Speech by Dr Janil Puthucheary, Senior Minister of State, at the 6th Asia Pacific Maternal and Child Health Conference and Integrated Platform for Research in Advancing Maternal and Child Health Outcomes International Meeting 2023

Professor Alex Sia, CEO, KK Women’s and Children’s Hospital (KKH)

Associate Professor Ng Kee Chong, Chairman, Medical Board of KKH

Professor Tan Kok Hian, Chairman, Organising Committee of Asia Pacific Maternal and Child Health Conference and Integrated Platform for Research in Advancing Maternal and Child Health Outcomes (IPRAMHO) International Meeting 2023

Professor Victor Samuel Rajadurai, President, Federation of Asia and Oceania Perinatal Societies

Distinguished Guests

Ladies and Gentlemen

     Good morning, everybody. It is nice to be back, and I congratulate Professor Tan Kok Hian and Professor Helen Chen for their excellent work and for their contributions on the national stage in many other different ways, and in a way, the work that we launch today, as we recognise today, crystallises much of their effort. It is my pleasure to join you at this year’s Asia Pacific Maternal and Child Health Conference (APMCHC) and the Integrated Platform for Research in Advancing Maternal and Child Health Outcomes (IPRAMHO) International Meeting.

2.     Today, I would like to highlight two key points in our efforts to improve the health outcomes of women and children. First, the importance of maternal mental health and well-being and its impact on child health. Second, the need to move upstream in our efforts to support mothers and their children. 

Maternal mental well-being and its impact on child health

3.     Over decades, Singapore has made great strides in improving   maternal and child health. Our infant mortality and maternal mortality rates are now one of the world’s lowest. Our infant mortality rate has dropped from 34.9 deaths per thousand live births in 1960, to 1.8 in 2021. I think if you work here in KKH, or you are a beneficiary of the excellent work done here at KKH, you take this type of outcome for granted. But you compare where we were not so many decades ago, you realise the amount of effort it took to arrive where we are today. During the same period, maternal mortality rate also declined significantly from 45.3 to 2.6 maternal deaths per hundred thousand live births. These improvements in health outcomes are the result of the strong commitment to improve public health support for the mother and the child, as well as our healthcare providers’ dedication and individual efforts to keep themselves well through the perinatal stages.

4.     But looking at our progress and our results today, we should not become complacent. We need to continue our efforts to do more to ensure the health of women and their children is optimised, and address emerging issues as they develop and evolve with global and local trends, such as obesity, metabolic health and mental health issues.

5.     KK Women’s and Children’s Hospital (KKH) launched the SingHealth Duke-NUS Maternal and Child Health Research Institute (MCHRI) in 2021, with its purposeto serve as a Centre of Excellence for maternal and child health research. One of the key programmes under MCHRI is IPRAMHO, which is led by KKH in partnership with SingHealth Polyclinics (SHP) and National Healthcare Group Polyclinics (NHGP).

6.     IPRAMHO seeks to develop a seamless integrated model of care by implementing effective population health strategies for women and children. It has launched key national guidelines to improve the metabolic health of women and their children. We have seen good efforts to encourage physical activities, address gestational diabetes, and tackle weight management and health issues arising from a sedentary lifestyle. These efforts include the Guidelines on Optimal Perinatal Nutrition in 2019 and the Singapore Integrated 24-Hour Activity Guidelines for Children and Adolescents in 2021 and 2022.

7.     While the IPRAMHO platform has called for efforts to enhance metabolic health outcomes, I am particularly glad that this year’s theme has gone beyond a focus on physical health to highlight maternal mental health. This is an important aspect as we look at how we can better support the holistic health of women and their children.

8.     Our local study, Growing Up in Singapore Towards Healthy Outcomes (GUSTO) has yielded findings that underscore the importance of maternal mental well-being and its impact on their child’s health and development outcomes. GUSTO found that perinatal depression and anxiety experienced by the mother impact the child’s neurodevelopment, through influencing microstructural brain changes, functional connectivity as well as epigenetic changes. All these heighten the child’s vulnerability to mood or anxiety disorders later in life and has downstream implications on the child’s learning and their behaviour, such as their language development, cognitive development, and executive functioning.

