'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. It affects approximately 10 to 15percent of mothers in developed societies. These figures are double in developing countries and depression ranks among the top five disabling mental or physical disorders worldwide. There is evidence that maternal depression badly affects the psychological and intellectual development of children.

Recent studies from South Asia suggest that maternal depression may also have serious consequences for a child's physical health. In rural Pakistan, for example, the risk of being underweight or stunted at six months is four times higher in children whose mothers are depressed than children whose mothers are not depressed. This data suggests that the incidence of infant stunting would be reduced by 30 percent if maternal depression was eliminated from the population. Infants of depressed mothers also have lower birth weight, higher rates of diarrhoea, and are less likely to be immunised. These studies also show that depression during pregnancy is linked to low birth weight. Thus, maternal depression makes an important and possibly major contribution to poor foetal and infant growth and morbidity in low income countries.

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

• Mothers lead a less healthy lifestyle and do not seek adequate care between conception and birth.
• Maternal disability in the postnatal period results in deficient physical and emotional care and psychosocial stimulation of the infant.
• Lack of family support and financial independence could weaken the mother's ability to adequately care for her child.
• In South Asia, marital violence and the birth of a girl child are associated with an increased risk of depression in mothers. The higher prevalence of postnatal depression in mothers of female children suggests that neglect of women's mental well-being is perpetuated from birth from one generation to the next.

There is a widespread lack of awareness of mental illness and its social origins. Women's mental health remains low on the agenda of policy-makers in the developing world. Highlighting the benefits of good maternal mental health to the infant's physical health could be a strong selling point for policy-makers to divert resources to services that could directly benefit women's mental health.

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

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

Child health programmes in developing countries must not direct policy agendas away from important maternal health needs. Programmes such as the World Health Organisation's Integrated Management of Childhood Illness 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 these programmes will be reduced.

Atif Rahman
Department of Child and Adolescent Psychiatry
Royal Manchester Children's Hospital
Hospital Road
Pendlebury
Manchester M27 4HA
UK
atif.rahman@ntlworld.com

See also

'Impact of maternal depression on infant nutritional status and illness: a cohort study' Archives of General Psychiatry 61: 946-952 by A. Rahman et al, 2004

'Why maternal mental health matters for infant growth in low-income countries: new evidence from south Asia' British Medical Journal 328: 820-823 by V. Patel et al, 2004

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