Mothers Time: Community-Based Mental Health

How might we provide care to postpartum women suffering from stress, anxiety, and depression, and unmet family planning and reproductive health needs?

Country: Ethiopia

Health Areas: Maternal Health, Family Planning/Reproductive Health, Mental Health

Context and Insights

Many postpartum women face unmet family planning (FP) needs and experience depression and anxiety; 33% of mothers in low- and middle-income countries (LMICs) experience common mental disorders (CMD), and 50% of women who are one year postpartum have unmet FP needs. In Ethiopia, young postpartum mothers (aged 16–24) share these needs, yet few interventions address both areas. FP programs rarely integrate cognitive behavioral therapy (CBT) into their activities, even though research shows it helps with depression and anxiety in many settings, prompting a need to create opportunities to test its effectiveness in this context.

The Solution

The project designed the four-session Mothers Time activity to be delivered by health extension workers (HEWs), Ethiopia’s community health workers. HEWs used Mother’s Time to engage postpartum women experiencing mild to moderate symptoms of depression or anxiety and unmet need for FP support and services. Mothers Time teaches CBT concepts by using stories of a mother, Birhan, who struggles with anxious and sad thoughts. Each story provokes discussion on “healthy” and “unhelpful” thinking around a specific area important for FP, such as planning for the future or couple communication. The intervention also includes pictorial worksheets for the mothers to complete between group sessions, which prompt them to thumbmark their moods each day and take time for activities that make them feel good (such as visiting friends or resting).

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“After the session, I become able to talk to my spouse and now I know about family planning services. The contraceptive I chose is the one that will last for 3 months…I choose this method because I have used it before and it was good for me.”

“When we feel bad, we have to open up for friends and family. […] Miss Birhan was just a character to show us our struggles, thoughts and emotions in our life.”

“The way I feel, and the peace of my mind has changed a lot. I am putting aside destructive thoughts. I am giving myself time. I am minimizing my stress level.”

The Innovation

CBT is an evidence-based practice that effectively reduces mental health symptom severity and changes health behavior. Programs using CBT across a range of low-resource settings have simultaneously addressed mental health and other health issues, though no studies have explored the application of CBT within FP settings. Members of the psychology field often consider CBT the “gold standard” for therapy, and CBT can work for people experiencing a broad range of depressive and anxiety symptoms. However, despite their promise, reproductive health practitioners often do not understand CBT practices well. Furthermore, evidence of the application and effectiveness of CBT-based approaches in LMICs is limited.

The Evidence

The intervention group had significantly greater reductions in depression from baseline to follow-up and significantly greater reductions in anxiety from baseline to endline and from baseline to follow-up. However, while symptoms of anxiety were lower at both endline and follow-up than at baseline, symptoms did not continue to improve from endline to follow-up.

Uptake of modern FP use increased significantly in the intervention group, and the intervention group showed a significantly greater increase in communicating with one’s partner about pregnancy prevention and reproductive agency immediately following the intervention. Furthermore, this study is one of the first to demonstrate that FP services, which consider postpartum mental health, can support women in fulfilling their reproductive intentions.

Scale-Up & Adapt

Evidence shows that integrating mental health care into routine sexual and reproductive health services can be effective in LMICs, though supportive policies are often lacking. Integrating CBT into FP and maternal health services offers a sustainable approach to supporting postpartum women. Further exploration of digital adaptations of these interventions could further expand reach, especially in urban areas.

Who can I speak with about this solution?

Jessica Moore, Senior Advisor, Camber Collective

Leah Mallett, Associate, Camber Collective

Tesera Bitew, Associate Professor, Mental Health Epidemiology, Injibara University

Lynn Van Lith, Technical Director, Breakthrough ACTION

Zoe Hendrickson, Associate Professor of Public Health Practice, University of Pittsburgh

Other resources

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