Maternal mental health: The missing link in a thriving democracy

Every August, South Africa celebrates Women’s Month to honour the courage, leadership and contributions of women past and present. We remember the 20,000 women who marched to the Union Buildings in 1956. Their struggle was for the right to participate fully and equally in society.

Though many of the barriers these women fought to dismantle have been removed, gender inequality remains deeply entrenched. Gender-based violence, poverty, lack of social support and the burden of unpaid childcare persist, all of which drive the high levels of common maternal mental health conditions that we see. 

In turn, maternal depression, anxiety and post-traumatic stress make women more vulnerable to being victims of violence, trapped in poverty and socially isolated. Caring for the next generation becomes extremely difficult in these circumstances.

Nomsa*, a 22-year-old mother of a three-year-old and a four-month-old, knows these problems intimately. Her partner is mostly absent and verbally abusive when at home. Her mother, already raising her late sister’s children, cannot offer daily help. Nomsa feels isolated, overwhelmed, and stuck.

The hidden crisis

In South Africa, the numbers for perinatal mental ill-health are stark. During pregnancy and the first year after birth, one in three women experience depression and or anxiety. These are among the highest rates in the world.

These conditions are not simply “baby blues” or private struggles. If ignored, they limit women’s agency and social connectedness, restricting access to care, completion of education, income-generation, and the ability to take part in community life. They also contribute to poor physical health and in severe cases can result in suicide which is a leading cause of maternal death worldwide.

The wellbeing of mothers and caregivers is inextricably linked to the wellbeing of their children. Pre-term birth, low birth weight, disrupted learning and emotional difficulties in children are linked to untreated depression and anxiety in their mothers. For many of these children, these problems continue throughout their lives and present as a failure to thrive and may also perpetuate a cycle of mental illness.

There is hope, however. When women are supported socially, economically and psychologically, their children are far more likely to grow up healthy and thrive.

The mental health gap 

In low-re

But the health economics research commissioned

The perinatal period offers a critical opportunity for mental healthcare for those women who are already in regular contact with health services during pregnancy and postpartum. With the right training, supportive supervision and referral systems, primary care providers, such as non-mental health specialists can identify distress early and offer evidence-based, affordable support, including counselling and effective referrals. 

At the antenatal clinic, Nomsa’s midwife noticed she was tearful and very low, and referred her to one of the on-site counsellors. Three sessions, timed with her antenatal visits, allowed her to tell her story and feel heard. With gentle support, she developed plans for returning to school and finding childcare help. She was also connected to a local support group, where she met other women facing similar struggles.

From Women’s Month to action

A mother supported

This Women’s Month should be about more than commemoration. We can honour the legacy of 1956

There are three key opportunities:

Democracy starts at home

When maternal mental health needs are ignored, we exclude women’s skills, leadership and voices. A healthy democracy begins with healthy communities and in the earliest caregiver-child relationships. These are shaped

Supporting women during the perinatal period is an investment in equality, human rights, and the nation’s future. This Women’s Month, let us recognise that perinatal mental healthcare is a necessity for gender justice, economic stability, and democratic vitality. 

*A pseudonym

Associate Professor Simone Honikman is the director of the Perinatal Mental Health Project based in the Centre for Public Mental Health at the University of Cape Town.