Co‐producing equitable perinatal mental health care: facilitators and barriers to access among underserved women in the PRAMS study

Introduction

Underserved women experience disproportionately high rates of perinatal mental health (PMH) difficulties but face substantial barriers to accessing appropriate care. Evidence on how services can be redesigned to improve equitable access remains limited. The Perinatal Redesign for Accessing Mental Health Services (PRAMS) study aimed to co-produce an intervention to improve access to PMH support for underserved women and birthing people.

Methods

PRAMS is a mixed-methods study informed by Accelerated Experience-Based Co-Design and the Medical Research Council framework for complex intervention development. This paper reports findings from Work Packages 1 and 2. Work Package 1 included a national survey of professionals (n = 129) and semi-structured interviews (n = 19) exploring service provision and barriers to care. Work Package 2 involved 10 focus groups and 4 interviews with underserved women and birthing people (n = 50) recruited through Community Research Link Workers with lived experience. Data were analysed using framework analysis guided by the Candidacy Framework.

Results

Barriers to PMH care were identified across all domains of candidacy. Structural barriers included fragmented services, unclear referral pathways, and limited resources. Cultural stigma, language barriers and fears regarding child protection services limited help-seeking. Trust, continuity of care and community-based services facilitated engagement. Both professionals and women described a mismatch between rigid service models and women's preferences for relational, flexible and culturally responsive support.

Conclusion

Access to PMH care among underserved populations is shaped by complex structural and relational factors. Findings highlight the need for flexible, community-based and relationship-centred models of care. Co-production with underserved communities offers a promising approach for developing equitable PMH services to better meet the needs of women facing multiple vulnerabilities.