Healthcare Professionals’ Assessment of Pregnant Women’s Psychological Health in Indonesia: A Qualitative Case Study

Introduction: Poor psychological health during pregnancy can contribute to adverse outcomes on mother’s health, her newborn baby and family when it is left unrecognised and untreated. Assessment for psychological health during pregnancy is recommended by the World Health Organisation (WHO) and has been part in maternity care in several Higher Income Countries (HICs). The psychological health assessment during pregnancy could provide opportunity for pregnant women to receive appropriate care and treatment if needed. However, such assessment is underdeveloped in Lower-Middle Income Countries (LMICs). This research is the first study in Indonesia which illuminate pregnant women’s psychological health assessment from the perspective of healthcare professionals and women in Indonesian primary healthcare settings during a routine antenatal booking visit. Method: A qualitative case study approach with 26 in-depth interviews were conducted involving 12 midwives, 2 General Practitioners (GPs), a psychologist and 11 pregnant women across two study sites. Interview data were analysed using a thematic analysis. Interpretation was strengthened by non-participant observations of practice, field-notes and documentary analysis. Findings: Pregnant women expected healthcare professionals to pay more attention to their psychological health during the routine antenatal visit. Women’s health and their social factors such as marriage life, financial situation and their relationship and support from spouse and families had critical roles in shaping their psychological health during the pregnancy period. Women were concerned about the lack of privacy and midwives’ attitudes during the assessment, which hindered disclosure of their personal feelings. Healthcare professionals (HPs) were aware that pregnant women’s psychological health need to be assessed appropriately. However, HPs felt ill-prepared to perform a sensitive and thorough enquiry related to pregnant women’s psychological health. A biopsychosocial approach in health and illness is used to interpret the findings. Conclusion and recommendation: This study have led to a model development which incorporates psychological, sociocultural and religious values that influence pregnant women’s views on their life difficulties and psychological health. A strong influence of Indonesian sociocultural and religious context also influenced healthcare professionals’ routine practice in psychological health assessment during antenatal visit. Healthcare professionals’ sociocultural awareness in perinatal mental health should be improved to empower women, their families and communities to optimise women’s pregnancy journey. Healthcare professionals need to be equipped with adequate training to improve their mental health literacy. Evidence based healthcare pathways need to be developed within the Indonesian health system to meet the women’s psychological needs during their perinatal period.