In low- and middle-income countries, maternal mental health needs remain neglected, and common mental illnesses during pregnancy and postpartum are routinely linked to hormonal changes. The psychosocial and spiritual components of childbirth are often neglected.
More information on health system responsiveness to explore the interrelationships between pregnant and postpartum women, their families, and the environment in Ghana and how these impact the interactions between women and health care providers in Ghana. A qualitative study was conducted as part of a broader realist evaluation.
Data collection methods included 6 qualitative interviews (n= 6) and 18 focus interviews with pregnant and postpartum women, their relatives, and primary care level healthcare providers (midwives, community mental health nurses). It was a combination of group discussions (n= 121). Data analysis was based on the context-mechanism-outcome heuristic of realist evaluation methodology. A program theory was developed and iteratively refined, drawing on Crowther’s birth ecology theory to elucidate how context shapes women’s interactions with public and alternative health care providers.
We find that context dynamically interacts with the specificity, relationality, temporality, spatiality, and mystery of the birth experience, which in turn influences women’s well-being in three key areas: I did. Pregnancy and mental health are intricately intertwined, influencing women’s expectations of temporality, which do not always align with the timing of formal health services. Social deficiencies in social support structures for women facing economic hardship are especially evident during pregnancy and the postpartum period, when women need even more support. Sociocultural beliefs related to the mystery of childbirth underpin the role of private health care providers in providing women with a sense of protection from anxiety.
Collaborating with stakeholders to develop context-specific interventions, including integrating maternal and child health policies with mental health policies, can help formal health care providers adapt to women’s perspectives on spirituality and mental health, and This in turn helps to align health systems with maternal mental health status.
© Author 2024. Published by Oxford University Press in association with the London School of Hygiene and Tropical Medicine.