9.     To address all of this, we need to intervene early, to better support the mental well-being of women during and after their pregnancy and hence minimise the detrimental effects on the child.   

Perinatal Mental Health Guidelines 

10.     This brings me to my second point – the importance of upstream efforts to support our mothers and their children in a holistic manner.

11.     This year, I am happy to officially launch the inaugural Perinatal Mental Health guidelines for women of child-bearing age in Singapore. These guidelines, jointly developed by KKH and the College of Obstetricians and Gynaecologists Singapore, will provide comprehensive and timely advice for women from preconception to the perinatal stage, and serve to form a stronger foundation for good perinatal mental health in Singapore. The guidelines emphasise the importance of screening for timely detection and treatment of mental health conditions in mothers. It also highlights the benefits of early intervention and support for women who are at risk of developing mental well-being issues during their pregnancy. There will be a specific focus on supporting vulnerable groups who might need more help such as women with special needs, adolescent mothers, and those who have experienced severe adverse obstetric events.

12.     As part of the process of development of these guidelines, KKH had conducted two surveys involving about 600 pregnant women and women who had just given birth, and more than 50 obstetricians and gynaecologists, to understand the current practices and awareness surrounding perinatal mental health. One of the surveys found that mental health literacy amongst the women could be improved, against a backdrop of a rather high prevalence of antenatal and postnatal mental health conditions such as anxiety and depression. Almost all the women surveyed were aware that perinatal mental health disorders could occur to them, but only two-thirds were aware of the signs and symptoms to look out for. More than three in five also reported that they have not received any mental health assessments or advice from their doctor. Only 16% said that they would seek professional help if they experienced symptoms.

13.     The survey results are telling, and we need to do more to equip women and their families with the relevant knowhow to recognise changes in their mental well-being, identify basic signs and symptoms of mental health conditions such as anxiety and depression, and encourage them to seek help when needed. It is timely that we launch and disseminate the perinatal mental health guidelines to healthcare professionals and the general public. We hope that the guidelines will make a difference to women who intend to get pregnant, are pregnant or who have just delivered and accord them with better maternal mental health support.

14.     The guidelines will also be disseminated to our healthcare professionals, including obstetricians, gynaecologists, family physicians, nurses, social workers, and psychologists, particularly those who, as part of their professional work, support women.

15.     The team has put in much effort to make the guidelines reader-friendly, so that they are accessible not just to professionals but that laypeople will find them useful as well. I encourage parents of newborns, expecting mothers as well as their spouses, especially their spouses, families and friends, to read the guidelines and learn how they can better support the mental well-being of mothers.

Psychological Resilience in Antenatal Management (PRAM) pilot

16.     To better support pregnant women’s mental health, KKH has also implemented a universal mental health screening programme for pregnant women receiving obstetric outpatient care at the hospital since December 2022. The programme, Psychological Resilience in Antenatal Management (PRAM), is part of the series of recommendations by the Inter-agency Taskforce on Child and Maternal Health and Well-being, which looks at how we could better support families with children to foster good health and well-being.

17.     PRAM will screen and identify pregnant women at risk of antenatal depression and accord them with early intervention, with the aim to achieve good health outcomes for the mother, and consequently, good health and development outcomes for the child. We also hope to raise more awareness of the importance of perinatal mental health, normalise discussions on maternal mental health, and encourage more women with mental health challenges to seek help.

Closing

18.     In closing, I would like to thank KKH and all the participating institutions for your continued efforts to improve the health outcomes of women and children in Singapore.

19.     I wish you all a very successful conference ahead and hope you benefit from the opportunity to exchange ideas and best practises from professional colleagues from around the world. Thank you.