Opinion: Addressing Postpartum Mental Health can Empower Reproductive Choice

Mental health issues among postpartum women in low to middle-income countries represents a silent epidemic that negatively impacts a range of health outcomes. The period following childbirth is fraught with physical, emotional, and psychological changes, which is further exacerbated by limited access to healthcare, lack of mental health awareness, and mental health stigma. Addressing these issues is vital not only for the health and well-being of mothers but also for their children, families, and the broader community. 

The implications of maternal mental health extend to critical areas like family planning (FP) and reproductive health, influencing decisions that have long-term impacts on family dynamics and societal health. Women with mental illness are particularly vulnerable to unplanned pregnancy, mental health relapse during childbearing, and psychological and economic burdens associated with unplanned pregnancies.

While several studies demonstrate such associations between unmet need for FP and low postpartum contraceptive use, solutions promoting the integration of mental health services in FP settings remain scarce and under prioritized. A recent study implemented by the Breakthrough ACTION project and Ethiopian-based partners, aimed to fill this gap. Funded by USAID, the study investigated the use of group-based Cognitive Behavioral Therapy (CBT), delivered by community health workers, to improve depression and anxiety and support uptake of postpartum family planning. The project involved co-creation with local stakeholders as well as qualitative and quantitative research.

The results from this cluster randomized controlled study were among the first to demonstrate that more holistic FP services which consider postpartum mental health can both reduce postpartum depression and anxiety while supporting women in fulfilling their reproductive intentions. In comparison to control groups who received standard of care, study intervention clusters showed significantly greater reductions in symptoms for both depression and anxiety compared to the control group. Modern FP use, communication with a partner, and reproductive agency also increased significantly more in intervention clusters as compared to control clusters.

Photo Credit: Maheder Haileselassie Tadese/Getty Images/Images of Empowerment

These findings are encouraging and point to several opportunities for mental health interventions to improve the well-being of postpartum women.

1.     First and foremost, there is an urgent need to integrate mental health services into existing FP and maternal and child health services at scale, in Ethiopia and beyond. This integration should aim to provide holistic care to postpartum women, addressing both their physical and mental health needs.

2.     Secondly, exploring the use of digital platforms for the dissemination of interventions could expand their reach, especially in urban areas with higher digital literacy.

3.     Thirdly, a deeper understanding of the interplay between mental health, sexual and reproductive health behaviors, and societal norms is essential for creating more targeted and effective interventions that address the multifaceted needs of postpartum women.

For additional details on the study design and results, please refer to the project brief here.

These recommendations should be considered as a starting roadmap for future initiatives aimed at enhancing the health and quality of life for postpartum women. As this study demonstrates, addressing mental health in the postpartum period can lead to positive outcomes in family planning and overall family health, setting a precedent for similar interventions globally. Together, let’s prioritize mental health as a fundamental component of global development and support comprehensive, community-driven solutions that foster cross-sector collaboration to ensure equitable access to quality mental health care worldwide.

Written by: Jessica Vandermark Moore

Jessica is a Senior Advisor to Camber Collective, a social-sector strategy consulting firm which is part of the Breakthrough ACTION (BA) project consortium. BA is led by the Johns Hopkins Center for Communication Programs and funded by USAID to lead SBC programming around the world. Jessica has been working for the last 18 years in global health with a focus on reproductive health and rights globally.