regnancy and childbirth, often celebrated as joyous life-changing events, also bring significant mental health challenges for expecting mothers. The celebrities who struggled with mental health challenges during these times included Princess Diana and Hollywood stars such as Brooke Shields and Drew Barrymore. While the anticipation of welcoming a new life is exhilarating, it is crucial to address the emotional and psychological aspects affecting women during this transformative journey. This is a very emotionally troubling time for a woman where she is undergoing a lot of psychological, hormonal and physiological changes. This vulnerable state of her body comes with many psychological issues that need to be addressed properly. Perinatal mental health issues encompass a spectrum of conditions, including post-partum blues; post-partum depression; psychosis; anxiety; obsessive-compulsive disorder; post-traumatic stress disorder; and body image concerns. These conditions can have serious consequences for both the mother and her child.

Despite their high incidence rate, perinatal mental health issues remain underdiscussed and often unacknowledged. Research has shown that four out of five women may experience postpartum blues and one out of five may develop postpartum depression. Accurate determination of postpartum depression in Pakistan is challenging due to cultural norms and a lack of reliable screening tools. However, studies suggest a prevalence rate ranging from 28 percent to 63.3 percent, the highest among Asian countries.

Sadly, mental health issues, particularly among women, are under-addressed in Pakistan due to a lack of awareness and stigma. Expectant and new mothers often have limited opportunities to seek mental health support. To add to the suffering, perinatal psychiatry, a specialised field that specifically deals with mental health during pregnancy, remains significantly underdeveloped.

Many factors are known to exacerbate mental health issues during pregnancy. Epidemiological studies have revealed that a lack of social support, marital discord, stress of low income, exposure to violence, living in a patriarchal society and some cultural practices, pre-existing mental health problems and presence of physical illnesses contribute significantly to development of mental health problems during pregnancy and after childbirth. Once developed, and if untreated, these mental health problems can have adverse effects on both obstetric and fetal outcomes.

Researchers have identified mental health problems during pregnancy associated with lack of self-care, self-doubt, turning to unhealthy behaviours like smoking and substance use, all of which negatively affect the quality of life for both the mother and the child. Self-harm during pregnancy, especially in women with a history of mental health problems, is identified as a complex factor contributing to maternal deaths. Even worse, mothers who experience depression and emotional instability pose an elevated risk not only to their lives but also to the lives of the infants they carry (particularly, if there are psychotic symptoms). In fact, suicide is the seventh most common cause of death in this population. Compared to those without a psychiatric history, women with postpartum psychiatric illnesses are several times more likely to die by suicide following childbirth. Likewise, medical researchers estimate that untreated postpartum psychosis leads to a 4 percent risk of infanticide. These statistics present a deeply troubling reality that demands immediate attention and intervention.

Early diagnosis and timely interventions can prevent the complications related to perinatal mental health conditions. Family support plays a pivotal role during this period. Family planning and counselling of the families to monitor and look after the pregnant women can be a wonderful strategy to cope with these conditions. To address these issues proactively, mental health education should be included in school curricula. This can help future generations understand and manage mental health challenges during pregnancy and beyond, right from the grassroots level.

Gynecologists are comparatively easily accessible to women. Collaboration between mental health professionals and gynecology departments can be a way to address perinatal psychiatric issues. Training gynecologists to implement routine mental health screenings during prenatal care can help identify at-risk individuals. Early intervention, including counselling and therapy, should be readily available to those in need. Likewise, research shows that postpartum depressive symptoms are more prevalent in working women due to added work-related stress. In light of these findings, it becomes imperative for workplaces to prioritise policies that support women-friendly working conditions and promote easy conditions for maternal leave. This way employers can contribute significantly to the mental well-being of working mothers and, in turn, to the health and happiness of their families.

Encouraging pregnant women to actively seek and embrace social support is of paramount importance. Community programmes, support groups and active involvement of family members in the care and emotional well-being of the pregnant woman forms a network of support, where pregnant women feel valued, understood and empowered. Building a robust support system equips mothers to navigate the complexities of pregnancy with confidence and resilience.

Perinatal psychiatry requires a multifaceted approach in Pakistan. Raising awareness, reducing stigma, integrating mental health into maternal care, expanding services, leveraging technology, promoting research and recognising the impact on partners and families are crucial strategies. It is time to prioritise perinatal mental health and ensure that no woman suffers in silence during this significant phase of her life.

The writer is professor of psychiatry at Ayub Medical Institute, Abbottabad. He is also a founding member and chair of Mental Health Council, Pakistan Health Parliament. He can be reached at aftab@ayubmed.edu.pk