Improving Maternal Mental Health through Active Engagement of Midwives within the Indian Public Healthcare Delivery System
Year: 2026
Type: article
Abstract: Dear Editor, Maternal mental health has been acknowledged as a key determinant for ensuing maternal and child well-being, yet mental health problems among them are often undermined.[1] In the absence of appropriate management, it can result in poor bonding with the newborn, impaired child development, and a high risk of emotional and behavioral issues in children as well as among mothers in the due course.[1,2] Mothers might experience postpartum depression, sleep disturbances, excessive worries, etc., which results in higher healthcare expenditures.[1] In India, midwives represent an integral member of the health workforce, and they can prove to be the critical link in improving maternal mental well-being and ensuring positive outcomes for both mothers and newborns in antepartum, intrapartum, and postpartum periods.[3-6] During pregnancy, midwives can conduct mental health screening during antenatal visits to identify high-risk women, promote involvement of partner and family members, and educate women about hormonal changes, stress management, and coping strategies to improve mental resilience.[2] In addition, they can advise pregnant women on nutrition, lifestyle (viz., exercise and sleep hygiene), practicing mindfulness, and relaxation techniques to manage stress and anxiety.[3] During the intrapartum period, midwives can create a calm and supportive birthing environment by providing emotional reassurance to minimize anxiety during labor.[4] Despite the framework provided through the Indian Public Health Standards (IPHS), significant gaps remain in implementing the midwife’s cadre at subcenter and primary-care levels.[5,6] In fact, the findings of a systematic review highlighted the presence of key barriers in ensuring provision of high-quality midwifery services in India, namely insufficient legal recognition for autonomous midwives, weak regulatory frameworks, and inadequate health-system infrastructure.[5] The findings of a qualitative extrapolation highlighted that due to the existing nursing–midwifery regulatory system in India, we have not been able to completely support independent midwifery practice, which has remarkably affected the quality of care.[6] These gaps clearly envisage the need to empower midwives to support maternal mental health in line with IPHS expectations.[5,6] During labor, midwives can extend continuous support to reduce the risk of birth-related trauma, educate women and the family on pain management techniques, and empower them to make informed choices about their birthing experience, thereby reducing fear and helplessness.[7] During the postpartum period, midwives can be involved in conducting early postpartum mental health assessments to detect depression/anxiety and facilitate mother–child bonding.[2] Midwives also are crucial in providing breastfeeding support, dealing with lactational problems, and motivating women to continue breastfeeding by enhancing their confidence.[8] These health workers can even carry out home visits to understand the mental well-being of mothers in their domiciliary settings.[2,3] Finally, midwives can take a call about the necessity of additional mental health care and refer mothers to specialists.[2] Regardless of the multiple ways in which midwives can improve the maternal mental health, we have not been successful in optimizing their potential.[1-4,9,10] This is mainly because of the shortage of trained midwives, especially in low-resource settings. To counter this problem, we must increase funding to recruit and train midwives in improving their competence level to discharge their roles.[2] It will be a good approach to train midwives in the domain of maternal mental health as a part of their curriculum and supplement it with periodic updates about best practices. In addition to midwives, the role of accredited social health activist (ASHA) workers in the provision of critical community-based support in impacting maternal health and well-being is vital. This was quite evident in a cross-sectional study done in Mysore, wherein more frequent visits by ASHA workers and the act of accompanying pregnant women during antenatal visits were linked with lower rates of antenatal anxiety.[9] In another single-arm pilot study done in India, the role of trained ASHA workers in delivering behavioral interventions resulted in a decrease in depressive symptoms among new mothers.[10] We must acknowledge that integrating midwife-led mental health screening alongside ASHA services can remarkably improve maternal mental health at the community level. Another option would be to use telemedicine and other mobile applications to assist them in discharging their roles efficiently and providing virtual consultations. The next concern is that maternal depression and anxiety are often stigmatized, due to which women are reluctant to seek help.[1] This will essentially require awareness campaigns to educate the masses to normalize discussions on mental health and motivate family members to extend support. The final concern is the limited access to mental health services, and this requires improving coordination between midwives and psychiatrists for delivering comprehensive care and exploring the option of telemedicine.[1] In conclusion, midwives play a vital role in providing holistic maternal mental health care and improving the well-being of mothers and newborns. The need of the hour is to overcome the existing challenges and take steps toward adopting a comprehensive approach and building a sustainable environment to ensure maternal mental well-being. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7128438907