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Perinatal mental health problems, defined as mental health problems occurring from the start of pregnancy to one year after birth, substantially affect women's and children's quality of life in low- and middle-income countries. In South Africa, despite high prevalence and documented negative impacts, most women do not receive any care.
A modelling study examined the costs of perinatal mental health problems, namely depression and anxiety, for a hypothetical cohort of women and their children in South Africa over part of their life course (10 years for women, 40 years for children). In sensitivity analysis, additional impacts of post-traumatic stress disorder (PTSD) and completed suicide were included. Data sources were published findings from cohort studies, as well as epidemiological and economic data from South Africa. Data from international studies were considered where no data from South Africa were available.
Lifetime costs of perinatal depression and anxiety in South Africa amount to USD 2.8 billion per annual cohort of births. If the impacts of PTSD and suicide are included, costs increase to USD 2.9 billion. This includes costs linked to losses in quality of life (USD 1.8 billion), losses in income (USD 1.1 billion) and public sector costs (USD 3.5 million).
Whilst important progress has been made in South Africa with regards to mental health policies and interventions that include assessment and management of perinatal mental health problems, substantial underinvestment prevents progress. Findings from this study strengthen the economic case for investing in perinatal mental health care.
This chapter highlights some of the changes occurring in services around the globe in the context of and as a result of political and economic changes. Globalization might lead to a globalized culture in which cultural values become more homogenized and cultural relativism gives way to a uniform view. There is no doubt that globalization has led to an increase in urbanization, which by itself brings a number of problems. As a result of internal migration from rural to urban areas, overcrowding may result and social support networks will change. In many countries, for example in India, the practice of medicine and delivery of health care has been brought under consumer legislation, where patients are seen as consumers and have no rights of protection as consumers. Consumerism can affect health care as a whole or psychotherapy or pharmacotherapy.
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