Written evidence submitted by Fatemeh Hajiali, Independent Researcher (GMBPsS, AMRSPH)
International Development Committee inquiry: Global Health
About the author
1. I am an independent researcher whose work focuses on perinatal mental health, early childhood development, and the health of migrant and bilingual families. I hold Graduate Membership of the British Psychological Society (GMBPsS) and Associate Membership of the Royal Society for Public Health (AMRSPH), and previously worked as a midwife with extensive clinical experience in maternal and perinatal care. My research has focused particularly on perinatal mental health among migrant mothers. I have previously submitted written evidence to House of Commons Select Committees on matters relating to maternal health, public health and education.
2. This submission focuses on Questions 2 and 5 of the Committee's call for evidence, with a shorter comment on Question 6. My central argument is that perinatal mental health is a significant and largely invisible casualty of global health ODA reductions, and that migrant, refugee and displaced women carry a compounded burden that current ODA effectiveness and transparency frameworks do not adequately capture.
Question 2: How do reductions in Official Development Assistance impact healthcare provision, particularly in relation to marginalised communities and conflict-affected states?
3. Reductions in global health ODA do not fall evenly across health services. Mental health provision, and perinatal mental health in particular, has historically been treated as a lower priority than physical and infectious disease programming, and is typically among the first areas to be reduced or removed when budgets contract. This is despite an estimated 10–20% of women worldwide experiencing a mental health condition during pregnancy or the year following birth, with the highest rates recorded in low- and middle-income countries.[1]
4. Recent modelling published in The Lancet Global Health found that higher levels of ODA were associated with substantial reductions in mortality over the past two decades, including a 23% reduction in overall age-standardised mortality and a 39% reduction in mortality among children under five, alongside significant reductions in maternal and perinatal mortality specifically. The same analysis forecasts that continued funding reductions, estimated at over 10% for 2026 alone, could reverse many of these gains.[2] Untreated perinatal mental illness is independently associated with adverse outcomes for both mother and child, including preterm birth, low birth weight, and longer-term developmental and behavioural difficulties. A reduction in global health ODA that overlooks perinatal mental health therefore risks undermining child health and development outcomes, not only maternal outcomes narrowly defined.
5. Conflict-affected states, and populations displaced by conflict, represent a particularly acute version of this problem. Systematic review evidence consistently finds that perinatal outcomes, including mental health, maternal mortality and preterm birth, are worse among refugee and asylum-seeking women than among the settled population, reflecting what researchers have described as a double burden of inequality.[3] Trauma exposure across the migration trajectory, before, during and after displacement, is a consistently identified driver of poor perinatal mental health in this group. These are precisely the populations that ODA-funded global health programming in conflict-affected states is intended to reach, yet perinatal mental health rarely appears as a named priority within that programming.
6. This is not solely an issue for ODA-recipient countries. The same evidence base, drawn substantially from the WHO European Region, shows that refugee and asylum-seeking women continue to face structural barriers to perinatal mental healthcare after they reach a destination country, including limited culturally responsive services, stigma, and reliance on interpreter-mediated consultations that can inhibit disclosure.[4] A global health architecture that treats displacement as a problem ending at resettlement will continue to miss this population at both ends of their journey.
Question 5: How effective has the UK's global health Official Development Assistance been in the past, and how could it be made more effective in the future?
7. Part of the difficulty in assessing the effectiveness of UK global health ODA in this area is that perinatal mental health is rarely tracked as a standalone indicator within global health monitoring frameworks. Researchers working on the development of global indicators for perinatal mental health have highlighted the continued absence of standardised measures suitable for use across health systems of differing income levels, which makes it difficult to know how much ODA reaches this area, or what difference it makes when it does.[1]
8. I would recommend that the Committee ask what proportion of UK global health ODA is currently directed towards mental health broadly, and perinatal mental health specifically, and whether any standardised indicators are used to track this. Where this information does not currently exist in a reportable form, that absence is itself a relevant finding for this inquiry.
9. To make future ODA more effective, I recommend that:
a. perinatal mental health be explicitly named within UK global health ODA strategy documents, rather than assumed to be captured under general “maternal health” or “mental health” headings;
b. programming aimed at conflict-affected and displaced populations include a specific perinatal mental health component, given the elevated risk in this group; and
c. UK-funded global health data collection include perinatal mental health indicators consistent with those being developed for global monitoring, so that future changes in funding can be evaluated against outcomes in this area rather than physical health indicators alone.
Question 6: How transparent is the UK's global health Official Development Assistance, and how could transparency be improved?
10. The measurement gap described above is also a transparency gap. If perinatal mental health spending and outcomes are not separately identifiable within ODA reporting, Parliament and the public cannot assess whether this area is being protected, reduced, or eliminated as budgets change. I would encourage the Committee to ask the Foreign, Commonwealth and Development Office directly whether perinatal mental health can currently be isolated within its global health ODA reporting, and, if not, to recommend that it be added as a distinct reporting line.
Summary of recommendations
11. In summary, I recommend that the Committee:
a. treat perinatal mental health as a distinct and currently under-monitored casualty of global health ODA reductions, rather than assuming it is protected within broader maternal or mental health budgets;
b. give particular attention to the compounded risk faced by refugee, asylum-seeking and displaced women, whose perinatal mental health needs are inadequately addressed both in conflict-affected and transit settings and in destination countries;
c. ask the Government what standardised indicators, if any, currently exist to track UK global health ODA spending and outcomes in perinatal mental health, and recommend their development where they do not; and
d. recommend that perinatal mental health be reported as a distinct line within future UK global health ODA transparency reporting.
Fatemeh Hajiali, GMBPsS, AMRSPH
3 July 2026
References
[1] Layton, E., Roddy Mitchell, A., Kennedy, E., et al. (2025). Maternal mental health matters: Indicators for perinatal mental health—A scoping review. PLOS ONE. https://doi.org/10.1371/journal.pone.0317998
[2] The Lancet Global Health (2026). Impact of two decades of humanitarian and development assistance and the projected mortality consequences of current defunding to 2030: retrospective evaluation and forecasting analysis. DOI: 10.1016/S2214-109X(26)00008-2
[3] BMC Medicine (2018). Perinatal health outcomes and care among asylum seekers and refugees: a systematic review of systematic reviews. DOI: 10.1186/s12916-018-1064-0
[4] Healthcare (2024). Enablers of and Barriers to Perinatal Mental Healthcare Access and Healthcare Provision for Refugee and Asylum-Seeking Women in the WHO European Region: A Scoping Review. DOI: 10.3390/healthcare12171742