Optimistic Voices
Vital voices in the fields of global health, global child welfare reform and family separation, and those intent on conducting ethical missions in low resource communities and developing nations. Join our hosts as they engage in conversations with diverse guests from across the globe, sharing optimistic views, experiences, and suggestions for better and best practices as they discuss these difficult topics.
Optimistic Voices
When Baby Blues Turns Deadly - Maternal Mental Health: Breaking the Silence & Sharing Prevention
Dr. Abdullahi Jawobah takes us deep into the critically overlooked world of maternal mental health, where his groundbreaking research reveals a staggering statistic: approximately 50% of pregnant and lactating mothers in Sierra Leone experience psychological distress. This silent epidemic has far-reaching consequences not only for mothers but for their unborn children, as Dr. Jawobah explains how stress hormones cross the placenta to affect gene expression in developing fetuses. Addressing this is a pathway to reducing stillbirths, preeclampsia, infant malnutrition, and physical health outcomes.
The conversation illuminates how mothers in Sierra Leone express their psychological suffering through culturally specific language—describing their distress as "my heart is spoiled" or "my heart is crying"—rather than using Western terms like depression or anxiety. Dr. Jawobah shares the heartbreaking cultural context where women who undergo cesarean sections may be viewed as "not fit to be women" and mothers whose babies develop malnutrition might be accused of infidelity, creating significant barriers to seeking mental health support.
What makes this episode particularly powerful is Dr. Jawobah's innovative solution: adapting Zimbabwe's "Friendship Bench" intervention for Sierra Leone. By training elderly women from existing mother-to-mother support groups to provide problem-solving therapy, his team created a culturally appropriate support system that produced "phenomenal" results. These elderly women, once feeling marginalized themselves, find new purpose in guiding younger mothers through their challenges, creating a beautiful intergenerational healing model. (Research)
Abdulai Jawo Bah completed his PhD in Global Mental Health at Queen Margaret University in Scotland. He is an NIH Diversity Supplement Research Fellow and Research Associate at Boston College's Department of Research Program on Children and Adversity (RPCA), investigating transmission of trauma from former child soldiers to their offspr
Maternal Health impacts child and family wellbeing, and is an indicator of societal wellbeing as well. If you want to support this work, please give to the HCW Maternal Health Mission - Maternal Health Matters!
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Welcome to the HCW Optimistic Voices podcast. I'm your host, yasmin Vaughn. On today's episode of the podcast, we are going to be discussing a big topic in global health, which is maternal mental health. With me today is Abdullahi Jawobah. He's a researcher based in Sierra Leone specializing in global health, particularly maternal mental health, parenting, early childhood development and health system strengthening in fragile and post-conflict settings.
Speaker 1:He completed his PhD in global mental health at Queen Margaret University in Scotland, where he utilized the Design, implementation, monitoring and Evaluation DIME model to create a collaborative care model for perinatal mental health in Sierra Leone. His doctoral research employed a rapid ethnographic approach and explored how pregnant women and new mothers experience and express psychological distress, along with their coping mechanisms and health seeking behaviors. Additionally, he developed and validated a screening tool for perinatal common mental disorders PCMD, and functional assessment scale. Abdullahi also culturally adapted and piloted the feasibility, acceptability and preliminary effectiveness of the friendship bench intervention for PCMD in Sierra Leone. Both of these, I believe, are the papers that he just recently had published and we'll share those in our episode notes. Currently, he is an NIH Diversity Supplement Research Fellow and a research associate at Boston College's Department of Research Program on Children and Adversity, rpca, where he investigates the intergenerational transmission of trauma from former child soldiers to their offspring, focusing on its influence on parenting styles and the mental health of their children. So Jawu welcome.
Speaker 2:Thank you very much, yasmin, pleasure to have you.
Speaker 1:Yes, it's so great to have you. We love bringing on researchers to talk about their work. Yes, it's so great to have you. We love bringing on researchers to talk about their work. So tell us a little bit. I just gave a big bio covering a lot of your research and the work that you're doing.
Speaker 2:But tell us a little bit about you, where you're from, how you got to where you are now. I'm from Sierra Leone where I witnessed firsthand the challenges faced by mothers and families in the post-conflict setting. We had like 11 years of civil war. Actually I'm a pharmacist. I'm a clinical pharmacist by background, did my master's in China in pharmacology and later proceeded to Liverpool School of Tropical Medicine where I did like a fellowship, so before going to Queen Margaret and where I did my PhD.
