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The Role of Policy in Addressing the Social Determinants of Health

What is the problem?

Postpartum is one of the major issues faced by the new mother that has to increase the burden over the health care and it also increased lifelong complication for the mothers

What are the viable options to address the problem?

The different guidelines and policy are framed to increase the accessibility of skilled health care professionals and resources to enhance the health status of the new mother

What implementation do considerations need to be borne in mind?

There is a need to increase the policy framing system that should address all the different aspect related to the postpartum care process that leads to the better health status of the new mother

Burden Over the Health Care System

Depression is one of the most serious mental disorders that have increased the health care sector burden due to increasing prevalence. Across the world, there are more than 264 million people encountered depression that directly leads to behavioural complication in the individual (World Health Organization, 2020). There are many reasons for depression but postpartum depression is considered to be one of the major issues faced by the women after the delivery. It is considered to be one of the major mental disorder faced by the new mothers that have a high prevalence. The prevalence rate of the post-partum depression is about 5-60% depending upon the different antenatal facility avail by the women. The post-partum depression directly increases the suffering of the new mother that directly leads to a feeling of life as death swamp. The post-partum depression increases the feeling of hopelessness that can directly raise the complication for the mother and sometimes it leads to suicide. Post-partum depression is one of the factors that lead 20% death of the new mother and it directly increases the burden over the health care sector (Ghaedrahmati et al., 2017).

One of the mental disorders faced by approximately 10-15% of the new mother includes postpartum depression that directly leads to depressive symptoms in the individual. Many factors directly lead to post-partum depression which includes physiological, situational and multifactorial factors. The social factors that directly increase the complication for the new mother include stressful life events, childcare stress and prenatal anxiety. The situational factors that directly increase the prevalence of post-partum depression include marital conflict, single parenthood and decrease support from family. These factors directly increase the rate of post-partum depression in new mothers (Anokye et al., 2018).

The American College of Obstetricians and Gynaecologists (2020) described that due to the post-partum depression directly lead to sadness, anxiety and despair in the mother that directly reduce the chances to perform the daily task. The post-partum depression directly increases complication for the patient and different factors include changes in hormonal levels, history of depression, emotional factors, fatigue and lifestyle factors.

Pregnancy and postpartum time is considered to be the life-changing and happy moment in the women’s life but sometime after the delivery women face post-partum depression that directly increases the complication. The postpartum is considered to emerge after 2-4 week after the delivery and it can lead to lifelong complication for the mother. The post-partum depression not only affects the mother wellbeing but it also affects the physical, emotional and psychological development of the baby. The post-partum depression directly increases the untoward feeling of the new mother in respect to the family and baby that directly increase the health care burden (Ay et al., 2018). The post-partum delivery is associated with many risk factors that encounter about 20% of the women which lead to increase complication. The major involvement in the post-partum depression is of the hypothalamic-pituitary-adrenal axis and it directly initiates the post-partum depression. The complication that arises due to the post-partum depression includes loss of interest, insomnia, agitation, loss of energy, worthlessness, suicidal ideation, decreased concentration and change in weight. Some other somatic arise that are associated with post-partum depression include unusual walking, anhedonia, psychomotor retardation, loss of libido and decreased responsiveness (Mughal et al., 2020).

The stressor related to the prevalence of the post-partum depression directly increases the inflammatory responses in the body that directly lead to pro-inflammatory cytokines that directly lead to increase depression in the mother. The post-partum depression directly increases the physical and mental status of the mother and this is one of the major concerns for the health care sector. The mother encountered with post-partum depression also faces emotional breakdown that directly increases chances of self-harm or suicide in the other (Webber & Benedict, 2019).

The Cost-Effective Programs

One of the policies that are used to promote the postpartum care of the mother proposed by the National Institute for Clinical Excellence includes “Antenatal and Postnatal mental health” guidelines. These guidelines help to enhance the prenatal and post-partum care and health care professionals are expected to identify the issue faced by the mother that helps to provide accurate assistances. The health care professionals are expected to identify the mental health of the mother and evaluate the chances of mental disorders to support the mother and family. The guidelines first aspect include consulting with women that utilize questioning with the mother regarding the risk factor, history of mental health disorders and history of post-partum depression. The next aspect of the guideline includes questioning about the women regarding her mental health status that include the experience of anxiety, hopelessness, sad and depressed. The third aspect includes if the health care professional evaluates the high-risk factor for the chances of post-depression then should utilize the Edinburgh Postnatal Depression Scale that helps to confirm the chances of post-partum depression. The last aspect that is included in the guideline is according to the Edinburgh Postnatal Depression Scale score care should be provided that include referrals for the psychiatrist, group therapies or interpersonal therapies to reduce chances of depression (Place et al., 2015). 

