Yevoo, L.L., Manzano, A. orcid.org/0000-0001-6277-3752, Gyimah, L. et al. (5 more authors) (2025) Conceptualizing maternal mental health in rural Ghana: a realist qualitative analysis. Health Policy and Planning, 40 (2). pp. 244-258. ISSN 1460-2237
Abstract
In low- and middle-income countries, maternal mental health needs remain neglected, and common mental disorders during pregnancy and after birth are routinely associated with hormonal changes. The psycho-social and spiritual components of childbirth are often downplayed. A qualitative study was conducted as part of a wider realist evaluation on health systems responsiveness to examine the interrelationships between pregnant and postnatal women, their families, and their environment, and how these influence women’s interactions with healthcare providers in Ghana. Data collection methods combined six qualitative interviews (n = 6) and 18 focus group discussions (n = 121) with pregnant and postnatal women, their relatives, and healthcare providers (midwives, community mental health nurses) at the primary healthcare level. Data analysis was based on the context–mechanism–outcome heuristic of realist evaluation methodology. A programme theory was developed and iteratively refined, drawing on Crowther’s ecology of birth theory to unpack how context shapes women’s interactions with public and alternative healthcare providers. We found that context interacts dynamically with embodiment, relationality, temporality, spatiality, and mystery of childbirth experiences, which in turn influence women’s wellbeing in three primary areas. There is an intricate intersection of pregnancy with mental health impacting women’s expectations of temporality, which does not always coincide with the timings provided by formal healthcare services. Societal deficiencies in social support structures for women facing economic challenges become particularly evident during the pregnancy and postnatal period, where women need heightened assistance. Socio-cultural beliefs associated with the mystery of childbirth, the supportive role of private providers and faith healing practices offered women a feeling of protection from uncertainty. Co-production of context-specific interventions, including the integration of maternal and mental health policies, with relevant stakeholders can help formal healthcare providers accommodate women’s perspectives on spirituality and mental health, which can subsequently help to make health systems responsive to maternal mental health conditions.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © The Author(s) 2024. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License (CC-BY-NC-ND 4.0). |
Keywords: | Ghana, maternal mental health, psycho-social, spirituality, health-system responsiveness, realist evaluation |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Education, Social Sciences and Law (Leeds) > School of Sociology and Social Policy (Leeds) |
Funding Information: | Funder Grant number MRC (Medical Research Council) MR/T023481/1 |
Depositing User: | Symplectic Publications |
Date Deposited: | 07 Feb 2025 10:14 |
Last Modified: | 07 Feb 2025 10:14 |
Status: | Published |
Publisher: | Oxford University Press |
Identification Number: | 10.1093/heapol/czae116 |
Related URLs: | |
Sustainable Development Goals: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:223007 |