Surviving and Thriving: Maternal Mental Health as a Global Priority

Written by United for Global Mental Health and UNICEF

Having a baby is a life-changing event, but becoming a mother is not just about the joys of motherhood. The perinatal period – from a child’s conception up until one year after their birth – is often a very physically and emotionally vulnerable time for mothers.

The physical risks associated with pregnancy and childbirth are well documented – from haemorrhages, pre-eclampsia and eclampsia to infections and other complications from delivery. The world has made progress in maternal healthcare – but more is needed and disparities remain. In low- and middle-income countries (LMICs), maternal mortality remains staggeringly high. In 2023, there were an estimated 200,000 maternal deaths worldwide – over 90% of them in LMICs. For this reason, safe motherhood is often synonymous with survival.

Mental health and motherhood

However, motherhood can also have a significant impact on a new mother’s mental health and psychosocial wellbeing – which in turn affects her ability to provide her children with nurturing care. Yet, maternal mental health has still not received the attention or funding it merits and remains insufficiently integrated into maternal and child health services, especially antenatal and postnatal care.

During and after pregnancy, women are at elevated risk of developing mental health conditions, such as anxiety, depression, obsessive-compulsive disorder, post-traumatic stress disorder, and psychosis. Global statistics reveal 10% of pregnant women and 13% of women who have just given birth experience a mental health condition, most commonly postpartum depression. Women are at even greater risk in LMICs, where it is estimated that 15.6% of pregnant women and 19.8% of women who’ve recently given birth experience a mental health condition. Meanwhile, vulnerable groups such as adolescent mothers are more likely to experience mental health challenges than their childless peers or adult counterparts.

These conditions can lead to further negative outcomes, by placing new mothers at a heightened risk for suicide, loneliness, and adverse economic outcomes through stigma and discrimination. Such adverse outcomes also often extend to the children’s health and education.

The statistics are stark and highlight huge global inequalities. They reveal just how dangerous pregnancy still is in much of the world today.

A holistic vision

Maternal health care cannot remain fragmented – divided between physical and mental health care. It must be integrated and oriented toward people-centred care that holistically addresses both mental and physical health needs. For this vision to become a reality, the world needs to treat the mental health of new mothers as just as important as their physical health, so they can survive and thrive. Parenting support programmes should be an integral part of this holistic approach, providing comprehensive care that addresses both physical and mental health needs.

The recent global cuts in humanitarian funding are putting essential health and social care under threat. In many parts of the world, countries have been forced to reduce vital services for maternal and child health. This has diverted attention away from the pressing need to integrate mental health into antenatal and postnatal care. The voices of pregnant women and mothers remind us just how urgent this is. They must be heard and empowered to shape the policies and priorities that affect them.

In this shifting and uncertain humanitarian context, we are calling on governments to scale up investment in:

Integrated care models: Integrating mental health into existing maternal and child health services can help ensure pregnant women have access to appropriate mental health prevention, treatment, and care – where and when they need it most. For example, in Belize, UNICEF supported the Ministry of Health to conduct a situation analysis of perinatal mental health, focusing on adolescent mothers. It identified strategic interventions to improve mental health. UNICEF Belize supported the training of 100 nurses, midwives and public health workers in perinatal mental health, focusing on depression and anxiety, and on the use of screening tools. This was designed to help better integrate mental health into maternal and child health (MCH) services and was the first time MCH workers in Belize have been trained in mental health.

A primary and community care workforce equipped to provide mental health support: Effective national-level interventions show maternal mental health care can be delivered even by non-specialist health workers, as long as they are well trained. If women, during pregnancy and after childbirth, had access to a primary or community health professional skilled in mental health, the risk and signs of maternal mental health conditions could be identified early, at routine antenatal and postnatal visits. For example, UNICEF’s Caring for the Caregiver initiative trains professional and community health workers to help caregivers develop strategies for coping with the challenges and stress that arise in daily life, and to find mental health support and services if they need them. The initiative was piloted in Bhutan, Brazil, Rwanda, Sierra Leone and Zambia, and is being rolled out globally to 17 countries.

Certain programmes also bring substantial returns on investment (ROI). Some of the best ROIs in mental health come from programmes where community workers support identification of risk of perinatal depression in women followed by provision of psychological therapies, whereas manualised parenting programmes for new parents report an impressive ROI of up to $15.80 per $1 spent through co-benefits for both the parents and the children.

Adequate funding earmarked for maternal and child health: Mothers and their children face significant social and economic costs associated with untreated maternal mental health conditions. Increasing access to prevention, care, and treatment for perinatal women at risk of or experiencing common mental health challenges is a smart investment. Countries should prioritise funding for essential maternal and child health services that include maternal mental health care, and mental health should be integrated into the design of maternal health programmes.

Maternal mental health care is a right not a privilege. Every mother in every community across the world should have access to comprehensive maternal health care that includes mental health support, as a matter of equity and dignity.

Make your voice count! Join us in calling on your governments to:

Integrate maternal health care.
Equip the primary and community health care workforce to deliver maternal mental health care.
Protect funding for maternal health.