Speaker 2:So when I was in Sierra Leone, proud to my PhD program, I was doing like a pro bono PI for mental health coalition, like doing their research. And there was instances where we came across women that were locked at the Palemba Road maximum security prison and the crime they committed was like infanticide, they killed their babies. And when we tried to go further we are doing like a field work, qualitative research the prison officers were telling us that these women are demon, they are possessed so like. It was a surprise to me because I knew very well that the literature is very clear that for women to commit such heinous crime it must have been some associated with psychological distress, you know. So that was when I became fascinated and my interest grew towards perinatal mental health issues in Sierra Leone.
Speaker 1:Wow, what a sad story, but what a formative experience for you. Let's take a step back for our listeners who are maybe unfamiliar with the topic. Can you define for us perinatal and maternal mental health and share how some of that is different from the work that's? Being done with general mental health.
Speaker 2:Yeah, perinatal mental health actually refers to the emotional well-being of women during pregnancy and the postpartum period.
Speaker 2:It's general, differs from general mental health, especially due to the fact that it addresses the unique psychological challenges that are associated with motherhood and it is influenced by hormonal changes and societal expectations and the new norm that new mothers experience when they are transitioning from the pregnancy to motherhood.
Speaker 2:So, as a result of these hormonal changes, they develop like these mood disorders and sometimes it can be very transient, which occurs like after two weeks, which is referred to as baby blues, but sometimes it persists beyond that, which develop into what we refer to as postnatal depression, but sometimes it occurs during the pregnancy, in which case we refer to it as the antenatal depression. And it is very, very important because it has lots of public health implication, because the unborn baby basically vulnerable to some of these developments. So there have been a lot of evidence-based research that have shown that, for example, pregnant women, when they are psychologically distressed, you have like stress chemicals that passes through the placenta and switch off genes of the puters, the unborn puters, and most of these genes has been associated with genes that are responsible for emotional regulation and these kids are bound to develop problems with emotional regulation. They have delay in terms of social development, emotional development, physical and even neurocognitive development, and this basically affect them throughout their life, because to adolescents and adults Wow, that's so interesting.
Speaker 1:I've heard previously in the past about, you know, postpartum depression in women after they give birth and how that affects their ability to care for the baby. But depression during pregnancy having effects on the mental health of their future children, I had no idea. Wow, you mentioned that women are taking on new roles and that is why their mental health tends to change during this period this new role of motherhood and that there were social factors that influenced that. Can you tell us a little bit more about those social factors?
Speaker 2:Yeah, for example, in Sierra Leone you have like the homes where you have multi-generational homes, where you have like the mom, the dad, the grandpa, the grandma and the cousin and extended family members. So you have like this mom who is basically taking care of normal daily chores and she also have like some income generating activities that she's engaging. So when they become pregnant, sometimes the experience like issue is with neglect or cheating from their partners, lack of support and that extent even beyond the pregnancy to the early when they give birth to their babies. So for new mothers, they experience some of these challenges in terms of lack of support.
Speaker 2:A study that I conducted in my PhD program, which was like a prevalence study and also risk factor study, the male components came out very strongly that you'll see a good number of these women that we interviewed. They make mention of domestic violence, there is domestic abuse, there is gender norms, that's patriarchy that is involved, you know, and they have like this lack of support and all those basically comes together and creates lots of burden on these women, which include like psychological distress which goes on to affect their mood and they develop things like stress, depression and anxiety, which in Sierra Leone we have the colloquial way that they describe it. For example, my heart is spoiled, your heart is heavy, your heart is crying. So that is how basically they describe it locally.
Speaker 1:Okay, so it's not just the internal experience of the woman taking on this new role of motherhood, experience of the woman taking on this new role of motherhood, but this isolation that she feels from others taking on that role, and external factors like domestic violence and things like that that are contributing to the mental health. Are there other cultural factors that influence the presentation and treatment of these conditions?
