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Postpartum Mental Health in Rural South Africa: Socioeconomic Stressors and Worsening Mental Health



This study aimed to characterize patterns of worsening mental health during the postpartum period among women in rural areas of Limpopo Province, South Africa, and to identify correlates with household demographic factors.


We collected data on maternal mental health symptoms shortly after birth and then again 7 months postpartum using the World Health Organization self-reporting questionnaire (SRQ-20) from December 2017 to November 2018. The absolute change in SRQ-20 symptom score was calculated to determine worsening mental health over the postpartum period. Linear regressions were performed to investigate factors associated with mental health symptom scores at varying postpartum time points.


We found increased reporting of poor mental health symptoms at 7 months postpartum as compared to shortly after birth (n = 224). Worsening maternal mental health over the postpartum period was associated with higher SRQ-20 symptom score shortly after birth (p < 0.001) and reported food insecurity at 7 months (p < 0.001). SRQ-20 symptom scores in the postpartum period were not associated with breastfeeding in the past 24 h reported at 7 months postpartum (p = 0.08).

Conclusions for Practice

Women in rural South Africa, like women in many settings, may be vulnerable to worsening postpartum mental health when they lack sufficient socioeconomic resources and when they have pre-existing depressive/anxiety symptoms.

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We would like to thank and acknowledge the invaluable contributions to this project from Eliud Nkuna, Kate Mocheki, Vongani Maluleke, Tintswalo Modiba, Patricia Lashabane, and Elvis Nekokwane at the Health Economics and Epidemiology Research Office (HE2RO) at the University of Witwatersrand, as well as Dr. Amanda Tarullo at Boston University and Dr. Jukka Leppänen at Tampere University. We would also like to thank Dr. Gabrielle Jacquet and Dr. Suzanne Sarfaty from the Boston University School of Medicine’s Global Health Equity Program for providing the support that made this project possible.


Financial support for this project came from the generous support of the Boston University School of Medicine’s Global Health Summer Scholarship. Additionally, research reported in this publication was supported by the South African Medical Research Council, as a sub-grant from the Bill and Melinda Gates Foundation.

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Correspondence to David T. Silverman.

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Silverman, D.T., Killion, J.P., Evans, D. et al. Postpartum Mental Health in Rural South Africa: Socioeconomic Stressors and Worsening Mental Health. Matern Child Health J (2021).

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  • Postpartum
  • Mental health
  • South Africa
  • Common mental disorder
  • SRQ-20