The COVID-19 pandemic has posed mental health challenges for women during pregnancy and early motherhood, according to a report by Centre for Mental Health and Maternal Mental Health Alliance.

There has been a decrease in the mental health of women during the perinatal period for a variety of reasons including an increase in anxiety due to fear of infection, and experience of infection and bereavements, combined with reduction in available support. There was also a reported increase in domestic violence.

Sarah Hughes, chief executive of Centre for Mental Health, which carried out the research, said: “The Covid-19 pandemic has been a mental health challenge across society, but it has not affected everyone equally. It has placed especial pressure on women during pregnancy and after they’ve given birth. And it has made inequalities that were always there in plain sight even more pronounced. We need to take this opportunity to review and reframe what support women should expect for their mental health during the perinatal period, and to make sure that we prepare for any future crisis to avoid another loss of support at a crucial time in people’s lives.”

From early on in the Covid-19 pandemic, Centre for Mental Health and Maternal Mental Health Alliance were concerned about the likely increased mental health challenges that women in pregnancy and early motherhood were facing as a result of the pandemic and government-imposed restrictions introduced to tackle it. The organisations set out to explore just how much of a challenge the pandemic has placed on perinatal mental health and the services that support women, their partners, and families during this time.

As a result, a literature review of the available published and unpublished/ non-peer reviewed literature, which evidenced impact was carried out as well as verbal evidence-giving events and written submissions of evidence.

The perinatal period is a time of significant risk to women’s mental health, with up to two in 10 women suffering some form of mental health problem, ranging from mild to moderate forms of anxiety or depression to a minority who will suffer from more severe mental health problems. Half of women with a history of psychosis are at risk of relapse during this period. During the perinatal period, women can be affected by a range of problems such as antenatal and postnatal depression, obsessive compulsive disorder, post-traumatic stress disorder (PTSD) and postpartum psychosis.

Stigma can be a significant barrier to seeking help and women may worry that they appear incompetent or that their children may be taken away from their care if they appear not to be coping. Of most immediate concern is the risk of suicide during this period which is a leading cause of maternal death in the UK.

“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.
Further, women from specific communities have been more markedly affected than others,” said the report.

It added that women and families experiencing socio-economic deprivation, and women and families of colour, were the most affected. They also 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.

The report highlights that there were worrying gaps in perinatal mental health services prior to COVID-19. There has been government investment across the four 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.

While there had been some investment in perinatal mental health care, there is also evidence of cuts in recent years to some services for women and families during the perinatal period, and so provision was not at its most optimal even prior to the crisis.

The report also highlighted how grandparents, family and friends can be a great support system for women during pregnancy and following birth but due to COVID-19 restrictions, social isolating meant many families were not able to access this help and support in person.

Furthermore, restrictions have caused anxiety due to some partners not being allowed to be present during labour and the birth or at scans and hospital appointments. This reportedly resulted in greater stress on expectant mothers, which in turn made for a more stressful birth experience and had a negative impact on fathers who were worried about their partners and missed out on a huge milestone.

The enforced isolation also meant that babies and infants were experiencing far less socialisation which had resulted in clinginess, introversion and concern at strangers. “We do not know what the longer-term impact on the wellbeing of these children could be, but it was a concern for those who provided us with evidence,” said the report.

“Whilst it was commendable that pregnant women and new mothers were identified as being at ‘moderate risk (clinically vulnerable)’ early on in the crisis, it seems this risk was viewed only through the lens of clinically vulnerable to infection, and the potential impact on the baby. 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 added.

The workforce supporting women and families in the perinatal period is facing its own wellbeing challenges and needs support with additional stress felt by staff and additional work due to redeployment of some workers.

The report also warns that while virtual support included, there could be some people missing out on such support including those who, through social deprivation or geography, have less access to these platforms. Some people within these communities may also be less able to benefit, for example those for whom English is not their first language.

The report makes a number of recommendations:

- The Department of Health and Social Care in England, and the equivalent bodies in the devolved nations, should conduct an immediate assessment of the level of need for perinatal mental health services in light of the impact of the pandemic.

- Perinatal mental health services should be future-proofed against future pandemics or similar public health crises.

- NHS Digital and equivalent bodies in each of the devolved nations should collect and publish routine data on the mental and physical health of women during the perinatal period.

- The NHS in all four nations needs to address the disparity in maternal mental health outcomes caused by the crisis, and by longer-term issues, for women of colour.

- Those funding and conducting research across the UK should prioritise understanding the longer-term emotional and psychological impacts of the pandemic on young families.

- Where face-to-face services have been replaced by remote services, we must understand how they work and whether there is an impact on quality, choice, patient satisfaction and most of all whether they help people with their mental health.

- NHS organisations commissioning mental health services must recognise and value the role of voluntary and community organisations in meeting women’s mental health needs during the perinatal period.

The report concludes that NHS employers in all parts of the UK and in every organisation must support the mental health and emotional wellbeing of staff working with women and families during the perinatal period, recognising the risk of exhaustion, anxiety, depression and post-traumatic stress disorder (PTSD) created during the pandemic.

Luciana Berger, chair of the Maternal Mental Health Alliance (MMHA) said: “Today’s report should serve as an ear-splitting warning siren about the dangers to women’s maternal mental health and potential risks to the wellbeing of their babies. The pandemic has placed additional challenges on new and expectant mums getting the care and support they need, taking many already-stretched services to the point of breaking. Women of colour and women from disadvantaged backgrounds have been particularly impacted, and Ministers must address this injustice with urgency.”

Maternal mental health during a pandemic