Today, we are going to talk about a critical but often overlooked issue — the psychological impact of pregnancy and childbirth on women’s mental health. 

Globally, around 10% of expectant mothers and 13% of postpartum women experience mental health disorders, with perinatal depression being the most prevalent. The numbers are much higher in developing nations like Nigeria, where the prevalence of perinatal depression affects between 10% to 30% of women.

To understand the extent of perinatal depression, we explored a research paper that examined the quality of perinatal depression care in primary care settings in Nigeria. The study, which covered 23 randomly selected primary health care (PHC) facilities in and around Ibadan, Oyo state, Nigeria revealed a major gap in maternal mental health support. Of the 2,989 women screened, nearly 85% of women with perinatal depression were undiagnosed in routine maternal healthcare checks.

Another study at the Lagos University Teaching Hospital (LUTH) examined how maternal mental health, particularly depression, affects mother-child bonding and child development. The research screened 98 women, revealing that 14.3% of mothers had postpartum depression, while 16.3% exhibited poor maternal-child bonding.

Both studies reveal that there is a growing maternal mental crisis, one that is not only affecting the mothers, but also impacting interactions with their child. To uncover the roots of this silent crisis, we sat down with Zelia Bukhari, Maternal Mental Health Policy Portfolio Manager at the Wellbeing Foundation Africa. 

Can you introduce yourself and tell us about your role at the Wellbeing Foundation Africa?

I’m Zelia Bukhari, and I am the Global Health Advocacy, Policy, and Communications Advisor for Her Excellency Toyin Ojora Saraki. My primary role is to support the frontline mission of the Wellbeing Foundation Africa, focusing on advancing maternal, newborn, and child health in Nigeria. In this capacity, I work across strategic advocacy, policy development, and communications to amplify the Foundation’s impact both locally and globally. I help lead multifaceted international health campaigns, ensuring we engage meaningfully with key stakeholders and communities. 

I’m also serving on various boards which allows me to further support the mission of the Wellbeing Foundation Africa while fostering leadership and Reproductive Maternal, Newborn, Child, Adolescent Health and Nutrition (RMNCAH+N) change across the continent.

Tell us about MamaCare360 and the program's goal of integrating mental health into maternal care.

MamaCare360 is the Wellbeing Foundation Africa's flagship antenatal and postnatal education program, designed to address Nigeria's high maternal and child mortality rates through free classes led by trusted WBFA globally trained midwives. This comprehensive programming aligns with the United Nations Sustainable Development Goal 3, which aims to ensure good health and well-being for all. By upholding Respectful Maternity Care as a fundamental human right, Mamacare360 advocates for women’s dignity and autonomy during childbirth. 

The program integrates mental health support into its holistic approach, recognizing the significant impact of psychological well-being on maternal and child outcomes. Through counseling, peer support groups (in-person and virtual), and community outreach initiatives, Mamacare360 addresses the unique challenges encountered by mothers, promoting mental health resilience and overall wellbeing.

Since its inception, MamaCare360 has been implemented in healthcare facilities across seven Nigerian states: Lagos, Kwara, Abuja, Cross River, Osun, Kano, and Sokoto. The program has actively engaged over one million  pregnant and lactating mothers through its sessions, leading to an 80% increase in attendance at antenatal visits. Additionally, the Digital Midwifery Service has established an online community of 9,840 mothers across 31 WhatsApp groups, providing continuous support and information. 

By combining physical check-ups, mental health support, respectful maternity care, and health education on topics ranging from nutrition to newborn care, MamaCare360 offers a "one-stop" model of care that empowers mothers and enhances maternal and child health outcomes.

How would you describe the current landscape of maternal mental health in Lagos? Are there specific trends or statistics that highlight the urgency of this issue?

Recent trends highlight the growing recognition of mental health's role in maternal care, but the integration of mental health support into routine maternal health services remains limited. 
Statistics show that up to 20%–25% of women in Nigeria experience perinatal mental health disorders, with a significantly higher prevalence in certain regions. In Lagos, a highly urbanized and densely populated state, the stressors on expectant mothers are exacerbated by economic pressures, social support challenges, and often a lack of mental health resources in primary healthcare settings. This is particularly concerning as perinatal depression and anxiety are common yet often go underdiagnosed, with long-term impacts on both maternal and child health.

Moreover, the National Mental Health Act of 2021 has provided a legal framework to address mental health in maternal care, but the implementation of these policies is still in its early stages. 

The MamaCare360 Programme reports an 80% increase in antenatal attendance and reduced postpartum depression rates. Despite this progress, what systemic gaps persist in addressing maternal mental health in Lagos, such as stigma or fragmented care?

