Predictors of post-partum depression amongst postnatal women in Kumasi, Ghana – BMC Pregnancy and Childbirth

Report on Postpartum Depression and its Implications for Sustainable Development Goals

Postpartum Depression (PPD) represents a significant global health challenge that directly impedes progress towards several Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being). As a mood illness linked to childbirth, PPD’s prevalence and debilitating effects undermine maternal and child health, gender equality, and efforts to reduce inequalities worldwide. Understanding its predictors is critical for developing policies aligned with the 2030 Agenda for Sustainable Development and the goal of Universal Health Coverage (UHC).

Global Impact of Postpartum Depression on SDG 3 (Good Health and Well-being)

PPD is a severe public health issue with a global prevalence affecting 6% to 26% of women after delivery. Its impact is a direct threat to achieving SDG Target 3.4, which aims to promote mental health and well-being.

Symptoms and Disabling Effects

The condition presents with a range of disabling symptoms that compromise a mother’s well-being and functionality. These include:

• Poor mood and irritability
• Exhaustion and sleeplessness
• Changes in appetite
• Anxiety and guilt
• Feelings of worthlessness and incapacity to cope
• Suicidal thoughts

Consequences for Maternal and Child Health

Untreated PPD has deleterious effects on both mother and child, undermining progress towards SDG Target 3.1 (reduce maternal mortality) and Target 3.2 (end preventable deaths of newborns). The consequences include:

1. Impaired Mother-Infant Interaction: PPD hampers crucial bonding, attachment, and sensitivity, which are vital for a child’s healthy development.
2. Negative Child Development Outcomes: Infants of mothers with depression may exhibit slower cognitive development, increased behavioral issues, and a higher risk of future mental illness.
3. Increased Maternal and Infant Risk: In severe cases, PPD elevates the risk of suicide and infanticide, representing the most tragic failure in public health and social support systems.

Socioeconomic Determinants and Alignment with SDGs 1, 5, and 10

The risk factors for PPD are deeply intertwined with socioeconomic conditions, highlighting the need for an integrated approach that addresses poverty (SDG 1), gender equality (SDG 5), and reduced inequalities (SDG 10).

Key Risk Factors

A multitude of bio-psycho-social factors contribute to the onset of PPD. Addressing these requires multi-sectoral action consistent with the SDGs.

• Gender-Based and Social Factors (SDG 5 & 10): Intimate partner violence, a history of sexual abuse, lack of social support, and marital difficulties.
• Health and Well-being Factors (SDG 3): A history of mental illness, anxiety, stress, risky pregnancies (e.g., emergency caesarean section), and poor eating or sleep habits.
• Economic and Educational Factors (SDG 1, 4, 8): Low income, unemployment, poor maternal literacy, and heavy workload.

Disproportionate Impact on Vulnerable Populations

PPD disproportionately affects women in vulnerable situations, exacerbating existing inequalities (SDG 10). Young, low-income, and minority mothers face a higher prevalence of PPD. The impact is particularly severe in low-resource settings like sub-Saharan Africa, where frail healthcare systems, poverty, poor sanitation, and malnutrition create a compounding crisis that prevents mothers from providing adequate care.

Challenges in Achieving Universal Health Coverage (SDG 3 Target 3.8)

Significant barriers prevent the effective diagnosis and treatment of PPD, undermining the goal of UHC. Despite its severe consequences, only an estimated 15% of women with PPD receive professional care.

Barriers to Diagnosis and Treatment

1. Underreporting and Stigma: Women often underreport symptoms due to fear of stigma or the inability to recognize the illness. Symptoms are frequently dismissed by mothers and caregivers as normal side effects of childbirth.
2. Lack of Systematic Screening: Routine PPD screening is not standard in many healthcare settings. Postpartum follow-up appointments often neglect mental health, focusing instead on physical recovery and infant care.
3. Systemic Failures: Even when help is sought, few adhere to treatment plans, indicating a need for more supportive and accessible mental healthcare systems.

The Case of Ghana: A Regional Perspective

In Ghana, a scarcity of comprehensive data, particularly from urban centers like Kumasi, hinders the development of effective, evidence-based interventions. Existing literature from rural areas indicates a significant problem, but a lack of broader data makes it difficult to formulate national policies that can effectively advance maternal mental health as a component of UHC.

