Bridging gaps in perinatal mental health services for socioeconomically disadvantaged women

Perinatal mental health (PMH) is a critical aspect of maternal and child wellbeing, yet many women, particularly those from socioeconomically disadvantaged backgrounds, face significant barriers in accessing timely and appropriate support. While national policies have aimed to improve PMH services, disparities in awareness, accessibility, and engagement persist. This study explored the challenges and facilitators to PMH service access in the North East and North Cumbria (NENC) region in England, with a focus on identifying actions to improve accessibility.

A two-phase qualitative study was conducted with 43 participants. Phase 1 involved semi-structured interviews with service providers from healthcare, voluntary, and community sectors who support women experiencing socioeconomic disadvantage (n = 23). Phase 2 comprised interviews with women from diverse, socioeconomically disadvantaged backgrounds who had experienced PMH challenges (n = 20). Data were analysed thematically and subsequently mapped to Levesque's conceptual framework of healthcare access, to examine individual and system-level factors influencing access to and engagement with PMH services.

Findings highlight multiple barriers to accessing PMH care, including the lack of routine mental health discussions in antenatal care, limited visibility of services, cultural stigma, and structural challenges such as service fragmentation and system distrust. Women from disadvantaged backgrounds often faced additional barriers due to digital exclusion, language difficulties, and lack of childcare. Participants identified six key actions to improve access: embedding PMH discussions into routine maternity care, enhancing service visibility through targeted outreach, expanding flexible service models, strengthening cultural competence, building trust through community-based models, and improving coordination and referral pathways between PMH support and existing healthcare and social services.

Addressing barriers to PMH access requires a multi-level approach that prioritises proactive service integration, workforce capacity building, and community-led engagement strategies. Strengthening service coordination and ensuring culturally responsive and flexible care models are critical steps toward improving equity in PMH support.