Mental Health Matters: Locally Driven Interventions for Perinatal Mental Health

Perinatal mental health (PMH) conditions, like postpartum depression and perinatal anxiety, can occur during pregnancy and up to two years after giving birth. But its impact on moms, infants, families, and communities can be felt far beyond that. 

In this episode, we speak with Dr. Prabha Chandra, a professor of perinatal psychiatry in India and co-chair of the global PMH Community of Practice, and Linos Muvhu, a passionate advocate for mental health support and founder of the Society for Pre and Post Natal Services' (SPANS), a maternal, paternal and child mental health program in Zimbabwe. We discuss the challenges of addressing PMH and why a "one-size-fits-all" approach doesn't work, and hear examples of successful PMH interventions from India and Zimbabwe.

Together, we explore the innovative partnerships and approaches that are turning a growing global movement to address PMH into real, locally driven, context-specific programs that address mental health and the overall health and well-being of women and their babies in a way that is tailored to each community's needs.

Transcript

[Introduction:] 

MOMENTUM Presents: Bringing in-depth experience and improving maternal, newborn and child health services, family planning, and reproductive health care in countries around the world; providing technical and capacity development assistance to country leaders and governments; and ensuring that mothers and babies have access to essential care in order to reach their full potential. We are MOMENTUM Country and Global Leadership, funded by the U.S. Agency for International Development. Welcome to MOMENTUM Presents. 

[Angela Pereira] 

Hello, listeners. Welcome to another episode of Momentum Presents. I'm your host, Angela Pereira. This season, we are focusing on how localization can improve maternal, newborn and child health, family planning, and reproductive health. And in this episode, we're looking specifically at localization’s impact on perinatal mental health, or PMH. Perinatal mental health conditions, such as postpartum depression, occur among mothers during pregnancy and up to two years after giving birth.

We will explore partnerships and approaches that are turning a growing global movement to address perinatal mental health into real, country-driven, context-specific programs and interventions that address the importance of mental health for the overall health and well-being of women and their babies. I'm thrilled to welcome our two guests to the podcast today for this urgent conversation. 

Dr. Prabha Chandra is co-chair of the global PMH Community of Practice and co-chair of a new country level PMH community of practice in India. She is also a Professor of Psychiatry and Head of Perinatal Psychiatry Services at the National Institute of Mental Health and NeuroScience, or NIMHANS, in Bangalore India. 

And Linos Muvhu is a global advocate for perinatal, paternal and child mental health. He is the founder, secretary and Chief Talent Team Leader of Society for Pre and Post-natal Services, or SPANS, a maternal, paternal and child mental health program in Zimbabwe.

Welcome, Dr. Chandra and Linos. 

[Dr. Prabha Chandra]

Thank you. Thank you for having us. And it's really exciting to be talking about PMH and sharing our thoughts. 

[Linos]

Welcome to this exciting episode. I'm really happy to be here. 

[Angela Pereira] 

Thank you both so much. And Dr. Chandra, I'm going to start with you. Let's set the scene. What are some of the pressing perinatal mental health conditions that you commonly see today?

[Dr. Prabha Chandra]

You know, traditionally it was thought that it's basically postpartum depression, and there was a lot of conversation around that. But we now know that there are several problems which need attention. Of course, it's postpartum depression, which still is the most important problem, but then there is perinatal anxiety, which basically means that women are quite anxious during the pregnancy as well as in the postpartum, and that causes a lot of problems for the mom. There are situations of post-traumatic stress disorder in mothers, particularly if women have gone through childbirth trauma, and lesser common conditions like postpartum OCD and postpartum psychosis, which is fortunately not very common. But when it happens, it needs a lot of attention. So, I think there's a range of conditions that we are concerned about.

And if you look at the infant, then there are conditions like mother-infant bonding disorders, which sometimes may be because of her perinatal mental health problem, but sometimes might be completely independent. And then there are mothers who are just stressed. So they may not have a disorder, but they are stressed and that also influences their sense of well-being and their mental health. 

[Angela Pereira] 

And how common are these conditions globally? 

