“They Don’t Ask If You’re Feeling Sad”: Perceptions Of Perinatal Mental Health And Barriers To Care In Benin City, Nigeria: A Constructivist Qualitative Study

Background Perinatal mental illness remains a critical yet chronically underaddressed public health challenge in low- and middle-income countries (LMICs). A 2023 JAMA Psychiatry meta-analysis of 589 studies demonstrated that 1 in 4 perinatal women in LMICs experience depression, with Nigeria among the most heavily burdened countries in sub-Saharan Africa. Despite this burden, evidence on how perinatal mental health is perceived, and on the barriers to care experienced at the facility level in Edo State, Nigeria, is virtually absent from the published literature. Objective To explore participant perceptions of perinatal mental health and the barriers to accessing or delivering perinatal mental health services among pregnant and postpartum women and healthcare providers at a public secondary health facility in Benin City, Edo State, Nigeria. Methods A constructivist qualitative study was conducted between January and March 2023. Two focus group discussions (FGDs) were held with 11 pregnant or postpartum women, and five individual key informant interviews (KIIs) were conducted with healthcare professionals. Data were collected using semi-structured guides, audiorecorded, transcribed verbatim, and analysed using Braun and Clarke’s (2006) six-step reflexive thematic analysis. The study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ). Results Six analytically distinct themes emerged, each articulated as an interpretive claim rather than a descriptive category: (1) lay illness frameworks and the limits of biomedical discourse; (2) social and economic determinants as primary causal explanations; (3) a self-reinforcing exclusion system composed of stigma, structural deficit, and economic deprivation; (4) the systematic silencing of psychological experience in antenatal encounters; (5) reactive care in a prevention vacuum; and (6) individualised provider initiative as a fragile and inequitable substitute for formal policy. The study reveals that barriers are not independent deterrents but constitute an interlocking system of exclusion, and that both groups shared a convergent readiness for integrated change. Conclusion This study demonstrates that the undertreatment of perinatal mental illness in this Nigerian facility reflects a compounding, mutually reinforcing system of cultural, structural, and economic exclusion. Addressing this requires not single-domain intervention but coordinated investment across provider training, service formalisation, community-based stigma reduction, and policy implementation aligned with Nigeria’s Mental Health Act (2023)