Table 5.

Refined program theory after data collection and analysis

In a socio-cultural context based on gender norms during pregnancy where often the fetus takes priority over women’s needs from families and women’s themselves, and in a society where maternal mental health is normalised as not seen as pathological; and where there is low literacy of maternal mental health, women are often unconscious of the relevance of their own symptoms. Since mental illness language also operates as a taboo, the fear of discrimination and family shame influence self-referral, family referrals and maternal services referral pathways and overall access to health care for pregnant women. Because of the fear of disclosure, women often self-care using alternative therapies instead of seeking support from health services and engaging with healthcare institutions, which in turn offer insufficient coverage for maternal mental health. Health care providers’ focus when engaging with women’s in high-risk groups for MMH (miscarriage, high risk pregnancy, victim of violence, etc.) appears to be primarily on the fetus and women’s physical health outcomes with little attention to their emotional and psychological needs.