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There are many barriers to effective mental health promotion with mothers living in socially disadvantaged communities. These include failure to take account of local cultural knowledge, community values and identities; feelings arising from experiences of poor health and disadvantage; mistrust of health professionals, and lack of engagement with services. Qualitative methodologies were used to explore maternal mental health and service delivery to people living in poor social conditions. Individual interviews and group discussions were undertaken with nine mothers living in a disadvantaged community. Further data were obtained from fieldwork contacts with seven health professionals working in the community. The research identified four discursive strategies used by participants when they and others encountered difficulties in relation to stigma, mental health and their daily lives as mothers within the community. These strategies were othering, counteracting, blaming, and resisting. The analysis offers a resource to community initiatives seeking to examine how mothers can deal most effectively with a lack of control and power in their lives.

Understanding parental psychopathology interaction is important in preventing negative family outcomes. This study investigated the effect of paternal psychiatric history on maternal depressive symptom trajectory from birth to 12 months postpartum. Maternal Edinburgh Postpartum Depression screens were collected at 1, 6 and 12 months and fathers' psychiatric diagnoses were assessed with the Structured Clinical Interview for DSM-IV from 64 families. There was not a significant difference in the trajectory of maternal depressive symptoms between mothers with partners with history of or a current psychiatric condition or those without a condition. However, mothers with partners with substance abuse history had higher levels of depressive symptoms relative to those affected by mood/anxiety disorders or those without a disorder. Our results call for a closer look at paternal history of substance abuse when treating postpartum maternal depression.

The purpose of this paper is to describe the major factors affecting health during pregnancy, birth and the postnatal period and outline the evidence for interventions to improve outcomes in women and their children.

Selective review of the literature. A number of electronic bibliographic databases were searched, including the Cochrane Database of Systematic Reviews, PubMed and PsycINFO, for relevant studies published since 1990. Papers were restricted to those published in English which presented data from studies conducted in high-income countries, with priority given to systematic reviews, randomised controlled trials and other quantitative studies which present a higher level of evidence.

Many factors may affect maternal and infant health during and after pregnancy. Potentially modifiable factors with an evidence base to support intervention include improving diet, and the avoidance of smoking, alcohol and illicit drugs. Good clinical management of underlying illness is also important, along with attempts to engage women in improving health prior to conception and postnatally rather than once pregnancy is established.

The evidence base for interventions on some potentially modifiable risk factors is incomplete. There is good evidence of benefit from some health behaviours such as smoking cessation and uptake of breastfeeding and accumulating evidence of the benefit of some models of maternity care.

Good maternal health during and after pregnancy plays a key role in giving the child a better start in life. Improved health behaviours are vital but often these are heavily dependent on social context and hence working to tackle social inequality and provide maternity care tailored to individual need is likely to be just as important as trying to directly alter behaviour.

Pregnancy and the postnatal period present an opportunity to improve maternal health and have a positive effect on future child health. Greater investment is required in this antenatal period of life.

Perinatal mental illness is an important public health issue. Conditions such as postnatal depression increase mothers' risk of suicide and can herald onset of recurrent and chronic mental health problems. Maternal mental illness can also adversely impact the cognitive, physical, and psychological health and development of children. In light of known psychosocial risks, there is concern that fewer than expected women from black and minority ethnic (BME) backgrounds access care and treatment. This paper aims to address this issue.

Responding to persistent reports of patchy service provision across the UK more generally and particular concerns about potentially unmet needs among BME women, mixed‐method research was undertaken between September 2009 and March 2010. Using survey questionnaires and telephone interviews, the study sought to explore professional stakeholders' perspectives on current perinatal mental health provision and the extent to which it meets the needs of BME women. Findings from the study were intended to inform policy and plans to improve provision by establishing managed care networks (MCNs) for perinatal mental healthcare.

In total, 45 questionnaires were returned from the national survey. One‐third of respondents (n=14) consented to follow‐up telephone interviews. There was evidence of multi‐agency working among the 27 professional groups which respondents reported as being directly involved in delivering perinatal mental healthcare across the country. However, there was also evidence of disjuncture and poor communication – particularly between statutory and voluntary sectors and NHS primary and secondary care. Some respondents had difficulty defining “BME” or identifying the women to whom the acronym might be applied. They also questioned the validity of providing “BME‐specific” services. Instead, they endorsed more ethnically “inclusive models” of provision and “signposting” women to appropriate “community” services.

