Mental health in the perinatal period: bridging the gaps in care, evidence, and policy

OBJECTIVES: Perinatal mental health has long been acknowledged as fundamental to the well-being of mothers and infants, yet the recognition of disorders such as postpartum depression, anxiety, and - far less commonly - psychosis still lags behind clinical need. Even where validated screening tools exist, detection remains inconsistent, and many women navigate pregnancy and the postpartum period with symptoms that go unspoken or unnoticed. In some high-income settings, suicide has emerged as a leading contributor to maternal mortality, a reminder that the health consequences of these conditions extend beyond emotional distress and reflect deeper systemic failings. METHODS: In this opinion paper, we draw on recent developments across epidemiology, neuroscience, psychology, and health-system research to consider why perinatal mental health continues to occupy an uncertain place in routine care. Fragmented service pathways, variability in provider training, and uneven adoption of evidence-supported interventions create persistent gaps between what is known and what is practiced. We highlight examples - stepped-care models, collaborative teams, and digital supports - that illustrate how more coherent systems could function, even if implementation remains uneven. RESULTS: Although a wide range of effective interventions exists, their practical reach is limited by sociocultural norms, structural constraints, and resource imbalances. Understanding these influences together - not in isolation - helps clarify why progress has been slower than the evidence might suggest. CONCLUSIONS: Meaningful improvement will depend on strengthening cross-sector integration, expanding scalable technologies, and tailoring policy responses to local realities. Sustained investment in perinatal mental health offers long-term benefits for families and communities and should be regarded as central to modern maternal care.