One key challenge is stigma — many women still face societal pressure and fear judgment when disclosing mental health issues, which often prevents them from seeking help. 
Additionally, while MamaCare360 offers integrated care, fragmented healthcare pathways persist, particularly at the primary care level, where mental health support is not consistently available. This lack of coordination between mental health services and maternal healthcare means that women may not receive timely or comprehensive care, particularly for more severe mental health issues. 
Furthermore, resource limitations, including insufficient mental health professionals and facilities, further hinder access to mental health services. Addressing these gaps requires stronger integration of mental health into maternal healthcare systems, increased training for healthcare workers, and ongoing efforts to reduce stigma.

What are the biggest challenges that expectant and new mothers face when it comes to mental health?

Expectant and new mothers face several significant mental health challenges, with stigma being one of the most pervasive. Additionally, a lack of awareness about perinatal mental health issues exacerbates the problem. Many women do not recognize the symptoms of anxiety or depression during pregnancy or after childbirth, which delays crucial intervention. Coupled with these issues are the economic and social pressures that many mothers face, including financial instability, inadequate housing, and insufficient family or community support. These stressors can significantly worsen mental health conditions, creating a cycle of distress that negatively impacts both the mother and her child. 

What specific initiatives has the Wellbeing Foundation Africa implemented to support new and expectant mothers dealing with maternal mental health challenges, particularly in low-income communities?

The Wellbeing Foundation Africa has pioneered several initiatives to address maternal mental health challenges, particularly for new and expectant mothers in low-income communities. A cornerstone of this effort is the creation of the Perinatal Mental Health Checklist, which was developed by the Foundation, integrated and validated into Nigeria’s Maternal and Child Health Handbook. 
This checklist is a groundbreaking tool that allows healthcare providers to screen for depression, anxiety, and mood disorders during both antenatal and postnatal care. By embedding this checklist in the Maternal and Child Health Handbook, the Foundation ensures that mental health screenings become a routine part of maternal care, making mental health support more accessible and reducing stigma around seeking help.

In addition, the MamaCare360 Programme incorporates the traffic light referral system we developed for the checklist to ensure that mothers receive the appropriate level of care based on their mental health needs. The system is structured into three levels:

• Blue (Primary Care): For mild to moderate symptoms, mothers receive basic screenings, counseling, and follow-ups from trained healthcare providers like midwives and nurses.
• Yellow (Secondary Care): For more moderate to severe symptoms, mothers are referred to general hospitals where specialized care is available.
• Red (Tertiary Care): For critical or severe cases requiring urgent, multidisciplinary care at specialized hospitals, ensuring no woman falls through the cracks.

These initiatives, along with training for midwives and healthcare providers, have proven essential in bridging the gap in maternal mental health care, especially in resource-limited settings. By creating a structured, accessible, and effective model of care, the Wellbeing Foundation Africa not only provides direct support to mothers but also shifts the paradigm around mental health in maternal healthcare, ensuring that it is treated with the same urgency and importance as physical health.

How does the Foundation track and measure the success of its mental health initiatives, and what key insights have emerged from the data collected so far?

The Wellbeing Foundation Africa tracks and measures the success of its mental health initiatives through a combination of quantitative data, qualitative feedback, and real-time monitoring across its programs. 

Key metrics include the number of mental health screenings conducted, the number of mothers referred through the traffic light referral system, and improvements in maternal mental health indicators, such as reduced levels of postpartum depression and anxiety. For example, the MamaCare360 Programme reports an 80% increase in antenatal attendance and a significant reduction in postpartum depression rates, which provides clear evidence of its effectiveness.

Additionally, the Foundation collects feedback from mothers, healthcare workers, and community leaders to assess the program's impact and areas for improvement. Focus groups and surveys also help gauge satisfaction levels, mental health improvements, and any barriers to accessing care. 
Insights from this data reveal that early identification and timely intervention are crucial. These insights have informed ongoing program improvements and the development of additional support structures for mothers in low-resource settings. 

By tracking both outcomes and experiences, the Wellbeing Foundation Africa continues to refine its approach to ensure that more mothers receive the holistic care they need, paving the way for better maternal mental health outcomes in Nigeria and beyond.

What is WBFA’s plan to reach more new and expectant mothers and what policy reforms are needed to scale this approach statewide?