Taken together, these findings suggests that whilst there might be a theoretical argument for perinatal mental health MCNs, considerable effort is required if policy‐makers' aspirations for more “joined‐up” services capable of meeting the needs of all women are to be fully realised. Furthermore, current proposals for public sector reform coupled with reduction in voluntary sector provision is likely to disproportionately affect women from BME and other marginalised communities as they provide significant amounts of “below the radar” care and support.

This paper is of particular relevance to policy makers and practitioners. Findings suggest that women from BME backgrounds might be particularly vulnerable to perinatal mental illness. Contraction of voluntary sector provision increases the likelihood that the needs of BME women will remain unmet with deleterious consequences for their health and wellbeing of their families. This has potentially serious public health implications. MCNs/clinical networks have the potential to reduce inequalities by providing more “joined up” care for all women. However, the evidence base for levels of need and appropriate service response to perinatal mental illness among BME women is weak. Further research is required to bridge the evidence gap and to evaluate the impact of health and social care reform on vulnerable groups.

Women with mental illness, substance-dependence or dual diagnosis are at increased risk of losing care of their children which leads to poorer outcomes for mothers. The purpose of this paper is to explore the service response to substance-dependent mothers, many of whom had a dual diagnosis, and reports outcomes for their infants from the perinatal period to the end of each infant's first year.

This was a longitudinal case study of 20 women substance-dependent women and their associated care. Semi-structured interviews were held with mothers recruited from a specialist alcohol and other drug obstetric service at infant age six weeks, six and 12 months. Structured interviews were also held with counsellors from the obstetric service at infant age six weeks. Child protection (CP) workers were interviewed at infant age six weeks, six and 12 months regarding mothers involved with the service.

By 12-month follow-up, CP services had been involved with 14 mothers and eight had lost the legal care of their infant. Mothers who retained legal care were more likely to have addressed their drug use and less likely to be in a domestically violent relationship. Domestic violence, homelessness and maternal recidivism to crime tipped the scales in favour of protection of the infant through removal from maternal care, essentially leaving mothers with minimal support for reunification and reduced incentive for treatment.

Reliance on mothers’ self-reports was a limitation of the study. The small sample size restricts generalisability of findings.

Key workers should engage women (and their partners) during the perinatal period to provide support, advocacy and case-management to enable substance-dependent mothers to safely parent.

This is one of few studies to report long-term outcomes for mother/infant dyads when substance-dependence and/or mental health are present that allows women to speak for themselves. The prospective design provides a contemporaneous account of events as they unfolded in situ.

This study aims to investigate the feasibility of health cadres in Indonesia to take perinatal depression screening in the community using Edinburgh Postnatal Depression Scale (EPDS) and Whooley.

The field study involved 11 health cadres (community volunteers who assist in maternal and child health) who were trained to administrate EPDS and Whooley towards 36 pregnant and postpartum mothers in a low resource urban setting for a month. A comparison of scores from both tools, the number and type of mistakes made by the cadres, and cadres perception about the tools were combined to determine the most feasible tool for cadres in identifying depression symptoms.

The results show both tools are comparable for screening depression symptoms in mothers; however, EPDS was better at differentiating the level of symptoms. Whooley, with two case-finding questions, is simpler for cadres, whereas the EPDS is more difficult to be computed by cadres. Cadres support the implementation of such a screening, as it provides a channel for mothers to express their negative feelings.

The findings indicate Whooley is sufficient for first-level screening in the community by cadres, whereas the EPDS should be used by qualified health-care workers for further evaluation at primary health clinics.

Health cadres could potentially be trained to use standardized yet simple psychological tools. Involving trained health cadres in integrated maternal mental health services in primary health care in Surabaya, Indonesia is promising.

The use of the EPDS and the Whooley questions has not been applied in Indonesia particularly among health cadres despite their long-lasting role in primary health-care system.

The purpose of this paper is to look at the positive future gains of reaching women with perinatal mental illness at the first midwifery booking-in appointment, a unique opportunity that could be more widely used as a point of detection, awareness and prevention of illness in the perinatal period.

A more robust section of this appointment that includes focussed detection and awareness of prior and current mental health concerns as well as the stigma attached to these conditions will allow midwives to signpost women to get much needed treatment prior to delivery. Suitable treatment options also need to be available and in place at this point.

