A mixed methods study of perinatal depressive and anxiety symptom prevalence and the role of traditional healing alongside clinical care in Southern Malawi

Background Perinatal mental health remains a critical yet insufficiently addressed component of perinatal care in sub-Saharan Africa. In Southern Malawi, where cultural beliefs and traditional healing practices profoundly shape health-seeking behaviour, the intersection of traditional and clinical care presents both challenges and opportunities for improving perinatal outcomes. Objective This study investigated the prevalence of perinatal depressive and anxiety symptoms and explored the role of traditional healing practices alongside clinical care in supporting perinatal mental health in Southern Malawi. Methods A convergent parallel mixed-methods design was employed. Quantitative data were collected from perinatal mothers (n = 330) using the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) scale. Qualitative data were gathered through semi-structured interviews with perinatal mothers (n = 10), healthcare providers (n = 10), and traditional healers (n = 10). Quantitative data were analysed with SPSS using descriptive statistics; qualitative data were analysed using Braun and Clarke’s reflexive thematic analysis framework. Results Approximately 35% of perinatal mothers screened positive for moderate-to-severe depressive symptoms on the PHQ-9 (mean score: 10.5, SD = 4.3), while 30% screened positive for moderate-to-severe anxiety symptoms on the GAD-7 (mean score: 9.2, SD = 3.9). These findings reflect validated self-reported screening results and should not be interpreted as clinical diagnoses. Sixty percent of mothers relied on traditional healing methods for perinatal mental health concerns, citing cultural familiarity and trust. Forty percent faced barriers to clinical care, including stigma and limited awareness of available services. Qualitative data revealed that traditional healers provided essential emotional support and community cohesion, while healthcare workers reported inadequate training in perinatal mental health assessment and intervention. Conclusion The integration of traditional and clinical practices represents a potentially feasible strategy for enhancing perinatal mental health outcomes in Southern Malawi. Findings highlight the urgent need for structured training of healthcare providers, community-sensitive interventions, and collaborative frameworks that leverage the complementary strengths of both healing systems. These insights are relevant to other low-resource settings across sub-Saharan Africa.