Perinatal mental health and COVID‐19 in Japan

Perinatal mental health is critically important because depression and other stresses not only cause psychological distress to pregnant and post‐partum women, but can also have adverse effects on the growth and development of their children and the mental health of their partners. ¹ The novel coronavirus disease (COVID‐19) outbreak has had a wide range of effects on perinatal mental health.

Pregnant women have a variety of concerns and anxieties. The results of an online survey conducted by MTI Ltd. about attitudes toward COVID‐19 in pregnant women were released on 23 April 2020. MTI provides the most widely used ovulation‐day‐prediction app and the most widely used information‐distribution app for pregnant women in Japan. A total of 2872 pregnant women participated in the survey and reported their main concerns as: the effect on the fetus when infected by COVID‐19 (91.0%), the possibility of themselves having serious complications when infected (74.3%), the lack of therapeutic drugs to treat COVID‐19 (71.2%), infections of children after childbirth (69.1%), and infections at medical institutions (64.8%). ² In addition, 68.4% answered that antenatal support was insufficient. ²

This survey has some limitations, such as a nonrepresentative sample of pregnant women, but given that the annual number of childbirths in Japan in 2019 was 864 000 ³ and that there are approximately 270 000 reports of pregnancy from the app's users, it can be assumed that the results generally reflect the voices of pregnant women.

To support pregnant women, on 17 April 2020, the Governor of Tokyo announced plans to distribute tickets that could be used for taking taxis to pregnancy checkups. Also, Tokyo Midwives' Association conducted a survey of 62 district midwife chiefs who have provided maternal and child health services in municipalities during the COVID‐19 crisis. According to the data from 49 respondents, 33% of home‐visiting services and all mothers' classes meeting face‐to‐face had been canceled, though midwives had begun to provide alternative services, such as telephone visits, online visits, and online parenting classes (Tokyo Midwives' Association, unpublished observations; the first author as a member has permission to use the association's data).

Furthermore, due to COVID‐19, pregnant women cannot choose the unique Japanese cultural custom of satogaeri childbirth. Many Japanese women plan to return to their parents' home when they are close to the delivery date and stay there for a few months of nurturing care for both mother and baby. A previous study showed that satogaeri childbirth was negatively associated with maternity blues, ⁴ though another study showed it did not lower the incidence of post‐partum depression. ⁵ As part of the COVID‐19 response, Japanese government and public health specialists have recommended avoiding visits to other prefectures. The Japan Society of Obstetrics and Gynecology has urged pregnant women not to visit their hometowns where their parents live but to give birth at their local hospitals in order to prevent further spread of the virus. ⁶ Pregnant women who had registered with a hospital near their parents' home in another prefecture have been forced to change hospitals. According to the news of 24 April, a woman who intended to deliver a baby by satogaeri in Iwate prefecture was refused admission to hospital because she was from the Tokyo metropolitan area. ⁷ This might have caused anxiety for pregnant women. In addition, some pregnant women have had to change their birth plans because hospitals now restrict families from attending childbirths to avoid infection. Many pregnant women now have to be alone during delivery, with no family support. This might affect their mental health adversely and worsen the fear of childbirth. ⁸

COVID‐19 has had widespread effects on perinatal mental health. It is important to thoroughly understand the impact of COVID‐19 on mental health, especially in Japan, with its unique practice peculiarities, such as satogaeri childbirth. It is also necessary to enhance the level of support that can be implemented even under the circumstances of COVID‐19. Online support is thought to be one of the most optimal options because of its high accessibility and lack of physical contact. We have developed a smartphone‐based cognitive‐behavioral therapy (iCBT) program for pregnant women and are conducting a randomized controlled trial aiming to evaluate the effectiveness of iCBT to prevent the onset of antenatal and post‐partum depression. ⁹ We hope to contribute to the implementation and dissemination of tools for the universal prevention of perinatal depression.

Disclosure statement

The authors have no conflicts of interest to declare.