Perinatal Psychological Distress in Malawi and the Impact of Group Antenatal Care

Background: Perinatal mental health has become a priority issue globally due to its relationship with adverse maternal and infant outcomes. One intervention that has shown preliminary evidence for impacting perinatal mental health is group antenatal care (ANC). This model allows for 8-12 pregnant individuals to attend ANC in a group facilitated by one midwife and one community volunteer. Each session includes a health assessment and interactive learning sessions. Though not a psychological intervention, this model of care strives to improve patient empowerment, build trusting patient-provider relationships, and increase connectedness among women of similar gestational ages. The impact of group ANC on mental health has been studied in HICs, but this relationship has been underexplored in LMICs. This work used data from a randomized-controlled trial in Blantyre District, Malawi to address this gap. Methods: Eligible participants (n=1886) across seven clinics were randomly assigned to group ANC or individual ANC. Data was collected through a survey at four time points: mid-pregnancy, late-pregnancy, 2-months postpartum, and 6-months postpartum. Data on psychological distress was collected at all four time points using the 20-item Self-Reporting Questionnaire (SRQ-20), which has been translated into the local language, Chichewa, and validated among pregnant women in Malawi. All data analysis was done using SAS software. Results: Participants who were HIV positive, who had experienced food insecurity in the last year, who were not in a relationship, who attended a rural/peri-urban clinic, and who were younger age experienced higher distress during mid-pregnancy compared to those who were HIV negative, who had not experienced food insecurity, who were in a relationship, who attended an urban clinic, and who were older age, respectively. Individuals who were primiparous, who had experienced food insecurity, and who were not in a relationship experienced increased odds of depression symptoms during mid-pregnancy, while those with higher levels of education experienced decreased odds. Individuals participating in group ANC experienced a greater decrease in psychological distress between mid- and late-pregnancy compared to those in individual ANC. Longitudinal analysis showed that each week, individuals in group ANC saw a slight but significantly greater decrease in psychological distress compared to those in individual care.