Integrate pregnant women with mental illness into all health care programs

The Chronicle

Gibson Mhaka, Senior Reporter

The story of a mentally ill mother who gave birth before the baby fell into a toilet bowl and died at Mpilo Central Hospital in Bulawayo following alleged negligence by nurses has caused sadness reading.

This was after nurses allegedly left the mentally ill 21-year-old mother to give birth unattended.

The horrific incident happened on December 30, 2021 after Nkulumane 12’s wife who was allegedly deprived of nurturing care due to her mental disability gave birth and decided to use the toilet where her baby was later trapped in the bowl.

His brother Lindelwe Maduma called the incident “gross negligence”.

“According to some pregnant women who were with her, she started experiencing extreme labor pains around 3am.

“While writhing in pain, she cried out for help, but no one came to help her. At around 5 a.m., when the pain became unbearable, she then got out of bed and went to the bathroom. As she was trying to relieve herself, that’s when the baby came out and fell into the toilet bowl,” Lindelwe said as she struggled to hold back tears.

This sad incident is a reflection of the fact that although women with disabilities may face unique challenges in pregnancy care, those with mental health conditions have been largely ignored when it comes to accessing pregnancy care services. maternal health care and reproductive health care. They are often thought not to be sexually active and less likely to marry or have children than other women with disabilities.

These beliefs may stem from the perception that women with disabilities are either ‘passive recipients of help’ or ‘patients’ unable to marry or give birth.

According to new mortality estimates recently released by UNICEF, the World Health Organization (WHO), the United Nations Population Division, UNFPA and the World Bank Group, about 2.8 million pregnant women and newborn babies die every year, or one in 11 seconds, mostly from preventable causes.

Although Zimbabwe, like all states in the Southern African Development Community (SADC), has made regional and national pledges to at least have maternal deaths or to ensure the rate is 70 per 100,000 live births by 2030, as stipulated in the Sustainable Development Goals (SDGs), it is important to note that the intersection between mental illness and maternal health care has not garnered much attention in Zimbabwe.

Although there have been a series of progressive programs implemented by the Ministry of Health and Child Welfare in recent times recognizing the right to reproductive choice of women with disabilities, unfortunately the programs have not had much addressed the issue of reproductive rights of women with intellectual disabilities. diseases.

This is despite the fact that one of the most comprehensive statements of the rights of people with mental illness is found in the United Nations Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care, 1991 .

Focusing on the 1991 principles, the WHO has formulated 10 fundamental principles of mental health care legislation.

One of the most important principles is that there should be no discrimination on the basis of mental illness and that all people with mental illness have the same rights to medical and social care as everyone else.

Mental health campaigner Miss Zenani Masuku, who is also the executive director of the African Institute to End Bullying, Depression and Suicide (Afribis), said women with mental illness encounter negative attitudes about pregnancy and parenthood from many sources, including family members, health care providers, and the general. Public.

Miss Zenani Masuku

“The specific needs of women with mental illness are unlikely to be addressed in mainstream sources of pregnancy and parenting information, such as popular books, magazines and mobile apps. The government must integrate maternal mental health into primary health care so that women with mental illness are supported before, during and after pregnancy,” Ms. Masuku said.

It is important to note that although the government advises women to give birth in health facilities, demographic data indicates that mothers with mental health conditions have faced significant difficulties in accessing health care and support. before, during and after pregnancy.

Numerous studies conducted in low- and middle-income countries have shown that women with mental illness feel the desire for motherhood as much as women without special clinical needs. Often their fertility is not affected by the disability and they can have children.

Another mental health activist, Ms. Gamuchirai Chinamasa, said that women with mental health problems face additional disadvantages compared to women with other forms of disability, as they face discrimination due to their sex and their disability.

“Women with mental illness have a higher risk of adverse pregnancy outcomes and should be considered an at-risk group. More knowledge and awareness programs and training of health workers on what mental health is and the care that can be offered to manage common mental health problems is widely needed to minimize health risks to women having mental problems.

“There is also a need for funding for those who cannot afford it. The lack of knowledge means that most of the time they don’t know the indicators of the problem and how to help the victims, when and where they can seek help,” Ms Chinamasa said.

According to Dr. Mazvita Machinga, a mental health specialist, women with mental illness are not fully supported during pregnancy, nor are their reproductive rights fully integrated into the country’s health programs.

She said healthcare providers are often not trained to provide reproductive care to women with mental illness.

“There are no trained clinicians to work to meet the needs of such a population and my experience has shown that nurses and even doctors do not have adequate training to help women, they are just the psychiatric health care workers who are supposed to help and often they are not in most health care facilities with these kinds of people.

“It’s because these women often don’t have relatives who help them or who are committed to helping them and there is a stigma towards being mentally ill and when they don’t take their medication.

“Families don’t take them seriously, so their needs often go unmet.

“Sometimes they miss their appointments. They do not know or do not know that they need care. The problem of mental illness stigma prevents them from receiving help,” said Dr Machinga.

She said providers who have specialized training may not be located near all women with mental illness who need their services.

On what should be done to address these challenges, Dr Machinga said: “Addressing the issue of stigma is necessary to enlighten society about mental health issues.

“There is a need to embed mental health literacy into all maternal care programs so that nurses, doctors and others learn how to respond. Educate families on how to travel with their loved one when pregnant

“Mental illness is vast. I think people only think of schizophrenia, but when we talk about mental disorders, we talk about depression, anxiety, substance use disorders, post-traumatic stress disorder (PTSD) and others, all this can affect access to care, so it is important that women are educated and perhaps an assessment of their needs will be made”.

From her observations, it is clear that the exclusion of women, particularly those with mental illness, from public health programs and services remains a neglected and unaddressed public health and human rights challenge in the developing countries like Zimbabwe.

Clearly, there is a need to address the neglect of mental health advocacy at multiple levels to ensure that the issue also moves up the political agenda.

Mental health advocates should point out that government budgets provide sufficient funding to cover mental health service needs in the country.

About Antoine L. Cassell

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