“We sometimes stress our own wives” - Perceptions of Maternal Mental Health Challenges and Recommendation towards Emotional and Psychological Support from Mothers, Fathers, Nurses, and Community Health Workers in Western Kenya

Background In low- and middle-income countries (LMICs), maternal mental health (MMH) during and after pregnancy is often neglected despite ongoing global efforts to reduce maternal mortality and morbidity. The complex nature of MMH problems and their stigmatization require a thorough understanding from the perspective of the different parties involved. Hence, we assessed the drivers of MMH problems, challenges in seeking help, and perceptions towards emotional and psychological support for pregnant women among four stakeholder groups in Western Kenya. Methodology A qualitative approach was taken to examine the perspectives towards MMH among mothers, fathers, nurses and community health workers (CHWs). Focus Group Discussions (FGDs) were organized among the four groups. Participants were drawn from three hospitals in Kisumu County, Western Kenya. The socio-ecological model for health behavior structured the analyses, with an initial deductive approach. The identification of specific themes within each level was conducted inductively. Additionally, suggestions for locally acceptable MMH care were collected. Results In total, ten FGDs were held with 73 participants. We found a large level of consensus among stakeholders regarding common causes, consequences and coping strategies for MMH challenges, such as poverty, stigma, intimate partner violence and a lack of social support. In contrast to mothers, fathers also highlighted domestic disputes stemming from disagreements over (resuming) sexual activity. Nurses predominantly mentioned medical consequences of MMH challenges, while CHWs had a more holistic perspective. Participants expressed a need and made recommendations for contextualized MMH care, particularly for a group-based intervention led by CHWs with partner involvement. Conclusions The findings show that there is a need for MMH support in rural, low-resource settings. Mothers and CHWs showed a high level of convergence illustrating the importance of the liaison function of the CHWs between the nurses and mothers. Group-based MMH care was perceived as suitable by all stakeholders. The results of this study guided the design of an MMH intervention that was tested for feasibility and acceptability in the same setting.