The Wellbeing Foundation Africa has developed a comprehensive strategy to expand its support for new and expectant mothers, particularly those in low-income communities. Central to this strategy is the Mamacare360 Programme. To scale this initiative statewide, several policy reforms are essential:

Integration of Mental Health into Maternal Health Services: The enactment of the National Mental Health Act of 2021 provides a legal framework for integrating mental health into maternal health services. However, the development of specific guidelines for maternal mental health care is crucial to ensure effective implementation.

Training and Capacity Building: Expanding the training of healthcare providers, including midwives and community health workers, is vital as it enhances the quality of care provided to expectant and new mothers.

Resource Allocation and Funding: The WBFA has committed over US $2.5 million per year to support Nigeria-led, Africa-focused maternal and child health efforts, demonstrating a significant investment in this area.

Policy Advocacy and Stakeholder Engagement: Collaboration with policymakers, healthcare authorities, and community leaders efforts can lead to the development of supportive policies and the allocation of resources necessary for maternal mental health program expansion.

Community Awareness and Education: Implementing community-based awareness campaigns can reduce stigma and encourage more women to seek mental health support during pregnancy and the postpartum period.

In our conversation with Eunice AlexGreat Akhigbe, Digital Midwife at The Wellbeing Foundation Africa, we gained insight into how the organization equips midwives and ensures women receive the care and support they need.

Could you tell us about yourself and your role at WBFA?

I’m Eunice AlexGreat Akhigbe, a registered nurse/midwife with over 17 years of experience. I currently work with The Wellbeing Foundation Africa as the Digital Midwife coordinating the MamaCare Online platform where I reach out to mothers with teachings on pregnancy, labor childbirth, safe motherhood and other related issues.

How has WBFA’s MamaCare360 training helped improve your approach to supporting mothers’ mental wellbeing, and have there been any positive outcomes since joining the program?

As a midwife, the WBFA Mamacare360 training, particularly in mental health, has significantly enhanced my ability to support the mental well-being of mothers. Before receiving this training, mental health was not always a primary focus during antenatal and postnatal care, and I was not always equipped with the tools to identify mental health concerns in expectant and new mothers. 

The MamaCare360 program provided me with crucial skills in mental health screening, helping me to recognize early signs of anxiety, depression, or emotional distress in mothers. The training also emphasized the importance of counseling and emotional support during antenatal and postnatal visits. Now, I am more confident in approaching mothers about their mental health and can create a safe, non-judgmental space for them to share any concerns. 

A positive outcome I've witnessed since implementing MamaCare360 in my practice is a noticeable improvement in postpartum depression rates. One specific case that stands out is a mother who initially showed signs of anxiety and sadness during her pregnancy. Through early mental health screening, I was able to provide timely counseling and refer her to appropriate care. She received continuous support, and over time, her symptoms significantly improved. She later shared that the timely intervention and consistent follow-up played a major role in her recovery. 

From your daily interactions with expectant and nursing mothers, what are the most common issues affecting mothers’ mental well-being in Lagos?

The most common issues affecting their mental well-being include lack of family support, economic challenges, and limited access to healthcare. 

Many mothers struggle with insufficient support from their partners or extended family, which can lead to feelings of isolation, anxiety, and stress. Another major issue is financial instability. Their inability to afford proper nutrition, transportation to healthcare facilities, or even basic baby supplies can heighten feelings of anxiety and depression. In addition, limited access to quality healthcare, particularly mental health services, is a major concern.

What would you like to see change in Lagos' healthcare system to ensure that every mother receives adequate mental health support?

To ensure that every mother in Lagos receives adequate mental health support, I would like to see several key changes in the healthcare system. First, mental health should be integrated into routine maternal care. Mental health screenings need to be included in every antenatal and postnatal visit, with mental health services fully integrated into the primary healthcare system. This would help identify and address mental health concerns early, reducing the risk of more severe issues later on.

In addition, more training and capacity-building for healthcare providers, including midwives and nurses, is essential. By improving the knowledge base and expertise of frontline healthcare workers, we can ensure that maternal mental health is treated holistically, addressing both the physical and psychological well-being of mothers.

Improved access to mental health services is also crucial, particularly in underserved and low-income communities. This means increasing the availability of trained mental health professionals, improving the referral system, and ensuring that mental health resources are available in both public and private healthcare facilities. Every mother should have access to the care they need, regardless of their socioeconomic status or location.

Community-based awareness campaigns are another important factor. When communities understand that mental health is as important as physical health, it encourages a more supportive environment for mothers.

Finally, I would like to see better policy implementation and more government support. These changes would ensure that mental health is treated with the same importance as other aspects of maternal care, ultimately improving the overall health and well-being of mothers and their children in Lagos.