Mental health specialists are calling for expanded psychiatric support within maternity services, warning that perinatal mental illness remains one of the most widespread yet under-recognized complications associated with pregnancy and childbirth.

The concerns come amid growing attention to gaps in screening, specialist access and treatment pathways for women experiencing psychiatric symptoms during pregnancy and the postnatal period.

Experts in the field say many women continue to face delayed diagnosis and inconsistent care despite national guidelines recommending routine psychosocial screening during pregnancy.Edna Lekgabe, a perinatal psychiatrist and co-founder of WARM Health Collective⁠, said the scale of the issue remains poorly understood relative to other pregnancy-related complications.

“Mental illness is the number one complication of pregnancy and the postnatal period,” Lekgabe wrote in an analysis examining failures within current maternity mental healthcare systems.Perinatal mental illness refers to psychiatric conditions occurring during pregnancy or within the first year following childbirth. According to specialists and public health agencies, up to one in five women experience a diagnosable mental health condition during that period.

Conditions can include depression, anxiety disorders, post-traumatic stress disorder related to traumatic births, obsessive-compulsive symptoms involving intrusive fears about infant harm, and, in rare cases, postpartum psychosis.Medical experts classify postpartum psychosis as a psychiatric emergency because of the heightened risk of self-harm, suicide or harm to the infant if untreated.

Lekgabe described a recurring clinical pattern in which women initially report symptoms during routine antenatal care but are reassured that emotional distress, insomnia or anxiety are normal features of pregnancy.

According to her account, many patients eventually reach specialist psychiatric care only after symptoms have significantly worsened.One illustrative example described a pregnant woman experiencing severe insomnia, hopelessness and suicidal thinking during the third trimester after earlier concerns were dismissed as routine pregnancy-related stress. The psychiatrist noted the case was fictionalized but based on recurring patterns observed across hundreds of patients.

The issue has gained increasing attention internationally as healthcare systems attempt to integrate mental health more fully into maternal care frameworks. Public health researchers have repeatedly linked untreated perinatal psychiatric illness to poorer outcomes for both mothers and infants, including impaired maternal functioning, disrupted bonding and elevated long-term developmental risks for children.

Despite those risks, specialists say mental healthcare remains inconsistently integrated into maternity services.In Australia, national guidelines recommend routine psychosocial screening during pregnancy and after childbirth, with many providers using the Edinburgh Postnatal Depression Scale, a standardized questionnaire designed to identify women at risk of depression and anxiety.

Lekgabe argued, however, that screening tools alone are insufficient without accessible treatment systems behind them.

“A screening tool is only as good as the pathway behind it,” she wrote.Mental health advocates and clinicians have raised concerns that women identified as high-risk frequently encounter lengthy delays for psychiatric assessment or psychological treatment. In Australia’s public healthcare system, wait times for mental health services can extend for months, particularly outside major metropolitan areas.

The psychiatrist pointed to disparities between urban and regional care availability, noting that specialist mother-baby psychiatric units and dedicated perinatal mental health services remain concentrated in larger cities. Women dependent on public healthcare or unable to afford private treatment often face more limited access.

Organizations including PANDA (Perinatal Anxiety & Depression Australia)⁠ and Centre of Perinatal Excellence (COPE)⁠ have sought to increase public awareness and improve access to support services across Australia.

Lekgabe also identified cultural expectations surrounding motherhood as a barrier to early intervention. According to her analysis, social narratives that idealize pregnancy and early parenthood can lead women to interpret severe psychological distress as personal inadequacy rather than a treatable medical condition.

The psychiatrist referenced the growing use of the term “matrescence,” which describes the emotional and identity transition associated with becoming a mother. While acknowledging the concept’s value in normalizing emotional adjustment, Lekgabe warned against conflating ordinary stress or disorientation with clinically significant psychiatric illness.

“There is a vast difference between the disorientation of new parenthood and a major depressive episode,” she wrote.Specialists in maternal mental health have increasingly emphasized that early symptoms are often minimized both by patients themselves and by healthcare systems focused primarily on physical outcomes such as blood pressure, fetal development and obstetric complications.

Lekgabe said many women internalize the belief that struggling emotionally reflects failure as a parent rather than evidence of illness requiring treatment.“I thought I was just a bad mother,” she said patients frequently tell her.The psychiatrist argued that statement reflects systemic diagnostic failure, particularly when women interact repeatedly with healthcare providers without receiving meaningful psychiatric evaluation or referral.

Mental health professionals have advocated for a more integrated care model in which psychiatric services are embedded directly within maternity clinics and obstetric care settings. Under such systems, psychiatrists, psychologists and mental health nurses would work alongside obstetricians and midwives rather than operating through separate referral systems.

Lekgabe identified three priorities for reform: integrating mental healthcare into maternity services, expanding the number of trained perinatal psychiatrists and improving public understanding of perinatal psychiatric illness.Australia currently has relatively few psychiatrists specializing in perinatal and reproductive mental health compared with overall demand, according to clinicians in the field.

Training opportunities within the subspecialty also remain limited.The psychiatrist stressed that perinatal mental illness is highly treatable when recognized early and managed appropriately. Treatment options can include psychotherapy, medication considered safe during pregnancy, supported birth planning and coordinated postpartum care.

