Pre-natal mental health support for mothers in Zimbabwe.

Tafadzwa Mwanengureni

When Fortune Munyoro got into labor in May 2019, she was exicted about becoming a mother despite the pains she was experiencing.

Like any other first time mother, she had high hopes of embracing and finding joy in the journey motherhood.

Giving birth at Chitungwiza Central Hospital which is located 30km Southeast of Harare, Zimbabwe’s capital, Munyoro’s joy turned into grief when she lost her baby two days after.

As a first time mother, the loss was unbearable to Munyoro and it resulted in plunging her into post partum depression.

“I became mentally disturbed because with the first fruit you expect so much hope and joy which comes from the family. It also disturbed our marriage a lot as we had some fights regarding the cause of the death of the baby,” Munyoro said.

Neonatal death is a medical term for the death of a baby within 28 days after birth.

Statistics from UNICEF reveals that globally, 2.3 million children died in the first month of life in 2022 – approximately 6,300 neonatal deaths every day.

Munyoro’s fate prompted the family to accuse some relatives of  witchcraft.

It wasn’t until after a month she decided to try seeking post-natal counselling and she contacted the Society for Pre and Post Natal Services (SPANS) since its offices are located nearby her residence in  Ruwa, Zimbabwe.

 Linos Muvhu SPANS Chief talent Leader.jpg

SPANS is a private voluntary organisation in Zimbabwe  which freely provides perinatal mental health support to new mothers and fathers through education,  family therapy and psychological support services to communities around Goromonzi district, in Mashonaland East Province.

Munyoro found solace through her interaction with Linos Muvhu, a Chief Talent Team Leader at SPANS who raised her hope  for the future.

Muvhu told this publication that SPANS covers the maternal lifecycle starting from the womb to the world.

“We are committed to support mental heath issues arises perinatal period. We provide mental health during  pre and post-natal through a family centered approach and this involves training family therapists, strengthening mental health literacy of education, providing one on one family therapy sessions coupled with subsequent sessions, follow up home visits, referrals and use of PHQ9 screening tools for early identification of cultural expressions of mental health problems,”Muvhu said.

In a 2022 the World Health Organization (WHO) released over  60 new recommendations on maternal postnatal experience in which the emphasis was also given to the screening for postnatal maternal depression and anxiety, with referral and management services where needed.

In the report Medical Officer with WHO’s Department of Sexual and Reproductive Health and Research and the UN Special Programme, HRP Dr Mercedes Bonet revealed that, evidence shows that women and their families want and need a positive postnatal experience that helps them navigate the immense physical and emotional challenges that occur after their babies are born, while building their confidence as parents.

Through the post-natal counselling Munyoro understood  that she  lacked antenatal mental health care which resulted in her failing to manage high blood pressure during pregnancy which can be medically referred as Hypertensive Disorders of Pregnancy (HDP) .

“I later on realised that I was responsible for the tragedy , having not addressed my high blood pressure during pregnancy. The baby died because of blood pressure, but at the end of the day I managed to get conselling and recover,”Munyoro told this publication.

According to Frontiers, HDP is a significant cause of mortality and morbidities for both mothers and neonates.

“Many people tend to blame other or allege witchcraft in such situations, but when you get counselling you may realise that it may be a scientific thing,” she said.

Indeed in most African settings  it is believed that incidents like Munyoro’s fate are associated with witchcraft as societies lack education on maternal mental health care.

Generally, maternal mental health depression is not regarded as a serious problem, but what women live with in  their daily lives.

They are worse off with postpartum in cases that the woman did not have any physical complications and challenge. Women do not even bother to seek attention for it.

Symptoms of postpartum depression mainly involves crying more often and having anger issues.

However, for Munyoro it was worsened by the loss of her child.

Munyoro is among more than 8,000 women that receive perinatal mental health services from SPANS.

With the guidance from SPANS, Munyoro slowly found her way back to normal and regained her hope as she managed to give birth two years after the tragedy.

She discovered the power of self care and mindfulness and she implemented it in her journey of second pregnancy.

“SPANS gave me hope, faith, strength and helped to build me up to what I am today and I am glad that I made it through. In 2020 again I fell pregnant and delivered my baby in 2021.”

SPANS is the first on its kind in Zimbabwe as it offers such services to anyone who may need perinatal mental health support.

In most cases mental health services are offered in private health care settings where patients pay for the services.

However, with the deteriorating health system in the country the majority continue suffering.

Registered Community Psychologist, Pamela Marwisa who is also an Emotional Wellness Consultant lamented over the shortage of perinatal facilities in the country’s primary health centres.

“We do not have comprehensive perinatal mental health services in our primary health institutions. Poor mental health can make it difficult for mothers to cope with the many tasks of childcare and day to day tasks for their families. Maternal depression can lead to serious health risks for both the mother and infant and may cause complications during birth and cause long-lasting or even permanent effects on child development and well-being,” she said.

Marwisa said only severe cases of mental illnesses reach qualified mental health practitioners as the services are centralised.

According to her, Zimbabwe currently has four tertiary psychiatric units namely Inguthseni in Bulawayo, Harare Hospital Psychiatric Unit and Parirenyatwa Annexe in Harare and Ngomahuru Hospital in Masvingo. There are four psychiatric units at provincial level in Chinhoyi, Gweru and Marondera as well as in the district of Mutoko.

She then stressed the urgency of decentralizing mental health services to reach more communities.

In addition to maternal support, SPANS embarked on the training of family mental health therapists and the first batch graduated last year.

“Globally, there is a huge shortage of mental health professionals and you find out there are only few psychiatrics in Zimbabwe. At SPANS we had recruited and trained 350 family mental health therapists and provided 150 family therapy. We managed to sendalmost 120 students on attachment across all 10 provinces,” Muvhu said.

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