Speaker 2:Yeah, we have gender inequality. Actually that plays a significant role and we have, like some of these women within the Sierra Leone setting, when they give birth, their husband ask them to move to their mothers, for their mothers to support them during the early phase of that transition in stage. While some do still stay with their husbands, and a good number of them experience significant distress because the husband, basically during that stage, is not providing the support that they needed and there is this societal expectation that prevents these women from asking for support because they deem that society will think or will perceive them as not being strong enough to be a mother. You know so I've even like uh, I encountered a case of a woman who gave birth like to cesarean section, and even giving birth to cesarean section for her was a depressing issue because she said her in-laws will deem her not fit to be a woman. She cannot like give birth on her own except like without being supported. So all these things basically like um, create like lots of psychological distress for this woman.
Speaker 2:There is also like a local um idiom that they use, which is referred to as banfa, also like a local idiom that they use, which is referred to as banfa. Banfa basically is like women, uh, when they have like these kids developing kwashiorkodi to like infant malnutrition, we have like this um societal way in terms, especially in this rural setting, we had to see this baby and describe them as banfa banfaa and when you ask them to give an explanation of what is Banffa, they said the woman basically might have had sexual intercourse with the husband or someone outside the marriage. That is what results in the baby presenting with this kwashiorko presentation. So basically these are local idiomatic way that they describe it, but I'm sure a good number of nurses and midwives have been sensitizing some of these women and even the husband, because the husbands are the ones that are very difficult to really talk to because for them, as far as they are concerned, the woman is cheating on them. That is why the baby develops such presentation.
Speaker 1:Wow, yeah, so there's still a lot of health education not present in the communities to help explain some of these conditions. Drowning their babies, um. I've even heard about, um, women who have obstructed labor or having prolonged labor. Uh, also being suspected of adultery, um, because if not, then you know why. Why is this labor not progressing like it's supposed to be?
Speaker 2:it must be something that she did, um yeah, sure, these are like cultural belief system that is really embedded within you know, this alien culture setting.
Speaker 1:Yeah, so from a community perspective, how do you go about approaching tackling issues like that, or does it have to be on the individual level, or does it have to be?
Speaker 2:on the individual level. Well, from the work that we did, actually like we tried to use this task shifting approach, task shifting, task sharing, that WHO is recommending we are community members, are being trained like we're non-specialists in providing psychosocial support for these pregnant women and lactating mothers. And we experimented it, like in Waterloo, where we consider two communities, lompa and Campbelltown, and Campbelltown was the experimental community while Lompa was the control. So we have, like this, mother support groups that we train. These are like women that we are trained by the directorate of nutrition, supported by unicef, to support pregnant women to attend uh, attend all the their antenatal care and also lactating mothers, for them to give like six months exclusive breastfeeding.
Speaker 2:So we leverage on these mother-to-mother support groups, we train them and they provided support for these pregnant and lactating mothers and the result, basically, was like mind blowing. It proved very, very effective and it was quite feasible because it was like this friendship bench developed in Zimbabwe. We have like this bench where this elderly woman will be sitting down and the lactating mother or the pregnant woman will join them for a talk, therapy and it's like and it's like a problem-solving approach where the pregnant woman or lactating mother will explain what their problems are and they work with them to support them in addressing these problems, one after the other, you know. So community-based approach has been found very, very effective, and it's also we're able to establish that in our work at Waterloo here in Sierra Leone. The paper has just been published.
Speaker 1:Oh, congratulations. Yeah, what a cool study. Can you tell us a little bit more about who the people who were trained to do the advising were?
Speaker 2:Yeah, the people that we are trained, we are the mother-to-mother support groups, which are laywomen, are volunteers living within the community, trusted by the community, and some of them are appointed by these communities. You know, and when we were doing the ethnographic study that is the formative phase of our work when we asked these women to, when we are talking with the pregnant women and lactating mothers, wanting to understand how they experience and express psychological distress and we later ask them how they cope with it and get health-seeking behaviors. So that was when they told us about these mother-to-mother support groups that has been supporting them. And when we went to the directory they gave us like a list of these mother-to-mother support groups and we recruited them, we trained them and they provided support for about a month. So we screened these pregnant women, lactating mothers, like prior to the start of the study, after two weeks and after a month.
Speaker 2:So the result was phenomenal and I think partly one of the reasons why the result was very effective, why the intervention was very effective, is this mother-to-mother support group has been engaged in this pregnant to men of lactating mothers prior to our study. They've already established trust, so they were like the liaison between the community and the community health centers. You know they link them up with the midwives and the nurses when they visit them at their houses and try to talk to them. You know so Pregnant and Men of Lactate Immunization models that needed support, they were the ones that were channeling them to the community health centers and even after the study, when we went there to engage to talk to them, we realized that pregnant women and lactating mothers had been even visiting this mother-to-mother support group even after the end of the study.