Another initiative that is utilized to enhance the post-natal depression in the new mother is a National Perinatal Depression initiative that was initiated in 2017. The initiative utilized the prevention and early detection of the antenatal and post-natal depression of the mother that need urgent support. The main of the organization is to support the mothers who are experiencing depression during pregnancy or in the postpartum duration. The initiative utilized different aspects that should be considered to reduce the chances of post-partum depression. The first aspect includes the routine screening of the sign of depression in the women by midwifery or health care professional by utilizing the Edinburgh Postnatal Depression Scale. The next aspect includes follow-up and support to the women who have a high score of the Edinburgh Postnatal Depression Scale that help to reduce the chances of depression. The last aspect is to continuously monitor the women health status to understand the impact of the treatment over the mental health of the patient (Australian Government Department of Health, 2013). 

National Perinatal Mental Health Guideline is another initiative that aims to increase the quality of care provided to the new mother to reduce the chances of postpartum depression and enhance the quality of life of the mother and baby. The guideline starts with the screening and psychosocial assessment that includes screening for depression, screening of anxiety that can be performed by psychosocial assessment tools. The screening also included evaluating the mother-infant relation and it also evaluates the risk for infant or suicide. The second step is to prevent the disorder and provide accurate treatment to increase the quality of life. That can be performed by providing accurate care planning, utilizing the pharmacological treatment and accurate support (Centre for Perinatal Excellence, 2017).

One of the issues faced by the health care service concerning the accuracy of the detection of the post-partum depression risk includes the lack of policy support and supervision that directly decrease the proper implementation of the guideline. Thus there is a need to design the policy that helps to better the detection process for the chances of depression that can be used to decrease the chances of post-partum depression and associated complication 

The policy will help to support the health status of the new mothers by making it more inclusive and responsive concerning the need of new mothers that help to utilize the person-centred approach. The policy helps to increase the patient-centric care as it helps to enhance the health status and reduce the chances of depression that can increase the complication of the new mother (Olin et al., 2017). There is need to identify the gap in the post-partum care that directly increase the chances of post0partum depression and the gap should be filled by the new policy and guidelines The policy can help to increase the integration with the other program to provide holistic care followed by improving effective partnership with health care associates. Many barriers are associated with post-partum care and thus there is great need to reduce the barrier that helps to reduce the chances of post-partum depression in the females. The accurate intervention tailored by considering different complication associated with the post-partum state should be addressed by the different strategies that can to be incorporated in the policy (Duysburgh et al., 2015).

The Conceptual Model for The Policy

The conceptual model utilizes the holistic approach for the policy framing and it helps to analyse the different aspects that are necessary to consider during the policy construction. The conceptual framework tries to form a tentative relationship between both dependent and independent factors (N & Rajendran, 2015). The policy will try to recollect all the different aspect related to the post-partum care to frame the policy in such a way that it will address all the barriers associated with the inadequate care process. The policy framed will help to utilize the conceptual model to frame the different aspect that can be used collaboratively as a policy. The policy will try to address 4 different aspects that include better awareness of the population, proper access to the post-partum care, adequate equipment and resources to address the patient need and to better the skill of the workforce.

Audience:  The audience for the policy will include the new mother and baby the policy should be framed following the issue faced by them as they are the primary care receivers. The policy should aim to enhance the quality of care for the new mother to reduce the chance of post-partum depression. The increase complication associated with decrease post-partum care increase the need to increase the quality of post-partum care that address the issue of the mother and complication faced by the mother (Benova et al., 2019).

Actors: The health care professional as they are the key player in the care process that increases their credibility. The different support services are also one of the actors that are included in the policy as they should implement the change to enhance the quality of care of the mother and health status of the baby. The third key actors include the stakeholder that is involved in the planning and implementation of the policy to increase the care process by incorporation of the new strategies (Peters et al., 2017). The government and public executives are also key players that are involved in the setting different aspect in the policymaking and involving different actors in the policy. The actors are directly involved in the implementation process of the policy and actors should include the key players that are related to the issue. Policy actor has the driven power as they are directly involved in the changes process that is going to reduce the complication associated with the issue (Koduah et al., 2015).

