Brown, Shelley Marie (2017). 'Capabilities Approach and Perinatal Mental Health in South Africa' Paper presented at the annual conference of the HDCA, Cape Town 2017.


Women are particularly vulnerable and uniquely at risk of adverse mental health outcomes, often as a result of threats to human security; empowerment and inequity, which frequently manifest during the perinatal period. Perinatal mental disorders adversely affect health and are associated with poor prenatal care, poor nutrition, substance misuse, self-harm, and possibly preterm birth and low birth weight which further marginalize this population throughout the lifecourse. South Africa endures a significant mental health disease burden and maternal depression rates are estimated to be almost triple that of the global prevalence. This is due in part to deeply entrenched and systemic discrimination, human rights violations, health inequities and marginalization of women. South Africa’s social and political context provides insight into the complex history, which shapes some of the environmental risk factors for mental health specific to this population. This includes high rates of poverty, the long history of violence and conflict and high rates of intimate partner violence, and high burden of HIV/AIDS. These risk factors are complex and not linear; therefore, some evidence supports efforts aimed towards improving mental health can impact development goals and using human security framework can further strengthen this (Tsai & Tomlinson, 2012). South Africa enshrines human rights into national healthcare plans yet fails to fully implement policies granting access to mental health services. The lack of access to human rights-based services, including screening, treatment, and high quality of care greatly impact the ability of women in this critical period the opportunity to achieve mental well-being. There is little theory available to guide implementation of equitable global mental health services, but the Capabilities Approach offers an approach to development focused on realization of “good” mental health and wellbeing. White et al write, in an article on Capabilities and mental health “efforts to identify the social, economic and political conditions that promote subjective wellbeing of populations may help augment efforts to reduce the burden associated with mental disorders (White, Imperiale, and Perera 2016).” This research examines these issues which contribute to an understanding of the capabilities approach in South Africa through semi-structured interviews to explore the lived experience of women living with perinatal mental disorders. 

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