By Daniela Silva-Rodriguez & Manuela de Szyszlo
This article was originally written in Spanish and can be viewed here.
The impact of nature on mental health
Globally, nature-based therapies are being incorporated into public health systems in several countries, as a complement to traditional medical treatments (White, 2017; Thomas, 2015; Pritchard, 2020; Sands, 2023) as the benefits of contact with nature on mental health and general well-being of people is widely documented, including the impact on the mitigation of socio-economic inequalities and the promotion of pro-environmental behaviors (Lumber, 2017). Thus, in countries such as Japan and New Zealand, “green prescribing“ has been used since 1980.

Although a very large meta-analysis was published in 2021 that demonstrated the positive impact of nature-based interventions on depression and anxiety (Coventry, 2021), to date there are very few studies on the impact of these interventions on pregnant women and peri-natality. However, there is still a need to study this group since it is known, through research, that the increase in mental disorders, sedentary lifestyles, and the increase in non-communicable diseases are related to urbanization and therefore to the lack of contact with nature, affecting mainly women (Lee, 2012; Bauman, 2009). Considering the fundamental role that women play in the well-being of the home and the community in general, for all those pregnant women and the peri-natal collective who lack sufficient connection with nature, we believe it is crucial to understand what are the mediators or factors that influence the use of green areas to achieve their physical and mental well-being in the context of urban areas.
Depression & anxiety in pregnant & postpartum women
According to several research studies, the reason why women are more susceptible to depression and anxiety, especially around peri-natality, is due to an increase in sex steroids during the menstrual cycle, the use of contraceptives, premenstrual syndrome, or other factors. This increase in sex steroids alters the mood of women, especially during pregnancy and the puerperium.
Pregnant women, especially younger women, are at high risk for depression and anxiety disorders. Mental disorders during pregnancy have a devastating impact on women’s quality of life, their relationships, and their ability to bond with their future baby. Gestational depression negatively impacts the fetus, manifesting as fetal hyperactivity, premature delivery, low birth weight or fetal growth restriction. All of these conditions can have an impact on the infant’s long-term neurological development, which can manifest as sequelae in the child’s fine and gross motor skills, communication skills, problem-solving abilities, and ability to develop social skills. Depression can also affect the breastfeeding period and, consequently, the formation of the maternal-fetal bond (Lee, 2007). In the case of teenage pregnancies, the situation is particularly precarious. Studies have found that teenage pregnancy is associated with an increased risk of depression and a low score on the Apgar test, a test that is performed at the first and fifth minute after the birth of the baby to determine how well the baby tolerated the birth process and then how well the baby is evolving outside the womb (Wong, 2020). Evidently, a low Apgar score will have a negative impact on public health costs as it will mean more medical interventionism.
The challenge of pregnant adolescents in Peru
According to data found by Vega Gonzáles, in Peru it is estimated that around 25% of pregnant women suffer from depression or anxiety. These disorders occur more frequently in unemployed women, or with a history of spontaneous abortions or unwanted pregnancies. To illustrate the condition of vulnerability of pregnant adolescents, in a local public hospital of a total of 45 pregnant women, mostly adolescents, 82.8% prevalence of depression was found according to the Edinburgh Scale (Vega Gonzales, 2019). In a similar context, a study conducted by Bonilla-Sepúlveda in Colombia also corroborated that the presence of depression is related to the age of the pregnant woman. The high rate of depression among adolescent pregnant women is attributed to factors such as lack of emotional support from the partner and/or family, unwanted pregnancies, hormonal factors typical of adolescence and economic precariousness (Gutiérrez, 2018; Ceballos, 2013).
Therapeutic horticulture as an intervention for pregnant women

