Understanding Perinatal Mental Health and Its Psychosocial Determinants Trough Ukrainian Women's Experience

Background and Purpose: The experience of pregnancy, childbirth, and becoming a mother is a special time for women full of emotions and changes in daily life. Even though most women recognize it as a positive life event, some of them might experience perinatal mental health (PMH) problems including depression, anxiety, and severe mental disorders.

Studies about PMH in low- and middle-income countries (LMIC) mostly recruited participants from health care facilities. Meanwhile, the studies with samples recruited from the community-based settings are more representative because of limited access to perinatal health facilities in LMICs.

This paper contributes to the existing research data as few studies have reported on women’s perception of PMH based on their experience. Also, this might explain the limited knowledge and understanding of PMH and its psychosocial determinants in Ukraine.

Methods: Thirty Ukrainian pregnant women and mothers of 0–5-year-old children (aged 23-44) participated in five focus groups. All participants had children; two of them were pregnant; two women participated from a hospital where they were receiving treatment for complicated pregnancies. Women were recruited by nongovernmental organizations providing services to them. Focus groups records were transcribed verbatim in Ukrainian and translated into English. Data were analyzed following the thematic analysis.

The qualitative data generated for this paper are part of a larger mixed-methods study exploring perinatal mental health in Ukraine. Ethical approval was obtained from the University of Kent, School of Sociology, Social Policy, and Social Research Ethics Committee. All women participating in the study were informed about available service providers where they can get support for their mental health.

Findings: Data analysis reveals that women explain their PMH through postpartum depression, difficulties, uncertainty, disorders, and fatigue. While a few of them described it with support, happiness, and confidence. Additional five subthemes were explored in understanding PMH, including (1) a wide range of feelings and emotions, (2) life will never be the same, (3) a woman in good mental health can take care of herself, (4) low mental health affects your body, mind, and behavior.

Women who participated in focus groups stressed that mental health depends on several determinants related to baby, woman and her previous experience, family, and society. Key subthemes covering determinants of PMH includes: (1) proper information about the baby, (2) woman’s previous experience matter, (3) family support is desirable, (4) I don’t want to be judged – respect the boundaries, (5) mothers in white coats, (5) COVID-19 and lockdown. Findings indicate that guilt and shame caused by stereotypes and cultural background lie at the foundation of PMH problems.

Conclusion and Implications: Findings indicate that feelings of guilt, blame, and shame accompanying women in their perinatal journey are socio-culturally determined and lead to PMH problems, stigmatization, and resistance to seeking proper help. The importance of providing relevant information about PMH and women’s specific needs during the perinatal journey is well documented. Supporting women during the critical 1001 days requires an understanding of the many contributing factors to PMH.