[Dr. Prabha Chandra]

So the prevalence actually varies depending on which population you're studying, which screening tool you're using, how vulnerable the group of mothers is. And of course, there's a difference between high-income and low-income countries. So the prevalence traditionally and based on systematic reviews is around 13% in the pregnancy, in the antenatal period, and around 20% in the postpartum period. But like I said, you may have much higher rates if a group is highly vulnerable, let's say very traumatized or, you know, they are in conflict-ridden areas, refugees, women who've had a past history of a stillbirth, moms whose babies are in NICUs. So, you know, as you can see, it's like a it's a range.

[Angela Pereira] 

What impact can these conditions have on women – on their quality of life, on their physical health, on the pregnancies that they have? You know, what does that look like? 

[Dr. Prabha Chandra]

Huge, huge impact. And I think that's the reason why we are all so passionate about this field and, you know, want to do something about it. There's so much evidence to suggest that anxiety and depression in pregnancy can actually lead to low birth weight and preterm birth. You know, this is after you control for a whole range of other variables. And of course, you know, pregnancy needs to be a pleasant time, a time that a woman looks forward to, bonds with the fetus. But if a woman has a mental health problem, then clearly she's very preoccupied. It impacts her nutrition. She's not eating well. She doesn't go to antenatal care properly. She doesn't get her shots. So I think there's a range of reasons why we need to pay attention to this condition. You know, going forward, it has an impact on the baby, not just the birth weight, but it includes cognitive development, physical development, breastfeeding issues.

So as you can see, it has an impact on the mom. It has an impact on the infant and also on the whole family. Linos will probably tell you a little bit about how it can actually impact dads and impact other children. Studies have actually shown that there's a huge impact on society as well, because you can see the ramifications are many. So I think that it's a condition that actually has a lot of potential for us to intervene and to do something about it to reduce the impact. 

[Angela Pereira] 

It certainly is a significant impact. And Linus, I do want to go over to you on that impact question as well. You know, you're a leader in an organization in Zimbabwe that's really supporting women on a day-to-day basis who might have or be struggling with a perinatal mental health condition. So what are some of the challenges that you see women and dads – families – facing on a day to day basis? 

[Linos Muvhu]

Let me start by saying this is not just about the dad, the mom, the child, but it's about the entire family, including the extended family members. That's why I think we are saying this is very important. 

However, there are a lot of challenges, you know, surrounding, you know, perinatal mental health issues. Let’s start by language. You know, the language that we are using here, we are talking of depression, anxiety. You know, these terms that we have within the medical around perinatal health issues. But if you go to the communities, you’ll find out they got their own local languages. You know, they express themselves both in the physical, mental, social or the spiritual.

And, you know, when it comes to perinatal mental health, it's a completely new area, not only for my community or for my country, but it's a global crisis. It's a global problem. You know, there's very little awareness, there's very little knowledge, though there's research, there’s science, but interventions, what are the interventions around perinatal mental health issues? You’ll find there's very little.

Let's talk about the mild, the moderate — where is the intervention? You find out that more emphasis is given on the severe and the chronic where we get the psychiatry intervention. What about the bigger part of the common perinatal mental health issues? Do we have intervention? What is being done, you know, to address that? 

Let's look at the shortages of human capital. Do we have mental health professionals, perinatal mental health professionals rightly at the community level? If we go to any local facility to do the early identification, to do the screening, you find out we don't really have. Of course, if you look even at the human capital and the health care services, but the healthcare workers that are already within the system – they’re overwhelmed. Can we assure that they can help whilst they are already overburdened with their workload that they have? So that becomes another issue. 

Let's look at the infrastructure itself. Do we have the infrastructure? Because remember, there's a lot of confidentiality around this topic. Remember this. There's trauma around this. You know, everyone wants his privacy. Do we have infrastructure within our primary health care, within our tertiary, within our secondary care. So that becomes a challenge again.

Let's look at the awareness itself. Do we have enough education around the societies? You know, let's look at the stigma. Of course, all these things that I'm talking about, that also results in the high stigma among this topic of perinatal mental health. There's a lot of impact. Not only -- imagine the child --- but we need a better generation. We'd be better economies. What are we doing?

