The postpartum period brings profound changes to a woman’s physical, mental, and reproductive health, yet maternal mental health has long been neglected as an integral part of postpartum care. Postpartum depression (PPD) affects 24% of women in low-and-middle-income countries (LMICs), nearly one out of every five women. The effects of this systemic neglect can, in turn, harm women’s reproductive health, the wellbeing of newborns, and family dynamics.
Unmet family planning (FP) needs and unintended pregnancy can increase a woman’s risk of PPD. At the same time, PPD can make it harder for women to make and act on reproductive and FP decisions, creating a harmful cycle in which mental and reproductive health challenges reinforce one another. Despite this, few interventions offer an integrated approach and even fewer are designed to work within the resource constraints of low-income settings.
Breakthrough ACTION (BA), the Johns Hopkins Center for Communication Programs’ largest initiative recognized this need for a more integrated approach to maternal mental health and family planning. BA engaged Camber and a multidisciplinary team of researchers and Ethiopian mental health specialists to develop a solution that supports new mothers experiencing depression and anxiety while also empowering them to make informed family planning decisions that reflect their needs and preferences.
In 2021, Camber, Breakthrough ACTION, and Ethiopian Mental Health Specialists built and tested Mother’s Time, a simplified, story-based cognitive behavioral therapy (CBT) intervention. The program was designed for Ethiopia’s community health workers (CHWs) to use with young postpartum women facing mild to moderate depression or anxiety and unmet FP needs.
An early pilot confirmed the approach was both feasible and welcomed by mothers and health workers alike. Camber then refined the intervention through a series of workshops with mothers and local stakeholders. These sessions refined the stories, reduced stigmatizing language and strengthened family planning education.
In 2023, the intervention was refined and tested at larger scale through a rigorous randomized control trial. Trained CHWs led women through four small-group sessions over the course of a month, using relatable stories, peer discussion, and practical exercises to help participants recognize and reframe negative thought patterns, strengthen coping strategies, and navigate family planning decisions. Between sessions, women used simple exercises to track their moods and identify activities that supported their well-being.
The Mother’s Time intervention successfully demonstrated that postpartum mental health and family-planning can be addressed together, and that integrated support can be delivered through the community health systems women already rely on.
Through Camber’s engagement, women who participated in Mother’s Time experienced meaningful, sustained improvements in both mental health and family planning outcomes:
Just as important, the intervention showed the potential to bring mental health support closer to women in their communities. Mother’s Time trained Ethiopia’s Health Extension Workers to lead the sessions through existing community health infrastructure. The results offer a promising model for expanding access by integrating mental health into family planning and maternal health services, while supporting women to strengthen their social connections, communicate with partners, and make informed decisions about their reproductive health.
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