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 Table of Contents  
COMMENTARY
Year : 2019  |  Volume : 35  |  Issue : 1  |  Page : 55-56

Perinatal (Mother-infant) psychiatry in India: Now is the right time to talk


Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Date of Submission29-Jun-2018
Date of Decision17-Jul-2018
Date of Acceptance08-Oct-2018
Date of Web Publication27-Mar-2019

Correspondence Address:
Dr. Balaji Bharadwaj
Peripartum Psychiatry Clinic, Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Puducherry - 605 006
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijsp.ijsp_52_18

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How to cite this article:
Bharadwaj B. Perinatal (Mother-infant) psychiatry in India: Now is the right time to talk. Indian J Soc Psychiatry 2019;35:55-6

How to cite this URL:
Bharadwaj B. Perinatal (Mother-infant) psychiatry in India: Now is the right time to talk. Indian J Soc Psychiatry [serial online] 2019 [cited 2019 Sep 22];35:55-6. Available from: http://www.indjsp.org/text.asp?2019/35/1/55/254999



In this issue, Harsha and Acharya call attention to this important subspecialty of perinatal psychiatry and its trajectory in India. The standard of a nation's health care is reflected in the status of health-care services for its women and children. The initial challenges for a developing country in maternal health include dealing with physical illnesses such as puerperal sepsis, cardiac diseases, and postpartum hemorrhage. In children, protein-energy malnutrition, infectious diseases, and vaccine-preventable diseases are major contributors to infant and under-five mortality initially. The high-income countries went through this stage of development in the 1950s and 1960s when availability of antibiotics, better antenatal care, and changes in childbirth practices led to rapid reductions in maternal mortality due to physical ailments.[1] Subsequent to this change, maternal suicides became the major contributor to maternal mortality and maternal mental health got the attention it deserved. More recently, Sri Lanka has also entered this stage of development where suicides contributed to about 17% of maternal deaths in the two regions studied.[2]

Notwithstanding the vast geographical expanse and population of India, the maternal mortality ratio (MMR) per 1,00,000 live births dropped from 677 in the year 1980 to 130 for 2014–2016,[3] and we are well on target to achieve the Millennium Development Goal 5 of reduction in MMR by 75% by 2030. Maternal suicides are only the tip of the iceberg when it comes to maternal mental health. Several studies have shown that about 13%–26%[4],[5] of postpartum women in India may be suffering from postpartum depression. Maternal mental health problems can have far-reaching consequences not only on the mother's health and birth outcomes but also on the child's development.[6]

The substantial reduction in MMR and the successful implementation of the District Mental Health Program (DMHP) across the country is a golden opportunity for this thrust for perinatal psychiatry in India. The DMHP must provide the training to health-care workers at primary and secondary care levels to detect and provide basic interventions to women with psychological problems during pregnancy and postpartum. A stepped care approach has been shown to be effective in other resource-limited settings such as South Africa where screening is done at the first antenatal visit by the midwife or nurse, and counseling is offered at each subsequent visit by counselors. Patients who require referral are referred to a psychiatrist.[7] The preexisting manpower of the Reproductive and Child Health (RCH) Program can take care of the screening and counseling of antenatal women, while the district level psychiatrist (under DMHP) may provide specialist care for those in need. Such a stepped care approach can help to maximize the benefits that can be derived from limited resources. Utilization of the manpower of the preexisting RCH program has the advantages of lesser stigma, feasibility of short-term training, and a workforce motivated to work for the cause of maternal well-being. The level of specialist knowledge and skills required to handle inpatient as well as referral services would require that the DMHP program is eventually expanded to provide specialist services at the secondary level. Given that a large proportion of health-care services is also provided by the private sector in the country, periodic training for obstetricians, pediatricians, and general practitioners is equally important as they are often the first point of contact with health care.

The National Institute of Mental Health and Neuro Sciences, Bangalore, has started a mother-baby Unit and a postdoctoral training course in perinatal psychiatry and women's mental health. It provides care for psychiatric disorders as well as interventions for bonding disorders and difficulty with lactation. More such apex centers or centers of excellence for specialized services for mothers with mental health issues may help the cause of growth of perinatal psychiatry in the country with teaching and training, clinical services and research as the three pillars of future development of the specialty [Table 1].
Table 1: Future of perinatal psychiatry in India

Click here to view
[8]

While it is encouraging that maternal mental health is getting the attention that it deserves, it is also essential that infant mental health is integrated into practice and research in the field of perinatal psychiatry. Since perinatal psychiatrists are often derived from the pool of adult psychiatrists, infant psychiatry runs the risk of being neglected in perinatal psychiatric practice. Relabeling the field as mother-infant psychiatry can help view the mother-baby dyad as the service utilizer, and the development can be more balanced.

The past decade has seen the emergence of child and adolescent psychiatry, addiction psychiatry, and geriatric psychiatry as subspecialties in psychiatry and mother-infant psychiatry are the most eligible candidate for the next wave of growth of subspecialties in psychiatry. There is an urgent need for the development of this specialty as it can have far-reaching impact on maternal as well as infant mental health.



 
  References Top

1.
Loudon I. Maternal mortality in the past and its relevance to developing countries today. Am J Clin Nutr 2000;72:241S-6S.  Back to cited text no. 1
    
2.
Agampodi S, Wickramage K, Agampodi T, Thennakoon U, Jayathilaka N, Karunarathna D, et al. Maternal mortality revisited: The application of the new ICD-MM classification system in reference to maternal deaths in Sri Lanka. Reprod Health 2014;11:17.  Back to cited text no. 2
    
3.
Home - HMIS-Periodic Report. Available from: https://www.nrhm-mis.nic.in/Part%20B%20Demographic%20and%20Vital%20Indicators/MMR%20Bulletin-2014-16.pdf. [Last accessed on 2018 Jun 28].  Back to cited text no. 3
    
4.
Zaidi F, Nigam A, Anjum R, Agarwalla R. Postpartum depression in women: A risk factor analysis. J Clin Diagn Res 2017;11:QC13-6.  Back to cited text no. 4
    
5.
Savarimuthu RJ, Ezhilarasu P, Charles H, Antonisamy B, Kurian S, Jacob KS, et al. Post-partum depression in the community: A qualitative study from rural South India. Int J Soc Psychiatry 2010;56:94-102.  Back to cited text no. 5
    
6.
Satyanarayana VA, Lukose A, Srinivasan K. Maternal mental health in pregnancy and child behavior. Indian J Psychiatry 2011;53:351-61.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Honikman S, van Heyningen T, Field S, Baron E, Tomlinson M. Stepped care for maternal mental health: A case study of the perinatal mental health project in South Africa. PLoS Med 2012;9:e1001222.  Back to cited text no. 7
    
8.
Chandra PS, Desai G, Reddy D, Thippeswamy H, Saraf G. The establishment of a mother-baby inpatient psychiatry unit in India: Adaptation of a Western model to meet local cultural and resource needs. Indian J Psychiatry 2015;57:290-4.  Back to cited text no. 8
[PUBMED]  [Full text]  



 
 
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