[Angela Pereira] 

Oh, thanks so much, Linus. I think there's a lot there, and it's clearly a very complicated issue that needs a well-rounded response that really looks at a whole woman and what she and her family and her baby might need. 

Since we've talked a bit about the impact and the prevalence – and Linos, you've started getting us thinking about, you know, what's really lacking in terms of addressing perinatal health, let's turn to maybe more of that services piece of things. So, Dr. Chandra, I'm hoping you might be able to give us a bit of a look of, from your experience, what does perinatal mental health services look like right now in terms of their availability, in terms of their quality? And also what do you think high quality perinatal mental health services should look like? So two questions there: What is the status and availability of them now, and then, you know, what should a high quality PMH service actually look like?

[Dr. Prabha Chandra]

It's very important to remember that services are really not there. Whatever we have in South Asia is, you know, research projects, which have done, sort of, bits of work and shown that it actually helps. It works. These are in the form of randomized controlled trials in Pakistan, in India, in Bangladesh, which actually have shown that programs like the WHO’s Thinking Healthy program, which is a peer led program, actually works, but unfortunately they haven't been scaled up. They haven't been taken up by governments. So at this point, you don't have a sort of countrywide policy or countrywide programs, though there's been a lot of push to do that.

Having said that, for example, in India, several states are now sort of being helped by various other organizations like USAID. They're all trying to mainstream perinatal mental health. And I think that's what is important that you integrate maternal mental health into routine maternal infant care. Because if you are going to bring it on as a new program, people are going to say, no, we don't want it because already there's so much of a burden. There’s malaria, there’s tuberculosis, malnutrition, there's all kinds of things. We don't want another program to be thrust on us. So I think the important thing is to piggyback mental health onto existing programs, which is easier said than done. 

How do you do it? Because what works in high income countries, like Linos mentioned, is not going to work in low and middle income countries. So, currently we have a model in a state called Telangana in the south of India, where we've integrated maternal mental health into nutrition programs and actually started a statewide program. And that's, to me, is very exciting because I'm part of that. And to see it actually, you know, flower in front of us is really very nice. 

So the first thing we've done is to enhance the health systems because there's no point in creating a demand when you don't have people to deliver care. So, we've actually trained all the medical officers, we've trained all the nurse midwives, and we've trained the community health workers statewide. 

We also use the ultra short screening tools, which have been developed in South Africa, and we are learning from other countries in the global South and not taking things which have worked maybe in the West, but learning from each other. So we're using very short screening tools because in high volume clinics, you won't have time for sort of elaborate screening tools. And, you know, the exciting part is that at least three states in India have included mental health questions into the maternal and child card, which according to me is a huge, huge step because then you are institutionalizing it.

And in a couple of states, we are actually also ensuring documentation and adequate referral pathways. So that's really exciting for us. And the important thing is that in these states, the policy makers are really behind it. So that's so important because we as professionals or people like Linos, as advocates, may constantly be talking about it but unless we have policy makers on board and they give funding for the program, they supervise and they monitor and they give us money to check the indicators, you know, and look at the impact, it's not going to work. 

So, I think at this point, I would say that it's still happening in little pockets, but we are really positive and hopeful that if we show that it works in 1 or 2 states in India, then other countries, other states in the region will also be looking at it. 

[Angela Pereira] 

Thank you. And can you tell us a little bit about the innovative work you are leading at NIHMANs with the creation of mother baby units? What does that model of care involve? 

[Dr. Prabha Chandra]

That's my baby! So I'm really excited to talk about it. So we didn't have anything for mothers with severe mental illness in the country. And I happened to go to the UK, get trained there, worked there for a year in the mother-baby unit, and realized that I needed to bring back a model. But then the model had to change because it can't be the same model. We now have a five bedded unit, and now we've got funding for a 12 bedded unit. It seems small, but it's a lot of work. So we basically do joint admission for mums and babies, where a mother has a severe mental illness or severe depression, if she's suicidal, if she has psychosis. And moms come from all over the region to get admitted.

