Cape Town - “I know other people are happy about being pregnant. But I was not happy, I was sad,” says Xolelwa, from Khayelitsha. “I was not eating, not sleeping nicely.
“When you are pregnant you are alone. Everybody is talking like you did it to yourself.
“You don’t have anybody. Everybody turns their backs on you."
Xolelwa is not alone in feeling this way.
According to research, one out of five women in South Africa suffers from depression or anxiety during and after pregnancy.
Most of these women come from disadvantaged communities, where they have little or no access to mental health care.
This is where the Perinatal Mental Health Project comes in.
In 2002, the PMHP started providing integrated maternal mental health services as a volunteer organisation at Mowbray Maternity Hospital. They now also have services at False Bay Hospital and Hanover Park Midwife Obstetric Unit.
When women and girls come into the clinics for their routine ante-natal physical check-up, the PMHP counsellor gives them a questionnaire which helps identify those vulnerable to or having symptoms of depression or anxiety.
Those who need support are referred to the PMHP counsellors for free on-site counselling, follow-up and case management for up to one year after their babies are born.
Integrating mental health services into routine antenatal care means that women do not have to go elsewhere to access counselling, or spend time and scarce resources to get help.
Some of the issues that pregnant women face include domestic violence, being a teenager, being a migrant or refugee, substance abuse or food insecurity. These issues might make women more at risk of suffering from depression or anxiety during pregnancy. Experiencing a major life event during pregnancy, for example losing a loved one, losing a job or moving home places women at increased risk.
Family or partner support can assist women during this time, but for many pregnant women, even if they live in close proximity to other people, they do not feel supported, and their mental health needs are not understood.
The Perinatal Mental Health Project’s counselling services are at the same site as antenatal care, so women accessing these services are less likely to face issues of stigma around mental health.
Counselling may support and empower them in facing difficult circumstances and draw on their own resilience - by the time their babies are born they are much more equipped to cope. The organisation believes these service should be available to all women who are pregnant. That’s their long-term goal.
And the benefits to mother and baby are evident, as PMHP recipient Xolelwa’s story shows:
“There are things you can’t talk about to your family. Because they don’t have that ear to listen. Before I met the counsellor it was bad. So you have so many options in mind. Maybe you want to take your own life.
“I know it is strange to talk to a stranger, but it feels safe sometimes. She makes you feel safe.
“I feel better when I talk to her. And then she was supportive taking the positive sides not just the negative sides.”
Xolelwa, who gave birth to a baby boy says: “I am very proud to be a mom, a working mom.”
The PMHP Director, Dr Simone Honikman says: “Quite simply, a mother who is cared for emotionally is better able to care of herself and consequently her children.”