From the Institute of Therapeutic and Social Horticulture (IHTS) we promote nature-based therapies and in particular the (re)connection with nature as a scientifically proven and cost-effective way whose impact produces a protective effect on the mental health of pregnant women, especially in the case of pregnant and postpartum women of low socioeconomic status. We believe that women with access to green areas, such as gardens, vegetable gardens or parks, will have a lower incidence of depressive symptoms and a lower risk of giving birth to low-birth-weight babies. In that sense, we assert that, horticultural therapy and therapeutic horticulture interventions and programs are promising, cost-effective, and of great impact for pregnant women (McEachan, 2016; Kaplan & Kaplan, 1989). As assessed by Kotozaki, a horticultural therapy program, unlike other medical treatments, can address the needs and problems of pregnant women, pre- and postpartum, in a holistic manner, positively impacting the physical, emotional, social, and cognitive health of pregnant women, extending the positive impact of the program on the infant’s development (Kotozaki,2014).
Benefits of a therapeutic horticulture program for pregnant women
Our vision of a horticultural therapy program for pregnant women, offered by a trained practitioner and following the EPN Methodology (Eco Psyche Nexus – APHTS, 2023 – https://www.htinstitute.org/blog/eco-psyche-nexus-methodology/), during prepartum and postpartum can be very effective in addressing goals such as:

- Relief from stress, depression or anxiety by creating an environment with plants that conveys calm and a place of refuge, where women can redirect their attention to the plants, observing, touching or smelling, and thus restore their attention.
- Development of attachment skills through the “adoption” of potted plants, anthropomorphizing and naming them.
- Improving self-esteem, self-worth, sense of pride and purpose by learning to care for plants, harvesting vegetables, and/or making crafts with materials from nature.
- Cultivate a sense of care by comparing the needs of germinating seeds with the care of their baby.
- Development of soft skills such as patience, empathy, delayed gratification, responsibility and commitment, or group work through the comparison of the life cycle of plants with the life cycle of humans and metaphors that would allow them to see life from another lens.
- Development of a sense of belonging by attending a place that they make their own, where there are plants that respond to their care, without judging them.
- Reducing isolation and feelings of loneliness by cultivating bonds with a community of women who share their needs and concerns.
- Develop a “green routine” by learning to care for plants. This routine would allow them to map out a daily plan in other scenarios of their daily lives, in addition to learning gardening strategies to channel unpleasant emotions, activate their healing capacity, and improve their self-esteem and self-worth.
- Practice self-awareness by recognizing aromas that relieve stress or anxiety or by identifying and recording their emotions in a journal.
- Acquire skills in gardening, horticulture or handicrafts with materials from nature that will enable them to get a job.
- Improvement and strengthening of family and community ties.
- Improve eating habits by learning to grow a variety of vegetables, prepare and consume them; understand the importance of healthy eating for good mental and physical health.
- Promotion of physical activity through gardening activities.
A personal experience of reconnection with nature

From our recent experience with motherhood, we believe that the disconnection with nature that many pregnant and postpartum women experience today is influenced by what Lucy Jones refers to in her book Matrescence as ‘the modern institution of motherhood’. This concept refers to a system shaped by capitalism and patriarchal structures, which impose the idea of self-sacrifice and servitude, especially on mothers (Jones, 2023). In this context, neoliberal economic policies erode community ties and raise living costs, generating unsustainable levels of stress in families. This translates into feelings of guilt, physical and mental health problems, and low emotional well-being for many mothers.
We are convinced that motherhood was conceived to be lived within strong communities and family support networks. The idea of a “tribe” of mutually supportive mothers not only reduces the stress of lone motherhood, but also provides opportunities for collective learning, enhancing newborn care. However, in modern society, mothers increasingly face isolation and loneliness during pregnancy and motherhood, which, as discussed above, can lead to anxiety disorders and depression.