We provide a lot of nursing care and the innovation is that we have grandmothers or, you know, sometimes moms’, sisters, or occasionally a father actually staying in. So unlike in the West, all the mother baby units don't really encourage families to stay on. But in a culture like ours, for example, in South Asia, no family would ever let a mother all by herself, like it is not acceptable. A new mom needs her mom, or need sometimes needs her mother in law, or sometimes needs a sister. So a female relative is really, really important.  And I think that's a model that we've developed, and we also do a lot of dyadic work so that it's not like, you know, if a mum has a psychosis, she cannot bond with her baby because families tend to sort of separate, worry. And so we make sure that we restitute that bond, which is so precious for the mother. And we do believe strongly that it also helps her become better. So this is the mother baby unit. 

We've now started taking pregnant mothers in as well. So we have separate beds for moms who are pregnant and who are unwell. And we also now encourage fathers to be part of it. Sometimes if a mum is very disturbed, we have a grandmother and a father in the unit. The father looks after the woman and the grandmother looks after the baby. So it's like a whole family unit being together at a very difficult time for the families. It's a great time for education of families, how to prevent the next episode, how to plan the next pregnancy. And it's also great for us because it's lovely to have babies of the ward and, you know, makes everybody smile and everybody be happy, honestly.

[Angela Pereira] 

It sounds wonderful and like very amazing work that you're leading, Dr. Chandra. I mean, I gave birth in a foreign country very far from all of my female relatives, so even when you were just talking about that experience, I started feeling emotional just thinking about my own experience, because it is true. You know, you really do need that support system in those beginning days. So thank you so much for the work that you're doing and for sharing it with all of us.

And Linos, I want to go back over to you now to talk about what you see in Zimbabwe in terms of the role of community based health workers. So those health workers who are embedded in communities, who maybe already have relationships with new mothers, and what role they can play in helping to support new mothers and addressing any perinatal mental health conditions.

[Linos Muvhu]

You know, they understand. You know, they understand their community. They understand the people. That alone can bring, you know, the sustainability, the continuity, you know, the success of, of, of the intervention.

Currently what we are doing, you know, we, we, we managed to introduce like a cadre, you know, from, which are already within the register of Allied Health. You know, they are family therapists, but they are going to be rightfully at the community where they are going to do the early identification, where they are going to do, you know, the early screening, where they're going to provide, you know, family therapy sessions, where they're going to do early referrals for any complicated common perinatal health issues, and also they are going to refer back, you know, to them, you know, for continued support.

Perinatal community health care workers, you know, they’re very, very important within our context. We like the support that we are getting from our ministry, you know, to make sure that cadre is being trained and also being, you know, accepted within the healthcare system. 

[Angela Pereira] 

And what are some barriers that might prohibit health workers from effectively preventing and treating perinatal mental health conditions in the communities in which they work?

[Linos Muvhu]

There are so many barriers to be honest. First, let me talk about, you know, the training itself. There are no cadres professionally trained to address this perinatal mental health immediate problem. Why? Do you know, addressing this issue that we are talking about, it's a process, not a one day issue. Remember, if you want to address, for instance, social problems you know that affect the mother, I doubt very much you need like a day. You know you need several sessions, coupled with subsequent sessions. We are talking of a process. We are talking of something that needs time, you know, to make sure that we provide the quality. Now, do we have people that would put time to sit down with mothers, families, you know, that need this care?

What we know now is the severe mental health issues, they get their medication, they go home. But we have therapists, grief counselors in place, you know, to take these cadres, you know, to train with them, you know, so that they are able to address their issues. 

Let's look at, do we have the correct infrastructure for these perinatal mental health issues? For instance, let's take a mother who lost a baby, who goes through the bereavement. Do we have, you know, a separate place to go with that mother? You know, do we have such places, you know, for them to heal?

Let's look at the funding. Do have funding now to support the scaling up of some of the interventions that we know they’re working, or we have started or we've been localized. 

