The guide, the first of its kind, gives advice to health care providers on how to offer high-quality mental health services to women during pregnancy and after birth
"The package of PMH care in a stepped-care approach includes interventions for mental health promotion and prevention of mental health conditions during the perinatal period, identification of mental health conditions and treatment.” WHO guide for integration of perinatal mental health in maternal and child health services
The WHO guide for integration of perinatal mental health in maternal and child health services aims to provide the best available information to support maternal and child health (MCH) providers to identify and treat mental health problems in pregnant women and new mothers.
It is designed to help providers to “develop and sustain high-quality, integrated mental health services for women during the perinatal period,” which it defines as the period as covering the duration of pregnancy and the year after birth.
The guide notes that poor mental health during the perinatal period is associated with “higher risks of obstetric complications” and “a poor birth outcome, such as low infant weight” as well as “greater risks for physical illnesses and emotional and behavioural difficulties in childhood.”
Maternal and child health (MCH) services during the perinatal period, the guide says, “provide a unique opportunity for service providers to connect with women and provide support.”
Some women are at greater risk of mental health problems during the perinatal period, the guide says. Poverty, adolescent pregnancy, gender discrimination, gender-based violence and substance use are among the risk factors listed. Factors that protect against mental ill-health, the guide says, include strong social support, educational opportunities, opportunities for generating income, positive childbirth experiences and high-quality MCH services.
As well as providing background information about the incidence, risk factors and symptoms of different perinatal mental health conditions, the document offers guidance on provision of care; integrating perinatal mental health (PMH) care into MCH services; providing tailored care for vulnerable groups; and monitoring and evaluating perinatal mental health services to make sure they are effective.
The guide recommends a stepped care approach to providing care for women with perinatal mental health problems. This approach “ensures provision of less resource-intensive evidence-based interventions to the majority of people.” It goes on: “Interventions that require increasing resources are provided to those with greater mental health care needs. The package of PMH care in a stepped-care approach includes interventions for mental health promotion and prevention of mental health conditions during the perinatal period, identification of mental health conditions and treatment.”
As an example of a successful stepped care approach, it cites the experience of Chile, in which guidelines were issued for early detection and treatment of depression during pregnancy and the postnatal period. Midwives and nurses carry out screening for depression, and they are able to refer to a general practitioner or psychologist to confirm a diagnosis. “Women with moderate-to-mild symptoms are seen in primary care in individual or group therapy, and psychotropic medication is provided as needed. Women who respond well to treatment are followed up for at least 6 months before being discharged from the programme,” the document says.
The guide also emphasises the importance of respectful care during pregnancy and labour. It notes that abusive care has been documented in maternity settings throughout the world, and includes physical abuse, such as slapping, verbal abuse, non-consensual care and abandonment. “Services are responsible for ensuring that such behaviour is not permitted and that mechanisms to bring perpetrators to account are in place. Women should be made aware of their right to respectful care and feel empowered to report maltreatment by service providers anonymously,” the document says.
Every year, 130m women give birth worldwide. As many as one in five of them experience mental health problems during pregnancy or the period after birth, including depression, anxiety and psychosis. Diagnosis and treatment for these conditions varies from country to country, so we welcome the WHO’s decision to publish a guide to caring for women with perinatal mental health problems, with an emphasis on sharing best practice to achieve the best outcomes. We hope providers will use the guide to establish and improve perinatal mental health care in their own countries.