Speaker 1:Yeah, yeah, so a sustainable pipeline of of community support existing meant that they they were better um able to to engage with them um and have better results, yeah, wow yeah, yeah.
Speaker 2:And the other flip of the coin is the fact that even the mother-to-mother support group, which are elderly women at community level, when we spoke with them, we realized that it also have like this positive psychological impact on them, because they never knew that they have anything to give back to to their communities.
Speaker 2:You know they they just thought that they are no longer needed, they don't have much role to play.
Speaker 2:Well, well, now they see themselves like speaking to pregnant women, like 30 mothers changing their lives.
Speaker 2:We have like cases, for example, a teenager who was sleeping with a friend abandoned by her family because they consider her to be like bringing shame to the family of becoming pregnant and having a baby, and at the end of that intervention, that teenager was able to go back to her parents. The parents were taking care of the baby and she returned back to school. So these elderly women were really impressed with what they are now doing and also, on the other flip of the coin, what we realize. The pregnant women and lactating mothers have a lot of trust with these elderly women because they realize that if it is like a peer-to-peer support group girls or women of their age they are probably with like opening up to them in terms of the secret, in terms of sharing their problems with them, because they just believe that they will explain it to others, this issue of gossiping. So secrecy is very, very important, and they believe that these elderly women will be able to keep their secrets and they can also benefit from their life experience as well.
Speaker 1:Oh, wow, so multi-generational support being fostered there. So it sounds like even the pregnant women feel that they're not seen and not supported. But the elderly women being able to have a role in society was significant for them as well. Wow.
Speaker 2:Yeah, sure.
Speaker 1:Sure, yeah, sure Sure.
Speaker 2:Yeah, that's amazing. So did you, in this study, see a lot of influence on health-seeking behavior as well? Yeah, during the study, we realized that a good number of these pregnant women like taking mothers. We are not seeking support because of the stigma and the labeling, Because even when we try to interview these women pregnant women, lactating mothers and even the elderly women we generated a clinical vignette from the ethnographic data that we collected.
Speaker 2:Let's assume that there is this lady who is about 25 years. Prior to her pregnancy, she was doing fine, she was very cheerful, but when she became pregnant she started withdrawing, keeping to herself, not talking to people, crying all the time. So we generated it like from the data that we collected at community level, and we asked them in a search community how do the community see them, how do they describe them? We realize that there are a lot of psychological labels that they give to these women there. They consider these people as people that some consider them to be rich, some call them like jealous women, some consider them to be like troublesome, some even describe them as trauma. So they have various labels that they give to them and I think this labeling also serves as a barrier for these women in terms of accessing care or seeking support.
Speaker 1:Yeah, so helping to remove some of the stigma within the mother-to-mother support groups was helpful to increase their ability to access services. Amazing, yeah, sure. And were the older women mostly giving advice or just mostly listening? Mostly giving advice or just mostly listening? Was there any training for them on what kind of advice to give, or did you guys depend on their wisdom of age?
Speaker 2:Yeah. So that was also another aspect that came out during the qualitative interview that we did at the end of the intervention. These mother-to-mother support groups told us that prior to this intervention, when they approached these pregnant women to encourage them for them to attend antenatal care services or the exclusive breastfeeding if they approached them, they realized that they are moody. They said they would just pass and move to the next house. With our intervention they are now confident enough to engage them, even when they are seeing extreme form of depression with them, with the skill we imparted to them. So what we did is like we culturally adapted the friendship bench intervention developed by professor chibanda in zimbabwe, which was like a problem solving approach. So what the elderly women we are doing is like engaging the pregnant women and lactating mothers, asking them what are the problems they're experiencing. So they will list, for example, like five problems and out of these five problems they will ask them which of these problems is the single most important one, and the pregnant women and lactating mother will identify that problem. And, being that these are pregnant women and lactating mothers will identify that problem. And, being that these pregnant women and lactating mothers and even the mother-to-mother support group, some of them have low literacy and numeracy. We try to develop very user-friendly manuals for them that they can relate with. So, basically, the elderly woman was there to brainstorm with them of solutions to that particular problem.