The political will, you know, do we have the political will? Remember this is a new subject, though there's a lot of research, scientific evidence, you know, about this topic. But do we have the political will? How many documents that we have to show that this subject is very important? How many policies that we have, you know, within our our different contexts about this topic? It is almost zero.

So those are the barriers now to say, guys, we definitely have the energy because I know the benefits. But do we have the political will? Do we have the policies? You know, do we have funding? Do we have enough healthcare workers, you know, to support at community level? You know, the all those are the barriers, Angela, to be very honest.

[Angela Pereira] 

Thank you Linos. I think, yeah. Is there the political will for the policies and the funding to make some of these key pieces a reality? The infrastructure, the trained health workers, the high quality services within those facilities? You know, I want to go back to you now, Dr. Chandra, to talk about this sort of global movement that is growing for perinatal mental health, because I think that is an important part of just building this momentum globally for a subject that hasn't always risen to the top of health agendas.

So tell me more about the global perinatal mental health community of practice. Who is involved? What's the mission? How is it trying to advance this conversation and advance the momentum for this topic? 

[Dr. Prabha Chandra]

It's a very exciting movement. And it's a community of practice of global people around the world talking to each other.

And we have three sort of basic tenets: coordinate, connect and disseminate. So it's like, you know, work with each other, connect with each other and make sure that whatever evidence is there, and knowledge is, there is shared. Because I think it's so important that learnings from one place should get translated into another. All of us can’t work in silos. 

We regularly have webinars, meetings, newsletters. And to me, it's very exciting because every time I connect with somebody on the community of practice, I learn something so new and something that I can use. For example, the whole South African experience of how do you use screening and intervention in high volume clinics and have the opportunity of sort of discussing with people from other parts of the world about what you can do to make things work?

Because sometimes when you're doing all this up-hill task, you feel really alone and you feel that you are sort of fighting against all these barriers and stigma. And you look in awe at the Western countries who have done this very well, and you think, why is it that we are not able to do something? And then you hear something from somebody else who's worked in the Global South or in another low- middle-income country, and you think, they're facing the same problems as we are, but they've done something new, so is it possible for me to learn from this? 

And now we've also started the community of practice within India, which is great, because, like I told you, there are different parts of India where, yeah, we're working, different groups are working, and each context is very different.

We have obstetricians, policymakers, advocates, practitioners, researchers, academics, people with lived experience, moms – everybody in this group of community of practice. The whole idea is to create a scenario, create a movement of perinatal mental health so that everybody's talking about it. It's not just the practitioners or the researchers, but the women and their families are getting to know. So I think it has to be like a bottoms up approach rather than a top down approach.

[Angela Pereira] 

This season is all about localization. So I think it's interesting to hear about how the experiences and solutions from different places, different countries– you’ve mentioned the South African model, what you all are doing at NIMHANs, how it gets fed up into this community of practice and shared out, and everyone can learn from each other and continue driving this global movement forward. 

And, I’m hoping you all will humor me for a moment, and I’d like to get a little bit personal as well. There’s so much passion from both of you on this subject and clearly you have both made perinatal mental health part of your life’s work, your life’s mission, your life’s passion. So I’m hoping – and we can start with you, Linos — you could just tell me a little bit about how and why you even became involved in perinatal mental health?  

[Linos Muvhu]

You know, it's a very interesting question, Angela: why? I am a man, and do you hardly see most men, you know, talk about this subject. I don't know, maybe some they feel it’s a women thing, or you know, it’s, it’s, it’s nothing to do with men. But, you know, when I went to school during my diploma in family therapy, you know, I had to realize something: these are negative life events. You know, they've got a lot of impact.

And when I read, you know, the definition of mental health just from the WHO’s definition to say it's a state of well-being. But, you know, there's something that strikes me most, you know, when they say, you know, if you don't have a sound mental health, it's very difficult for you to contribute productively now within your own life as an individual, within your family, within your society, you know?  So, as an individual, honest, it brings a lot of interest to me. 

