Mental health in pregnancy: Is it part of the fertility equation?

News

Australia’s birth rate has reached record lows, with the number of registered births falling by 4.6% from 2022.

 

The fertility rate now sits at 1.5 babies per woman, well below the replacement level of 2.1, a threshold not met since 1976.

 

During this time, mental health conditions have increased to 18%. While rising living costs and housing insecurity are often cited as major factors, another contributor may be hiding in plain sight: mental health during pregnancy.

 

Research by GP and perinatal mental health specialist Dr Jacqueline Frayne reveals that many women are navigating pregnancy and parenthood without adequate mental health support.

 

However, many GPs feel underprepared.

 

‘GPs are often the first point of contact for women navigating mental health in pregnancy, yet may lack the confidence, resources, or support they need to make informed decisions,’ Dr Frayne said.

 

Her study, supported by the Australian General Practice Research Foundation and Therapeutic Guidelines, found almost two thirds of GPs are unaware of Australia’s primary perinatal mental health resource, the Centre of Perinatal Excellence.

 

Rural GPs reported greater prescribing confidence, likely due to necessity in areas with limited access to non-GP specialists.

 

Disparities across Australian communities

About 13% of Aboriginal and Torres Strait Islander mothers report a diagnosed condition during pregnancy though this likely understates broader distress linked to trauma, discrimination, and social disadvantage, the study found.

 

Among culturally and linguistically diverse groups, rates range from 10% to 25%, highest among refugees.

 

Lesbian and bisexual mothers face significantly higher anxiety and depression rates, whilst the PANDA helpline reports up to 15% of fathers calling are experiencing anxiety and depression.

 

‘We hear a lot about cost of living and affordability, but mental health in pregnancy is a huge part of the story that’s not getting enough attention,’ Dr Frayne said.

 

Supporting GPs to support women

The study surveyed 132 GPs and interviewed 12 more, finding that while many felt confident prescribing selective serotonin reuptake inhibitors, they also face barriers such as time constraints, delayed referrals, and limited access to integrated care.

 

But Dr Frayne said prescribing is only one part of the picture.

 

‘Women need information, reassurance, continuity, and care that is tailored to their circumstances,’ she said.

 

The research calls for early training in perinatal psychiatry, greater awareness of evidence-based tools, and stronger collaboration between GPs, psychiatrists, and obstetricians.

 

Infertility and mental health policy

Infertility affects 15% of people wishing to conceive, with studies showing up to 75% of patients report anxiety or depression during fertility treatment.

 

However, less than 20% receive mental health support and nearly half of women with fertility issues continue to experience psychological distress even after successful conception.

 

At a policy level, the Federal Government’s Better Access initiative allows GPs to create a Mental Health Treatment Plan and refer patients to up to 10 subsidised psychology or mental health sessions via Medicare when developing a fertility plan.

 

Looking ahead

Dr Frayne’s work is already making a difference by strengthening links between general practice and mental health services, and inspiring early career doctors to pursue further training in women’s mental health.

 

‘Improving perinatal mental health is not just good clinical care … it is part of building a future where starting a family does not feel like a mental health risk,’ she said.

 

The Australian General Practice Research Foundation is the philanthropic arm of the RACGP, for more information visit the Australian General Practice Research Foundation website.

 

Since 2011, the Foundation has partnered with Therapeutic Guidelines to fund GP-led research into the use and implementation of clinical guidelines across areas such as heart and kidney disease, osteoarthritis, mastitis, antimicrobial use, and medical abortion.

 

These projects continue to inform national guidelines and strengthen evidence-based care in general practice.

 

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