Introducing a New Approach to Maternal Mental Health Care in Rwanda
At the fourth edition of the Africa Health Tech Summit, held at the Kigali Convention Centre from October 13 to 15, Maisha Mothers, a programme by Thalia Psychotherapy, introduced a groundbreaking proposal that could revolutionize maternal mental healthcare funding across Rwanda and the broader region. This initiative aims to create a public–private partnership (PPP) model that would use local pension funds to finance postpartum depression screening, therapy, and follow-up care.
Thalia Psychotherapy, a digital mental health startup based in Nairobi, Kenya, is working to integrate mental health services into primary healthcare systems across Africa. The organization is seeking to implement its model in Rwanda, where it plans to provide the necessary systems, trained staff, and digital tools, while the government would offer the enabling environment and integration into public clinics. Pension funds would supply the capital, which would be repaid through impact bonds and outcome-based agreements.
Understanding Postpartum Depression
According to clevelandclinic.org, postpartum depression is a type of depression that occurs after childbirth. It involves emotional fluctuations, frequent crying, fatigue, guilt, and anxiety. It affects up to 15% of women globally. Recognizing risk factors can help individuals and families prepare for and identify emotional changes after childbirth, allowing for earlier support and intervention when needed.
Some major risk factors include a personal or family history of depression, postpartum depression, or premenstrual dysphoric disorder (PMDD). Limited social support can also contribute to emotional difficulties. When new mothers feel isolated or lack help from friends, family, or community, it can intensify feelings of stress, loneliness, and overwhelm. Marital or relationship conflict may also increase emotional strain. Tension or instability in the partner relationship can add emotional pressure during an already challenging transition to parenthood.
Ambivalence about the pregnancy, whether due to unplanned circumstances or personal uncertainty, can also play a role. These mixed feelings can lead to guilt or anxiety after the baby arrives, making it harder to cope emotionally. Pregnancy complications, such as maternal health issues, a difficult labor and delivery, or a premature birth, can be physically and emotionally traumatic. These experiences may increase vulnerability to mood swings or depression.
Being under the age of 20 or being a single parent presents additional challenges, such as financial stress, lack of experience, or limited access to support systems, all of which can contribute to emotional strain. Caring for a baby with special needs or one who cries frequently can be exhausting and emotionally taxing. It can lead to sleep deprivation, frustration, and feelings of helplessness, all of which may intensify postpartum emotional struggles.
The Importance of Mental Health in Universal Health Coverage
“Universal health coverage means nothing if mental health is left behind. We want every mother to be asked how she’s feeling—not just if the baby is okay, but if she is okay too,” said Mercy Mwende, co-founder and Head of Operations at Thalia Psychotherapy.
Postpartum depression affects at least 1 in 5 mothers in Rwanda, according to recent studies. Yet services are scarce, and cultural stigma makes it even harder to ask for help.
Symptoms of Postpartum Depression
You may have postpartum depression if you experience feelings of sadness, worthlessness, hopelessness, or guilt, worrying excessively or feeling on edge, loss of interest in hobbies or things you once enjoyed, changes in appetite or not eating, loss of energy and motivation, trouble sleeping or wanting to sleep all the time, crying for no reason or excessively.
Other symptoms include difficulty thinking or focusing, thoughts of suicide or wishing you were dead, lack of interest in your baby or feeling anxious around your baby, as well as thoughts of hurting your baby or feeling like you don’t want your baby.
Impact on Babies
Research suggests that postpartum depression can affect babies. The mother may have trouble bonding with her baby and may not establish a connection with them. The child may have behavioral or learning problems, and the mother may skip appointments with the child’s pediatrician. The child may have feeding and sleeping issues and may be at higher risk for obesity or developmental disorders.
The mother may neglect their child’s care or not recognize when they are ill. The baby may have impaired social skills.
Steps to Take
“We can make changes by screening women during routine antenatal and postnatal visits, referring them to care early, and offering financial relief through discounted baby essentials like nappies and food,” explained Mercy Mwende.
A public–private partnership (PPP) model could reduce suicide, improve infant bonding, and lead to healthier families. The approach, presented during the summit’s track on Universal Health Coverage, was aligned with the broader goal of building resilient systems that are locally funded, locally managed, and scalable.
“If Rwanda adopts the PPP model, it would be among the first African countries to use pension-backed bonds to fund mental health services. Early discussions with government stakeholders are reportedly underway. In a country known for bold, systems-level reforms, Maisha Mothers may be Rwanda’s next big step,” she noted.
Seeking Help
Experts advise that you notify your healthcare provider right away if you have thoughts of harming yourself or your baby, recurrent thoughts of death or suicide, depressed mood for most of the day nearly every day for the last two weeks, feeling anxious, guilty, hopeless, scared, panicked or worthless, or loss of interest or pleasure in most activities nearly every day for the last two weeks.
There isn’t a specific test that diagnoses postpartum depression. Your healthcare provider will evaluate you at your postpartum visit. This visit may include discussing your health history, how you’ve felt since delivery, a physical exam, pelvic exam, and lab tests.
