Understanding perinatal mental illness as a governance concern in South Africa through health provider perspectives

摘要

Women in South Africa experience a disproportionately high prevalenceof common perinatal mental disorders (CPMDs). These disorders oftenremain a silent burden and a complex health, social, and policyconcern, both nationally and globally. Moreover, policy efforts toaddress this concern have been fragmented. Greater understanding ofthe governance of perinatal mental illness is needed to address thiscomplex issue. No research to date has focused explicitly on theimportance of ‘issue framing’ to advance governance for perinatalmental health. We sought to achieve a more nuanced understanding ofclinical governance and issue framing for perinatal mental health inSouth Africa by interviewing 24 key informants with expertise inperinatal mental illness. Dominant themes encompassed: framing ofperinatal mental health determines its priority; perinatal mental healthis not prioritised due to competition from other health concerns; and,screening policy responses are shaped by the framing. We found thatunderstanding the varying views influencing perinatal mental illnessprovides insights into how experts frame the problem. Findings suggestthat a better understanding of policy implementation and responses inSouth Africa is important in guiding research, policy, and practice, whileimproving the governance of perinatal mental illness.