key: cord-326414-kq8gru3c
authors: Aryal, Shreyashi; Pant, Sagun Ballav
title: Maternal Mental Health in Nepal and its Prioritization During COVID-19 Pandemic: Missing the Obvious
date: 2020-07-04
journal: Asian J Psychiatr
DOI: 10.1016/j.ajp.2020.102281
sha: 
doc_id: 326414
cord_uid: kq8gru3c

nan

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Dear Sir, COVID-19 pandemic has taken a toll on all health services and reproductive health has also been bearing its brunt. There should be no divided opinion that psychiatry is related to COVID-19 and more so in Asian countries due to their political and economic vulnerabilities (Tandon, 2020) .

Under-prioritization of womens' psychiatric issue at these times would be missing the obvious.

Nepal has a high maternal mortality ratio of 239 deaths per 100,000 live births (NDHS, 2016), due to which safe motherhood, contraception and abortion have always been a priority despite having an impoverished health system. On the other hand, mental health issues of women which J o u r n a l P r e -p r o o f is also burgeoning but under-acclaimed problem, is under-researched and grossly overlooked (Regmi et al., 2015) . Reproductive health and mental health are interwoven and a complete well being cannot be obtained without their integration.

The first witnessed COVID related death in Nepal was a young woman in her postpartum period and this has paramountly increased the stress that millions of pregnant women are currently facing. Mental health in pregnancy and puerperium is not addressed to the extent of its necessity and this pandemic has increased the ever present gap in maternal mental health issues.

Nepal has just above 57% institutional deliveries and this pandemic may force women to go back Screening for maternal mental health issues is a low priority in Nepal and addressing this issue should be a priority now than ever before. When the focus is in COVID positive cases, policies to detect early signs of mental illnesses which are increasing in non COVID women also have to be formulated. Culturally validated screening tools can be used for all antenatal care packages, and question on suicidality must be accessed. A liaison plan should be made with the involvement of mental health service providers to identify antenatal and postnatal psychiatric issues during hospital stay.

Video conferencing for antenatal care and tele-psychiatry can be a cost effective method for screening, evaluation and management of pregnancy in Nepalese context, where there is scarcity of health professionals. But these may not always be feasible due to low literacy rate especially in rural areas. Mobilization of Female Community Health Volunteers at the community level, to detect pregnancy at risk including mental illness can be continued while maintaining rules of physical distancing.

Obstetrics is one clinical subject where continuity of care is inevitable. Pregnancy and labor cannot wait and along with this comes mental health care. This is the time when women need to exercise their reproductive rights more than ever before and obstetric service providers play a pivotal role in ascertaining that they are able to do so. We need to make sure that these women go through a pleasant birth experience through the integration of physical and mental health. The crisis may always remain, so living with it with essential precautions, innovations and improvisations is the only option. 

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