Addressing Common Perinatal Mental Health Disorders In Low- and Middle-Income Countries: A Silent Burden No More

CPMDs, including prenatal and postpartum depression, anxiety, and somatic disorders, are the leading complications of pregnancy and childbirth globally. Approximately one in five women in low- and middle-income countries (LMICs) suffer from one or more CPMD. The prevalence of CPMDs has been associated with adverse development in newborns and children. Women in LMICs are at greater risk for CPMDs if exposed to multiple risk factors, such as negative experiences with the health system, obstetric trauma, perinatal loss, and poor social support. CPMDs have also been linked to increased risk of preterm births, low-birthweight babies, stunting, and wasting in children. A landscape analysis conducted by the MOMENTUM Country and Global Leadership project found that successful core components of perinatal mental health interventions at both the community and facility levels include stepped care, detailed context assessments, task-sharing models, and talk therapy. At the health facility level, core components include pre-service training on mental health, trained and supervised providers, referral and assessment processes, mental health support for providers, provision of respectful care, and linkages with gender-based violence services. The analysis also highlighted significant gaps in understanding how to address CPMDs, which underscores the urgent need to provide CPMD prevention and care to women in LMICs. A technical consultation facilitated by MOMENTUM, the World Health Organization, and the United Nations Population Fund brought together 689 participants from 89 countries to collaborate and inform the path forward for perinatal mental health. The consultation led to the development of a prioritized list of implementation research questions and a global perinatal mental health theory of change. The theory of change provides essential guidance for well-coordinated and designed programming and can serve as the basis for future metrics and implementation guidance. The MOMENTUM team is now planning for perinatal mental health implementation research in India, focusing on integrating perinatal mental health programming into existing platforms and programs at the facility and community levels. In Nigeria, the MOMENTUM team hosted a maternal mental health dialogue in November 2022, which resulted in a commitment to eight solutions, including integrating maternal mental health services into existing services and mainstreaming services into primary health care using the Basic Health Care Provision Fund. These efforts aim to address the pressing need to improve perinatal mental health outcomes for women and children in LMICs.