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Battling double depression long after childbirth

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…*Nthabeleng finds it hard to understand her 12-year-old’s behavioural patterns

Ntsoaki Motaung

According to early intervention to prevent adverse child emotional and behavioural development following maternal depression in pregnancy: study protocol for a randomised controlled trial, substantial evidence indicates that maternal depression during pregnancy (i.e., antenatal depression) is associated not only with maternal wellbeing but also with child emotional and behavioural development.

The evidence epitomises Nthabeleng’s reality of her 12-year-old child going missing or having episodes of emotional switch-offs.

The child’s irregular behaviour can be attributed to Nthabeleng’s lengthy battle with depression when she was pregnant at the age of 17.

A young unsuspecting, teenager in love, Nthabeleng’s world shattered when her sweetheart denied impregnating her.

She was the apple of her father’s eye and in his eyes, nothing wrong could come from her hand or behaviour.

It took a swift angry decision by her father and siblings to disown her after they learned she was two months pregnant. 

“We were raised by our father as a single parent after our mother died. We were brought up in a family that was able to provide for our primary needs. We did not lack. 

“As the last born child, and a girl at that, I was deemed daddy’s little girl and I enjoyed that relationship until the day I missed my period and later discovered I was pregnant.”

Nthabeleng grew up in a remote little village in the district of Mafeteng, 76 km south of Maseru.

With a population of no more than 150,000, many unplanned pregnancies yield early marriages, but for Nthabeleng, her fate was different.

“All of my siblings were married at the time and being denied by a boy was an undoubted shame to my family, mostly my father.”

Being denied also meant shame and shattered dreams as she was forced to drop out of school.

“I first told the boyfriend who shocked me and I was left with the mammoth task of facing my family.

“They immediately turned their backs on me. I was left in a lurch, I had to drop out of school and seek help from relatives,” she recounts.

The world closing in on her, she remembers feeling helpless.

“A cloud of indescribable emotions engulfed me. I didn’t know what to expect and how it was possible to move forward regardless of having been offered shelter. My mental health immediately went from health to down and under.”

 “I was grateful I had somewhere to stay, but knowing that I was abandoned by my family killed me. I was so depressed, I had no interest in doing anything meaningful including going for my antenatal check-ups, I was an uninterested living being,” she describes.

She indicates that her first antenatal check-up was only at four months.

“As time went by, there were ‘nags’ for me to go for pregnancy check-ups until I decided to shush the nagging and paid my first visit to the village health centre. I was four months pregnant.

“I was checked and everything was perfectly okay with the baby, but I got my first confirmation that I was depressed.

“A native word and a disease I knew nothing about. When it was explained and how one could cope with it, it was nearly impossible for me, I had problems equivalent to a mountain.”

As months passed and delivery time neared, she needed baby clothes and other needs.

“I had nothing and I did not know where I would get them, but the day I gave birth my relative who had taken me in bought the baby a vest and a receiver blanket,” Nthabeleng recollects, saying the sight and sound of the newborn was enough to drive her mad.

Aviwe Funani, the Senior Policy and Advocacy Officer for United for Global Mental Health, when speaking at the 3rd International Conference on Public Health in Africa (CPHIA 2023) in Lusaka, Zambia, last year revealed a groundbreaking discovery that places mental health as a pivotal cross-cutting concern alongside Sexual and Reproductive Health and Rights (SRHR).

“Research indicates that the onset of various mental conditions often initiates around the age of 14 and the challenges young mothers face during the maternal stage, encompasses stigma, shame, and exclusion,” she said, highlighting the precarious state of mental health among young individuals, particularly young women and unborn children,” Funani said.

According to her, stigma, shame, and exclusion contribute to conditions such as anxiety, depression, and postnatal depression, impacting both the mother and child’s relationship.

“I was not ready for the next chapter of my life so I thought the best solution would be killing the infant I tried suffocating her with a pillow but someone walked in on me. Failing to kill the child meant I was next.

“I attempted twice when the two months and nine months but both times failed. I was forced to deal with and seek help,” she said.

She narrated accepting her situation and seeking counselling at the clinic, a step that helped her learn to love her child and deal with her depression.

“Loving my daughter did not improve my mental health as much as I had anticipated, but the help I received helped me cope with life.”

Funani articulated that the mental well-being of young women was notably fragile, along with the vulnerability of unborn children citing that neglecting the recognition and prioritisation of mental health jeopardises the attainment of Sustainable Development Goals (SDGs).

Equity is pivotal in achieving these goals, and mental health is a key component; without it, the 2030 objectives remain unattainable.

She underscored a critical point, stating that children born to young mothers face heightened risks of developing mental health conditions.

The Early intervention to prevent adverse child emotional and behavioural development following maternal depression in pregnancy: study protocol for a randomised controlled trial also confirmed that children of antenatally depressed women are at risk of emotional and behavioural problems, including internalising problems (e.g., anxiety and depression) and externalising problems (e.g., attention problems), that may last at least to adolescence. 

Nthabeleng indicates that she still battles with anxiety issues which are not helped by her current situation which involves odd behaviour by her child.

“From when she was young, she was withdrawn. She is awkwardly quiet and sometimes would just disappear for days without a word leaving me with worry, and she would just return with no explanation or remorse to respond to my interrogation.”

Nthabeleng says the more she tries to reach out to her child the harder it is, but “she is very bright because her school results set her as an exemplary”.

Funani revealed that globally, mental health receives less than two per cent of financial contributions and shockingly, when considering children and young people, it plummets to just US$0.01 and Lesotho’s reality is far dire.

The Director of Primary Health at the Ministry of Health, Dr. Makhoase Ranyali, revealed that the country has no budget strictly allocated for addressing mental health issues, however, noted that mental health forms part of the overall health package.

Ranyali highlighted a collaborative need for effective ways to deal with mental health and noted that all government ministries had a part to play.

Dr Abdulaziz Mohammed Head of the Division of Disease Control and Prevention, Africa CDC revealed to the CPHA 2023 attendees the US$ 10 million donation towards mental health during the “Unmasking the silent Epidemics: NCDs, Mental Health and Injuries.”

Mohammed said the funding would be used to support countries in strengthening their Mental Health care systems as well as new and innovative ways of addressing mental health. 

“These grant programs will expand access to proven treatments, interventions, and other recovery supports while developing new and innovative solutions to strengthen mental health services for our people,” he said.

Every year, at least 40 million women are likely to experience a long-term health problem caused by childbirth, according to a new study published in The Lancet Global Health.

The study shows a high burden of postnatal conditions that persist in the months or even years after giving birth. 

“These include anxiety 9-24 per cent, depression 11-17 per cent, pain during sexual intercourse (dyspareunia) affecting more than a third 35 per cent of postpartum women, low back pain 32 per cent, anal incontinence 19 per cent, urinary incontinence 8-31 per cent, perineal pain 11 per cent, fear of childbirth (tokophobia) 6-15 per cent and secondary infertility 11 per cent.

According to the World Health Organization (WHO), 1 in every 8 people in the world lives with a mental disorder, mental disorders involve significant disturbances in thinking, emotional regulation, or behaviour, there are many different types of mental disorders, and most people do not have access to effective care. 

Regarding Lesotho, there is no study with specific statistics indicating the burden of mental health in the country.

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