Being a woman is hard work, said Maya Angelou. True indeed. A woman has to go through various stages of mental and physical changes throughout her life, from adolescence to pregnancy and postpartum period and, if that was not enough, comes menopause.

In addition to that, many women go through specific distressing life events such as miscarriage, intimate partner violence, surgery for removal of uterus or surgery for family planning. Unfortunately some further suffer from sexually transmitted diseases, HIV/AIDS, fistulas, or uterine prolapse. A few number of women also go through traumatic experiences in health care facilities during abortions, family planning counseling, childbirth or postpartum periods. These reproductive health events in a woman’s life cause physical changes and has been associated with various mental disorders like anxiety, mood disorders and depression. But, regrettably, this association has been inconspicuously addressed. 

Expression of emotions has always been blamed on “hormonal imbalance”.  Estrogen, a prime role hormone, has been implicated in many of the mind and body changes that take place in a woman. The association of reproductive and mental health has been attributed to hormonal activity but there are many social issues that need to be addressed as well.  

Women in developing nations have low education and employment opportunities, have an extra unpaid workload of taking care of children and household tasks and also have lesser part to play in household and political decision making. Increase in the number of male migrant workers has added responsibilities for women who are left alone at home. All these factors add to the mental burden of these women and when physical distress sets in, the effect is exponentially increased.   

Mental health is a determinant of reproductive health and vice versa. In developing nations, this integration of gender and human rights is still an unconsidered issue. But without a combined approach, women cannot be treated as a whole and an important aspect of women’s health will be missed. 

The first step towards this integration would be to focus on research establishing the cause and effect of mental and reproductive health and addressing the socio-economic factors related to mental and physical well being of women. We need research which tells us how she felt after that miscarriage, still birth or a prolonged labor, or how well she is handling the hot flushes after menopause or how she is managing her three children after her husband left for Qatar five years ago. We need statistics on how many women underwent reproductive health problems that led to mental health problems during the Maoist insurgency or during and after the massive earthquake. Our knowledge is very limited in these aspects so we really don’t know. So research linking mental and reproductive health in relation to the socio economic context of the country needs to be enforced.

Secondly, health service providers should see beyond the physical symptoms and screen for mental disturbances in women who come for physical check up but otherwise keep their mental problems to themselves. Healthcare providers should develop mechanism to identify these silent sufferers. Health centers are the first point of contact between rural women and service providers. They come to these facilities with their physical ailments, so these centers can be developed as screening sites for mental symptoms so that women in early stages of mental disturbance can be identified, counseled and referred for specialized care. Roles of primary health care professionals are to be defined in these aspects so that they can assess psychological wellbeing and provide comprehensive care to all women.    

Finally, reproductive health services should target delivery of quality care that would be an atraumatic experience for women. Counseling, empathy, support, and comfort are all a part of quality health care that might reduce the chances of developing mental symptomatology in a woman undergoing medical treatment.  In low-income nations, where basic health care is still a struggle, mental health of women is given low priority but if we want to reduce gender disparity, then it is necessary to combine physical and mental health and give our women a sound mind in a sound body. 

Professional debates regarding this issue are required and health systems should respond to policies designed to expand the existing reproductive health services to incorporate a mental health perspective within the socio economic contexts. With some changes in health care policy, we might be able to achieve for our women a pleasant sail-through from adolescence to menopause. 

October 10 is World Mental Health Day.

 
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