Identifying Barriers to Detection of Perinatal Depression: A Qualitative Study of Midwives’ Perspectives in South African Primary Care

Introduction Perinatal depression is a significant global health challenge that has immense implications for maternal and child wellbeing. Despite the increasing awareness of mental health challenges surrounding pregnancy and childbirth, perinatal depression remains underdiagnosed and undertreated in many low- and middle-income countries. This study provides unique insights by applying the Theory for Health Promotion in Nursing (THPN) to comprehend midwives’ perspectives on identifying and overcoming barriers to early identification of perinatal depression within a low-resource setting. Methods A qualitative study, theoretically grounded by the THPN, which considers that health promotion happens through interactive processes between midwife and their environment, positioning them as therapeutic agents to promote maternal health, particularly in the external environment of midwife-led obstetric units. As such, data were collected from seventeen (17) midwives between April and May 2024 using semi-structured face-to-face interviews, and thereafter, analysed using thematic analysis. Results Three overarching themes emerged, namely, (1) sociocultural barriers, (2) healthcare system and provider-related barriers, and (3) proposed solutions to address barriers. A complex interplay of factors such as cultural stigma, inconsistent screening practices, and sub-optimal working conditions was identified to influence early detection. Discussion The findings reveal that the barriers to detecting perinatal depression are embedded in cultural, systemic, and provider interactions with the women. Through the lens of the THPN framework, the study uncovers how midwives as therapeutic agents not only encounter resource constraints, but stigma and systemic barriers hinder their ability towards early detection. There is a need for multi-level interventions to address the identified barriers to improve perinatal mental health care. Conclusion Both sociocultural and health care system barriers exist in the South African maternal health care settings. The results of this study suggest the need for integration of mental health services into maternal healthcare to enhance management of women who are at risk of developing perinatal depression.