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Shelina Bhamani^1*, Khadija Khan^2*, Shaista Siddiqui³, Misbah Shams¹, Tehreem Fatima²

¹ ECD PREP Lead, Program Director Outreach & Asst Professor (ObGyn) Aga Khan University ²CEO Pakistan Alliance for Early Childhood
³ Technical Advisor Health Initiatives, Program Lead Ruhbaru, Charter for Compassion

*Correspondence: [email protected] & [email protected]

Early childhood development (ECD) begins at conception and continues until the age of eight. This period is one of the most significant in the human life span. Children develop holistically, encompassing various aspects of physical, cognitive, language, social, and emotional development. Mental health, like any other domain, is a crucial factor in ECD ⁱ. Globally, mental health issues such as anxiety, depression, long-term trauma, and social isolation are on the rise, particularly among young children. The prevalence of these issues is also observed in Pakistan.

Research indicates various factors that impact young children’s mental health, including environmental factors, socio-economic conditions, childhood traumatic experiences, home environment, unsafe events, and parental mental health. According to a brief produced by Harvard University, traumatic and adverse experiences like extreme poverty, abusive family relationships, and chronic stress in early childhood can potentially cause developmental delays, affecting healthy brain development, academic performance, the ability to maintain healthy relationships in the future, and overall well-being. Maternal mental health also has a significant impact during the earliest years of life. Traumatic experiences, maternal stress and anxiety, and parental mental health conditions begin influencing development from the womb and can affect children throughout early childhood and later in life.

Maternal Mental Health: Globally the prevalence of maternal mental health is as high as 13-15% and in Pakistan averaging antenatal to later postnatal, maternal mental health issues are staking high as 25-30% ⁱⁱ. Maternal Mental Health refers to the emotional and psychological well-being of mothers during pregnancy, childbirth, and the postpartum period.

Impact of Maternal Mental Health on Early Childhood Development: Several studies have outlined the significant link between maternal mental health (MMH) issues and developmental indicators in young children. Key factors such as mood, well-being, interactions, self-worth, and self-regulation influence a child’s development. When a baby feels loved and cared for, the brain regions responsible for love, social connection, and emotional regulation develop healthily, facilitating better emotional management and relationship skills in adulthood ⁱⁱⁱ. Conversely, negative maternal factors like dislike, low interactions, unresponsiveness, and lack of co-regulation with the child can lead to children feeling detached. This underscores the importance of responsive and nurturing care-giving for the secure attachment and overall healthy development of children. These responsive interactions may only be achieved with thriving maternal mental health and overall well-being ^iv.

Children who suffer from mental health issues in their early years often face problems later in life, such as difficulty understanding language, low Intelligent Quotient (IQ), and trouble acquiring education ^v. Children from less privileged families, especially in low- and middle-income countries, are three times more likely to develop developmental disorders later in life. Growing up in environments with high adversity and stress during the early years can increase the risk of stress-related diseases and learning difficulties ^vi. The impact is not limited to early and later life but can also affect intergenerational health. Adverse experiences can be passed on to future generations, creating a threat of generational trauma. Early interventions are needed to break this cycle.

The diagram below shows the impact of positive and negative maternal mental health on early childhood and transgenerational health.

Interventions to Support Maternal Mental Health: The first 1,000 days of a child’s life are considered a critical window of opportunity during which 80% of their brain development occurs. During this period, a child’s brain can form 700 to 1,000 neural connections every second, which serve as the building blocks of their future. This phase is crucial for determining the optimal growth and development of a child. In other words, these 1,000 days shape the child’s future in terms of physical, emotional, and mental health. Poor maternal mental health during this time can profoundly impact a child’s physical, cognitive, emotional, and behavioral development, with lasting effects. Evidence indicates that early intervention for depressed mothers during pregnancy not only improves maternal mental health but also enhances children’s short-term socio-emotional development, particularly during the critical first year of life. Therefore, there is a need for interventions at all levels to support maternal mental health and early childhood development ^vii.Poor maternal mental health during this time can profoundly impact a child’s physical, cognitive, emotional, and behavioral development, with lasting effects. Evidence indicates that early intervention for depressed mothers during pregnancy not only improves maternal mental health but also enhances children’s short-term socio-emotional development, particularly during the critical first year of life. Therefore, there is a need for interventions at all levels to support maternal mental health and early childhood development ^viii.

