Maternal mental health

To support maternal and child health (MCH) nurses in conduct ing screening and counseling for perinatal depression, PATH has co-created and piloted, first in Mozambique and later in Ethiopia, a protocol for management of perinatal depression. The protocol was designed to follow a three-part structure used in the tools for integrated management of childhood illnesses, namely, “Observe and Ask,” “Classify,” and “Treat.” The first two questions of the Patient Health Questionnaire (PHQ-2) were used for screening, and pictorial tools adapted from the Thinking Healthy program (WHO, 2015) were used for initial counseling.

Assessments from Mozambique and Ethiopia suggest that MCH nurses find perinatal depression screening and counseling to be feasible and within their mandate. Between 60% and 80% of antenatal and postnatal (ANC and PNC) clients receive screening. At the same time, detection rates are still low and may be affected by overall uptake and quality of ANC and PNC services. 

In Mozambique, the protocol for perinatal depression management was integrated into national postnatal consultation guidelines in 2023.

Below, you can find sample protocols, training and mentoring tools, a take-home booklet (Mozambique), and briefs summarizing intervention steps and results.

In Kenya, in 2022, PATH joined forces with Homabay County, USAID’s Nuru Ya Mtoto project, and KMET to co-create and pilot a group-based parenting package for adolescent girls and young women (AGYW) who are mothers, to be delivered within DREAMS, the USAID HIV prevention program. While 15% of 18–19 year-olds taking part in DREAMS activities in the project were mothers, there were no interventions specifically addressing their needs as parents. Based on over ten focus group discussions with the girls, a support and learning program was developed to strengthen the girls’ mental health, co-parenting skills, and provision of adequate nutrition and early learning opportunities for their children. Additionally, to allow the girls to bring their children along, community volunteers were trained to engage in structured play with children using local playthings, while their mothers were taking part in the program.

Pilot assessment results suggested a decrease in moderate depression and in physical partner violence, increased engagement of partners, and improvements in practices around child feeding, early learning, and positive discipline.

In Ethiopia, taking advantage of a strong community health extension system, PATH worked with the Amhara Regional Health Bureau to supplement facility-based screening and counseling on depression with community-based support. In six woredas recently affected by conflict, Health Extension Workers (HEWs) were trained in 2022 to conduct mother-baby support groups using a structured program promoting maternal mental health, co-parenting, adequate child feeding, and early learning practices. Participation in the sessions resulted in a dramatic decrease in rates of depression and in improved caregiving knowledge. HEWs expressed willingness to adopt the program as part of their routine community services.