Background: Poor maternal mental health is a major public health concern since it adversely impacts both maternal and child health outcomes. This study aimed to document the barriers to utilizing perinatal mental health services in Karnataka, India, and to determine its relationship with risk factors of poor maternal mental health in this context.
Methods: Qualitative research methods using in-depth interviews were conducted on twenty-one local stakeholders who represented health service providers in various capacities: mental health specialists (n = 4), gynaecologists (n = 2), government officials from the Department of Health and Family Welfare (n = 2), and Department of Women and Child Development (n = 2), senior state consultant to United Nations Children’s Fund (n = 1), and frontline workers (n = 10). Data were analysed using a thematic framework analysis approach.
Results: We identified multiple barriers to service utilization operating at the levels of the health system, community, family, and the individual. Health-system level barriers included lack of a universal screening mechanism, poor infrastructure, poor training of frontline workers on mental health issues, and inadequate time for counselling and treatment. Community-level barriers included stigma and misconceptions, leading to a lack of social support. Family and individual level barriers included the financial burden of availing services, lack of family and partner support, and lack of empowerment and motivation in the woman to seek services. Family and individual level barriers interacted with risk factors of poor maternal mental health. Based on this evidence and drawing from the literature, we propose a contextualised, stepped-care model for universal screening, detection, referral, and treatment of women with perinatal mental health conditions for Karnataka that is integrated with the reproductive, maternal, and child health (RMNCH) program in primary care settings.
Conclusions: The framework developed in this study suggests that addressing the identified barriers would potentially increase uptake of available services, create awareness about and demand for high-quality mental health services, reduce the risk factors of poor maternal mental health, and eventually improve our understanding of its true burden in the state of Karnataka. This is essential for proper implementation, monitoring, and evaluation of programs relevant to perinatal mental health.