Maternal Mental Health in Malawi

In the course of my work over the last two decades I have encountered a lot of women with mental health issues around the perinatal period (in pregnancy and period following childbirth). Although my organization offered the best possible care to  women and their babies, we were mindful of a larger population who had no access to mental health services, nor an opportunity to talk about their experiences with health workers.

At St John of God Hospitaller Services, Malawi, we decided to start planning and implementing maternal mental health awareness sessions for women as well as health workers in maternal and child health departments in hospitals within our catchment area. I eventually saw the need to further my studies, as I realized that there were a lot of areas in maternal mental health that we didn’t have sufficient knowledge of.

I was awarded an African Mental Health Research Initiative (AMARI) PhD scholarship in 2017. In the first year of my programme, I conducted a needs assessment: I talked to perinatal women with depression, primiparous women, health workers at implementation as well as policy level, and found that perinatal depression was common in Malawi but rarely identified. There were huge challenges in Primary health care including a shortage of staff, lack of knowledge and treatment guidelines. Perinatal depression was associated with psychosocial factors including intimate partner violence, and there were unmet needs for information, health care and support. Following this formative work, we are adapting a psychosocial intervention – the “Thinking Healthy Programme-Peer Delivered”, a low intensity intervention that is delivered by trained volunteer women. It is my hope that this  kind of an intervention can easily be implemented in low resource settings like Malawi with minimal resources and that it will improve the lives of mothers and their infants.

I became connected with Maternal Mental Health Scotland through my advisor, Dr Robert Stewart, a Scottish Perinatal Psychiatrist working with the University of Malawi at the time. And through our partnership with Maternal Mental Health Scotland, we were awarded a startup grant by THET in 2019. The grant enabled us to develop a peer support group of women with lived experiences in Lilongwe, Malawi as well as to conduct staff training and shared learning resources. Completion of activities in the project, however, was affected by the Covid-19 pandemic. The team from St John of God Hospitaller Services in Malawi was unable to make an exchange visit to maternal mental health services in Scotland. We are grateful that THET allowed us to repurpose the funds allocated to the  trip to enable  women to acquire mobile phones and airtime so that they can continue to support each other in times where physical meetings are not desirable and to enable us to  support women in acute mental health care and continue staff capacity building. We hope to acquire additional funding to make it possible for us to strengthen the voice and role of mothers experiencing mental health problems and to build capacity in maternal mental health in PHC & Specialist settings. Ultimately, our aim is to enhance health care services for women with severe mental disorders and their babies and infants by strengthening networks, collaboration and research.

– Mwawi Ng’oma