Early-stage development of a complex, community-based intervention to improve women's perinatal health in rural communities in India

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Perinatal mental health is a global public health priority. It is estimated that 1 in 5 women has a mental health problem during the perinatal phase (pregnancy to one year after birth), and the rates are even higher for women in low- and middle-income countries (LMICs). In India, between 14-31% of women experience anxiety, depression, stress, or suicidal ideation (common perinatal mental disorders; CPMDs). In rural India, women are also affected by social determinants of CPMDs and intersecting issues, such as gender inequity, poverty, domestic violence, caste, and stigma. Yet, most women with CPMDs do not receive care, with little research exists on how to best address CPMDs in low resource, rural settings. Integration of mental health into maternal health services is often not thought feasible in LMICs, where health systems are overburdened and under-resourced. Task-shifting of mental health care from specialist health workers to peer workers has good evidence and underused potential to support weak health systems in LMICs. The Perinatal Mental Health project (PRAMH) aims to develop an intervention to address the significant challenge of preventing, detecting and supporting women with CPMDs in rural India, by integrating mental health into maternity care. Our aim is to develop a clear theory of change and pathway for future development, implementation, and evaluation.