The existing booking-in process, for highlighting and diagnosing mental health conditions, has limited suitability. Detection in the postnatal period has inherent difficulties due to time pressures on women, the costs to the mother, baby, family and the economic costs to society, which are considerable. The postnatal period may be too late for treatment, with the harm already done to the woman, their baby and their family.

Research is needed to assess the efficacy of such a strategy, including the costs to train the midwives to deliver this additional service, and the consideration of suitable treatment options at the antenatal stage. This may help to reduce the high levels of attrition within treatment programmes currently running.

This paper fulfils a need to diagnose and prevent perinatal mental illness at an earlier point in pregnancy.

The demographics of rural America are rapidly changing and concerns about mental health are growing. This study examined relationships between individual, family, and community factors and depressive symptomology among rural low-income Latina and non-Latina White mothers.

The sample for this study was drawn from the study, Rural Families Speak about Health. Data from interviews with 371 rural low-income mothers (36% Latina; 64% non-Latina White) were analyzed and descriptive and multivariate analyses were performed.

One-third of mothers experienced clinically significant depressive symptomology; non-Latinas experienced twice the rate as Latinas. Limitation in daily activities due to poor physical health predicted clinically significant depressive symptomology among both groups. Among non-Latinas, high levels of financial distress and lack of healthcare insurance predicted clinically significant depressive symptomology, and use of WIC and high levels of healthful eating and physical activity routines were protective factors. Age, single marital status, unemployment, transportation barriers, food insecurity, and inadequate health insurance predicted clinically significant depressive symptomology among Latinas.

Program administrators should consider factors associated with depression among specific populations as they design programs and services.

Factors not accounted (e.g., nativity of mothers) should be explored to more fully understand predictors of depressive symptomology among rural Latina and non-Latina mothers.

This original research considers how the relationships between individual, family, and community factors and depressive symptomology differ between rural low-income Latina and non-Latina White mothers. The authors discuss potential factors and outcomes related to depressive symptomology and provide suggestions for research, programs and services.

Work-life challenges experienced by employees navigating pregnancy, maternity, and parenting young children are well documented in the literature. Correspondingly, work-life balance policies and provisions aimed at supporting affected staff are well established in many modern organizations. Within this agenda however, complications within maternity journeys, and specifically the intersection with mental health has been neglected. In this chapter, we consider the work-life issues associated with perinatal (pregnancy and post-birth) mental illness. After introducing perinatal mental illness, and its impact on individuals and families, we consider the two-way relationship between illness and work: how employment factors influence the development of perinatal mental illness and recovery trajectories, with implications for family life; and how such illnesses impact work and employment. We offer key insights from our empirical research on this topic in the context of UK policing, highlighting challenges linked to the nature of police work and organization culture, and issues that are more broadly applicable to how maternity and mental illness are treated in the workplace. The chapter offers recommendations for people management practice aimed at reducing or mitigating occupational factors that exacerbate illness and maximizing those facilitating recovery in the perinatal period and beyond, thus advancing work-life inclusion.

Refugee and asylum-seeking women are particularly vulnerable to experiencing mental health difficulties during the perinatal period, with social factors compounding these experiences. Research is limited into the mental health needs of perinatal women who are refugees or seeking asylum. The purpose of this paper is to examine the best available international evidence on this topic and to discuss the findings with relevance to the UK context.

A modified population, intervention, comparison, outcome was used to formulate the research question and search strategy. Databases searched were: cumulative index of nursing and allied health literature, Medline, PsychINFO, Web of Science and Scopus. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis framework, results were screened against an inclusion and exclusion criteria. Each study underwent a quality assessment in which they were appraised using the mixed methods appraisal tool.

Eight papers were retrieved, and a thematic analysis was conducted. Two major themes were identified: mental health needs and social influences. Refugees and asylum seekers are likely to have experienced trauma as reasons for migration. Post-migration stressors, including hostility and dispersal from social networks, lead to cumulative trauma. These each add to the mental health needs of perinatal refugee and asylum-seeking women that cannot be ignored by policymakers, health and social care services or professionals.

Refugee and asylum-seeking women are particularly vulnerable to mental health difficulties in the perinatal period. Stressors accumulated pre-, during and post-migration to the host country exacerbate mental distress. In the UK, the treatment of this population may be detrimental to their mental health, prompting the need for greater critical awareness of the socioecological environment that refugee or asylum-seeking women experience.