The fictionalized patient example described in Lekgabe’s analysis ultimately improved after receiving psychiatric medication, psychological treatment and coordinated maternity support tailored to her mental health needs.However, the psychiatrist argued that many women never receive that level of coordinated intervention.

“Not every woman who walks the path Mia walked finds that team,” Lekgabe wrote.

Mental health organizations globally have increasingly highlighted maternal suicide and severe psychiatric illness as major public health concerns linked to inadequate perinatal care systems. Several countries, including the United Kingdom and Australia, have expanded investment in specialized maternal mental health programs over the past decade, though advocates argue access remains uneven.

Lekgabe said greater public literacy around perinatal psychiatric illness could help reduce stigma and encourage earlier intervention among expectant parents and their families.

“We need expectant parents and their families to understand that perinatal mental illness is common, treatable and not a reflection of character,” she wrote.

At Jemo Health Centre on the outskirts of Addis Ababa, health worker Tewodros Tibebu says social stigma and limited awareness continue to delay access to comprehensive abortion care, despite Ethiopia legalizing broad abortion services more than two decades ago.

Tibebu, who has worked in comprehensive abortion care for four years, is among only three trained providers currently delivering the service at the facility. According to his account, many patients arrive after significant delays, often seeking help only after complications emerge from procedures carried out elsewhere.

“The biggest challenge is stigma,” Tibebu said in a feature published by the World Health Organization on May 5. “Many women are afraid someone will recognize them when they come here. Others do not even know the service exists.”Comprehensive abortion care has reportedly been available at Jemo Health Centre for nearly a decade.

However, Tibebu said access barriers remain widespread, particularly for women seeking confidential and medically supervised treatment.According to his account, many patients first visit private clinics where procedures may be carried out by practitioners lacking formal training in abortion care. By the time some women reach public facilities such as Jemo, they are already suffering from infections or sepsis that could have been prevented through earlier medical intervention.

Ethiopia expanded legal access to abortion in 2005 under revised provisions that allowed the procedure under broader circumstances than previously permitted. Despite the legal framework, health care providers and reproductive health organizations have continued to report uneven access across regions, driven by social stigma, provider shortages and gaps in public awareness.

Tibebu said the stigma surrounding abortion services affects providers as well as patients. “Some coworkers oppose the comprehensive abortion care department,” he said. “Some people in my community do not know what I do.”The social pressures attached to abortion care are a recurring issue in reproductive health systems globally, particularly in countries where legal reforms have outpaced shifts in public attitudes or health infrastructure.

Health workers often face professional isolation, ethical scrutiny and personal criticism while providing services that remain politically and culturally contested.Tibebu said professional training helped him better understand both the clinical and ethical dimensions of abortion care. “Before, it was difficult,” he said.

“After I received specific training, I understood the work differently and could provide the care women need.”The experiences described by Tibebu formed part of a broader announcement by the Human Reproduction Programme, known as HRP, regarding a new international training initiative on comprehensive abortion care.

The programme, launched through the WHO Academy platform, combines four separate learning modules focused on medical abortion, surgical abortion, post-abortion care and human rights integration in comprehensive abortion care. According to HRP, the courses are designed to provide modular and interactive learning environments that simulate real clinical decision-making scenarios encountered by frontline health workers.

WHO said the training initiative is intended to strengthen evidence-based care and improve consistency in abortion services across different health systems. The programme also places emphasis on privacy, non-discrimination and accountability within clinical practice.

The human rights integration component links medical treatment with broader principles related to patient dignity and access to care, according to WHO. Together, the courses are intended to establish a standardized framework for providers working in comprehensive abortion care settings.The launch reflects continuing international efforts by global health organizations to reduce preventable maternal complications associated with unsafe abortion procedures.

WHO has repeatedly stated in policy guidance that access to trained providers, accurate information and safe clinical environments are central to reducing maternal morbidity and mortality.At facilities such as Jemo Health Centre, providers say the gap between legal availability and practical access remains significant.

Tibebu noted that many patients learn about the service only through informal networks and word-of-mouth referrals rather than official health campaigns or referrals from primary care systems.That reliance on informal communication channels, he said, contributes to delays that can worsen medical outcomes.

The WHO feature also highlighted the operational pressures facing providers in facilities with limited staffing. With only three trained workers handling abortion care services at Jemo, workloads remain concentrated among a small number of clinicians.

Training programmes such as the one launched by HRP are intended in part to address those shortages by expanding provider knowledge and strengthening clinical capacity. WHO said the interactive nature of the courses allows health workers to engage with practical decision points similar to those encountered during patient care.

The organization has increasingly used digital and modular learning systems to expand access to specialized medical training, particularly in lower-resource health settings where formal clinical education opportunities may be limited.Tibebu said the training reinforced his understanding of abortion care not only as a technical medical service but also as direct patient support during periods of vulnerability and medical risk.

“People may not understand what we do,” he said. “But when you think about the woman in front of you, the decision is clear. You are helping someone.”WHO separately announced a webinar linked to the comprehensive abortion care learning programme scheduled for April 28, 2026.

The organization also published updated abortion-related fact sheets in December 2025 as part of its broader reproductive health guidance materials.The HRP programme operates jointly under the United Nations Development Programme, the United Nations Population Fund, the United Nations Children’s Fund, WHO and the World Bank, focusing on research, policy development and training in human reproduction and reproductive health services.