{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T16:50:40Z","timestamp":1793983840140,"version":"4.8.0"},"reference-count":81,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2024,11,29]],"date-time":"2024-11-29T00:00:00Z","timestamp":1732838400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"MRC\/ESRC\/DFID\/Wellcome Trust Health Systems Research Initiative","award":["MR\/T023481\/2"],"award-info":[{"award-number":["MR\/T023481\/2"]}]},{"name":"MRC\/ESRC\/DFID\/Wellcome Trust Health Systems Research Initiative","award":["MR\/T023481\/2"],"award-info":[{"award-number":["MR\/T023481\/2"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,2,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>In low- and middle-income countries, maternal mental health needs remain neglected, and common mental disorders during pregnancy and after birth are routinely associated with hormonal changes. The psycho-social and spiritual components of childbirth are often downplayed. A qualitative study was conducted as part of a wider realist evaluation on health systems responsiveness to examine the interrelationships between pregnant and postnatal women, their families, and their environment, and how these influence women\u2019s interactions with healthcare providers in Ghana. Data collection methods combined six qualitative interviews (n = 6) and 18 focus group discussions (n = 121) with pregnant and postnatal women, their relatives, and healthcare providers (midwives, community mental health nurses) at the primary healthcare level. Data analysis was based on the context\u2013mechanism\u2013outcome heuristic of realist evaluation methodology. A programme theory was developed and iteratively refined, drawing on Crowther\u2019s ecology of birth theory to unpack how context shapes women\u2019s interactions with public and alternative healthcare providers. We found that context interacts dynamically with embodiment, relationality, temporality, spatiality, and mystery of childbirth experiences, which in turn influence women\u2019s wellbeing in three primary areas. There is an intricate intersection of pregnancy with mental health impacting women\u2019s expectations of temporality, which does not always coincide with the timings provided by formal healthcare services. Societal deficiencies in social support structures for women facing economic challenges become particularly evident during the pregnancy and postnatal period, where women need heightened assistance. Socio-cultural beliefs associated with the mystery of childbirth, the supportive role of private providers and faith healing practices offered women a feeling of protection from uncertainty. Co-production of context-specific interventions, including the integration of maternal and mental health policies, with relevant stakeholders can help formal healthcare providers accommodate women\u2019s perspectives on spirituality and mental health, which can subsequently help to make health systems responsive to maternal mental health conditions.<\/jats:p>","DOI":"10.1093\/heapol\/czae116","type":"journal-article","created":{"date-parts":[[2024,11,29]],"date-time":"2024-11-29T12:04:23Z","timestamp":1732881863000},"page":"244-258","source":"Crossref","is-referenced-by-count":6,"title":["Conceptualizing maternal mental health in rural Ghana: a realist qualitative analysis"],"prefix":"10.1093","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-4256-3541","authenticated-orcid":false,"given":"Linda Lucy","family":"Yevoo","sequence":"first","affiliation":[{"name":"Research and Development Division, Dodowa Health Research Centre, Ghana Health Service , Dodowa-Accra, P.O. Box DD1,","place":["Ghana"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6277-3752","authenticated-orcid":false,"given":"Ana","family":"Manzano","sequence":"additional","affiliation":[{"name":"School of Sociology & Social Policy, University of Leeds , Leeds, Woodhouse Lane, LS2 9JT,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2323-4718","authenticated-orcid":false,"given":"Leveana","family":"Gyimah","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Pantang Hospital , Accra, P.O. Box PL81, Legon-Accra,","place":["Ghana"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4858-7344","authenticated-orcid":false,"given":"Sumit","family":"Kane","sequence":"additional","affiliation":[{"name":"Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne , Melbourne, Victoria 3010,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Awini","sequence":"additional","affiliation":[{"name":"Research and Development Division, Dodowa Health Research Centre, Ghana Health Service , Dodowa-Accra, P.O. Box DD1,","place":["Ghana"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Danso-Appiah","sequence":"additional","affiliation":[{"name":"Centre for Evidence Synthesis and Policy, School of Public Health, University