Speaker 2:But the solutions, basically, or the potential solutions, comes from the pregnant woman or the lactating mothers and what we realized at this point when they are psychologically distressed, their brain cannot function properly. Distressed, their brain cannot function properly. So the elderly woman is there to guide them and support them in making decisions with regards to these options that they want to explore, and they will now go and explore this option. For example, if the pregnant woman or lactating mother said the husband has not provided anything, abandoned them, they don't have life food to eat, they will then ask the pregnant or lactating mothers what are the options they have.
Speaker 2:Some of them might say, okay, there is this microfinance loan that is available. They will then map out a strategy for them to access it. They will access it and start, let's say, having some form of business that they are doing. After a week, they will come back to the mother-to-mother support groups and give them like a feedback, and the mother-to-mother support group will now try to know what worked and what didn't work. And if it worked, they will now proceed to the next problem. And if it didn't work, they will now brainstorm and to try to profile solution around it. And what we realized for the most part after the first second problem, the women are now confident enough to address the remaining problems, you know so, more or less it's a way of like giving them life, lifelong skills in addressing problems throughout their life, because even after the pregnancy or the postnatal period, Wow, wow.
Speaker 1:So it's really more of a therapy relationship of guiding and helping them explore their own emotional experience, guiding their options, but not forcing or influencing in a negative way. That's so interesting.
Speaker 2:Sure, and we made it very flexible. Flexibility was key because we realized that sometimes, in some of these cases, the husband, basically, is the one or the partner is the one that is the problem and the pregnant woman or lactating mother want to access care, but they are afraid of the partner, for the partner not to know that they are accessing care. So, unlike the intervention in Zimbabwe, where the friendship bench was placed next to the community health center, the pregnant woman or lactating mother has to visit. In this case, sometimes even for has to visit. In this case, sometimes, even for them to visit, they have, they need to have, like, permission from the partner. You know.
Speaker 2:So we made it very flexible that this mother-to-mother support group, if they don't see these, uh, pregnant, lactating mother, they themselves can visit them at their homes and when they go there, if, like, the partner is there, they will use their eyes to communicate to them. You know, so that they will move from outside, maybe like to inside the house or look for a safer place, space where they can interact. You know, so, all these, like some of the things that we brought in as part of the cultural adaptation, so that it will be very flexible for them. You know, in terms of the implementation and that also came out during the post-pilot interviews that they really appreciated that flexibility.
Speaker 1:Yeah, that makes a lot of sense. It sounds like you guys have really worked hard, not just to find tools that will be useful in the context, but to approach the participants and say you know, let's adapt these tools to the work that we're doing. Yeah, that drives us.
Speaker 2:Yeah, that's right.
Speaker 1:Great Well, you spoke at our maternal and child health conference one of the mornings on this into clinical practice and how health care providers can help screen women and maybe even make referrals to these kinds of networks integrate this within the maternal child health program, especially so when it is within the national mental health policy and strategic plan but not translated to the maternal child health program.
Speaker 2:And there are lots of calls from the WHO, the global, the GCC that is, global Canada challenge and so many other international organization for the need. Even the Lancet Commission also recommended for mental health to be integrated within the maternal child health program. And so that is what actually we are working towards, because in this study we also developed like a screening tool that speaks to the local context. For example, one of the 10 items within that tool is talking about shame. If the pregnant woman or lactating mother has felt shame for the past two weeks and shame is a very, very important phenomenon that basically drives these women towards isolating themselves, especially if they have, like pregnancy out of wedlock or other aspects around their social life. Isolating themselves, especially if they have like pregnancy out of wedlock or some other aspect around their social life, you know. So basically, it's like now what we are trying to do is move towards like doing like a randomized control study using multi-centers, and at that point at least we will have generated that proof of concept and we all see how best we can scale up at national level Because, like the intervention, as we can see, is like a task sharing approach, we are not using health workers that are already in short supply.
Speaker 2:We already have shortage of health care workers.
Speaker 2:So this mother to mother support group are found across the country and, in line with Professor Chibanda's philosophy you know when he was designing this intervention in terms of using elderly women. This issue of attrition is very, very difficult to see because if we train like young women, there will come a time when they will travel to bigger cities to see greener pastures. But these elderly women are found across all communities across the country. So the idea actually is to really integrate it within the maternal child health program, have these tools and the tools actually I also translated it into graphic presentation so which means that the mother to mother support group can also use these tools in screening and also in doing their follow up with these women. So that is what basically we are looking forward to and we can't wait to meet the ministry in due course to see how best we can work towards that, because we engaged them before the start of the study and I've also did like a dissemination. So the next aspect will be like uptake, which is very, very important.