In our first experience as mothers, the self-imposed pressure to be a perfect mother and completely devoted to the baby affected our self-esteem, making us feel inadequate and leading to isolation. Although we loved our child deeply, we soon realized that it was not possible to fulfill all roles at once: mother, wife, professional, nurse, cook, among others. Now, in this new stage of motherhood, we draw on the wisdom of that first experience. We have adopted a more compassionate and patient perspective, finding comfort and healing in the natural processes and contact with the cycles of life. These remind us that, although we live in a modern society, we are still human beings, connected to our natural environment and to an evolutionary history that continues to claim us.
References:
- Bauman, A., Bull, F., Chey, T., Craig, C. L., Ainsworth, B. E., Sallis, J. F., Bowles, H. R., Hagstromer, M., Sjostrom, M., & Pratt, M. (2009). IPS Group. International Journal of Behavioral Nutrition and Physical Activity, 6(21).
- Ceballos, G., & others (2013). Pregnant adolescents: sociodemographic characteristics, depression and suicidal ideation. Revista de Psicología Universidad de Antioquia, 5(2), 31-44.
- Coventry, P. A., Brown, J. V. E., Pervin, J., Brabyn, S., Pateman, R., Breedvelt, J., Gilbody, S., Stancliffe, R., McEachan, R., & White, P. C. L. (2021). Nature-based outdoor activities for mental health: Systematic review and meta-analysis. SSM-Population Health, 16, 100934.
- Gutierrez, E. P., Moquillaza Alcántara, V., García Cajaleón, J., & Cuya Candela, E. (2020). Psychosocial factors associated with depression in pregnant women treated in a Peruvian maternal and child center. Revista Chilena de Obstetricia y Ginecología, 85(5), 494-507.
- Jones, L. (2023). Matrescence: On the metamorphosis of pregnancy, childbirth and motherhood. Allen Lane.
- Kotozaki, Y. (2014). The psychological effect of horticultural therapy intervention on earthquake-related stress in women of earthquake-related areas. Journal of Translational Medicine and Epidemiology, 2(1), 1008.
- Lee, D. T. S., & Chung, T. K. H. (2007). Postnatal depression. An update. Best Practice & Research Clinical Obstetrics & Gynaecology, 21, 183-191.
- Lumber, R., Richardson, M., & Sheffield, D. (2017). Beyond knowing nature: Contact, emotion, compassion, meaning, and beauty are pathways to nature connection. PLoS ONE, 12.
- McEachan, R. R. C., Prady, S. L., Smith, G., Fairley, L., Cabieses, B., Gidlow, C., Wright, J., Dadvand, P., van Gent, D., & Nieuwenhuijsen, M. J. (2016). The association between green space and depressive symptoms in pregnant women: Moderating roles of socioeconomic status and physical activity. Journal of Epidemiology and Community Health, 70, 253-259.
- Pritchard, A., Richardson, M., Sheffield, D., & McEwan, K. (2020). The relationship between nature connectedness and eudaimonic well-being: A meta-analysis. Journal of Happiness Studies, 21, 1145-1167.
- Sands, G., Blake, H., Carter, T., & Spiby, H. (2023). Nature-based interventions in the UK: A mixed methods study exploring green prescribing for promoting the mental wellbeing of young pregnant women. International Journal of Environmental Research and Public Health, 20(6921). https://doi.org/10.3390/ijerph20206921. https://doi.org/10.3390/ijerph20206921.
- Thomas, F. (2015). The role of natural environments within women’s everyday health and wellbeing in Copenhagen, Denmark. Health & Place, 35, 187-195.
- Vega-Gonzales, ., Guerrero-Rosa, A., Guzmán-Castillo, B., Huamaní-Morales, E., & Herrera-Chenett, G. (2019). Anxiety and depression in adolescent pregnant women in a hospital in Lima, Peru. International Journal of Maternal-Fetal Health, 4(3), 3-7.
- White, M. P., Pahl, S., Wheeler, B. W., Depledge, M. H., & Fleming, L. E. (2017). Natural environments and subjective wellbeing: Different types of exposure are associated with different aspects of wellbeing. Health & Place, 45, 77-84.