of Ghana , Legon-Accra, P.O. Box LG 25,","place":["Ghana"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0193-5882","authenticated-orcid":false,"given":"Irene A","family":"Agyepong","sequence":"additional","affiliation":[{"name":"Research and Development Division, Dodowa Health Research Centre, Ghana Health Service , Dodowa-Accra, P.O. Box DD1,","place":["Ghana"]},{"name":"Faculty of Public Health, Ghana College of Physicians and Surgeons , Ministries-Accra, P.O. Box MB 429,","place":["Ghana"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2959-9187","authenticated-orcid":false,"given":"Tolib","family":"Mirzoev","sequence":"additional","affiliation":[{"name":"Department of Global Health and Development, London School of Hygiene and Tropical Medicine , London, Keppel Strees, WC1E 7HT,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,11,29]]},"reference":[{"key":"2025020615420953900_R1","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1177\/1359105307076240","article-title":"Health psychology in African settings: a cultural-psychological analysis","volume":"12","author":"Adams","year":"2007","journal-title":"J Health Psychol"},{"key":"2025020615420953900_R2","article-title":"A view from Accra City Hall: The \u201cokada\u201d phenomenon: to legalise or not to legalise?","author":"Adjei-Sowah","year":"2020"},{"key":"2025020615420953900_R3","doi-asserted-by":"publisher","first-page":"1779","DOI":"10.1002\/nop2.564","article-title":"Barriers to addressing mental health issues in childbearing women in Ghana","volume":"7","author":"Adjorlolo","year":"2020","journal-title":"Nursing Open"},{"key":"2025020615420953900_R4","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0280496","article-title":"Seeking and receiving help for mental health services among pregnant women in Ghana","volume":"18","author":"Adjorlolo","year":"2023","journal-title":"PLoS One"},{"key":"2025020615420953900_R5","doi-asserted-by":"publisher","first-page":"558","DOI":"10.3109\/09540261.2010.536149","article-title":"\u2018Whether you like it or not people with mental problems are going to go to them\u2019: a qualitative exploration into the widespread use of traditional and faith healers in the provision of mental health care in Ghana","volume":"22","author":"Ae-Ngibise","year":"2010","journal-title":"Int Rev Psychiatry"},{"key":"2025020615420953900_R6","article-title":"Common perinatal mental disorders: a study of correlates, quality of life and birth outcomes among pregnant women in Accra, Ghana","author":"Agyekum","year":"2022"},{"key":"2025020615420953900_R7","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0162305","article-title":"Prayer camps and biomedicalcare in Ghana: Is collaborationin mental health care possible?","volume":"11","author":"Arias","year":"2016","journal-title":"PLoS One"},{"key":"2025020615420953900_R8","doi-asserted-by":"publisher","first-page":"12","DOI":"10.35630\/2199-885X\/2020\/10\/3.2","article-title":"Primary health care in Ghana: the structure and functions in relation to preventing neglected tropical diseases","volume":"10","author":"Armah","year":"2020","journal-title":"Archiv Euromed"},{"key":"2025020615420953900_R9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12914-016-0096-9","article-title":"Does the operations of the National Health Insurance Scheme (NHIS) in Ghana align with the goals of Primary Health Care? Perspectives of key stakeholders in northern Ghana","volume":"16","author":"Awoonor-Williams","year":"2016","journal-title":"BMC Int Health Hum Rights"},{"key":"2025020615420953900_R10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12961-018-0382-1","article-title":"An integrative review of potential enablers and barriers to accessing mental health services in Ghana","volume":"16","author":"Badu","year":"2018","journal-title":"Health Res Policy Sys"},{"key":"2025020615420953900_R11","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00860-0","article-title":"Maternal depression in the 5 years after childbirth among women with and without perinatal depression: a population-based cohort study","volume":"386","author":"Baker","year":"2015","journal-title":"Lancet"},{"key":"2025020615420953900_R12","volume-title":"Mindfulness in the Birth Sphere: Practice for Pre-conception to the Critical 1000 Days and Beyond","author":"Balabanoff","year":"2022"},{"key":"2025020615420953900_R13","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1017\/S0033291714001044","article-title":"Perinatal depression and child development: exploring the economic consequences from a South London cohort","volume":"45","author":"Bauer","year":"2015","journal-title":"Psychological Med"},{"key":"2025020615420953900_R14","doi-asserted-by":"publisher","first-page":"582","DOI":"10.1016\/j.midw.2015.02.009","article-title":"Risk factors of transient and persistent anxiety during