The Ha Noi Expert Statement: recognition of maternal mental health in resource-constrained settings is essential for achieving the Millennium Development Goals

Jane Rw Fisher,Meena De Mello,Takashi Izutsu,Tuan Tran

doi:10.1186/1752-4458-5-2

Abstract

Mental health problems in women during pregnancy and after childbirth and their adverse consequences for child health and development have received sustained detailed attention in high-income countries. In contrast, evidence has only been generated more recently in resource-constrained settings.In June 2007 the United Nations Population Fund, the World Health Organization, the Key Centre for Women's Health in Society, a WHO Collaborating Centre for Women's Health and the Research and Training Centre for Community Development in Vietnam convened the first international expert meeting on maternal mental health and child health and development in resource-constrained settings. It aimed to appraise the evidence about the nature, prevalence and risks for common perinatal mental disorders in women; the consequences of these for child health and development and ameliorative strategies in these contexts.The substantial disparity in rates of perinatal mental disorders between women living in high- and low-income settings, suggests social rather than biological determinants. Risks in resource-constrained contexts include: poverty; crowded living situations; limited reproductive autonomy; unintended pregnancy; lack of empathy from the intimate partner; rigid gender stereotypes about responsibility for household work and infant care; family violence; poor physical health and discrimination. Development is adversely affected if infants lack day-to-day interactions with a caregiver who can interpret their cues, and respond effectively. Women with compromised mental health are less able to provide sensitive, responsive infant care. In resource-constrained settings infants whose mothers are depressed are less likely to thrive and to receive optimal care than those whose mothers are well.The meeting outcome is the Hanoi Expert Statement (Additional file 1). It argues that the Millennium Development Goals to improve maternal health, reduce child mortality, promote gender equality and empower women, achieve universal primary education and eradicate extreme poverty and hunger cannot be attained without a specific focus on women's mental health. It was co-signed by the international expert group; relevant WHO and UNFPA departmental representatives and international authorities. They concur that social rather than medical responses are required. Improvements in maternal mental health require a cross-sectoral response addressing poverty reduction, women's rights, social protection, violence prevention, education and gender in addition to health.

Highlights

Safe motherhood is assured and pregnancyrelated deaths are rare in women living in the world’s high-income countries
They are less likely to have completed primary schooling, to be able to generate an adequate and secure income; and to have had the sexual and reproductive health education that is essential to being able to make autonomous choices about when and how many children they wish to have. They are more likely to live in crowded circumstances and to be poorly nourished and carrying a coincidental burden of infectious diseases including the substantial burden of HIV and AIDS. Their lives are more likely to be constrained by rigid gender stereotypes about appropriate roles and responsibilities for women
Gender-based violence is prevalent in all contexts, but especially in cultures in which girl children and women are devalued and their rights ignored. In these contexts women are at greater risk of dying from pregnancyrelated causes, to experience the maternal morbidities of haemorrhage and infection, to give birth to babies who are underweight and not to have access to the health care they need in these circumstances

Summary

Introduction

Safe motherhood is assured and pregnancyrelated deaths are rare in women living in the world’s high-income countries. About 10% of pregnant women and 13% of mothers-of-infants in high-income countries have significant mental health problems of which depression and anxiety are the most common [6,7].

Results

Conclusion