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First 1000 days and maternal mental health


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The first 1000 days of a child provide a unique opportunity to shape healthier and prosperous futures. A mother who is cared for emotionally is better able to care for herself and consequently her children.
We appeal for mental health care for all mothers!

Published in: Healthcare
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First 1000 days and maternal mental health

  1. 1. The Western Cape 1st 1000 Days Initiative: Review and Future Focus Perinatal Mental Health Dr Simone Honikman October 2017
  2. 2. In South Africa In High Income Countries Maternal depression 16-20% 22-47% Periurban • Antenatal 22% • Postnatal 35% Rural • Antenatal 47% and anxiety? In Low and Middle Income Countries 10-13%
  3. 3. Maternal Outcomes Complications during birth Suicide Poor use of services Loss of economic potential Domestic violence Problems with bonding Drinking/drugs
  4. 4. Child Outcomes Low Birth Weight, prematurity Difficulties with breastfeeding Difficulty bonding Crying and irritability Abandonment abuse or neglect Mental health and conduct problems Impaired language and motor skills sickness and immunisation non-adherence
  5. 5. Clinical services: principles of how we respond • Prepare the environment – policy and relationships • Support the providers • Routine and integrated • Early detection and referral • Adapt evidence-based psychosocial intervention to meet clients’ needs – on-site – brief (2-3 sessions) – linked to social support • Liaison (social support, medical support) and follow-up • Monitor and evaluate
  6. 6. Where have MMH matters been recognized? • Basic Antenatal Care – procedures and new training • Postnatal Care Policy and guidelines 2016 • General IEC Materials for booking mothers • Community Based Services • Catch and Match • Screening and referral procedures (in process) • Patient-Centred Maternity Code • Recognising abuse – zero tolerance • Client feedback mechanisms • Staff support and debriefing • Training • People’s Development Centre (DoH training unit) • First Thousand Days • Theory of Change • IEC materials • Maternity Stationery • Primary Care Guidelines PACK
  7. 7. PMH within TOC
  8. 8. First 1000 Days – info material
  9. 9. Other Viral load Date Viral load Date CD 4: ART initiated on (date): Date: Reactive HIV retest at 20 weeks: Reactive Non-reactive Urine MCS Reactive Rapid syphilis test: Rhesus: COUNSELLING Nutrition HIV Mental health Alcohol/ substances/ tobacco Declined IPT Declined Non-reactive 2 nd HIV test: N Hb g/dl Tetanus toxoid: 1 st Declined Infant feeding Parental preparedness Pos Neg Pos NegRepeat syphilis test: 3 rd Antibodies: Y FUTURE CONTRACEPTION (provide dual protection) Injectable Oral Intra-uterine device Tubal ligation Implant Non-reactive Name & Title Domestic violence Booking visit and assessment of risk done by: Misc A = Alive md md y Not done Ultrasound FL AC LNMP Done Vulva & Vagina: BMI: BPD y Congenital Other Referral: NAME: FOLDER NO: DATE OF BIRTH: LEVEL OF CARE Sex Complications Age: (yrs) OBSTETRIC & NEONATAL HISTORY ID = Infant Death NND = Neonatal Death IUD = Intra-uterine Death Year Gestation Delivery Weight Details: Family History Twins Diabetes CLINIC EXAMINATION BP kg VAGINAL EXAMINATION WeightcmHeight TB Diabetes Cardiac Single / Married / Stable relationship TB No Tobacco Alcohol Substances HIV retest at 32 weeks: Co-trimoxazole TB symptom screen: Cervix: Uterus: Y MEDICAL & GENERAL HISTORY Hypertension Epilepsy Other (specify) Operations: Descriptions of complications: Medication: Allergies: Psycho-social risk factors: Yes 1 st Date / Urine: Result: Pap Smear done? HIV Psych If yes to any of the above give further details, e.g. duration: Abdomen: Lungs: Heart: Thyroid: Date:N G P 3 rd Transport when in labour: GESTATIONAL AGE SF measurement: cm Average gestation HC d d m m y y Antenatal clinic: Delivery site: Placenta Date: Y NCertain? Labour companion INVESTIGATIONS Rx received: MUAC: y y U/SDates Breasts: SF height According to Estimated date of delivery d d m m 2 nd Date 1 Date 2 ANTENATAL RECORD
  10. 10. Antenatal care record: changes up close
  11. 11. PACK material
  12. 12. MMH - where are the gaps? • Resource mapping • Stepped care referral pathways • Standard Operating Procedures • Mental health counsellors • What cadre? • What training? • What clinical supervision?
  13. 13. MMH - where are the gaps? • Lack of policy implementation • Resource allocation • Attendant HR procedures missing – KPAs, job descriptions • Attendant M&E procedures/indicators missing • Accountability? • Where there is implementation – what can we learn? • Armchair intersectoral collaboration • DoH and DSD • DoH and NPOs
  14. 14. Dr Simone Honikman, PMHP Director