Maternal Mental Health and Violence against Women in South Africa

Facilities

14 facilities in the Cape Town Metropolitan area. They are both Basic Antenatal Care (BANC) clinics and Midwife Obstetric Units (MOUs). Four selected for diagnostic phase (Bishop Lavis, Macassar, Hanover Park, Vanguard) serve low income neighbourhoods. Mainly Afrikaans and IsiXhosa speaking population. High levels of unemployment, poverty, gang violence and abuse.

Disease Prevalence

There is a high prevalence of perinatal common mental disorders among antenatal women attending MOUs. Interpersonal violence is the second highest contributor to the burden of disease In South Africa, after HIV/AIDS,1 and intimate partner violence (IPV) accounts for two-thirds of the burden in women. More women are killed in South Africa by a male partner than in any other country.2 There is a strong link with anxiety and depression, and increased risk of HIV infection.3 The Western Cape Department of Health (WCDoH) has recently mandated brief screening questions for mental health and intimate partner violence at antenatal book-in. Senior Managers in the WCDoH are supportive of scaling up a counselling service for antenatal depression in all 12 MOUs in the Cape Town metropolitan area, based upon a brief structured psychological intervention evaluated in a recent randomised control trial. However, previous research has indicated a marked reluctance by providers to screen for, or act upon detection of IPV.

References

  1. Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016. Lancet Lond Engl 2018;391:2236–71. doi:10.1016/S0140-6736(18)30994-2
  2. Kruk ME, Gage AD, Arsenault C, et al. High-quality health systems in the Sustainable Development Goals era: time for a  revolution. Lancet Glob Health 2018;6:e1196–252. doi:10.1016/S2214-109X(18)30386-3
  3. Wagner EH, Austin BT, Davis C, et al. Improving chronic illness care: translating evidence into action. Health AffMillwood 2001;20:64–78.