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A Closer Look: Q&A with Sara Gorman

Sara Gorman PicSara Gorman, PhD, is an MPH candidate at Columbia University Mailman School of Public Health, studying health policy and infectious disease epidemiology. She has written extensively about HIV, TB, and women’s and children’s health for a variety of public health organizations, peer-reviewed journals and textbooks. She most recently worked in the policy division of the HIV Law Project and in the Department of Epidemiology at Harvard University. She holds a PhD from Harvard University. Sara was recently featured in PLOSMedicine where she talks about the importance of treating maternal mental illness.

1. Briefly describe the issues surrounding maternal health and maternal mortality rates.

Access to mental health care in the US is impeded by stigma and high costs. While mental health problems are discussed more readily in our country than in some developing countries, addressing postpartum depression as a major cause of maternal morbidity, as well as its contribution to poor health outcomes for children, should still be prioritized. An estimated 9-16% of postpartum women will develop postpartum depression. Maternal depression is specifically associated with pre-term birth, low birth weight, and under nutrition among infants, especially in developing countries. There is increasing evidence that very early childhood experiences have an extremely important effect on the mental health and well-being of individuals, and that a mother’s mental illness is stressful and detrimental to the infant’s physical and mental health. In terms of the link between maternal mental health and maternal mortality, a little known fact is that suicide is actually a leading cause of maternal death worldwide. We have an obligation to pay attention to this particular issue as it is not being properly dealt with both in the US and on a global level. It’s important to mobilize the community around this issue and emphasize the direct relationship between maternal mental illness and maternal mortality.

2. Are there certain mothers who are more at risk for maternal mortality due to suicide?

Women who have a history of mood disorders or who have had postpartum depression in a previous pregnancy are at increased risk. A family history of depression and young motherhood are also risk factors. Additionally, women of low socioeconomic status and who have poor social support are also more likely to develop postpartum depression.

3. Describe some of the barriers that prevent us from focusing on maternal mental health.

I think the most significant barrier on a global level is always limited resources, of course.  And, because the link between maternal mental illness and maternal death is not immediately obvious, it is more difficult to engage stakeholders and policymakers in the importance of the issue. Maternal depression can also be difficult to detect, especially in resource-poor settings, in part because some of the tell-tale signs of depression, such as fatigue and poor sleep, are also common among new mothers.

4. In your opinion, what do possible solutions/interventions look like?

The first step is to engage donors in a dialogue about the importance of this issue. It’s vital to make them realize that if we are serious about getting closer to achieving the goals of dealing with maternal mortality rates, mental illness has to be part of the strategy. One useful argument is to demonstrate to donors that integrating mental health services into existing treatment platforms actually offers a way of leveraging resources efficiently and contributes to health systems strengthening. In addition, integration of mental health services into antenatal and postpartum care in developing countries will be key, going forward.

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