Conclusion: A Call for Integrated Action for the 2030 Agenda

Postpartum depression is not merely a health issue but a critical development challenge that intersects with health, poverty, gender, and inequality. Addressing PPD requires an integrated approach that recognizes its impact across multiple SDGs. Gathering baseline data, as proposed by research in Kumasi, is a crucial first step. To achieve the 2030 Agenda, particularly UHC, policies must prioritize maternal mental healthcare, implement routine screening, combat stigma, and address the underlying socioeconomic determinants of this debilitating condition.

Analysis of Sustainable Development Goals (SDGs) in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being: The article’s central theme is postpartum depression (PPD), a significant mental health issue affecting mothers. It discusses the prevalence of PPD, its debilitating symptoms, and its negative impact on both maternal and newborn health. The text explicitly mentions the need to “enhance positive maternal and newborn outcomes towards universal Health Coverage (UHC) of 2030,” directly linking the issue to the core objectives of SDG 3.
• SDG 5: Gender Equality: The article highlights issues that disproportionately affect women. PPD is a condition linked to childbirth, primarily impacting women. Furthermore, it identifies risk factors such as “intimate partner violence,” “a history of sexual abuse,” and “preference for a specific gender,” which are all manifestations of gender-based discrimination and violence that SDG 5 aims to eliminate.
• SDG 10: Reduced Inequalities: The article points out significant disparities in the prevalence and treatment of PPD. It states that the condition is “more common among young, low-income, minority moms” and that “poor people and women are more at risk.” It also contrasts the global issue with the more severe impact in “sub-Saharan Africa with limited resources, poor access to care and frail healthcare systems,” highlighting health inequalities between and within countries.

2. What specific targets under those SDGs can be identified based on the article’s content?

• Target 3.2: End preventable deaths of newborns and children under 5. The article establishes a direct link between maternal mental health and child survival by stating there is an “association between probable post natal depression and increased infant mortality and morbidity.” It also mentions that the repercussions of PPD include an “elevated risk of… infanticide.”
• Target 3.4: Promote mental health and well-being. The entire article is focused on PPD, a serious mental health disorder. It describes PPD as a “severe issue” with “disabling symptoms” and an “elevated risk of suicide.” The call for better diagnosis, treatment, and policy development (“initiatives to enhance maternal perinatal mental healthcare are required”) directly supports the promotion of mental health.
• Target 3.8: Achieve universal health coverage (UHC). The article explicitly mentions the goal of “universal Health Coverage (UHC) of 2030.” It highlights major barriers to achieving UHC, such as “poor access to care,” “frail healthcare systems,” underdiagnosis due to the “rarity of regular postpartum depression screening,” and the fact that “Merely 15% of women who have this illness obtain professional care.”
• Target 5.2: Eliminate all forms of violence against all women and girls. The article identifies “intimate partner violence” and “a history of sexual abuse” as significant predictive factors and risk factors for developing postpartum depression. Addressing these forms of violence is crucial for preventing PPD and protecting women’s health.
• Target 10.2: Empower and promote the social, economic and political inclusion of all, irrespective of… economic or other status. The article underscores that PPD disproportionately affects vulnerable populations, stating it is “more common among young, low-income, minority moms” who face “many obstacles… including lack of understanding, stigma associated with mental illness, and transportation.” This points to a lack of inclusion and unequal access to health resources for marginalized groups.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• Prevalence of Postpartum Depression: The article provides statistics on the prevalence of PPD, stating it affects “6% to 26% of women after delivery” and that “one in seven women get a postpartum depression diagnosis” within a year. This can serve as a direct indicator for monitoring the burden of mental health conditions under Target 3.4.
• Infant Mortality and Morbidity Rates: The article implies this indicator by noting the link between PPD and “increased infant mortality and morbidity.” Tracking these rates in relation to maternal mental health status would measure progress towards Target 3.2.
• Proportion of women receiving mental healthcare: A key indicator for UHC (Target 3.8) is explicitly mentioned: “Merely 15% of women who have this illness obtain professional care.” Increasing this percentage would be a clear measure of improved access to essential health services.
• Prevalence of violence against women: The article identifies “intimate partner violence” and “sexual abuse” as risk factors. Data on the prevalence of these forms of violence would be an indicator for Target 5.2 and could also be used to predict and address PPD risk.
• Suicide Rate: The article mentions that PPD carries an “elevated risk of suicide.” The maternal suicide rate is a critical, though tragic, indicator for Target 3.4 (specifically indicator 3.4.2: Suicide mortality rate).

SDGs, Targets, and Indicators Table

Source: bmcpregnancychildbirth.biomedcentral.com