Speaker 1:Yeah, so this is something that you see has to be done at the health system level, at the national level, with policymakers, and at the very top, not just a clinic to clinic, hospital, hospital behavior, because really, what you're doing is integrating. I mean you're integrating care within the system. It's comprehensive care now, instead of just focused on one thing but seeing a person as a whole person.
Speaker 2:And we also, during the intervention, have these referral pathways where this motor support group can refer cases that are very resistant to their support towards the community health centers. We have some CHOs, community health officers that went through some training by WHO in terms of providing the image gap, which is like the psychological treatment I mean through a task sharing approach, and also we have, like, at district level, we have mental health nurses that are also providing support. So there is this cascading effect in terms of referral pathways from model to model support groups towards, in terms of the pathways from moderate to moderate support groups to us up to like, a district level. And the other aspect that I would also like to make mention of the fact is the fact that we also had like a lexicon that we generated from the data collection process. That is how women at community level communicate psychological distress without using anxiety, depression, which are like the stigmatizing Western construct that is driving them away from seeking support. So what we realized? That using those things like well, hearts, that is, their heart is foil, like things like their heart is heavy, their heart is crying, their mind is not steady we realized that those were like colloquial terminologies which are non-stigmatizing and which basically can facilitate not only their seeking of support but also engaging with these treatment services. These treatment services and those are the lexicon that we also want to engage with these institutions. For example, I'm like a lecturer at Comas engaging, for example, like Comas College of Medicine, jala and other training institutions so that this can be included in the training curriculum, so that when they are engaging these pregnant and lactating mothers they start talking about Puellat.
Speaker 2:They should know that there is something in addition to the physical component. There is also a psychological component that is involved, because a good number of them realize that they do a lot of um support to these women. They do like tests. They cannot see anything. So meaning that there is like this somatization that is going on. You know, somatization from the literature is very widespread in asia and africa as well. You know we are like this psychological stuff. All the psychological distress they are experiencing is presenting as physical symptoms, like digestive issues, like probably um respiration, like pain, you know. So all these are basically somatizations which are coming from the psychological distress. So at least it will be something like an eye opener for healthcare workers to look out for and refer some of these women for psychological support.
Speaker 1:Yeah, yeah. So the hope is that clinical care people can learn to recognize it, not just in terms of the success that you've had in this project and the work that you're doing. What are some of the key challenges, though, that you've seen in doing this research?
Speaker 2:Some of the challenges that we experience is in terms of the implementation of the study. You know, at the rural community setting it's a bit easier compared to the urban setting and but notwithstanding that, from the lessons that we've learned from the urban setting, where we conducted this study, we'll definitely be able to also replicate it within the urban setting. So, for now, some of the challenges I think we have is in terms of having funding, in terms of doing a randomized control study, but in terms of the piloting phase, we didn't have much problems in terms of challenges because we engaged stakeholders and we engaged the chiefs, we engaged the Mami Queens, so all of them were involved and we got their support and it was very easy for us in terms of doing our pilot study, doing our pilot study, you know. But another challenge I think that is worth mentioning is this aspect of Linking the mother-to-mother support groups and the pregnant women, lactating mothers.
Speaker 2:You know, because when we did like the screening, there was a time when we we have, like this, research assistant that did the screening, we screened them and those that got above the cutoff point, we had the one that we recruited. So when the mother to mother support group went to locate them, some of them their addresses. We are not like they cannot. We cannot locate them because of the addresses and some of of them we are not having phone numbers. You know they gave us the phone numbers of their relatives.
Speaker 1:So those are like some of the technical challenges that we had yeah, yeah, we we've experienced some of the same technical challenges and and tracing people, and and that's not uncommon in research, but it sounds like you guys did a lot of work to make sure that this was well integrated into the community. Um, and that's not uncommon in research, but it sounds like you guys did a lot of work to make sure that this was well integrated into the community and that you had community support. You weren't just coming in and enforcing it, but seeing what already existed and building upon it.
