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By Tamar Vardiashvili

While childbirth holds immense significance for Georgia's declining population, there are glaring gaps in maternal health care, particularly in mental health support, that demand urgent attention. Under international human rights law, States have legal obligations to maintain the highest possible standard of health and health care for women, children, and adolescents. A human rights-based approach (HRBA), recognised by the United Nations (UN) Human Rights Council, aims to support better and more sustainable development outcomes by analysing and addressing the inequalities, discriminatory practices, and unjust power relations, which are often at the heart of development problems. By applying this approach, the post examines how Georgia's policies align with international human rights standards and their potential to improve maternal mental healthcare.

The Hidden Crisis of Maternal Mental Health

According to the World Health Organization (WHO), around 10% of pregnant women and 13% of new mothers, around the world, experience mental disorders, primarily depression. These conditions not only affect mothers but can also negatively impact children's development. In severe cases, maternal mental health issues can lead to tragic outcomes, including suicide and infanticide. As reported by the Ministry of Internal Affairs of Georgia, in 2023, cases of intentional infanticide by mothers increased by 66.67% compared to 2022.

Based on the latest Concluding Observations of the UN Committee on the Elimination of Discrimination against Women, women in Georgia often do not access the mental health-care system owing to fear of stigmatization, alongside having inadequate mental health services for women and girls.

Additionally, observations concluded within the UN Joint Programme for Gender Equality in Georgia show that maternal health services in Georgia do not include mental health services, which has a negative impact on maternal mortality. The reported maternal mortality in Georgia continues to be four times as high as the EU average and almost twice as high as the European region average (22.4 deaths per 100,000 live births).

The Right to Maternal Health: the International Human Rights Framework and Georgia's International Obligations

Georgia has ratified several international treaties that contain provisions relevant to maternal health rights:

• The International Covenant on Economic, Social and Cultural Rights (ICESCR);
• The International Covenant on Civil and Political Rights (ICCPR);
• The Convention on the Rights of People with Disabilities (CRPD);
• The Convention on the Elimination of All Forms of Discrimination against Women (CEDAW).

Article 12.2 (a) of ICESCR particularly underscores state parties’ obligation to improve child and maternal health, sexual and reproductive health services, including access to pre- and post-natal care, and access to information, as well as to resources necessary to act on that information. Lack of services can lead to maternal mortality and morbidity, which can lead to a violation of the right to life or security and in some cases even amount to inhumane or degrading treatment.

Under Article 6 of ICCPR, states should develop strategies for improving access to medical examinations and treatments designed to reduce maternal and infant mortality, whereas Article 6 and Article 25 of CRPD recognize that persons with disabilities have the right to the enjoyment of the highest attainable standard of health without discrimination on the basis of disability or sex.

Furthermore, Article 12 of CEDAW stipulates that states parties shall take all appropriate measures to eliminate discrimination against women in the field of health care and shall ensure women equal access to health care services and appropriate services in connection with pregnancy, confinement and the post-natal period, granting free services where necessary.

These provisions obligate Georgia to improve maternal health care, including mental health services, and to collect data to inform policy decisions. However, according to the country review within the “EU4GenderEquality’’ project, services provided by the State Programme on Maternal Health are limited to physical health and do not include psychological assistance for pregnancy, childbirth and the post-partum period.

Assessing Maternal Mental Health Care in Georgia

The UN Committee on Economic, Social and Cultural Rights (OHCHR) developed the Availability, Accessibility, Acceptability, Quality (AAAQ) framework within General Comment No.14 (2000) to assess national public health policies and to measure the impact on human rights of possible national reforms. Using the AAAQ framework as a baseline and by considering the conclusions of national stakeholders, as well as UN treaty monitoring mechanisms, we can summarise the current status of Georgia's maternal mental health care as follows:

