"My mother died when I was eight, and my aunt raised me. She did not teach me anything about sex or pregnancy. When a 'friend' offered to help me with my schoolwork, he raped me."
That's how one young woman became pregnant. Feeling "desperate and angry", she sank into a deep depression — joining the masses of women who experience mental illness around the time of giving birth.
In developed countries, 10% to 15% of mothers experience mental health problems — particularly anxiety and depression — during or after pregnancy. But in South Africa it is a staggering 34% for many communities.
On Tuesday in Malawi, the region's first alliance to tackle this issue will be launched. Cape Town's Dr Simone Honikman and psychiatrist Robert Stewart (University of Malawi), are the key drivers behind this African Alliance for Maternal Mental Health.
Honikman has been a warrior for this cause for several years.
Honikman is the founder of the Perinatal Mental Health Project in Cape Town, which since 2002 has offered clinical services, training, research and advocacy to help women during pregnancy and after they have given birth.
Her personal story illuminates the "eureka" moment when she realised there was a "huge gap" in our health system.When her daughter was a year old, "I was struck by a whole lot of colliding things ... I knew that the mothers I had seen in Khayelitsha as patients were having an experience a world apart from my own.
"Yes, I was utterly exhausted and sleep-deprived, but I had what I needed — food, a loving husband, beautiful spaces where I could walk the baby."
Around that time, she was invited to a conference on maternal mental health at the University of Cape Town, where she was "exposed to a whole part of medicine that was new" to her.
Immediately after the conference, tragedy brought it all into even sharper focus.
"A colleague of mine, an accomplished doctor in Sea Point, committed suicide eight months after giving birth. She had all the outer trappings of privilege but was clearly in distress, and the paradoxes of all this made me think: we have to step up and do something in South Africa. There is a massive gap, and we need to act."
For most women in South Africa, the risk factors are so high it's little wonder one in three mothers struggle with mental health."So many women are dealing with extremely difficult situations, with multiple problems that play into each other. It is not uncommon to find that one family is trying to cope simultaneously, for example, with violence, unemployment, chronic hunger and substance abuse, to name but a few."
A pregnant woman's risk of depression and anxiety then "rises exponentially".
ALLIANCE
A study at the London School of Economics found that screening and treating costs governments a fraction of dealing with the long-term effects of illnesses left untreated. Based on this and other research, the British government invested millions of pounds in maternal mental health.
Honikman said because pregnant women came to the same health facility repeatedly in a short time, it made sense to also provide a mental health service at those places.
She tells the heartbreaking story of one woman who made 19 visits in 18 months to the same clinic. It was clear from the medical records repeatedly noting "stress" that something wasn't right, but because it was psychological and not physical, "nobody mobilised a response".
One day, the woman hanged herself and her little boy.
Globally, suicide is one of the leading causes of maternal deaths.
With millions of women across Africa facing the same risk, it is hoped that the new alliance, which is the first regional group formed from the Global Alliance of Maternal Mental Health, will develop "a critical mass of advocates for health systems to change at national and policy level".
Honikman said: "This work is not unaffordable or a luxury.
"We could divert money away from things like military spending and other sorts of spending that do not support the development of communities, and invest in our mothers' wellbeing. It's a smart investment in any country's development."..