Perceptions and experiences of healthcare providers in Bangladesh surrounding perinatal mental health: A qualitative study

Perinatal mental health (PMH) is a global health concern. Healthcare providers play an important role in the way PMH is perceived and provision of care. However, assessment and management of PMH is poorly integrated into maternal healthcare in Bangladesh. Stigma, lack of awareness and poor understanding of PMH can impact the provision of care. Therefore, this study, in collaboration with Maternal Aid Association (MAA), aims to explore the perceptions and experiences around PMH within the maternal healthcare sphere in Bangladesh. Online semi-structured interviews (n=14) were conducted with healthcare providers (midwives, doctors, medical students and community health workers) in Bangladesh. Participants were recruited via purposive sampling and provided signed informed consent. Transcribed interviews were analysed using Braun and Clarke’s method of thematic analysis. Four themes were synthesised: 1) maternal healthcare sphere in Bangladesh, 2) conceptualisation of pregnancy and PMH, 3) perceived social determinants of PMH issues and 4) PMH care provision. Healthcare providers acknowledged the importance of PMH; however, lacked education and training on screening and management methods. Social determinants such as unplanned pregnancies, lack of support, intimate partner violence and poverty were highlighted. Barriers to PMH care provision included lack of time, workforce shortage and stigma, whereas enabling factors included trust, free health camps and integrating mental health protocols and experts into antenatal care. Education and training integrated within the curriculum and via seminars are key to equipping healthcare providers with the tools for PMH screening and management. Task shifting and outreach in rural regions can increase access to PMH care and mental health advocates should be introduced to reduce PMH stigma. The findings from this study will inform training and educational programmes for healthcare providers in MAA’s health clinics in rural Bangladesh. This will ensure healthcare providers in the maternal health clinics are equipped with the necessary training to provide effective perinatal mental health care. Strategies can also be implemented in wider healthcare settings in Bangladesh.