pregnancy","volume":"31","author":"Bayrampour","year":"2015","journal-title":"Midwifery"},{"key":"2025020615420953900_R15","volume-title":"A Realist Theory of Science","author":"Bhaskar","year":"1978"},{"key":"2025020615420953900_R16","article-title":"Factors militating against the academic growth of females in the Dangme-west district","author":"Boateng","year":"2009"},{"key":"2025020615420953900_R17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12889-021-11954-8","article-title":"Health care providers\u2019 perceptions of barriers to perinatal mental healthcare in South Africa","volume":"21","author":"Brown","year":"2021","journal-title":"BMC Public Health"},{"key":"2025020615420953900_R18","doi-asserted-by":"crossref","DOI":"10.4324\/9781315389646","volume-title":"Spirituality and Childbirth: Meaning and Care at the Start of Life","author":"Crowther","year":"2017","edition":"Ist edn"},{"key":"2025020615420953900_R19","author":"Crowther","year":"2017","journal-title":"Routledge"},{"key":"2025020615420953900_R20","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1016\/j.midw.2014.11.005","article-title":"Kairos time at the moment of birth","volume":"31","author":"Crowther","year":"2015","journal-title":"Midwifery"},{"key":"2025020615420953900_R21","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1080\/02646838.2019.1616680","article-title":"Association of psychosocial\u2013spiritual experiences around childbirth and subsequent perinatal mental health outcomes: an integrated review","volume":"38","author":"Crowther","year":"2020","journal-title":"J Reprod Infant Psychol"},{"key":"2025020615420953900_R22","doi-asserted-by":"publisher","DOI":"10.1186\/s13033-021-00466-y","article-title":"\u201cWe do not know how to screen and provide treatment\u201d: a qualitative study of barriers and enablers of implementing perinatal depression health services in Ethiopia","volume":"15","author":"Dadi","year":"2021","journal-title":"Int J Ment Health Syst"},{"key":"2025020615420953900_R23","doi-asserted-by":"publisher","first-page":"103","DOI":"10.24248\/eahrj.v2i2.572","article-title":"Perceptions of mental disorders and help-seeking behaviour for mental health care within the maasai community of northern tanzania: an exploratory qualitative study","volume":"2","author":"Daniel","year":"2018","journal-title":"East Afr Health Res J"},{"key":"2025020615420953900_R24","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-022-07678-z","article-title":"Mental health seeking behaviour during the perinatal period among rural in rural Bangladesh","volume":"22","author":"Dutta","year":"2022","journal-title":"BMC Health Service Res"},{"key":"2025020615420953900_R25","doi-asserted-by":"publisher","DOI":"10.3402\/qhw.v10.26226","article-title":"\u201cI can\u2019t stop worrying about everything\u201d-experiences of rural Bangladeshi women during the first postpartum months","volume":"10","author":"Edhborg","year":"2015","journal-title":"Int J Qual Stud Health Well-being"},{"key":"2025020615420953900_R26","doi-asserted-by":"publisher","first-page":"139","DOI":"10.2471\/BLT.11.091850","article-title":"Prevalence and determinants of common perinatal mental disorders in women in low-and lower-middle-income countries: a systematic review","volume":"90","author":"Fisher","year":"2012","journal-title":"Bull World Health Organ"},{"key":"2025020615420953900_R27","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1016\/S2215-0366(16)30284-X","article-title":"Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries","volume":"3","author":"Gelaye","year":"2016","journal-title":"Lancet Psychiatry"},{"key":"2025020615420953900_R28","article-title":"The health sector in Ghana: Facts and Figures facts in 2015","author":"Ghana Health Service","year":"2016"},{"key":"2025020615420953900_R29","article-title":"2010 Population and Housing Census. District Analytical Report-Shai-Osudoku District","author":"Ghana Statistical Service","year":"2014"},{"key":"2025020615420953900_R30","article-title":"Ghana Poverty Mapping Report","author":"Ghana Statistical Service","year":"2015"},{"key":"2025020615420953900_R31","article-title":"Ghana Maternal Health Survey 2017","author":"Ghana Statistical Service, Ghana Health Service & ICF","year":"2018"},{"key":"2025020615420953900_R32","article-title":"Ghana 2021 population and housing census: General Report Volume 3A","author":"Ghana Statistical Services","year":"2021"},{"key":"2025020615420953900_R33","doi-asserted-by":"publisher","first-page":"52","DOI":"10.4103\/IJPSYM.IJPSYM_96_19","article-title":"Psychiatric morbidity, cultural factors, and health-seeking behaviour in perinatal women: A cross-sectional study from a tertiary care centre of North India","volume":"42","author":"Goyal","year":"2020","journal-title":"Indian J Psychol Med"},{"key":"2025020615420953900_R34","doi-asserted-by":"publisher","first-page":"1853","DOI":"10.1007\/s10943-022-01643-0","article-title":"Seeking