Speaker 2:Yeah, sure.
Speaker 1:Great.
Speaker 2:Go ahead, structured format, you know. And yeah, I think one of the things that I'm looking forward to is not to let them down and also to scale it to other communities after the randomized control study. I'm going to say yes, man.
Speaker 1:Yeah, no, I love that. I love that it's something that they love so much that they want it to continue, and I hope that it will as well. And it would also be very interesting to see, over time, if you're able to measure the impact it has over many years and many, many pregnant women.
Speaker 2:Sure, definitely, that's also something we'll be looking forward to, and another aspect that we are also looking forward to, and another aspect that we are also looking forward to into the future, is how best we can also be able to refer some of these women to some of the services that they really needed in terms of support. You know, yeah.
Speaker 1:Services like.
Speaker 2:This is like like, for example, um, some of them we are having uh, problems with, for example, like abuse, you know how we can be able to link them, for example, like the, you know, social support services to support them in some of these problems that they're experiencing, which is unique, you know, and which sometimes, as an intervention, the intervention basically does not have much to do in terms of, like, supporting them through that pathway, you know. So, linkages with services is something also we are looking forward to.
Speaker 1:Well, are there other areas? You know it sounds like. Your paper on the cultural adaptations of the language that's used to describe anxiety and depression is being published. Your pilot study on these mother-to-mother support groups is being published. What's next?
Speaker 2:Well, the next aspect is, as I said, looking for grants and do like a randomized control study and see how best we can scale it up to other communities and districts across the country.
Speaker 1:Amazing. Well, best of luck with those research grants in that way. Is there anything else you'd like our audience to know about your research and work in perinatal mental health?
Speaker 2:We also have, like, two papers that I'm also working on, which definitely will be published very soon.
Speaker 2:One of them is looking at the prevalence and the risk factors and the prevalence it will surprise you to know that it's about 50%, so meaning that one out of every two pregnant women, lactating mothers, is experiencing psychological distress. And also the other paper is looking at the maternal child health impact of the psychological distress. You know, because you can see it clearly from the data we collected, we are women describing that a particular woman at the community, for example, like Adama, experienced miscarriage because of the distress she was experiencing from the partner, or she experienced stillbirth. So all these at community level, you can see elderly women or the pregnant or lactating mother like describing that when the woman is going through the psychological distress, even the baby in the womb is having like, so which in western constructs we can in fact, as like in the tradition, you know. So basically, at level, they can describe it colloquially of which we can extrapolate and see the Western equivalent of it, you know. So we're also working towards publishing those two papers as well.
Speaker 1:It's amazing. Well, we look forward to reading those as well. You're not just taking your work and taking these Western terms and forcing it on these communities, but exploring it within the community and saying how does this equivocate to something that you know is in the DSM? Question that we ask all of our guests is what are you optimistic about?
Speaker 2:Well, I'm optimistic about the scaling up of this intervention because I am very, very sure that if we can scale up this intervention at national level and have each and every community having mother-to-mother support groups that are not only supporting with the infant malnutrition program but also supporting with the psychological aspect of pregnant women and lactating mothers, I foresee that in the long run, there will be a decline in things like cases of eclampsia and preeclampsia, which has been directly linked with psychological distress. We can also see a decrease in terms of infant malnutrition, of which we have the evidence linking them as well, and even things like stillbirth, you know, and low birth weight, you know, and all these indicators actually, which we are always struggling with, you know, for me, which I consider to be distal, you know, distal factors so, of which we need to address the proximal factors, which are like the psychological components, psychological aspect of pregnancy, when a lactating mother is.
Speaker 1:Yeah, so it does come back to maternal and child mortality as well. Not just their mental health and their morbidity and their well-being, but even has implications for that as well.
Speaker 2:Yeah, definitely, yes, that as well. Yeah, definitely, yasmin.
Speaker 1:Yeah Well, thank you so much for joining our episode today. It's been a pleasure talking with you and hearing about this work and the way that you're exploring how to help women and children through this innovative approach.
Speaker 2:Thank you very much, Yasmin.
Speaker 3:Thanks for listening. If you enjoyed this episode, please subscribe, share it with others, post about it on social media or leave a rating and review. To catch all the latest from us, you can find us at Helping Children Worldwide on Instagram, linkedin, twitter and Facebook Hashtag Optimistic Voices Podcast.