In 2016, introduced an Afrocentric international conference on maternal mental health in Africa. Why? Because I had seen there's a lot of silence around this topic. So I thought, I need a voice for this. And fortunately, when I approached the ministry, they gave me a strong support letter to support this initiative. In 2021, we did the second one very successfully.

I need to be a champion. We need to invest in this area. We need to take this area very seriously. You know, because we need to be there for others, you know, specifically for mental health issues. So that brings a lot of energy in me. That brings a lot of hope.

[Angela Pereira] 

And Dr. Chandra, tell us how you got involved in perinatal mental health. 

[Dr. Prabha Chandra]

I was an obstetric intern.I was working in an obstetric ward, and one of the things I realized is that moms were quite anxious and tense. There were mothers with pre-eclamptic toxemia, mothers who had had abortions, and really, nobody was paying any attention to their mental health. And all the focus was on their physical health. And then I had the opportunity to study psychiatry and even as a psychiatry resident, I realized that there was nobody who was really trained in this area. People were not paying attention to perinatal mental health. And so I chose to find mentors in the area of maternal mental health and found people in Australia, in the UK and realized that there was a lot happening in these countries, which we really needed to learn and start working in countries like India. 

And so began my journey. I would go to conferences, I would meet people, I would find mentors, I would look at models which are available in different countries and then began, all the services in India. And it's already been about 15 years, since we started our services and, also helping other countries in the region to start their own services, you know, creating models. Because many times when you're working in a low and middle income country, you always look at models in other countries and think, you can't do something like this because you don't have the resources. But then if you develop a model in a country which does not have too many resources, it encourages other people to start. So after our mother baby unit, the Sri Lankans, started their own mother baby units and they have a great model where they have smaller units in different provinces, and that's really working very well. 

And for me now, the challenge is to basically do the complete integration of mental health into routine maternal care. For me, that's where I'm going to be spending the next years of my life trying to make sure that that happens.

[Angela Pereira] 

Thank you. And this season is all about localization in the podcast. So I want to ask our final questions for today around that theme. Linos, why is localization crucial to addressing perinatal mental health? 

[Linos Muvhu]

Localization is very, very, very important. 

It's not wise, you know, to say you come to Zimbabwe, you know, you find a tree that has been there for more than 20 years. Then you say, no, guys, I want to remove this tree and I want to put a fence. I want to do this, you know, and I want to put a new tree. You know, remember, that tree has been there, well-suited to the conditions and everything. 

So for acceptance, for scaling up, for the success, it needs effective, you know, localization processes. There’s sustainability. But if you go and make sure that the society itself, the community itself, the family itself, they started something for them, you know, using their own language, they will understand each other. They will find each other. You know, they’re supportive. You know, like families they bring, you know, supportive care, which is very important.

You know, we accept that they've got their own competence, skills, knowledge, you know, that then help them to sustain their solutions for whatever challenges that they're facing.

So localization for me, it's very important to the country, to the region and the community where people are coming from. 

[Angela Pereira] 

And Dr. Chandra, why is localization crucial for making meaningful partnerships that can benefit perinatal mental health? 

[Dr. Prabha Chandra]

When we asked mothers, how would you like perinatal mental health to be addressed? How would you like these questions to be asked? They said that we want conversations. We want to tell our stories. We don't want questionnaires. 

So one of the things that we've done is to have those conversations when a woman is having her weight taken or is having a talk about her exercise and nutrition, because in very, very high volume clinics where there's no privacy, no confidentiality, we need to find these little spaces where mothers can be spoken to in private. And so that's localization for you.

If there are mothers who want to talk about it in a group and don't feel very safe talking about it individually, or if a mother wants to be able to come back to the nurse and speak to her whenever she feels ready. I think these are things that we really need to understand what the community wants and how they want to navigate this space, and that's where the localization comes in.

I think trying to find uniquely local solutions. How do you make a woman feel safe to talk about her mental health, you know, and feel that she can discuss the violence that she's facing and not be judged for it? Things that are very important for women need to be addressed in a way that is meaningful to them.

