Biological memories of apartheid:  Intergenerational effects of prenatal and early life stress and trauma on birth outcomes,  HPA axis function, and mental health in Soweto, South Africa

Kim, Andrew Wooyoung

doi:https://doi.org/10.21985/n2-th5d-rh25

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Biological memories of apartheid: Intergenerational effects of prenatal and early life stress and trauma on birth outcomes, HPA axis function, and mental health in Soweto, South Africa

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South Africa’s rates of mental, neurological, and substance use disorders are among the highest in sub-Saharan Africa. In 2016, the estimated 12-month prevalence for any psychiatric disorder was 16.2%, or approximately 9.1 million individuals. Despite these elevated rates of psychiatric morbidity, access to mental health treatment is poor: only 27% of patients living with severe mental illness are expected to receive treatment. The current state of public mental health in South Africa is foregrounded by a long and recent history of institutionalized White supremacist policies implemented during the Apartheid regime (c. 1948-1994).Since South Africa’s democratic transition, nationalist ideologies promoting aspirations for unity, equality, and freedom in the new “rainbow nation” have continuously been met with chronicities of anti-black violence, misogynoir, and structural violence, all of which are known risk factors for psychiatric disorders. These legacies of white supremacist apartheid policies underpin the dramatic inequities seen in mental health disparities. In addition to these ongoing societal effects, there is growing evidence that the stressors of the past could have lingering biological effects that continue to influence and mental health across the lifecourse. Growing evidence from the fetal origins of health and disease framework shows that past stress and trauma exposures, particularly those that occur during early development, can durably alter the development and function of various stress regulatory mechanisms in humans. Among reproductively aged women, these long-term impacts could shape the gestational environment experienced by the next generation, thereby influencing grandoffspring development. Thus, maternal exposures during gestation may not only affect their developing children but also affect the health and biology of subsequent generations - thus describing a possible intergenerational mechanism for stress transmission. While the sustained and deleterious effects of prenatal stress and cortisol exposure are increasingly evident, it is not yet clear the extent to which their long-term and intergenerational impacts on stress physiological function, specifically the hypothalamic-pituitary-adrenal (HPA) axis are reversible. Very early findings suggest that positive developmental conditions can ameliorate the durable effects of past trauma on the HPA axis. Scientists have thus far been unable to test this hypothesis, however, because there are very few longitudinal studies that directly assess maternal exposures to stress and trauma during pregnancy and that span multiple generations. Drawing from data from a 30-year multigenerational birth cohort study based in Soweto and 21 discontiguous months of ethnographic research with mental health patients, professionals and NGOs in South Africa between June 2017-October 2020, this dissertation examines the biocultural transmission of embodied trauma from apartheid and its impacts on human biology and mental health in subsequent generations among families in Soweto, South Africa. I draw on two separate longitudinal cohort studies based in Soweto and a comparative study in Cebu, Philippines to examine the intergenerational and lifecourse impacts of early life stress during prenatal development and childhood.

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