Exploring the effects of mental health on bonding and caregiving among pregnant and postpartum persons with likely depression and/or PTSD in South Africa: a qualitative analysis

Perinatal mental health disorders place a particularly high public health burden on South Africa (SA) via adverse health outcomes for the birthing parent and for their infants, and contribute to emotional and behavioral problems later in childhood. There is little research exploring the anticipated impacts mental health symptoms have on one’s ability to emotionally connect or care for their infant after delivery. HIV-negative pregnant persons were recruited from an antenatal clinic in Cape Town as a part of a larger study investigating mental health barriers to pre-exposure prophylaxis (PrEP) uptake during pregnancy. Participants qualified for an in-depth interview based on elevated symptoms of depression and/or PTSD. The interviews explored the likely impact of their mental health symptoms on their baby’s wellbeing, their ability to bond with their baby, and their ability to meet their baby’s needs. After transcription and translation of interviews, a codebook was developed using inductive and deductive methods. Coded data were analyzed using thematic analysis. Twenty-three participants completed 30 interviews (seven were interviewed twice—once during pregnancy and once post-delivery); on average, they were 25.1 years old and had 2.1 previous pregnancies. Three themes emerged from interviews: (1) a strong perceived connection between maternal mental health and baby’s wellbeing; (2) perceived strains on bonding with the baby; and (3) the impact of mental health on the likelihood of completing parenting tasks. These results provide insight on how women expect their mental health symptoms to impact their ability to care for their baby, and also how a sense of resilience can contribute to overcoming anticipated mental health challenges. This study will inform future mental health programming to prepare pregnant persons with mental health symptoms for a successful postpartum period with respect to bonding and caring for their infant.