Evaluating an Intervention to Improve Respectful Maternity Care and Reduce Perinatal Mental Disorder in Bharatpur, Nepal

Main Supervisor: KC Ashish
Co-supervisors: Mats Målqvist, Sibylle Herzig van Wees och Miia Bask

What is your educational background?
I have completed Bachelor in Nursing from Rajiv Gandhi University, India and Master’s in Nursing from Tribhuvan University, Nepal

Why did you apply to WOMHER's interdisciplinary graduate school?
The interdisciplinary concept of WOHMER motivated me to apply for the graduate school. I was familiar with one part of the PhD project as I am nurse midwife and have worked in the context of maternal and newborn health in Nepal. I was always curious about women’s mental health provided their low social status and mistreatment which had little importance amid other general mental health problems. I visualized WOHMER’s graduate school as a leaning platform for me to gain knowledge and explore perspectives from different disciplines’ fellows and experts. I also saw an opportunity to work under the guidance of interdisciplinary supervisors’ team. I believed this school will be a pathway to generate strong evidence on the mental health of women globally through interdisciplinary approach.

Tell us more about your research project?
In low- and middle-income countries, 19.7% of women suffer common perinatal mental disorders during pregnancy and 39.4% suffer from the disorders during postpartum period1. There are several health care, societal and family related risk factors for CPMD. Evidence suggests that only an estimated 30% of women received standard intrapartum care, 24% of women received unnecessary medical interventions and 63% of women were not appropriately consented for medical interventions2 3. Evidence also shows that ethnicity and maternal age has a strong influence on the risk of maternal mistreatment and disrespect of women in Nepal. This project will be guided by an interdisciplinary expert. Prevalenceof anxiety and depression among postnatal mothers delivered in a health facility will be assessed using EPDS (The Edinburgh Postnatal Depression Scale) and GAD-7 (Generalized Anxiety Disorder 7-item scale) in association with socio-demographic diversity and maternity care practices. With a 5% margin of error, 80% statistical power to detect change of 5% from 24% of CPMD, we plan to include 1004 women for the survey. Concept and perspectives of health care workers, women and community on childbirth experience in the health facility will be explored with in-depth interviews and body mapping methodology. Through participatory action research a tailored intervention will be co-created together with stakeholders and women to improve effectiveness and adherence. The co-creation outcome evaluation as a feasibility trial will be conducted and is believed to provide new evidences on the perinatal mental health burden, childbirth experience and also maximize women’s engagement in creativity.

What do you hope the impact of this project to be?
This implementation research if successful has threefold benefits. First, the project will generate new evidence on prevalence of disrespect and abuse and its association with perinatal mental disorder in Nepal. Second, a participatory approach to co-create intervention tool and third, this project is a proof of concept on the implementation approach to reduce disrespect and abuse and improve women’s mental health during pregnancy, childbirth and postnatal period. Maximizing women’s engagement in care contributes to Sustainable Development Goal (SDG) 3 (healthy well-being) and SDG 5 of improving gender equality. This implementation research will maximize the participation of women during birth for improving respectful care and reducing perinatal mental disorder.

Other information, references and links:

1. Fisher J, Cabral de Mello M, Patel V, et al. Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review. Bull World Health Organ 2012;90(2):139g-49g. doi: 10.2471/blt.11.091850 [published Online First: 2012/03/17]
2. Bohren MA, Mehrtash H, Fawole B, et al. How women are treated during facility-based childbirth in four countries: a cross-sectional study with labour observations and community-based surveys. Lancet 2019;394(10210):1750-63. doi: 10.1016/s0140- 6736(19)31992-0 [published Online First: 2019/10/13]
3. Kc A, Axelin A, Litorp H, et al. Coverage, associated factors, and impact of companionship during labor: A large-scale observational study in six hospitals in Nepal. Birth 2020;47(1):80-88. doi: 10.1111/birt.12471 [published Online First: 2019/11/26]