Editor’s note: The following article has been submitted on behalf of the Period Priority Project and its founder, Leisha Toory, as part of the project’s new series, The SRHR Conversation. This is the third article in the series. For the first article, see Reproductive justice barriers still exist in Newfoundland and Labrador and the second at Decolonizing sexual and reproductive health rights
Talking about perinatal mental health is essential for the well-being of both parents and their infants, reducing stigma, enabling early intervention, fostering support networks, increasing health-care provider awareness, and driving positive changes in public policy and research. When conversations about these issues are normalized, health-care professionals are more likely to ask the right questions, offer appropriate screenings, and provide necessary support or referrals.
As part of Period Priority Project’s “The SRHR Conversation”, I had the opportunity to have a chat with Karen Clarke, a mother, counsellor, certified postpartum doula and registered social worker located in Mount Pearl, N.L.
LT: What is perinatal mental health, and why is it important to address during the perinatal period?
KC: The perinatal period is most simply defined as the period before and after having a baby. For families giving birth, it includes preconception, pregnancy, birth and postpartum. I define it as the time from when a person or couple decides they would like to have a baby, until the baby’s third birthday. Perinatal mental health describes the mental health of the person or couple during the perinatal period.
Perinatal mental health is the main determining factor for infant mental health. What happens during postpartum, birth, pregnancy and preconception impacts both the parent’s and the baby’s well-being. Addressing issues early in the perinatal period can prevent mental health issues for parents and children, as well as reduce demand on mental health intervention services.
LT: How do you perceive the current state of perinatal mental health policies and programs in our health-care system in N.L.? What areas do you believe need improvement?
KC: Our current perinatal mental health policies and programs are inadequate with improvements needed in every area.
Newfoundland and Labrador has the second highest rates of postpartum mood disorders in the country with 28 per cent of mothers reporting symptoms of postpartum depression or anxiety (2018/19 Survey on Maternal Health). We currently do not have provincial perinatal mental health policies and programs in N.L. And what does exist, is inaccessible to many. However, in June 2022, the provincial government committed to “formalize a provincial perinatal mental health program” (Our Path of Resilience, 2022) and launched a task force to work toward this goal, which includes members of the Perinatal Mental Health Alliance of N.L.
Future policies and programs must address concerns and provide treatment through early screening and accessible care and interventions. Equally vital should be efforts to create healthy communities, raise awareness and education, and provide prevention services that mitigate risk factors and enhance parental wellbeing during the preconception, prenatal, birthing, and postpartum periods. This includes having access to sexual and reproductive health-care in the preconception and prenatal stages.
LT: What are some potential barriers that pregnant and postpartum individuals might face when trying to access mental health services, specifically in N.L.? How can these barriers be addressed at a policy level?
KC: In my experience, there is currently low awareness and understanding of perinatal mental health and its importance among the general population, health-care providers, social program providers and others. Individuals themselves are often not aware they are in the perinatal period or that their well-being impacts their baby’s well-being. Therefore, they do not access supports that may enhance their well-being during this time. Further, there is limited access to prevention-focussed supports.
There is also a lack of psychological safety for parents to honestly express concerns about their emotional well-being – they feel unsafe telling others about their struggles, as they fear being negatively judged. Further, health-care providers and others often do not ask parents about their emotional well-being, leaving the onus on parents to broach the difficult topic. Without a trusting relationship with a support person or health provider, parents often wait until they are at a crisis point before asking for help.
For those experiencing symptoms (knowingly and unknowingly), screening for mental health issues during the perinatal period is limited, and often non-existent. For those identified as symptomatic or diagnosed with a perinatal mood disorder like postpartum depression or anxiety, access to perinatal mental healthcare is limited with a current focus on psychiatric interventions.
Policies and programs need to be underpinned by a more holistic and upstream understanding of the perinatal period and infant well-being that uses a stepped-care approach and recognizes the roles of mental health promotion, community, prevention, and accessible intervention services. Efforts need to go beyond the health-care system, with all departments in all levels of government working together with non-government organizations and communities.
If you are struggling with your mental health, please reach out for help. Speak with your family doctor or other health-care professional.
Visit Bridge the Gapp: https://nl.bridgethegapp.ca/
Call the Channel Warm Line: 1-855-753-2560
Contact Postpartum Support International: www.postpartum.net; 1-800-944-4773
If you would like to learn more about perinatal mental health, visit the Perinatal Mental Health Alliance of N.L.: www.pmhanl.com
The policy concepts referenced above are further explained in the Atlantic Summer Institute Policy Brief (2022). Upstream Investment: Placing infant, child and youth mental health promotion at the forefront, and Daymark Foundation (2021) Discussion Paper: A Holistic Approach to Stepped-Care in Perinatal Mental Health.
Karen Clarke is a mother, counsellor, certified postpartum doula and registered social worker located in Mount Pearl, N.L. She is a member of the board of directors with the Perinatal Mental Health Alliance of N.L. and vice-president of the board of directors with the Atlantic Summer Institute on Healthy and Safe Communities. Contact www.openbookservices.ca.
Leisha Toory is a political science undergraduate at Memorial University, the founder of Period Priority Project, and an SRHR activist.