Treating maternal depression isn’t costly, and the benefits are substantial

Simple, cost-effective interventions to support women’s mental health during pregnancy and early motherhood can have lasting positive effects on wellbeing, parenting and empowerment.

When we talk about mental health, maternal mental health isn’t the first thing that comes to mind. Yet in the UK, as many as 1 in 5 women suffer mental health difficulties during pregnancy and/or early motherhood.

This problem has significant impacts not just on women suffering maternal depression, but also on their families.

We know that investing time, care and money in children from early infancy can affect children’s outcomes in later life. But fatigue and the feeling of helplessness linked to depression might make it harder for mothers to make these investments.

Women suffering depression might also feel less able to participate in creating or managing household income, or negotiating some control over their income with their partners. This can lead to a sense of disempowerment and lack of financial independence.

And the impacts of maternal depression can persist for years – contrary to the common perception that ‘pregnancy blues’ don’t last.

In its recently published Women’s Health Strategy for England, the UK government acknowledged that mental health was one of the top five topics selected for inclusion by respondents. It also noted that professional bodies had called for more support for perinatal mental health.

The government has now pledged £100 million for ‘bespoke parent-infant relationship and perinatal mental health support’.

The good news is that support for women suffering maternal mental health issues needn’t be complex or costly. Research by CAGE Associate Sonia Bhalotra and a group of international colleagues has looked at the mid-term effects of providing simple cognitive behavioural therapy (CBT) to depressed mothers.

The programme offered mental health support and general health advice during home visits to women, starting in pregnancy and ending when their baby was ten months old.

The researchers found that seven years after the treatment, women were still experiencing the benefits of improved mental health. The CBT treatment closed the gap between mothers who suffered maternal depression and mothers who did not – in terms of both parental time and money spent with children – by between 70 and 90%.

Mothers treated with the therapy were not only more likely to invest (in both time and money terms) in their children, they also reported a sense of financial empowerment through greater control over household income.

In a different but related study, the researchers found that when asked if they anticipate finding breastfeeding or playing with their newborn child tiring, about a third of all mothers said yes, and this fraction was significantly larger among those suffering depression. In line with this, depressed women were significantly less likely to breastfeed or play with their children.

Treating depression early using this simple therapy, therefore, has the potential to help mothers spend more quality time with their children.

This CBT programme was conducted in rural Pakistan. But treatments like this could be adapted and applied in countries across the globe. With perinatal depression affecting between 10 and 30% of women globally, all countries can learn from these positive results.

Indeed, the NHS-led IAPT programme is a step in this direction, and researchers currently engaged in evaluating the programme have consulted Bhalotra and other authors of the research in Pakistan.

When it comes to parenthood, policymakers have a difficult line to tread, between supporting parents to raise their children well and instructing them on how to be ‘better’ parents.

It’s easy to get the balance wrong. Policymakers have a duty, for example, to explain the well-proven benefits of breastfeeding. Yet, research in the UK has found that bottle-feeding mothers can suffer a sense guilt in their feeding choices. In 2018, the Royal College of Midwives published new advice encouraging practitioners to supply new mothers with information on feeding, but to respect their feeding decisions.

Interventions like this simple CBT treatment, then – ones that empower women in their parenting – should be an obvious choice for policymakers seeking to improve outcomes for mothers and their children. The real challenge will be to ensure that mothers who need help are identified and treated quickly.

Stephanie Seavers

Communications Manager, CAGE

Read the research

Baranov,V., Bhalotra, S., Biroli, P. and Maselko, J.(2020). Maternal Depression, Women's Empowerment, and Parental Investment: Evidence from a Randomized Controlled Trial. American Economic Review. 110 (3): 824–59

Bhalotra, S., Delavande, A., Font Gilabert, P., and Maselko, J. (2020). Maternal Investments in Children: The Role of Expected Effort and Returns. IZA Discussion Paper No. 13056. Revised version available from the authors.

The authors of these papers acknowledge the incredible support and inspiration they have received from Atif Rahman, Siham Sikander and the HDRF team in Pakistan.