1. Availability: Although pregnant women receive eight free antenatal visits focusing on physical health, psychological assistance is neither regulated nor provided. The National Maternal & Newborn Health Strategy 2017-2030 does not address psychological support, leaving women without guidance on potential mental health issues.
2. Accessibility: Psychological support for women during pre- and post-natal periods is practically inaccessible through state program. It is neither affordable nor widely discussed, creating significant barriers to care. According to the Report of the Special Rapporteur on the rights of persons with disabilities within which laws, policies and concrete measures that the Government is taking to protect and promote the rights of persons with disabilities in the country were examined, general practitioners in Georgia are not usually trained to detect or manage mental health issues, which also inhibits efficient referral. The same report also emphasized that there is a shortage of mental health-care professionals in Georgia, which undermines the accessibility and availability of mental health services.
3. Acceptability: According to UNICEF Georgia’s study on accessibility to mental health services, mental health specialists suggest that young people often avoid receiving mental healthcare due to the stigma in society. Furthermore, Council of Europe Action Plan for Georgia 2024-2027, acknowledges that the extent of application of a patient centred and gender-sensitive approach by the medical professionals in the field of mental care needs to be enhanced. Therefore, it is implied that the needs of pregnant women are not fully recognised, validated, and respected in healthcare.
4. Quality: Within the latest Universal Periodic Review of Georgia by the UN Human Rights Council, it was recommended to Georgia to place greater emphasis on strengthening the quality and efficiency of primary health care and prioritize investments in quality and accessible mental health services. The absence of information on postpartum depression and the lack of consideration for psychological assistance during pregnancy significantly hinder the quality of maternal mental health care in Georgia.

The Path Forward

The lack of attention to maternal psychological needs in Georgia suggests that the conventions (such as CEDAW, ICCPR, ICESCR, ICRPD) for which Georgia bears responsibility are not sufficiently implemented. Maternal mental health services are neither available, accessible, nor acceptable, and they lack reasonable quality, which can have far-reaching consequences for maternal and child health outcomes. While statistical information of post-natal depression rate remains uncollected, recent academic research indicates that 48% of Georgian mothers are only partly aware of postpartum depression, whereas 40% of their depression awareness comes from the internet.

While Georgia ratified key international treaties such as the ICESCR and the CEDAW, which obligate states to provide comprehensive maternal healthcare, the country has yet to translate these commitments into effective domestic policy.

To align with its international obligations and improve health outcomes, based on the reviews and recommendations of Public Defender (Ombudsman) of Georgia, as well as UN human rights bodies (CEDAW, UPR, the Committee on the Rights of Persons with Disabilities (CRPD ) and other stakeholders (such as: UN Joint Programme for Gender Equality, UNICEF Georgia and European Union), Georgia shall:

1. Establish a national maternal mental health policy, drawing on WHO guidelines and successful models from countries exemplified by the Netherlands and Belgium which have adopted straightforward and effective approaches. In the Netherlands, pregnancy care is mainly provided by midwives who monitor not only the physical but also mental state of women and make specific referrals for treatments where needed. Whereas, in postnatal period healthcare checks are performed by the maternity nurse for both mother and infant, who informs and helps parents with common problems during the postpartum period including mental health problems. Belgium has a protocol on mental health care for the screening, detection and treatment of perinatal anxiety and depressive disorders. Assessments are conducted by midwives in the hospital and take approximately 30 minutes during a standard hospital visit.
2. Integrate mental health screening and support into existing maternal care programmes.
3. Address regional disparities in care access, particularly in rural areas where mental health stigma is higher than in urban centers.
4. Implement comprehensive training programs for healthcare providers to acknowledge, identify, and provide services to individuals experiencing mental health challenges during the prenatal and postnatal periods.

By adopting a human rights-based approach to maternal mental health, Georgia can not only fulfill its international commitments but also significantly improve outcomes for mothers, children, and society at large. The path forward requires not just legislative action, but a fundamental shift in how maternal care is conceptualised and delivered, placing mental health at the forefront of comprehensive reproductive healthcare.

Bio:

Tamar Vardiashvili is a practicing lawyer in Georgia. She holds a Bachelor of International Law (summa cum laude) and a Master of International Law (cum laude) from Tbilisi State University, with a semester spent at the University of Groningen.