healing for a mental illness: understanding the care experiences of service users at a prayer camp in Ghana","volume":"62","author":"Gyimah","year":"2023","journal-title":"J Relig Health"},{"key":"2025020615420953900_R35","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1007\/s10597-013-9640-4","article-title":"Cultural variations in interpretation of postnatal illness: Jinn possession amongst Muslim communities","volume":"50","author":"Hanely","year":"2014","journal-title":"Community Ment Health J"},{"key":"2025020615420953900_R36","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-022-04642-x","article-title":"Perceptions and attitudes around perinatal mental health in Bangladesh, India and Pakistan: a systematic review of qualitative data","volume":"22","author":"Insan","year":"2022","journal-title":"BMC Pregnancy Childbirth"},{"key":"2025020615420953900_R37","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18115857","article-title":"Prevalence and correlates of prenatal depression, anxiety and suicidal behaviors in the Volta region of Ghana","volume":"18","author":"Kugbey","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"2025020615420953900_R38","doi-asserted-by":"publisher","DOI":"10.1017\/gmh.2020.21","article-title":"The treatment of mental illness in faith-based and traditional healing centres in Ghana: perspectives of service users and healers","volume":"7","author":"Lambert","year":"2020","journal-title":"Global Ment Health"},{"key":"2025020615420953900_R39","first-page":"657","article-title":"Addressing the unmet need for maternal mental health service in low and middle income countries","volume":"62","author":"Lasater","year":"2017","journal-title":"Am College Nurse-Midwives"},{"key":"2025020615420953900_R40","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1016\/j.whi.2011.03.005","article-title":"Perceptions of mental health services among low-income, perinatal African-American women","volume":"21","author":"Leis","year":"2011","journal-title":"Women\u2019s Health Issu"},{"key":"2025020615420953900_R41","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1590\/1982-0194201700007","article-title":"Depressive symptoms in pregnancy and associated factors: longitudinal study","volume":"30","author":"Lima","year":"2017","journal-title":"Acta Paul Enferm"},{"key":"2025020615420953900_R42","doi-asserted-by":"publisher","DOI":"10.1016\/j.worlddev.2023.106253","article-title":"Identifying deprived \u201cslum\u201d neighbourhoods in the Greater Accra Metropolitan Area of Ghana using census and remote sensing data","volume":"167","author":"Mactavish","year":"2023","journal-title":"World Dev"},{"key":"2025020615420953900_R43","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1177\/1356389016638615","article-title":"The craft of interviewing in realist evaluation","volume":"22","author":"Manzano","year":"2016","journal-title":"Evaluation"},{"key":"2025020615420953900_R44","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1089\/154099903765448880","article-title":"Depressive symptoms among pregnant women screened in obstetrics settings","volume":"12","author":"Marcus","year":"2003","journal-title":"J Women\u2019s Health"},{"key":"2025020615420953900_R45","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1080\/13645579.2023.2184920","article-title":"For Want of a Nail\u2019: developing a transparent approach to retroduction and early initial programme theory development in a realist evaluation of community end of life care services","volume":"27","author":"Mcewan","year":"2024","journal-title":"Int J Soc Res Methodol"},{"key":"2025020615420953900_R46","article-title":"The lived experience and meaning of pregnancy in women with mild to moderate depression","author":"Mckillop","year":"2009"},{"key":"2025020615420953900_R47","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-022-04589-z","article-title":"The silent burden: a landscape analysis of common perinatal mental disorders in low-and middle- income countries","volume":"22","author":"Mcnab","year":"2022","journal-title":"BMC Pregnancy Childbirth"},{"key":"2025020615420953900_R48","first-page":"219","article-title":"Emergence of squatter settlements in the greater accra metropolitan area in Ghana: An issue of state failure or survival?","volume":"7","author":"Mensah","year":"2021","journal-title":"Int J Geogr Reg Plann"},{"key":"2025020615420953900_R49","doi-asserted-by":"publisher","first-page":"1244","DOI":"10.1093\/heapol\/czaa076","article-title":"Tracing theories in realist evaluations of large-scale health programmes in low-and middle-income countries: experience from Nigeria","volume":"35","author":"Mirzoev","year":"2020","journal-title":"Health Policy Plann"},{"key":"2025020615420953900_R50","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0245755","article-title":"Realist