Experts call for a roadmap to improve perinatal mental health for women in rural India

New Delhi, Sep 22 (PTI) There is an urgent need to create a roadmap for action and to improve perinatal mental health whilst addressing the key social determinants, particularly for women in rural India, according to experts.

The experts shared their opinions during a national expert consultation held as part of the Perinatal Mental Health (PRAMH) Project, led by The George Institute for Global Health India in partnership with the University of Oxford, supported by the UK Medical Research Council.

According to the experts, India has more than 25 million births per year, but most women with mental health problems during pregnancy and one year after birth (perinatal period) go undetected and untreated, especially in rural areas.

A recent systematic review among perinatal women in India found that the prevalence rates for perinatal depression ranged from 14 to 24 per cent in community-based studies, while some meta-analyses reported a pooled estimate of around 22 per cent for postpartum depression.

"Perinatal mental health is a major concern in India with large number of women with undiagnosed and untreated perinatal depression and psychosis which not only affect the mother but also the health of the baby and wellbeing of the family," said Pallab Maulik, Director of Research, The George Institute for Global Health India.

Another cause for concern is that, although maternal mortality in India has reduced by over 50 per cent since the early 2000s to 97 deaths per 100,000, maternal suicide constitutes an increasing proportion of maternal deaths. A recent report in Kerala estimated that maternal suicide accounted for nearly one in five maternal deaths in 2020.

The disparity is made worse by stigma, lack of access to mental health services, and growing socio-economic inequalities. Despite several efforts by NGOs, healthcare workers, and policymakers, there is a lack of an integrated framework to address these complex challenges that demand urgent action.

Findings shared from the PRAMH study in Telangana and Haryana highlighted the importance of engaging with perinatal women on their mental health and emphasised the need for scalable, culturally sensitive interventions integrated within health systems.

The PRAMH study is working to integrate perinatal mental health into routine maternal care by addressing barriers such as poverty, gender inequity, domestic violence, and stigma.

After identifying critical gaps in states like Telangana and Haryana, Phase 2 of the PRAMH study tested practical, scalable models to ensure mothers in rural India receive timely and culturally sensitive support.

"The findings from the PRAMH project underscore the profound impact that social determinants -- such as child sex preference, domestic violence, and poverty -- have on maternal mental health.

It is imperative that we only prioritise the mental health of women but also address these underlying social challenges within the communities. Supporting women in both areas is essential for fostering healthier mothers, children and families, and stronger societies," said Nicole Votruba from University of Oxford, UK, who is the Principal Investigator.

The session highlighted how deep-rooted male child preference and rigid social norms continue to deny women autonomy over their bodies and decisions around pregnancy. Speakers discussed the mental health impact of repeated pregnancies, domestic violence, and stigma faced by women -- especially when giving birth to a girl or a child with a disability.

The discussion called for breaking these harmful traditions, educating sarpanches, in-laws, especially men, employers across all job sectors, ASHAs, and frontline health workers, and closing critical gaps through capacity building, orientation, and practical training.

The panelists emphasised the importance of engaging community leaders, politicians, and religious figures, while also establishing clear tools, protocols, and a robust referral system to extend counselling support not only to women but also to their families.

"It is critical to ensure that perinatal mental health is not seen as a standalone as this might increase the stigma and discrimination that women with perinatal mental health problems face; rather it should be included within the routine antenatal and postnatal care that pregnant and lactating women receive, thus making it sustainable," said YK Sandhya, Program Lead - Mental Health, The George Institute for Global Health India. PTI GJS NB