ULAB's 'Maternal Mental Healthcare' dialogue: How good is our treatment protocol?

Eight specialists, that included healthcare professionals, psychiatrists, psychologists, government representatives, journalists and educators, participated in the discussion. Photo: Rajib Dhar

According to a study published in the National Library of Medicine, 39.4% of 376 Bangladeshi mothers suffered from postpartum depression 12 months after childbirth in 2019 alone. However, in our culture, pregnancy and motherhood are almost always associated with joy and fulfilment and rarely with depression, anxiety or similar mental health issues. 

To address these issues, the University of Liberal Arts Bangladesh (ULAB) is collaborating with the University of Liverpool on a four-year research project titled ENHANCE on scaling up care and technological enhancements for perinatal depression. This research project is funded by the National Institute for Health Research. 

On 23 March 2023, ULAB organised a roundtable titled 'Maternal Mental Healthcare' moderated by Prof Sumon Rahman, Director of the Centre for Critical and Qualitative Studies. Eight specialists, ranging from healthcare professionals, psychiatrists, psychologists, government representatives, journalists and educators, participated in the discussion on managing perinatal/postpartum mental health in the low-resource settings of South Asia. 

Prof Imran Rahman, Vice Chancellor of ULAB, gave an opening remark where he emphasized on the importance of collaborative research that can make a significant impact on society. 

The discussion started with the importance given to the issue of maternal mental healthcare in the existing treatment protocol in Bangladesh. Here the term "maternal" refers to the perinatal period – which starts during pregnancy and continues till one year postpartum or childbirth.  

Dr Mekhala Sarker, a psychiatrist and Associate Professor at the National Institute of Mental Health, pointed out that mental health issues do not receive equal validation and recognition to physical health issues in the Indian subcontinent, especially considering the high population and low-resource setting of this region. 

And when most people cannot access adequate healthcare services, focusing on the issue of mental health often seems like a luxury. This is one of the reasons why the treatment for perinatal and postpartum depression does not make the priority list for most people, sometimes including the government.

According to Dr Sarkar, depression has two components – mental and physical. When someone is severely depressed, sometimes it shows through physical symptoms such as burning sensations, headache, lethargy etc. These physical symptoms are usually treated by physicians without taking the mental component into consideration. "Pregnant women or mothers would go to the general practitioners with psychiatric issues, and they would ignore it and prescribe medicine for the physical problems only," she said. 

Dr Mahjabeen Haque, Professor at the Department of Educational and Counselling Psychology, University of Dhaka, also commented that the lack of awareness regarding mental health among the general practitioners of Bangladesh is alarming. This lack of awareness among the physicians, along with the ignorance of the people, put the mothers in a very vulnerable situation. 

Even though the government is working diligently on increasing awareness related to maternal healthcare, especially through the community clinic programme throughout the country, there still remains a lot of room to up the ante and aggressively take measures to address this issue. 

In 2018, Bangladesh passed a new mental health act. To meet Sustainable Development Goal 3 "Ensure healthy lives and promote well-being for all at all ages," the Ministry of Health and Family Welfare also published Bangladesh National Strategy for Maternal Health (2019-2030). These are indeed commendable efforts. But there is still a clear treatment gap when it comes to maternal mental health. 

However, this inadequacy in maternal mental health services is not an isolated issue. 

According to a report in The Borgen Project, there are only 270 psychiatrists and roughly 500 psychologists in Bangladesh. The country has a population of more than 166 million. So this equates to 216,000 people per specialist. 

Moreover, most mental health professionals are located in urban areas – which further limits access to mental health across the country. The lack of specialists and the high cost of mental health services make it nearly impossible for people in rural areas to access mental healthcare services, especially for women who are struggling with perinatal depression.

To tackle these types of challenges, World Health Organisation (WHO) launched the Thinking Healthy programme, which is a manual for the psychosocial management of perinatal depression. According to this, mental health care services can be delivered by community health workers who are not essentially psychologists. But it is imperative to follow through and find out the impacts of these services. 

According to Farjana Sharmin, the Programme Manager of Brac Health, Nutrition and Population Programme, Brac is already working in collaboration with the government of Bangladesh on several projects to improve maternal mental healthcare services. They have para-counsellors, a group of trained paraprofessionals who provide mental health services to pregnant women across Bangladesh, which functions in a very similar way to the Thinking Healthy program. 

While discussing the role of mobile devices in providing maternal mental healthcare services, Dr Nizam Uddin Ahmed, CEO of National TeleHealth Services (Shashtho Batayon), said, "Since we do not have enough specialists to provide maternal healthcare services, we should opt for alternative options that are already there. 

For example, we have 300 doctors at Shashtho Batayon who are one phone call away. Why don't we connect, collaborate and train them? That way, anyone who is struggling with perinatal depression can access mental healthcare services by using their mobile device from anywhere in the country." 

Dr Tanjilur Rashid Soron, the founder and managing director of Telepsychiatry Research and Innovation Network, also emphasised the importance of digital health helplines for providing services to mothers struggling with perinatal depression.

Dr ANM Ehtesham Kabir of the Directorate General of Health Services (DGHS), Md. Riaz Uddin Khan of Bangladesh Health Watch, Aminul Islam, Senior Lecturer of ULAB Media Studies and Journalism Department and Mahmudunnabi, PhD candidate of the University of Liverpool also took part in the discussion.