support grant? How do I explain COVID-19 to my children?”, and provides links to essential advice, information and support. Besides physical health, parenting and mental health – including some resources on domestic violence – it offers specially crafted mindfulness podcasts and helpline repositories.
M4M’s work continues PMHP’s core mission, said Honikman.
This is to support the integration of quality maternal mental healthcare into mother and child initiatives in low- and middle-income settings. To accomplish their mission, they have four focus areas: advocacy for action, strengthening of maternal mental healthcare systems, generating knowledge and building the capacity of service providers.
High depression and anxiety rates
The stakes are high, said Honikman.
“Prior to COVID-19, the prevalence of depression and anxiety in pregnant and postnatal women was about one in three.”
“Prior to COVID-19, the prevalence of depression and anxiety in pregnant and postnatal women was about one in three. For each mental health condition separately, the rate was about one in five, but there’s a lot of co-morbidity. This is based on PMHP’s research at our service site in the Hanover Park Midwife Obstetrics Unit where we used diagnostic tools to assess for these mental health conditions.”
In communities such as Hanover Park, social dysfunction is characterised by high drug and alcohol abuse, gang wars, food insecurity and gender-based violence.
“We also want to address domestic violence as there has been an enormous escalation of this since lockdown, and the negative associations with mental health and maternal health, and child physical outcomes are well documented.
“There are so many terrifying things for under-resourced mothers to cope with.”
“Besides caring for young children under strained circumstances, there are so many terrifying things for under-resourced mothers to cope with.”
Honikman hopes the resources M4M provides will filter down into mother and caregiver networks.
‘Kind and supportive’
Mothers who access the M4M website are welcomed in an introductory video. Leaders of the alliance partners share a warm welcome and expressions of solidarity from their own homes or community settings.
“We’ve created M4M to help share the load by sharing information, tips and advice in a space that is evidence-based, kind and supportive,” explained the PMHP’s Liesl Hermanus.
During the lockdown, Hermanus still conducts telephonic counselling with existing clients and face-to-face sessions with “very vulnerable clients” or those without access to privacy or private phones. High-risk women are referred by midwives on a case-by-case basis.
To offset the limitations of high data costs, M4M has developed shorter graphic message versions of their articles. They’ve also used technology to shrink their audio resources, such as the mental health and mindfulness podcasts.
“We’re actively campaigning that the materials are made available on zero-rated websites.”
“We’re actively campaigning that the materials are made available on zero-rated websites and on the National Department of Health WhatsApp line,” Honikman noted. “We plan now to move into a phase of getting the messages out on radio, either as pre-recordings that can be prepared or with live interviews with experts who speak a range of South African languages.”
Since starting the M4M campaign, the most clicked resources have been:
Working with other partners, Honikman is also helping to develop the messaging component of the “National Framework and Guidelines for Maternal and Neonatal Care During a Crisis: COVID-19 response” for the director of Maternal and Neonatal Health at the National Department of Health, Dr Manala Makua.
This component has been designed to be adapted for potential future crises.
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COVID-19 is a global pandemic that caused President Cyril Ramaphosa to declare a national disaster in South Africa on 15 March 2020 and to implement a national lockdown from 26 March.
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