Interests: The health care professionals are directly involved to increase the understanding of the process to deliver the quality of care. The support services are interested to increase the quality of care thus involved in the policy to enhance the health status of the new mother and the baby. The stakeholders are involved to accurately plan and implement the different strategy associated with the policy. The recommendations that can be suggested to the audience include better utilization of the health care services to enhance the quality of care. The health and community intervention is considered to be one of the best methods that can be utilized to better the care process and the individual should utilize accurate care services.

Recommendations: There is a need to increase the perspective of both the health care professional and patient concerning the post-partum care. The health care professional should enhance their skill concerning the different technologies that can be utilized to decrease postpartum depression and enhance the quality of life of the patient. The patients are recommended to aware about the different care facility that can be utilized to address the issue faced post-partum and they should seek for accurate care to reduce the complication associated with post-partum depression.

How-To: The educational intervention will be utilized to help the pregnant and new mothers to understand the importance of post-partum care and understand different complications that are associated with decreased post-partum care. The educational session will also include helping them to understand management skill that can be utilized to reduce the chances of post-partum depression. 

The training intervention can be utilized to increase the skill of the health care workforce and enhance the quality of care. The training session will include different clinical skills that can be incorporated to increase the post-partum care and help the patient to reduce complication associated with the post-partum state.

Options for Addressing the Problem

Category of finding

Nature of findings from systematic reviews and other available research evidence

Benefits

Ø The revised policy will help to enhance the quality of care that is required post-partum to reduce the chances of post-partum depression.

Ø It helps to not only increase the health status of the mother but the new policy help to support the mother that indirectly support the growth and development of the baby.

Harms

Ø The increased concern over the post-partum issue can decrease the chances of funding for other issues that can hamper the health care facilities

Costs and cost-effectiveness

Ø The increase complication with post-partum depression does not require a huge amount of funding but it only requires to increase the perspective and services concerning the patient need thus it is cost-effective

Uncertainty regarding benefits and potential harms

Ø Uncertainty regarding harm

Improving the post-partum care does not have any negative effect over the society this there is uncertainty

Ø Uncertainty regarding benefits

Many benefits are associated with better post-partum care as it helps to reduce the chances of post-partum depression that directly reduce the complication of the mother and family.

Key elements of the option (how and why it works)

The policy has four objectives to enhance the post-partum depression

Ø A better understanding of the patient regarding post-partum care

Ø Revised post-partum care procedure help to increase the quality of life of the patient

Ø To reduce the rate of post-partum depression in the female that directly help to increase the growth and development of the baby

Ø To provide accurate health care facilities that aim to enhance the early detection of the complication faced by the female after delivery.

Stakeholders' views and experiences

Not identified

 

Levels

Option 1

Option 2

Option 3

Consumer

New mothers

Partner

Family

Healthcare provider

Nurses/ Midwifery 

Health care staff

Support services staff

       

Organisation

Government organization

Non-government organization

Support services

 

 

• A list of those involved in establishing the terms of reference for the policy brief and their affiliations

The different actors play a major role in the establishment and implementation of the policy that include stakeholders, health care staff and support services. These actors in collaboration will help to plan and implement the change in the proves 

• A list of key informants who were contacted to gain additional perspectives on the issue and to identify relevant data and research evidence, and their affiliations

The first key informants will be the government bodies working concerning increased post-partum depression as they can help to understand the different aspect.

The second key informants will be the health care professional working in close collaboration with the pregnant women’s 

The third key informants will be the stakeholders that help to analyse and feedback over the different policy that helps to identify the gap in the care system.

• A list of funders (for the organisation producing the policy brief and for the policy brief itself)

Ø Government organization

Ø Non-government organization

Ø Different organization partners

• Methods used to identify, select, and assess synthesised research evidence (including assessments of quality, local applicability and equity considerations)

The relevant sources are utilized to collect the data that is following the issue and its related aspects. The different policies and guidelines will be utilized to collect the relevant data concerning the issue and possible changes.

• Review process used to ensure the scientific quality and system relevance of the policy brief

The review is performed to evaluate the equality and efficacy of the policy that help to understand the different aspects that are needed to be considered while planning for change in policy

Conclusion on Postpartum Depression

The post-partum depression is one of the leading health care burdens as it increases the impairment of the mother that directly influence the growth and development of the baby. The increasing prevalence of post-partum depression increases the need to enhance the intervention that can help to address the issue faced by the new mother to reduce the chances of depression. There is one program that is initiated to increase the post-partum care and reduce chances of depression that include Antenatal and Postnatal mental health” guidelines, National Perinatal Depression initiative and National Perinatal Mental Health Guideline. There is a need to enhance the policy that is more people-centred and able to address all the issue faced by the new mother. The changes can be implemented at the individual level, workforce level and organisation level by incorporating educational and training program to increase understanding regarding the importance of post-partum care to reduce chances of post-partum depression.

