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Dr Chido Rwafa Madzvamutse-Mental Wellness

As discussed in previous articles, mental health is defined as a state of well-being in which an individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a meaningful contribution to their community.

Reproductive health challenges including infertility, effects of contraception, chronic pelvic pain, pregnancy related complications contribute significantly to disease burden but also have a profound effect on women’s mental health and wellbeing.

The link between reproductive health challenges and mental health

Menstrual cycle challenges

Dysmenorrhea (pain during the menstrual cycle) can be debilitating and can result in anxiety and depression. The hormonal changes that occur during each menstrual cycle can result in premenstrual symptoms.

Contraception side effects

The hormonal changes caused by some contraceptives can affect the mood of women, causing depression as well as loss of libido which can be devastating for their relationships. The side effects may reduce the quality of life for women.

Pregnancy related challenges

Women are at increased risk of depression, anxiety and other mental health challenges during and soon after pregnancy. Women who have difficult pregnancies, complicated deliveries and severe injuries as a result of childbirth such as fistulas are at even greater risk of mental health challenges. Women who have severe tears in childbirth or develop fistulas causing them to leak urine or faeces after childbirth often face shame, ridicule and social exclusion.

Infertility and assisted reproduction

The social pressure to reproduce can be immense on women and challenges with subfertility or infertility can result in emotional distress. The stress at repeated failed attempts at having a baby can weigh on the mind.

Miscarriage

This often goes unacknowledged as a legitimate loss that must also be grieved. Miscarriages can also be traumatic and the loss of a pregnancy can result in trauma related mental health challenges.

Chronic pelvic pain from fibroids, endometriosis, pelvic inflammatory disease and other causes can result in depression, helplessness and hopelessness as well as prescription drug abuse.

Gynaecological cancers such as cervical cancer, uterine cancer, endometrial cancer and ovarian cancer can cause much anxiety and fear.

Interventions that can improve women’s mental well-being in relation to reproductive health

1. Perinatal mental health screening and support to women during the mentally vulnerable periods of pregnancy, childbirth and the period post delivery.

2. Protecting women from sexual and other forms of violence.

3. Improving responsiveness of health workers and the health system to the mental well-being effects of contraception.

4. Making mental health care a key component of infertility treatments.

5. Encouraging and supporting male involvement on contraceptive care, pregnancy, child birth and child care.

6. Offering comprehensive mental health support to women who have lost their babies through miscarriage, still births or infant deaths. The grief of these deaths need to be acknowledged and the women who have suffered these losses need to be supported.

7. Strengthen family and community support for women to help reduce the burden of unacknowledged, unpaid work of women and helping to improve the quality of life of women.

8. Integrating mental health into reproductive health services to improve accessibility of mental health services to women who need them.

9. Adopting a life course approach to women’s mental health supporting girls, adolescents, young and older women in the most appropriate ways in each phase of life.

If you think you or a woman that you know may be experiencing a mental health problem linked to pregnancy and child birth, please contact your nearest health care provider and get help.

Association of Health Care Funders of Zimbabwe (AHFoZ) article written by Dr Chido Rwafa Madzvamutse, Consultant Psychiatrist. Feedback (Dr. Chido Rwafa Madzvamutse +263777727332) (www.ahfoz.org ; [email protected])