“There’s no miracle drug to handle life through a crisis” – The reflections of single motherhood and mental health in the face of the Covid-19 pandemic

In post-Covid, women continue to experience the pandemic’s repercussions in every aspect of life, and single mothers – many of whom previously faced hidden difficulties are disproportionately affected.

According to the Gallup World Poll 2018, Sub-Saharan Africa has the highest percentage of single mothers worldwide, at 32%.  In South Africa alone, more than 40 percent of mothers are single parents and the number continues to grow. [1]

When South Africa called for strict lockdown measures in March 2020, Tracy Khumalo (not a real name), a 32-year old single mother of one and pregnant (during the time of interview) was employed and everything was going well. As a single mother, the working from home norm gave her the flexibility that she needed. However, all this came with a prize of increased domestic duties and homeschooling while managing a full-time job remotely – this became overwhelming as the lockdown measures continued. 

” I was alone and I thought it was going to be easy to manage my lifestyle and that of my daughter. But eventually, something took over, it was my mental health not in a good condition” said Tracy. 

The strict lockdown measures escorted by uncertainties created serious threats to the public mental health in South Africa – a society where one in three individuals have reported symptoms of anxiety or depressive disorder during their life[2]. With limited resources, lack of adequate domestic and emotional support, research reveals that single mothers are one of the population group highly affected by mental health challenges. Global Studies identify that mental health disorders are common among single mothers as compared to their married counterparts. The Covid-19 pandemic worsened the situation due to economic hardships and reduced levels of social support. 

Despite the responsibilities of single motherhood that Tracy had to shoulder during the lockdown, her mental health issues were elevated by a combination of factors including pregnancy and financial hardships due to the loss of her job during the lockdown. 

Maternal mental health 

Pregnant women are a unique population, with particular mental and physical healthcare needs.[3] They undergo significant physiologic and immunologic changes and, in many cases, likely to experience mental health disorders.  In South Africa, about 30% of women experience anxiety and depression during pregnancy and following birth. [4]Tracy was not different from this group of pregnant women. Firstly, the feelings of anxiety, fatigue and depression were highly associated with limited access to antenatal care. Tracy tried to access antenatal services in a local clinic about six times without receiving any attention. 

“I tried to access two local clinics and all pregnant women and children were told to return home as the clinics were being disinfected – which became an everyday story until I gave up antenatal altogether” 

With limited antenatal services, the misconceptions about vertical transmission of the virus to the infant triggered Tracy, although this was not clear as the research was still underway. With such fear, Tracy was forced to follow strict social distancing which increased her psychological problems.

“In addition to the fear of giving birth to a baby infected with Covid, I was worried that maternal depression would affect the development and growth of my baby”.

Maternal depression is a growing trend globally [5][6] with high rate among single mothers as they are sole to their families. In South Africa, the prevalence of women at high risk of depression or suffering from depression ranges between 21% and 39% antenatally with the highest percentage being single mothers. 

Single mothers hit hard by job loses

As the lockdown measures continued, many people were exposed to situations linked to poor mental health outcomes such as isolation, less productivity and job losses. Over three million people lost their jobs in South Africa due to the impact of Covid-19 increasing the unemployment rate to 32.5% – the highest since 2008. According to the National Income Dynamics Study – Coronavirus Rapid Mobile Survey (NIDS-CRA), [7]the net job losses were higher for women than for men. Women counted for over 50% of the population who lost their jobs [8]. 

During the lockdown, globally, women had to juggle many responsibilities alone at home — educating schoolchildren, caring for ageing parents, cooking, cleaning, household management while working. With so many responsibilities and lack of support, single mothers, in particular, were hit hard by the unemployment crisis and Tracy is now amongst that population, back in the job market. While some have shown remarkable resilience in handling their lives especially during the pandemic, the story is not the same for Tracy.

Tracy lost her job in August 2020 as a result of the inability to deliver efficiently at work due to anxiety and depression. 

“Due to many responsibilities and lack of support, I was finding it difficult to concentrate or remember things which affected my productivity and the ability to deliver efficiently at work,” said Tracy.

Working for a small company and with her poor performance, Tracy knew that her employer would not buy her anxiety and depression story. By June 2020 she was already thinking about her inability to earn an income as well as her career goals that seemed to be shutting down.

“When I lost my job, I was forced to change my lifestyle literally within a short space of time. The whole financial support system that I had put in place to keep me going completely fell apart”

According to the South African Depression and Anxiety Group (SADAG), parental stress, depression, and anxiety increased during the lockdown. The call volumes of anxious and depressed people seeking help doubled during the lockdown up to 1400 calls per day. From the calls received, the majority (about 85%) came from women. It is with no doubt that the highest percentage was from single mothers facing hardships in all aspects of life.