So for me, localization has been about going where the woman is, finding her safe space, how can she talk about it, including measurements, you know, Angela. So, for example, if you have questionnaires with, say, mild, moderate and severe, like Linos said, these are these are words which some of our women don't understand. And we have developed a method where we show glasses, where we have a glass empty, half full, quarter full, completely overflowing for women to indicate how severe their problem is. Many women in India have low literacy, so they cannot self read, they cannot self evaluate. So it has to be somebody who's asking them these questions. 

So I think we need to have local solutions which work for women in the rural areas, in semi-urban areas and urban areas, high-literacy women, low-literacy, women. I think you can't have one size fits all. 

[Angela Pereira]
Thank you both for those insights. Do you have any questions for each other after, you know, hearing the conversations that we've had about aspects of perinatal mental health and localization?

[Dr. Prabha Chandra]

I have a question to Linos. I've been wanting to ask this for a long, long time, so I’ve got this opportunity. 

One of my biggest challenges has been to create interventions that are gender transformative. And, you know, in patriarchal societies where the pressure on the woman is so high to be a mom, she's very often away from her support systems, doesn't have any power in the family. I feel it's very important to involve the fathers very early on. But in countries like India, where fathers seldom come to antenatal clinics, it's a huge challenge. So I really want to ask Linos, what tips do you have for us in India? But how do we get the fathers involved? 

[Linos Muvhu]

Thank you so much, Prof. Chandra. You know, yes, it’s a problem I know in most programming.

How to involve men. But to be very honest, all things start from the planning phase, how we are designing our programs. Most programs, they’re designing for the child, for the mother, very little programs for the boys and the fathers. From my own experience now, every women is attached to a man, being the father, being the brother, being the husband. So what it means is if we want to implement something, definitely we need to involve the men. 

So how are we going to attract the men? So we can then start to incentivize men now, to appreciate the presence of men. Like here in Zimbabwe, when women they are accompanied by their husbands, you know, they'll always be given the first preference. I think men, they can definitely come. Every man wants, you know, to have their child. So at the end of the day, if they're being given their role, or if their role is seen or accepted within the healthcare system or in any given set up, I think the men they can be there on the forefront, you know, supporting their women. That's my, my, my thinking, Prof. 

[Dr. Prabha Chandra]

Thank you Linos. I'm going to try that a little bit and see … I think you said something very important that, you know, give the men a role, appreciate their presence. And I think let's try that and see. So thanks for that tip 

[Linos Muvhu]

Okay, thank you. Prof. You know for me, Prof., you know I like our countries. If you look Indians and Zimbabweans, will look similar in terms of how our families are structured. You know in Zimbabwe we believe in extended families. In India, you believe in extended families. So Prof, I just want to understand from your context, is it similar now, do our families support each other when it comes to the pregnancy issues? 

[Dr. Prabha Chandra]

I do think you're very right that our countries are very similar, cultures are similar. The very fact that we have these large extended and joint families really makes a difference to women.

They get the support. But sometimes I feel that it can also add to the pressure, because navigating multiple relationships in families is not always easy. There are too many opinions. Everybody has to have a say in how the baby is being brought up, what the name of the baby should be, what the baby should be fed. So sometimes that also acts as a little bit of a stress for the mother. So I think there are advantages and disadvantages, probably advantages are more because the support is definitely more.

But I do think that involving families, especially in cultures where extended families have a major role to play is very important. We do mothers-in-law groups so that we make sure that they understand the importance of perinatal mental health and provide shared caregiving when a mom is unwell. In fact, we've developed a tool for shared caregiving in our culture so that we can actually measure it. So yeah, great point.

[Angela Pereira] 

Thank you so much, Linus and Doctor Chandra and listeners, thank you for joining this important conversation. I hope that you have enjoyed it just as much as I have. We invite you to share this conversation with your friends and your colleagues. You can also listen to previous episodes of the Momentum Presents podcast and subscribe to it to stay tuned for future episodes on improving maternal, newborn and child health, family planning and reproductive health.

This podcast is produced by Momentum Country and Global Leadership, funded by the U.S. agency for International Development.

[Concluding Recording]

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