Perinatal mental health among young women in urban China

Abstract: In order to reach the WHO’s Sustainable Development Goals relating to maternal and infant health, maternal mental health preconditional needs to be addressed. The purpose of the thesis project was to explore how Shanghai women and health care providers perceive mental health problems during the perinatal period in urban China, in the light of the two-child policy. Method: Data collections were conducted in Shanghai, urban China. In Study I, thirty-seven women were interviewed regarding their judgement and decision-making whether to have a second child after the introduction of the two-child policy. Qualitative systematic text condensation analysis was used to describe their decision-making factors. Study II involved 15 interviews with key health care informants and their perceptions of the current situation of perinatal mental health care in urban China. Qualitative content analysis was used to describe their responses. In Study III, sixteen women were interviewed about their insights on perinatal mental health problems. Thematic analysis of the semi-structured interviews was conducted. Study IV was a web survey study of 487 women. The topics discussed related to women’s perinatal and current mental health status, help-seeking behavior for mental health care, disclosure opportunities and preferences, and the kind of help they would expect and request. Descriptive and comparative statistics were performed. Results: Urban Chinese women’s decision-making regarding having a second child in reference to the two-child policy include women’s status, career, challenges of two children, one-child generation, restriction of reproductive freedom, and the expectation of governmental support. The outcomes highlight the impact of the child policy societal, economic, and on perinatal health changes (I). Key health care informants described how mental health was influenced by tradition affecting the perception of mental health in both society and the individual. The health care experts, policy makers, and public health professionals stressed the required resources and reflected in the lack of professional training, limited staff, and resources available to provide adequate care for patients with mental health problems (II). Intergenerational transition, maternal mental health, and transition into motherhood capture the Shanghai women’s position of being in between the traditional and modern Chinese role of motherhood. The urban Chinese woman in a modern society with a professional life expects to have access to high-tech medicine and all aspects of a cosmopolitan lifestyle (III). A total of 487 women confirmed the results in a survey and emphasized the trust in friends, husband, and community health care centers, but all of these were overshadowed by online resources. Women from the one-child generation reported less mental well-being compared to the older generation. The vast majority of the participating women (82.2%) would seek help from online resources and over 70% of the participants would seek help primarily at community health centers. The majority of the women trusted their friends and husband as their first contact to share their mental health problems with. The mother-in-law was the person the women trusted least. Conclusion: The findings provide an enhanced understanding of mental health problems in the perinatal period on local level, and provide suggestions for improved perinatal mental health care for urban Chinese women. The public health concern and cause for action to reach out to the young mothers of the one-child generation are evident. Hesitation to seek care due to lack of knowledge or lack of trust in the health care system are identified as obstacles for young women to seek care. These results are relevant in the current discourse surrounding the reduction of the fertility rate in China, despite the introduction of the two-child policy. This thesis illustrates the need to continue understanding perinatal mental health and the contribution of the new child policy on a societal and family level.