References for Postpartum Depression

American College of Obstetricians and Gynaecologists. (2020). Postpartum depression. Retrieved from https://www.acog.org/patient-resources/faqs/labor-delivery-and-postpartum-care/postpartum-depression

Anokye, R., Acheampong, E. & Budu-Ainooson, A. (2018). Prevalence of postpartum depression and interventions utilized for its management. Ann Gen Psychiatry 17(18), 1-8. https://doi.org/10.1186/s12991-018-0188-0

Australian Government Department of Health. (2013). National Perinatal Depression Initiative. Retrieved from https://www1.health.gov.au/internet/main/publishing.nsf/Content/mental-perinat

Australian Government Department of Health. (2013). National Perinatal Depression Initiative. Retrieved from https://www1.health.gov.au/internet/main/publishing.nsf/Content/mental-perinat

Ay, F., Tektaş, E., Mak, A. & Aktay, N. (2018). Postpartum depression and the factors affecting it: 2000-2017 study results. Journal of Psychiatric Nursing, 9(3), 147-152. Retrieved from https://www.journalagent.com/phd/pdfs/PHD-31549-RESEARCH_ARTICLE-AY[A].pdf

Centre for Perinatal Excellence. (2017). National Perinatal Mental Health Guideline. Retrieved from https://www.cope.org.au/health-professionals/health-professionals-3/review-of-new-perinatal-mental-health-guidelines

Duysburgh, E., Kerstens, B. & Kouanda, S. (2015). Opportunities to improve postpartum care for mothers and infants: design of context-specific packages of postpartum interventions in rural districts in four sub-Saharan African countries. BMC Pregnancy Childbirth 15(131), 1-11. https://doi.org/10.1186/s12884-015-0562-8

Ghaedrahmati, M., Kazemi, A., Kheirabadi, G., Ebrahimi, A. & Bahrami, M. (2017). Postpartum depression risk factors: A narrative review. Journal of Education and Health Promotion, 6(60), 1-10. https://doi.org/10.4103/jehp.jehp_9_16

Koduah, A & Dijk, H. & Agyepong, I. (2015). The role of policy actors and contextual factors in policy agenda setting and formulation: Maternal fee exemption policies in Ghana over four and a half decades. Health research policy and systems / BioMed Central, 13(27), 1-20. DOI: 10.1186/s12961-015-0016-9.

Mughal, S., Azhar, Y. & Siddiqui, W. (2020). Postpartum Depression. Treasure Island, United Kingdom: StatPearls Publishing.

N., E. & Rajendran, R. (2015). Conceptual Model: A Framework for Institutionalizing the Vigor in Business Research. DOI: 10.13140/RG.2.1.2164.8484

Olin, S. S., McCord, M., Stein, R., Kerker, B. D., Weiss, D., Hoagwood, K. E.& Horwitz, S. M. (2017). Beyond Screening: A Stepped Care Pathway for Managing Postpartum Depression in Pediatric Settings. Journal of Women's Health (2002), 26(9), 966–975. https://doi.org/10.1089/jwh.2016.6089

Peters, D. H., Bhuiya, A. & Ghaffar, A. (2017). Engaging stakeholders in implementation research: lessons from the Future Health Systems Research Programme experience. Health Res Policy Sys, 15(104), 1-73. https://doi.org/10.1186/s12961-017-0269-6

Place, J. M. S., Billings, D. L., Frongillo, E. A., Blake, C. E., Mann, J. R. & deCastro, F. (2015). Policy for promotion of women’s mental health: insight from analysis of policy on postnatal depression in Mexico. Administration and Policy in Mental Health and Mental Health Services Research, 43(2), 189–198. https://doi.org/10.1007/s10488-015-0629-x

Webber, E. & Benedict, J. (2019). Postpartum depression: A multi-disciplinary approach to screening, management and breastfeeding support. Archives of Psychiatric Nursing, 33, 284-289. DOI: 10.1016/j.apnu.2019.01.008

World Health Organization. (2020). Depression. Retrieved from https://www.who.int/news-room/fact-sheets/detail/depression

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