1. Acknowledge the Importance of Maternal Mental Health from Conception: Maternal mental health begins the moment a woman conceives. Early and consistent mental health screening, from conception until the child turns two, can prevent both mother and child from becoming victims of mental health issues.

2. Provide Free and Integrated Mental Health Services: Offer free mental health services that are integrated with antenatal, postnatal, and pediatric visits. This approach allows mothers to access the essential support needed to thrive during their transition into motherhood, while also reducing the financial burden of care.

3. Raise Public Awareness to Break the Taboo Surrounding Maternal Mental Health: Launch campaigns in various languages using different mediums such as theater, radio shows, TV advocacy, and print media to ensure equitable dissemination of information to the masses.

4. Establish Community-Level Support Groups: Create support groups for mothers at the community level, enabling them to be part of a network where they can seek immediate assistance.

5. Adopt a Multisectoral Approach: Collaborate with sectors such as healthcare, social services, and education to provide comprehensive support for maternal mental health.

6. Invest in the Workforce: Train midwives, doctors, and allied health professionals to support and facilitate maternal mental health. Given the shortage of psychiatrists and psychologists, alternative pathways are needed to address significant workforce gaps.

7. Develop a National Maternal Mental Health Strategy: Create a national strategy to guide provincial bodies in defining their needs and planning actions accordingly.

8. Enact Legislation and Regulations: Implement and enforce legislation and regulations that protect and promote maternal mental health, including rights to maternity leave, mental health care, and anti-discrimination laws.

9. Set and Document Evidence-Based Intervention Models: Develop evidence-based maternal and child mental health intervention models tailored to the Pakistani context. Recognise that Pakistan’s bio-psycho-social model differs from Western cultures and even varies within different regions of Pakistan.

By adopting a multisectoral approach, we can break the vicious cycle of generational trauma by supporting mothers during their transition into motherhood and ensuring positive early childhood experiences for both, them and their children.

References:

1. Khatib MN, Gaidhane A, Ahmed M, Saxena D, Syed ZQ. Early childhood development programs in low middle-income countries for rearing healthy children: A systematic review. Journal of Clinical & Diagnostic Research. 2020;14
2. World Health Organization. (2020.). Mental health: Strengthening our response. https://www.who.int/ news-room/fact-sheets/detail/mental-health-strengthening-our-response/? gad_source=1&gclid=Cj0KCQjwzby1BhCQARIsAJ_0t5OltHxwQB3r43TFaM8LgCY9ctFNmyIkn- OWvlfu2MVOqOhPGNd-ToUaAnyGEALw_wcB
3. https://www.scottishconflictresolution.org.uk/learning-zone-attachment-and-brain-development
4. Luby JL, Rogers C, McLaughlin KA. Environmental conditions to promote healthy childhood brain/ behavioral development: Informing early preventive interventions for delivery in routine care. Biological psychiatry global open science. 2022;2(3):233-41.
5. Marshall C. Teasing apart disadvantage from disorder: The case of poor language. Current issues in developmental disorders: Psychology Press; 2012. p. 135-60.
6. Zhang L, Ssewanyana D, Martin M-C, Lye S, Moran G, Abubakar A, et al. Supporting child development through parenting interventions in low-to middle-income countries: an updated systematic review. Frontiers in Public Health. 2021;9:671988.
7. Bhamani S, Syed A, Sheikh L, Mian A. Investing in mental health during the first 1,000 days of life: Now and future. JPMA The Journal of the Pakistan Medical Association. 2023;73(2):374-6.