Table 1.

Recommendations for improving PMH care for women

System-level factor	Theme	Recommendation
Individual	Beliefs about health services Beliefs about HPs Beliefs about mental illness Fear of judgement Logistics	Improvement of mental health literacy for, women, family, friends and all who meet perinatal women*† Free access to healthcare‡ Woman-centred care§
Healthcare professional	Characteristics Time Training and knowledge	Attend training in communication skills** Attend training in PMH to reduce stigma** Attend training in cross-cultural presentations of mental health difficulties**
Interpersonal	Relationship and rapport Language barriers Shared decision making Communication Information provision	Healthcare professional to attend training in communication skills** Healthcare professional to attend training in PMH to reduce stigma** Healthcare professional to attend training in cross-cultural presentations of mental health difficulties¶** Provision of continuity of carer¶
Organisational (including ideal care)	Lack of services/overstretched services Characteristics of the service including continuity of carer Collaboration across services	Individualised and culturally appropriate care co-designed with women.¶ Improved funding for PMH services.‡ Improved guidance for implementing PMH care*††
Political	Immigration and economic status Healthcare costs	Equal rights to healthcare* Free healthcare* Laws to protect those with immigration status* International policy that supports the funding and implementation of personalised culturally appropriate care¶
Societal	Stigma Culture Maternal norms	International, culturally sensitive public mental health campaigns to increase knowledge about mental illness and improve attitudes about people with mental illness76 95–99¶ The continuation of international policies to promote gender equality, higher paid parental leave,65 increased opportunity for women in the labour force,66 67 100 the right to access contraception and abortion.68*

*Recommendations for public health services (eg, the NHS, the European Public Health Association, Public Health Association of Australia).

†Recommendations for third sector organisations (eg, the National Childbirth Trust, UK; The Babes Project, Australia).

‡Recommendation for the government.

§Recommendation for organisation.

¶Recommendations for healthcare professionals.

**Recommendations for implementing PMH assessment, care and treatment can be found in Webb et al. ³⁷

††Recommendations for academics/researchers.

HP, health professional; NHS, National Health Service; PMH, perinatal mental health.