evaluation to improve health systems responsiveness to neglected health needs of vulnerable groups in Ghana and Vietnam: study protocol","volume":"16","author":"Mirzoev","year":"2021","journal-title":"PLoS One"},{"key":"2025020615420953900_R51","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0245755","article-title":"Realist evaluation to improve health systems responsiveness to neglected health needs of vulnerable groups in Ghana and Vietnam: Study protocol","volume":"16","author":"Mirzoev","year":"2021","journal-title":"PLoS One"},{"key":"2025020615420953900_R52","first-page":"1021","article-title":"Son preference in India: implications for gender development","volume":"48","author":"Mitra","year":"2014","journal-title":"J Econ Issues"},{"key":"2025020615420953900_R53","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12913-016-1547-7","article-title":"Perinatal mental health care in a rural African district, Uganda: a qualitative study of barriers, facilitators and needs","volume":"16","author":"Nakku","year":"2016","journal-title":"BMC Health Serv Res"},{"key":"2025020615420953900_R54","article-title":"Health Department","author":"Ningo-Prampram District Assembly","year":"2023"},{"key":"2025020615420953900_R55","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1752-4458-5-5","article-title":"Stakeholder\u2019s perceptions of help-seeking behaviour among people with mental health problems in Uganda","volume":"5","author":"Nsereko","year":"2011","journal-title":"Int J Ment Health Syst"},{"key":"2025020615420953900_R56","doi-asserted-by":"publisher","first-page":"99","DOI":"10.4314\/ajpsy.v13i2.54353","article-title":"A situation analysis of mental health services and legislation in Ghana: challenges for transformation","volume":"13","author":"Ofori-Atta","year":"2010","journal-title":"Afr J Psychiatry"},{"key":"2025020615420953900_R57","doi-asserted-by":"publisher","DOI":"10.1093\/bmb\/ldr047","article-title":"Postnatal depression and its effects on child development: a review of evidence from low- and middle-income countries","volume":"101","author":"Parsons","year":"2012","journal-title":"Br Med Bul"},{"key":"2025020615420953900_R58","doi-asserted-by":"publisher","first-page":"820","DOI":"10.1136\/bmj.328.7443.820","article-title":"Effect of maternal mental health on infant growth in low income countries: new evidence from South Asia","volume":"328","author":"Patel","year":"2004","journal-title":"BMJ"},{"key":"2025020615420953900_R59","doi-asserted-by":"publisher","first-page":"295","DOI":"10.2307\/591728","article-title":"Theorizing the interview","volume":"47","author":"Pawson","year":"1996","journal-title":"Br J Sociol"},{"key":"2025020615420953900_R60","doi-asserted-by":"crossref","DOI":"10.4135\/9781849209120","volume-title":"Evidence-based Policy: A Realist Perspective","author":"Pawson","year":"2006"},{"key":"2025020615420953900_R61","article-title":"Realist synthesis-an introduction","volume":"2","author":"Pawson","year":"2004","journal-title":"ESRC Res Methods Prog"},{"key":"2025020615420953900_R62","article-title":"Four decades of community-based primary health care development in Ghana","volume":"15","author":"Phillips","year":"2020","journal-title":"Achiev Health for All"},{"key":"2025020615420953900_R63","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1111\/j.1748-0361.2009.00212.x","article-title":"A rural perspective on perinatal depression: prevalence, correlates, and implications for help-seeking among low-income women","volume":"25","author":"Price","year":"2009","journal-title":"J Rural Health"},{"key":"2025020615420953900_R64","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1177\/0020764006074527","article-title":"Beliefs and community responses to mental illnes in Ghana: the experiences of family carers","volume":"53","author":"Quinn","year":"2007","journal-title":"Int J Social Psychiatry"},{"key":"2025020615420953900_R65","doi-asserted-by":"publisher","DOI":"10.11604\/pamj.2016.25.236.10220","article-title":"Public health professionals\u2019 perceptions of mental health services in Equatorial Guinea, Central-West Africa","volume":"25","author":"Reuter","year":"2016","journal-title":"Pan Afr Med J"},{"key":"2025020615420953900_R66","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1016\/j.jad.2009.06.027","article-title":"Pre- and postnatal psychological wellbeing in Africa: a systematic review","volume":"123","author":"Sawyer","year":"2010","journal-title":"Affect Disord"},{"key":"2025020615420953900_R67","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4102\/phcfm.v9i1.1404","article-title":"Community perceptions of mental illness in rural Uganda: an analysis of existing challenges facing the Bwindi Mental Health Programme","volume":"9","author":"Shah","year":"2017","journal-title":"Afr J Primary Health Care Fam