‘For the sake of the child, look after the mother’

The World Health Organisation’s theme for World Health Day 2005 is ‘healthy mothers and children’. While the physical health of women and children is emphasised, the mental and social dimensions of their health are often ignored in developing countries. However, recent evidence suggests that the mental and physical health of mothers and children are linked, and that one cannot be possible without the other.

Mothers often suffer from depression after childbirth. Itaffects approximately 10 to 15 percent of mothers in developed societies.These figures are double in developing countries and depression ranks among thetop five disabling mental or physical disorders worldwide. There is evidence thatmaternal depression badly affects the psychological and intellectualdevelopment of children.

Recent studies from South Asia suggestthat maternal depression may also have serious consequences for a child’sphysical health. In rural Pakistan, for example, the risk of being underweightor stunted at six months is four times higher in children whose mothers aredepressed than children whose mothers are not depressed. This data suggeststhat the incidence of infant stunting would be reduced by 30 percentif maternal depression was eliminated from the population.Infants of depressed mothers also have lower birth weight, higher rates ofdiarrhoea, and are less likely to be immunised. These studies also show thatdepression during pregnancy is linked to low birth weight. Thus,maternal depression makes an important and possibly major contribution to poor foetaland infant growth and morbidity in low income countries.

Maternal depression affects infant growth and illness in anumber of different ways:

• Motherslead a less healthy lifestyle and do not seek adequate care betweenconception and birth.
• Maternaldisability in the postnatal period result in deficient physical andemotional care and psychosocial stimulation of the infant.
• Lackof family support and financial independence could weaken the mother'sability to adequately care for her child.
• In SouthAsia, marital violence and the birth of a girl child areassociated with an increased risk of depression in mothers. The higherprevalence of postnatal depression in mothers of female children suggeststhat neglect of women's mental well-being is perpetuated from birth fromone generation to the next.

There is a widespread lack of awareness of mental illness andits social origins. Women’s mental health remains low on the agenda of policy-makersin the developing world. Highlighting the benefits of good maternal mentalhealth to the infant's physical health could be a strong selling point forpolicy-makers to divert resources to services that could directly benefitwomen's mental health.

Health workers, using simple checklists, can identifydepression in a community with relative ease. More specifically, theseinstruments can help identify mothers whose infants are at greaterrisk of poor health. Resources can then be targeted at these groups.

Health workers can be taught simple mental health techniquesto more effectively engage with mothers and provide counselling, practical helpand advice on child health. Encouraging positive interaction between depressedmothers and their children is likely to benefit not only their physical, butalso psychological and cognitive development.

Child health programmes in developing countries must notdirect policy agendas away from important maternal health needs. Programmessuch as the World Health Organisation’s Integrated Management of ChildhoodIllness strategy rely heavily on the mother for infant feeding,sanitation, immunisation, health education and health seeking behaviours.Unless attention is given to maternal mental health, the effectiveness of theseprogrammes will be reduced.