Tracy was tempted to join the forces in seeking help from SADAG but she thought it was pregnancy and would probably go away with time and this hindered her to deal with her mental health from the onset. The failure to seek help is often the case for many Africans. 

“I was really resistant to seek help, until I shut down completely. I could hardly take care of my daughter and when I gave birth, I went through a horror phase of postnatal”

With family interventions, Tracy managed to seek help from mental health professionals and now she is still recovering while searching for another job. The Covid-19 pandemic has significantly impacted Tracy’ financial security and that of her children. 

“It has been an incredibly difficult year for me – my life has been changed drastically but I have learnt that there is no there is no miracle drug to handle life through a crisis”

Mental health in Africa

Until recently, mental health was never taken seriously in many African societies and often neglected on health policy agenda, funding as well as research and development initiatives. According to Lancet Global Health, while the global annual rate of mental health outpatient facilities is 1051 per 100 000 population, in Africa the rate is 14 per 100 000. The proportion of people with mental illness but do not receive treatment ranges from 75% in South Africa to more than 90% in Ethiopia and Nigeria[9]. In South Africa, only one out of 10 people have access to mental health treatment[10].

As the number of Covid-19 cases escalated, many African countries were forced to make tough decisions about the most important health services, mental health as always not a priority. In South Africa, mental health only counts to 5% of the national budget[11]. By neglecting mental health, it will be difficult to attain many of the Sustainable Development Goals related to women empowerment. Although with less attention, giving greater priority to mental health is very crucial for improving socioeconomic wellbeing for women as single mothers.

Mental health disorders are likely to ratchet up as the African population is expected to double over the next three decades, and a sharp rise of families headed by single mothers (currently at 42.6% in South Africa), who are already struggling to make ends meet and some are struggling to find employment in highly competitive labour markets. Literature reveals that single mothers experience severe psychological and economic strain which is often passed on to their children[12]. According to the 2020 Old Mutual Savings and Investment Monitor Covid-19 Special Report, 60% of single mothers receive no financial contribution at all from the fathers of their children. This is Tracy’s situation. 

“With the pressures on single mothers caused by the pandemic, many will experience mental health disorders as they struggle financially and fail to realize their ambitions. And some will turn to substance misuse as a means of alleviating their frustration”, said Tracy.

Michelle Obama once said, “Sadly, too often, the stigma around mental health prevents people who need help from seeking it. But that simply doesn’t make any sense. Whether an illness affects your heart, your arm or your brain, it’s still an illness, and there shouldn’t be any distinction…we should make it clear that getting help isn’t a sign of weakness — it’s a sign of strength — and we should ensure that people can get the treatment they need.

On this World Mental Health Day, let us take this opportunity to shape the future of mental healthcare across Africa and do away with ignorance, stigmatization and mistaken beliefs that mental health cannot be treated. The solution to mental health is not a one-size-fits-all, there is a need to find localized solutions to cater to every group with single mothers included. 

By Sakhile Dube

References 

According to the Gallup World Poll 2018, Sub-Saharan Africa has the highest percentage of single mothers worldwide, at 32%.  

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[1]http://www.hsrc.ac.za/en/news/media-and-covid19/women-integral-to-foodforward-sa-approach

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7310654/

[3] https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-021-01070-6

[4] https://www.denovomedica.com/modules/covid-19-and-mental-health-in-pregnancy/

[5] https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-019-2082-y

[6] https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-019-2355-y

[7] https://cramsurvey.org/reports/

[8] https://cramsurvey.org/reports/

[9] University of Cape Town. 2019. SA’s 92% mental health treatment gap. https://bit.ly/3SNIyOD

[10] University of Cape Town. 2019. SA’s 92% mental health treatment gap. https://bit.ly/3SNIyOD

[11] Daily Maverick. 2021. Heal by numbers: We can fix mental healthcare by spending smart – but will the state buy in? https://www.dailymaverick.co.za/article/2021-11-22-heal-by-numbers-we-can-fix-mental-healthcare-by-spending-smart-but-will-the-state-buy-in/

[12] Kim GE, Kim EJ. Factors affecting the quality of life of single mothers compared to married mothers. BMC Psychiatry. 2020 Apr 15;20(1):169. doi: 10.1186/s12888-020-02586-0. PMID: 32295559; PMCID: PMC7161072.