Understanding Barriers and Strategies to Perinatal Mental Health Care in Kenya: Insights from Pregnant and Parenting Women

Abstract

Perinatal mood and anxiety disorders are prevalent in Kenya, yet screening and treatment are largely inaccessible. The Integrated Perinatal Mental Health program (IPMH) fills this gap with a stepped care model implemented in antenatal care clinics, including universal screening, Problem Management Plus, and telepsychiatry. Formative qualitative research with perinatal women identified barriers and strategies across routine perinatal mental healthcare cascade steps, including screening, diagnosis/treatment, and referral/remission. This cross-sectional study aims to (1) describe levels of (a) criticality of barriers and (b) impact of strategies for each care cascade step, and (2) examine the association between perinatal women’s demographic and clinical characteristics and their reported criticality of screening, diagnosis/treatment barriers. Highly endorsed barriers were structural and resource-related, and impactful strategies centered around improving provider attitudes, patients’ care experience, and integrating mental health treatment and referral into routine maternal health care. Regression analyses revealed that several predictors were significantly associated with select barriers at individual cascade steps; however, only two predictors, urbanicity and prior receipt of mental health screening in routine care, were statistically significant predictors across all steps and barriers, indicating these are salient factors that shape perinatal mental healthcare. These findings suggest that integrated care models, like IPMH, have the potential to address attitudinal, provider-based, and structural barriers to perinatal mental healthcare.