COVID having unequal impact on women and affecting perinatal mental health, report finds

A coalition of over 100 organisations has found a significant decline in maternal mental health during the pandemic, with “unequal” mental health challenges for women during pregnancy and early motherhood.

The report, commissioned by the Maternal Mental Health Alliance (MMHA) and conducted Centre for Mental Health, says the “significant increase in poor mental health” is the result of an increase in anxiety due to fear of infection and experience of infection and bereavements, combined with a reduction in available support.

The alliance also says there is “clear evidence” that COVID-19 has had a disproportionate impact on women, compared to men, as they are more vulnerable to socioeconomic inequalities, gender inequalities, domestic violence and economic insecurity.

Women from specific communities have been more markedly affected than others with women and families of colour being the most affected, the report found.

The report found these communities “felt markedly more exposed and less protected than other communities” over the crisis, with a greater proportion of women of colour and their family members being employed in front-line roles.

Authors found that there had been government investment across the UK nations in perinatal mental health care, most significantly in England with the development of new specialist perinatal mental health teams and investment in psychological provision through the Improving Access to Psychological Therapies (IAPT) programme.

However, despite the evidence of investment in perinatal mental health support, this has not been implemented to the same extent across all four nations, the report said.

There is also evidence of a decrease in investment in other services, such as maternity, that interact directly with women in the perinatal period, due to public spending austerity policies, the report said.

The report found the reduction in informal support, such as from family and friends, as well as COVID-19 restrictions in the birth and labour processes have also increased stress and anxiety.

There have also been “missed opportunities for understanding or fully responding to what being classed as ‘vulnerable’ really means in the perinatal period,” authors said.

Early in the crisis, pregnant women and new mothers were identified as being at ‘moderate risk (clinically vulnerable)’. However, this risk was “viewed only through the lens of clinically vulnerable to infection, and the potential impact on the baby,” the report stated.

“There is no evidence that this understanding of ‘vulnerability’ acknowledged the critical importance of supporting perinatal mental health, both for the woman and her baby.”

The report also found that vital services such as health visits, contact with some voluntary and community sector services, and mental health services were all reduced in the initial stages of the pandemic despite the increased need – though many of these services returned, to varying degrees, after better availability of PPE and the establishing of ‘virtual’ services.

“We do not know enough yet to judge if the move from face-to-face to virtual assessments has caused any harm, though our contributors were worried virtual appointments might make mental health monitoring more difficult with some women,” authors said.

Worryingly, the report found the workforce supporting women and families in the perinatal period is now facing its own wellbeing challenges and needs support.

“Just as we have had reports of increased challenges to the wellbeing of women and families, so we were given evidence of the increased stress felt by staff, in both the public and voluntary and community sectors,” authors said.

“Those who work in these sectors are just as exposed to COVID-19 and the anxieties about it as those they support.”

As a result of the review, the MMHA and Centre for Mental Health are calling for an “immediate assessment of the level of need for perinatal mental health services,” as well as “future-proofing” perinatal mental health services against future pandemics.

Other recommendations include tackling racial discrimination within health systems, understanding the impact of ‘remote’ mental health care, for the Government and NHS to recognise the importance of voluntary and community organisations, and to support the mental health of all health and care staff.