Maternal mental health in low and middle income countries

Hannah Sender

25 April 2024

Post-natal depression affects around 20% of women in low- and middle-income countries – nearly twice as many as women in high-income countries. An ongoing trial I’m working on together with Professor Henrietta Moore is examining the effectiveness of a culturally-appropriate form of group Interpersonal Therapy in Lebanon and Kenya, testing whether this adapted therapy will yield superior outcomes in terms of child development, maternal depression, and the mother-child relationship compared to high-quality standard care.

SUMMIT (SUpporting Mothers’ Mental health with Interpersonal Therapy) is a collaboration between UCL Anna Freud Centre, the Institute for Global Prosperity at UCL, the Lebanon Ministry of Public Health, Nairobi City County Government, University of Nairobi, Columbia University, Health Strat Kenya, Bangor University, ABAAD Beirut and the American University of Beirut. Professor Henrietta Moore and I have led a programme of research as part of the trial, which seeks to map the diverse social, economic, and political conditions which impact women’s mental health and capacity to access appropriate mental health services.

This conceptual mapping programme was central to understanding how the group Interpersonal Therapy impacted women in the trial, and the management of the trial itself and we made sure that it was culturally specific to the Lebanese and Kenyan contexts. To this end, I applied the Citizen Social Science methodology alongside our research teams in Lebanon and Kenya, to train local citizen science researchers and co-design together the conceptual mapping programme. These researchers co-designed the research tools, including focus group guides for mothers, fathers, faith leaders, community health care providers and mental health professionals, and then used these in data gathering. The analysis of the data led to a conceptual map of maternal mental health factors to accessing appropriate care in Lebanon and Kenya.

Learnings from conceptual mapping include the importance of engaging fathers in discussions about maternal depression, and in decisions about accessing mental health care. Community health workers play a central role not only in disseminating information about mental health and care, and in linking mothers with care, but keeping in contact with women and supporting them throughout therapy. In addition, we found that many members of mothers’ communities play a role in supporting women’s transition to motherhood, including faith leaders and traditional birth attendants, who could be integrated into formal health care practices and improve trust between communities and formal health care providers.

One of the major challenges to accessing mental health support is migration to another part of the country or to a different country altogether, as providers lose contact with mothers and mothers struggle to sustain supportive relations. Finally, the coincidence of poor mental health with domestic violence and other health problems indicated the importance of offering additional support to mothers alongside the trial therapy.

This research is disseminated as part of a larger paper in Trials, a leading journal on randomised controlled trials in human health. The paper situates the conceptual mapping in relation to the larger randomised controlled trial, particularly its two-year feasibility study.

The feasibility study provides learning for the full trial, which is ongoing and due to finish in December 2024.

About Hannah Sender

Dr Hannah Sender is an ESRC Postdoctoral Research Fellow based at UCL Department of Geography. Her research is about rapid urban change in contexts of forced migration. Hannah is motivated inform a more inclusive and sustainable urban planning practice with an eye towards a future defined by movement. Hannah’s ESRC project, titled ‘ Limbo urbanism: developing planning theories and practices from small but rapidly urbanising places in the South West Asian/North African (SWANA) region’, focuses on creating shared, practical knowledge through research dissemination, critical discussion and building a network of actors committed to rethinking planning norms. Previously, Hannah has been a co-Investigator on UKRI-funded UK and international projects, leading and training qualitative research teams to explore perceptions of health, ill-health and care in Lebanon, the UK and Kenya.

Photo by Tiago Bandeira on Unsplash