As the true scale of the mental health burden of COVID-19 continues to emerge, it is now apparent that the restrictive measures such as quarantine, physical distancing, closure of schools and essential social services, have resulted in unprecedented stress on vulnerable groups within communities [19]. This is coupled with constraints on people’s ability to work and seek support from loved ones along with the ensuing financial worries [20]. Loneliness, fear of infection, grief after bereavement, health worker burnout are also stressors that have been linked to anxiety and depression following the emergence of COVID-19. Self-harm, harmful alcohol and drug use, insomnia, and suicidal behavior have reportedly risen on a global scale since the onset of the COVID-19 pandemic [21]. With families spending more time at home together during quarantine, an increase in cases of domestic violence was recorded among women who had no escape from their abusers [22,23,24].

The COVID-19 pandemic has exacerbated many of the recognized risk factors for maternal mental health disorders such as poverty, extreme stress, exposure to violence (domestic, sexual and gender-based) and low social support. This tenuous situation has been further worsened by the severe disruptions to mental health services and informal support, leading to huge gaps in care for vulnerable women who desperately require this. There are significant concerns that women with pre-existing mental health conditions could have been impacted negatively by these disruptions in service. Although virtual contact massively increased with mixed potential consequences there is a need to carefully evaluate the impact and outcomes of adopting virtual consultation. All this is further complicated by the data that shows that many women are disinclined to take antidepressants even when prescribed [25, 26].

Stigma is another major barrier which often prevents people from accessing care for maternal mental health disorders. Research has shown that women with mental health disorders present late for antenatal care due to the fear of stigma and judgmental attitudes of healthcare professionals [27].

Reproductive services have also been impacted negatively by COVID-19. Prior to the start of the COVID-19 pandemic, availability, access, and quality of interventions to address infertility was a challenge in most countries with women, poor, unmarried, uneducated and unemployed being disproportionately affected [28]. A systematic review of fifteen studies involving 5851 patients seeking fertility care unanimously concluded that the COVID-19 pandemic had a negative impact on fertility care [29]. Some of the risk factors included female sex, single marital state, prior diagnoses of anxiety or depression, and length of time trying to conceive.

A key barrier to the implementation of mental health services has been the perennial shortage of mental health workers, a problem which has persisted during the COVID-19 pandemic. In low and middle income countries (LMICs) approximately 85% of people with mental, neurological and substance-use (MNS) have been unable to access care [30] with the mental health work shortage estimated at estimated at 1.18 million mental health workers [31].

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