BACKGROUND: Perinatal depression affects up to 30% of women in Kenya, yet many contributing factors remain poorly understood. We explored mental health problems, social needs, and associated risk factors among women ante- and postnatally in Kajiado County, southern Kenya, from the perspectives of women and health-care workers (HCWs). METHODS: We conducted a qualitative study based on dual-perspective focus group interviews with mothers (ante- and postnatal) and HCWs in five health-care facilities (two urban and three rural) across Kajiado County (5-11 March 2025). Interviews were recorded, transcribed verbatim, translated into English when needed, and analysed using qualitative content analysis with an explorative and inductive approach. The text was divided into meaning units and manually coded in Atlas.ti ( https://atlasti.com ). Themes, subthemes and categories were articulated following a stepwise, iterative and reflexive process of abstraction and interpretation. RESULTS: Across five sites, 51 mothers and 39 HCWs participated. Three themes were developed relating to stress, distress and affecting mental wellbeing, (a) Women's autonomy and self-determination - mothers lacked control over resources or decision-making, while shouldering most household responsibilities, and HCWs highlighted the vulnerability of girls subjected to early marriage and female genital mutilation, often unprepared for motherhood, (b) Responsive maternal and mental health care - distance, costs, and low expectations limited access, while women feared traumatic births, miscarriage, and caesarean sections, and (c) Community knowledge and acceptance of mental health problems - mental health problems were often seen as irrationality or spiritual possession, delaying care. Stigma was particularly associated with caesarean sections, mental health problems, and HIV. CONCLUSIONS: Our findings describe how maternal mental health is closely intertwined with gender norms and prevailing perceptions of mental illness including stigma. Expanding maternal mental health services may be important but it is unlikely to be sufficient in isolation. Sustainable change may depend on the promotion of women's rights, increased mental health literacy at the community level, and the engagement of men. In addition, fear of traumatic birth and stigma associated with CS may need to be addressed not only at the individual level but also within the broader community context.
Kamau et al. (Tue,) studied this question.