Perinatal Mental Health of Malagasy Women
Open Access DepositedA Mixed Methods Study
4) barriers and facilitators to care (e.g., limited access to healthcare especially in rural areas). Common perinatal mental disorders are highly prevalent in Madagascar and further research is warranted, for example, in addressing social determinants of health (e.g., economic instability, education access inequity, and gender-based violence) as well as childhood trauma for reducing perinatal mental health issues among Malagasy women, especially in rural contexts.
Childbearing women in Madagascar are at high risk for common perinatal mental disorders (CPMDs), such as perinatal depression and anxiety. Emerging evidence suggests that Malagasy women experience high levels of stress during the perinatal period, which may contribute to the existing high maternal morbidity (Bakohariliva, 2019). Studies conducted in two urban areas Madagascar found a 14.5% prevalence for postpartum depression in Toliara (Andriamanjato et al., 2022) and a 42% prevalence for prenatal anxiety (Bakohariliva et al., 2019) in Antananarivo
3) coping strategies (e.g., family support, reliance on faith and religion)
2) exploring the views and experiences of perinatal mental health among Malagasy women as well as the current prevalence of common perinatal mental disorders in urban and rural settings of Antananarivo, the central capital city of Madagascar. This exploratory study included two phases of research. Using a quantitative approach, the first phase included survey responses from 186 perinatal women aged between 18-40 years old, residing in urban and rural parts of Antananarivo. Demographic data, depressive symptoms (Edinburgh Postnatal Depression Scale, EPDS), mental distress (Self-Report Questionnaire-20, SRQ-20), and psychosocial risk factors (e.g., health history, adverse childhood experiences [ACES], intimate partner violence [IPV]) were collected. Risk factors for perinatal depression were evaluated using correlational analysis and mean differences. A qualitative approach followed and included 25 randomly chosen women from the quantitative sample, who participated in a face-to-face, individual in-depth interview to explore their experiences of perinatal mental health and associated factors. Qualitative data was analyzed using content analysis. Most participants had given birth to their infants (84%), were married (84.4%), lived in rural areas (65.6%), and had attained a middle school level of education or below (84.4%). . The EPDS scores of one quarter (25.8%) of the participants were between 9 and 12, indicating they were at high risk of developing perinatal depression and almost one-third (31.9%) scored in the severe depression range (score ≥ 13). The SRQ-20 scores indicated that 60.2% of participants experienced mental distress (score ≥ 8). Additionally, depressive symptoms and mental distress were negatively associated with education and income levels and were positively associated with childhood trauma. The majority of participants reported experiencing at least one adverse childhood experience, and 44.6% reported experiencing intimate partner violence in the form of controlling behaviors. Exploratory analysis on geographical differences indicated that rural participants reported higher depression scores, lower education, and lower income levels compared to urban counterparts. Four themes emerged in the qualitative data
however, little is known about the rates of common perinatal mental disorders in other settings. This exploratory, mixed methods study seeks to expand the research on the current state of the perinatal mental health in Madagascar by 1) examining risk and protective factors of common perinatal mental disorders among pregnant and postpartum women, including adverse childhood experiences, intimate partner violence, social support, and relevant social determinants of health impacting perinatal women’s mental well-being
1) risk and protective factors at multiple levels of the Bronfenbrenner’s socio-ecological model (e.g., poverty, unplanned pregnancy, marital conflict, and family and faith-based support)
2) perinatal mental health experiences (e.g., symptoms of common perinatal mental disorders , discussion of cultural traditions such as “Mifana” as a protective factor, cultural idioms of distress relating to mental well-being)
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Rabemananjara_gwu_0075A_17226.pdf | 2025-12-11 | Open Access |
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