Med"},{"key":"2025020615420953900_R68","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1016\/j.genhosppsych.2015.10.005","article-title":"High-frequency intimate partner violence during pregnancy, postnatal depression and suicidal tendencies in Harare, Zimbabwe","volume":"38","author":"Shamu","year":"2016","journal-title":"Gen Hosp Psychiatry"},{"key":"2025020615420953900_R69","doi-asserted-by":"publisher","DOI":"10.1177\/1609406917741796","article-title":"Building realist program theory for large complex and messy interventions","volume":"16","author":"Shearn","year":"2017","journal-title":"Int J Qual Methods"},{"key":"2025020615420953900_R70","doi-asserted-by":"publisher","first-page":"1800","DOI":"10.1016\/S0140-6736(14)61277-0","article-title":"Effects of perinatal mental disorders on the fetus and child","volume":"384","author":"Stein","year":"2014","journal-title":"Lancet"},{"key":"2025020615420953900_R71","first-page":"17","volume-title":"The Sage Hand book of Qualitative Research in Psychology","author":"Terry","year":"2015"},{"key":"2025020615420953900_R72","doi-asserted-by":"publisher","first-page":"678","DOI":"10.3109\/01612840.2011.595534","article-title":"The experience of mental health service use for African American mothers and youth","volume":"32","author":"Thompson","year":"2011","journal-title":"Issues Ment Health Nurs"},{"key":"2025020615420953900_R73","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1207\/S15324796ABM2401_02","article-title":"Spirituality and health: what\u2019s the evidence and what\u2019s needed?","volume":"24","author":"Thoresen","year":"2002","journal-title":"Ann Behav Med"},{"key":"2025020615420953900_R74","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1111\/birt.12343","article-title":"Depression and anxiety during pregnancy: the influence of maternal characteristics","volume":"45","author":"Van De Loo","year":"2018","journal-title":"Birth"},{"key":"2025020615420953900_R75","doi-asserted-by":"publisher","first-page":"84","DOI":"10.3109\/0167482X.2014.947953","article-title":"Rates and risk factors associated with depressive symptoms during pregnancy and with postpartum onset","volume":"35","author":"Verreault","year":"2014","journal-title":"J Psychosomatic Obstet Gynecol"},{"key":"2025020615420953900_R76","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1007\/s11013-009-9159-x","article-title":"The temporality of \u201cchronic\u201d mental illness","volume":"34","author":"Von Peter","year":"2010","journal-title":"Cult Med Psychiatry"},{"key":"2025020615420953900_R77","doi-asserted-by":"publisher","DOI":"10.1186\/s12905-023-02444-7","article-title":"Late postpartum depression and associated factors: community-based cross-sectional study","volume":"23","author":"Wedajo","year":"2023","journal-title":"BMC Women\u2019s Health"},{"key":"2025020615420953900_R78","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jad.2014.04.009","article-title":"Prevalence and determinants of antenatal depression among pregnant women in a predominantly rural population in Ghana: the DON population-based study","volume":"165","author":"Weobong","year":"2014","journal-title":"J Affect Disord"},{"key":"2025020615420953900_R79","doi-asserted-by":"publisher","first-page":"72","DOI":"10.3167\/ca.2016.340108","article-title":"But isn\u2019t it the baby that decides when it will be born?\u2019: temporality and women\u2019s embodied experiences of giving birth","volume":"34","author":"White","year":"2016","journal-title":"Camb J Anthropol"},{"key":"2025020615420953900_R80","article-title":"World Mental Health Report: Transforming Mental Health for All","author":"World Health Organization","year":"2022"},{"key":"2025020615420953900_R81","first-page":"1","article-title":"RAMESES publication standards: realist syntheses","volume":"11","author":"Wong","year":"2013","journal-title":"BMC Med"}],"container-title":["Health Policy and Planning"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/heapol\/advance-article-pdf\/doi\/10.1093\/heapol\/czae116\/60898840\/czae116.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/heapol\/article-pdf\/40\/2\/244\/60898840\/czae116.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/heapol\/article-pdf\/40\/2\/244\/60898840\/czae116.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,6]],"date-time":"2025-02-06T15:42:32Z","timestamp":1738856552000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/heapol\/article\/40\/2\/244\/7912589"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,29]]},"references-count":81,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,11,29]]},"published-print":{"date-parts":[[2025,2,6]]}},"URL":"https:\/\/doi.org\/10.1093\/heapol\/czae116","relation":{},"ISSN":["1460-2237"],"issn-type":[{"value":"1460-2237","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,3]]},"published":{"date-parts":[[2024,11,29]]}}}