Women and Health Together for the Future

University Of Cape Town: Lockdown Is Taking A Toll On The Mental Health Of Pregnant Women

Jul 28, 2021

Pregnant women attending 14 healthcare facilities in Cape Town were enrolled in the study. Data on their socio‑demographic information, presence of common mental disorders (CMD), experiences of psychological distress, food insecurity and domestic violence were collected.

Of the 885 women enrolled in the Health System Strengthening in Sub Saharan Africa (ASSET) study, the team found that 12% of them had probable CMD and 43% were severely food insecure. Psychological distress increased significantly during the lockdown period, compared with before the pandemic. While they did not find an increase in women who felt suicidal, significantly more women reported feeling anxious and depressed.

“We found that the risk of CMD was almost three times greater in women who were severely food insecure.”

“We found that the risk of CMD was almost three times greater in women who were severely food insecure, or who experienced psychological or sexual abuse. Importantly, we found strong associations between certain risk factors (having more than four pregnancies or a previous miscarriage or stillbirth, experiencing increased crime in the community, decreased income or less food in the household, severe food insecurity, or any form of abuse) and psychological distress during the lockdown,” said the lead researcher, Dr Zulfa Abrahams.

“We found that the proportion of women experiencing psychological distress during the lockdown was higher than those who were distressed at their first clinic visit. While the lack of a control group makes it difficult to draw strong conclusions about the effect of the lockdown on symptoms of depression and anxiety, evidence from a longitudinal study in the same population indicates that symptoms of depression detected early in pregnancy tend to abate during the course of pregnancy and the first year of the baby’s life.”

However, Dr Abrahams added that their findings “indicate the opposite, namely an increase in [the] prevalence of psychological distress. As there were no other significant societal level events during this period that may have contributed to such an increase, we believe there is some support for the hypothesis that it was due to the lockdown.”

Increased risk

The study also found that being severely food insecure doubled the odds of CMDs during the lockdown, and that 80% of participants reported experiencing various levels of food insecurity.

During April and May 2020, when South Africa was at alert Level 4 and Level 5 of the lockdown, all non‑essential services were halted. This resulted in high levels of unemployment, affecting the most vulnerable workers, who were low‑skilled and less educated.

“In our already vulnerable group of perinatal women living in low‑resource settings, we found that more than 40% were severely food insecure.”

Six weeks into the lockdown, Statistics South Africa, using an online survey, found that 4.3% of respondents reported experiencing hunger during the month prior to the lockdown, while 7% experienced hunger during the lockdown.

Abrahams said this is likely being under‑reported as those living in poverty and experiencing hunger would be unlikely to have access to a web‑based survey.

“In our already vulnerable group of perinatal women living in low‑resource settings, we found that more than 40% were severely food insecure.

“This translates to 40% of perinatal women living in households where they were eating fewer meals than needed, lacked the resources to acquire more food, went to sleep hungry or went a whole day and night without eating,” she added.

They also found that the risk of CMDs was almost three times greater in women experiencing psychological or sexual abuse, even though the prevalence of domestic abuse was quite low.

“We found that 15% of participants reported experiencing psychological abuse, 14% reported experiencing physical abuse and less than 2% reported experiencing sexual abuse,” said Abrahams.

“Our findings highlight how a crisis such as the lockdown amplified the psycho‑social risk factors associated with CMDs in perinatal women.”


"On Women’s Day, we, the women of South Africa, have nothing to celebrate. We have nothing to celebrate when our sisters are daily maimed and butchered by South African men. We cannot celebrate when we continue silently to wonder: “am I next?” No Mr President, this Women’s Day is not a cause for celebration."

On Women’s Day, 9 August 2021, we will deliver our letter to the President of the Republic of South Africa calling for his urgent action on Gender Based Violence in our country. 

We, the Women of South Africa

761 have signed The Embrace Project’s petition. Let’s get to 1,000!

Sign now with a click

As the rate of gender-based violence in South Africa continues to soar, it is evident that despite legislative reforms, and the Presidency’s Emergency Response Action Plan to address the violence, the South African government, and its institutions, lack the political will to reduce, let alone eradicate, the threat to the lives, and the enjoyment of life, of every South African woman and child.

South Africa’s own Commission for Gender Equality confirmed this in its report released in April 2021. The following month, in May 2021, the UN’s Commission on the Elimination of Discrimination against Women found that, because of the extremely high rate of domestic violence in South Africa, the South African government was in systematic violation of the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW). 

For that reason, we will be submitting the letter below to the President of the Republic of South Africa symbolically on 9 August 2021 - Women’s Day, the day that we celebrate the Women’s March to the Union Buildings in 1956 when they too handed a petition to the then Head of State. Add your signature to this letter, through this petition, and be part of the 2021 version of the Women’s March.

Dear Mr President

On Women’s Day, we, the women of South Africa, have nothing to celebrate. We have nothing to celebrate when our sisters are daily maimed and butchered by South African men. We cannot celebrate when we continue silently to wonder: “am I next?” No Mr President, this Women’s Day is not a cause for celebration. 

Rahima Moosa, Sophia Williams, Lillian Ngoyi, Helen Joseph and 20 000 South African women did not march on the Union Buildings for a South Africa that promises equality, freedom and security of the person, and freedom of movement to only half of its population. We, the women of South Africa, are not free, and we are not equal. We cannot be when we are required to make considerations for things of which you cannot conceive; considerations that we make in order simply to step outside of the front door. For, as a woman of South Africa, “I carry my pass every day in my heart. Because as a woman I can’t walk freely on the streets.” – Fatima Meer.

Even in our beds we are not safe, Mr President. Every South African woman knows a woman, and every South African woman has imagined what she would do when that day comes. When her turn comes. That is not a way to live Mr President. We, the women of South Africa, are alive but we are not living.

So no Mr President, this Women’s Day is not a cause for celebration.

You made promises to us. You even learned to speak our language when you told us that it was not our fault that we were being violated and mutilated. You even said our names. But with the passing of time, it is obvious that your promises are not our new dawn, Mr President. For as long as you lack the political will to end the war being waged against us, the women of South Africa, no Action Plan or law ever will be.

Why is it, Mr President, that you cannot find it in you to fight, with the same vigour, what you have termed, the "second pandemic" ravaging this country, as you have done the first? I know, Mr President, that the patriarchy serves you well for, after all, you too are a South African man.

So please Mr President, no more pretty promises written on fancy paper. The public sector’s crocodile tears bemoaning its paucity will no longer cut it either. That will not wash away the rivers of blood of millions of South African women, nor prevent the spilling of millions more.

We have reached judgment day on this pandemic – this war – Mr President, as many of our murdered sisters already have. We now ask you to account to us, the women of South Africa. Tell us when it is that we will be able to enjoy the same rights enshrined in our Constitution as you do? When will we walk the streets as freely as you?

What do we tell our daughters? What do you tell yours, Mr President? Not on your watch should we expect that to happen?

Yours faithfully

We, the Women of South Africa

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About the association

Committed women and men from diverse

professions: academics, community

organizers and activists from over 22

countries who educate, advocate and

implement programs to improve women’s

health around the globe.

Address of association

Women and Health Together for the Future (WHTF)

Community Health Science

University of The Western Cape

Robert Sobukwe Road

Bellville, Cape Town


South Africa

Global Health Education, Training and Service (GHETS)

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Attleboro Massachusetts 02703


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Dr. Hester Julie

Executive Director, WHTF


Dr. Judy Lewis

Chair, WHTF 


Micarla Abrahams

Administrative Staff, WHTF


Kamayani Bali Mahabal

Digital Head, WHTF


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