Strong Minds for Stronger Adolescent and Young Mothers

Asha liked to go to a women's center in her village where she was learning how to sew, read and write, and care for her health. Most of all, she liked the safe space to talk about her sister's death, and advice about how to cope with the feelings and anguish of her loss. Twelve-year-old Asha had found her sister hanging in the one-room house where her family lived. Because of the stigma around suicide, she felt like she couldn't talk about what happened or her feelings. Luckily, a neighbor knew about the center and invited Asha to join her there.

Annie held her newborn son in her arms, in awe that she had given birth to this tiny person. At her first postnatal visit to the local clinic, the 15-year-old met an older woman who turned out to be a community health worker. The kind woman asked her how she was feeling and invited her to sit together on a quiet bench in the garden of the clinic. Safe in the anonymity of their conversation, Annie opened her heart, expressing not only her love for her son, but also her fears and worries. Her boyfriend had not contacted her since he found out about the pregnancy, her parents were disappointed in her, and Annie did not know how she would make enough money to provide for her child. The woman was a good listener. Over the next few months Annie met with her on a weekly basis, and the woman taught her different strategies to better manage her challenges.

There are far too many stories of adolescent and young mothers who struggle with depression, psychosocial stress, anxiety, and other mental health conditions. These stories are important to highlight so that we can gain insight into how we might help the 15.6% of pregnant women in low and middle income countries who suffer from depression or anxiety.^[i]

Here are some of the things we know about maternal depression:

1. A cohort study showed that children of depressed mothers had an increased incidence of frequent diarrhea.^[ii] How could a greater consideration of the mental health of young mothers lead to improved health outcomes for their children?
2. A fourteen-study meta-analysis found that maternal depression is associated with lower cognitive scores in children under 5.^[iii] How might peer groups and youth-friendly mental health services be designed to tackle this outcome?
3. Maternal depression interventions involving trained community health workers do improve maternal mental health outcomes in low and middle income countries.^[iv] How can these interventions be designed to scale up while taking into account local context?
4. A cluster randomized controlled trial in Pakistan using Lady Health Workers to deliver community cognitive behavioral therapy showed improvements in immunization rates, among other positive child health outcomes.^[v] How might this design be scaled up? How might technology or social media be leveraged?

There are many more hypotheses and creative solutions out there, and together with Grand Challenges Canada (funded by the Government of Canada), we are excited to announce a Grand Challenge Exploration to learn about and support your ideas.

Since 2011, Grand Challenges Canada's Saving Brains, Global Mental Health, and Stars in Global Health programs have invested a combined total of $86 million in 215 innovations to protect and nurture early brain and child development, and improve mental health treatments and services in low- and middle-income countries. This has included $3.9 million CAD across 10 projects in the past 6 years focused on maternal health, given the importance of maternal health not only for the women themselves, but also to that of their children.

The need to focus on adolescent and young mothers has become crystal clear given the high rates of mental disorders that begin during adolescence. As such, a particular area of interest for the sixth request for proposals of the Saving Brains program, which was recently accepting applications for innovations that provide support to adolescent parents.

The opportunity to put a dent in maternal morbidity by facilitating stronger minds for adolescent and young mothers is substantial. You can find out more about the challenge here.

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[i] Fisher J, Cabral de Mello M, Patel V, Rahman A, Tran T, Holton S et al. Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review. Bull World Health Organ 2012;90:139G–49G. Doi: http://dx.doi.org/10.2471/BLT.11.091850 PMID:22423165

[ii] Rahman, A., et al., Maternal depression increases infant risk of diarrhoeal illness: --a cohort study. Arch Dis Child, 2007. 92(1): p. 24-8.

[iii] Liu, Y., et al., Maternal depressive symptoms and early childhood cognitive development: a meta-analysis. Psychological Medicine, 2016. 47(4): p. 680-689.

[iv] Rahman, A., et al., Interventions for common perinatal mental disorders in women in low- and middle-income countries: a systematic review and meta-analysis. Bull World Health Organ, 2013. 91(8): p. 593-601I

[v] Rahman, A., et al., Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial. The Lancet, 2008. 372(9642): p. 902-909