Partnership to improve school sanitation
ALICE felt ecstatic when she saw the two dark pink lines on her pregnancy test. She wasn’t surprised when fatigue and nausea soon followed. But Alice began to worry when she couldn’t sleep and became engulfed in sadness that eclipsed her maternal joy. She confided in a couple of close girlfriends. “Everyone told me that I was hormonal and that I would begin to feel better during my second trimester,” she said.
By the end of her first trimester, the nausea and fatigue had lifted, but Alice’s tearfulness and insomnia lingered. She would toss and turn through the night worrying that she wouldn’t be a “good enough” mother to her baby.
Her husband told her she had “always been a worrier” and just needed to try to rest and relax.
A constant stream of worries raced through her mind: “What if there’s something wrong with the baby and the ultrasound didn’t detect it yet?” “What if I develop gestational diabetes, and I have to go on bed-rest?” “What if I have one of those difficult babies who cries all of the time because of colic?”
“On top of all that, I began to worry that my thoughts were hurting my baby,” Alice said.
Even though she had heard of postpartum depression (PPD), the mental health disorder that affects up to 20% of new mothers, she was unaware that depression often begins during pregnancy.
When her obstetrician asked her how she was feeling during her pregnancy, Alice broke down in tears. Her doctor asked her a few more questions about how she was sleeping and if she was feeling overwhelmed. When Alice finally opened up to her doctor about her struggles, she learned that she was suffering from prenatal depression.
As a psychologist specialising in prenatal and postpartum depression, I’ve treated many women like Alice, who may not be aware that depression can begin during pregnancy, not just after giving birth. (I’ve changed Alice’s name to protect her privacy.)
Similar to postpartum depression, prenatal depression is accompanied by feelings of worry, sadness and anxiety. But there are some unique symptoms as well, which is why researchers at Northwestern University are raising awareness by informing women and their doctors about the signs of pregnancy-related depression.
Results from their recent study suggest that women like Alice, who develop depression before or during their pregnancies, suffer from a more TWO ORGANISATIONS have partnered to help provide quality sanitation to South African schools.
The UN Children’s Fund (Unicef) and Domestos said in a joint statement that they would be rolling out a programme to strengthen the capacity of schools through the provision of improved sanitation.
“In its first three years, the partnership reached over half a million learners with behaviourchange sanitation programmes.
“Of these, 655 000 people are now living in open defecation-free communities, allowing them to benefit from improved health and safety – thus giving them back their dignity. In South Africa, Domestos aims to give over 2 severe version of this mental health concern, and experience more intense feelings of sadness, sleep concerns and in rare instances, paranoia.
“These women are often juggling a multitude of life stressors, such as pregnancy complications, as well as family and financial stress. In many instances, they struggled with depression or anxiety before they became pregnant,” says Sheehan Fisher, a psychiatry professor and a lead researcher in the study.
“I felt ashamed to tell my doctor that I was struggling during my pregnancy. I wanted to believe that my feelings would go away on their own like my friends reassured me they would,” Alice said.
This past year, the US Preventive Task Force recommended that all expectant and new mothers receive maternal mental health screenings, yet many women continue to fall through the cracks of the health-care system. Often, it’s not until after the birth of their babies that these women receive the mental health treatment that they needed during pregnancy.
Even when women are assessed for this mental health disorder, they are often screened with the Edinburgh Postnatal Depression Scale, a 10-item, self-reported questionnaire that asks women to respond to statements such as, “I have felt sad or miserable,” and “I have been anxious or worried for no good reason”.
While this questionnaire helps screen expectant and future mothers for depression, it only asks about symptoms for the past seven days, which doesn’t account for symptom severity and length of maternal suffering.
“It’s important to recognise that the symptoms of prenatal and postpartum depression vary for each woman,” said Meg Earls, director of the Perinatal Task Force for California Pacific Medical Center in San Francisco.
In addition to using screening tools, such as the Edinburgh, Earls recommends asking two more screening questions when working with pregnant and postpartum women: “Do you have any thoughts that disturb you?” and “Are you feeling more agitated or irritable?”
She says that these questions can help clinicians garner more accurate data about their patient’s emotional well-being.
Because Alice’s doctor asked her those kinds of questions, she recognised that Alice was suffering. She referred her for psychotherapy at the local mental health clinic for expectant and new mothers.
“When I began therapy, I was able to connect million people improved access to sanitation by 2020,” they said.
To date, they said, more than 500 000 children had been affected, through the brand’s sanitation programmes.
As part of this programme, Domestos was currently running a campaign where it donated 5% from every bottle that was purchased, towards Unicef ’s sanitation programmes.
Unilever SA chairman Peter Cowan said: “There are currently more than 475 schools lacking basic water and sanitation facilities in South Africa. The Department of Education has highlighted that this backlog would require R88 billion to address. Domestos is working to address this challenge by contributing the proceeds to Unicef.”
Water and sanitation-related diseases such as diarrhoea remain the biggest killers of children across the globe, accounting for 9% of all deaths among children under the age of 5 worldwide in 2015.
These infections continued to prevail, as 18 million South the dots,” Alice said. “I had experienced a depressive episode when I left home for college, but didn’t realise how these two experiences were related. My therapist helped me understand I was more sensitive to stress, and with her support and weekly therapy, I learned tools that helped me to feel calmer during my pregnancy.”
Sometimes, individual therapy is not enough to help women suffering from prenatal depression. “It’s so important for each pregnant woman to have a postpartum team of care providers – doctors, midwives and mental health therapists,” says Patricia Robertson, an obstetrician at UCSF hospital in San Francisco.
She recommends that all expectant mothers join a pregnancy support group so that they can connect with their peers as they prepare for the path to motherhood.
Alice is now the mother of a beautiful baby girl. Even though her depression improved, she remains in psychotherapy and hopes to break the stigma that’s associated with maternal mental health concerns.
“I want all women to know that they are never alone. If you are feeling sad, worried or frightened during your pregnancy or after your baby is born, seek help.”
Wendy Davis, director of Postpartum Support International, echoes these sentiments.
“It’s important for every woman to know that she’s never to blame, and with help, she will feel better.” – The Washington Post
* For help in South Africa contact SADAG at 0800 567 567 or SMS 31393 Africans did not have access to adequate sanitation facilities.
Unicef ’s representative to South Africa, Hervé Ludovic de Lys, said: “Water and sanitationrelated diseases remain among the world’s biggest killers, especially of children. But sanitation is about more than just building toilets: it starts with basic hygiene and personal care.
“At least 2.5 billion people in the world still do not have access to adequate sanitation; almost two fifths of the world’s population. Everyone can play their part by supporting the course and save lives”.
According to the World Health Organisation, without proper toilet facilities, one child dies every 15 seconds from diseases such as diarrhoea, caused by oral faecal contamination.
The partnership, said Cowan, supported Unicef ’s global sanitation programme, which Domestos was backing as part of the United Nations Sustainable Development Goals.
“The programme addresses the demand for improved sanitation at the community level through the use of demonstrations explaining the link between open defecation and disease-causing germs, encouraging families to change their sanitation practices.”
For more information visit www.unicef.org