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The Carter Center and Partners Work with Liberian Government to Improve Maternal Mental Health

September 2021

Nearly all women are at risk of developing mental health disorders during pregnancy and following delivery. Common perinatal mental disorders, like depression and anxiety, pose a significant threat to the well-being of pregnant women, new moms, and their infants. Yet, a significant number of these women in low- and middle-income countries do not receive the mental health care they need. When women’s mental health needs are addressed, both maternal and child health outcomes improve.

Maternal mortality in Liberia is among the highest in the world, with 1,072 maternal deaths for every 100,000 births. Infant and early childhood mortality is also staggeringly high. A key factor in sub-optimal maternal and child health outcomes is poor maternal mental health. It is imperative that women be given the mental health care needed during this critical time in their lives and their children’s lives.

The Carter Center’s Mental Health Program in Liberia works to improve maternal and child health care across the country. The program has had a decade-long presence in Liberia, supporting the government of Liberia to develop and institutionalize the national mental health policy, develop and pass mental health legislation, and bolster the workforce for mental health care across the country. The Center has also contributed significantly to curtailing stigma by building a vibrant consumers movement whose advocacy led to the first national mental health budget.

  • Photo of Liberian women wearing masks sitting at conference tables arranged in a U-shaped formation.

    Pregnant women and mothers meet in Monrovia to validate the Thinking Health Program for managing perinatal depression. (Photo: The Carter Center)

Since 2010, The Carter Center has trained 302 mental health clinicians, including 140 child and adolescent mental health clinicians. Additionally, in tandem with its implementing partners — the Liberia Center for Outcomes Research in Mental Health, the Liberian government, and generous donors — the Carter Center’s Mental Health Program is adapting a data-driven intervention known as the Thinking Healthy program.

Developed in Pakistan and endorsed by the World Health Organization, Thinking Healthy is a manualized psychological intervention consisting of 16 sessions that begin during pregnancy and continue after delivery. The program is being adapted for use in the Liberian context and, ultimately, training will be embedded into pre-service and in-service health force curricula and become a standard component of maternal and child health care service delivery. Grand Challenges Canada, Grand Challenges Africa, and Open Society Foundations have joined forces to support the adaptation, implementation, and scaling of the Thinking Healthy program in Liberia.

The government of Liberia, through the Family Health Division and the Mental Health Unit, embraced the program and coordinated with The Carter Center and the Liberia Board of Nursing and Midwifery on the selection and training of 17 Liberian health workers as master trainers to be responsible for implementing the program. The master training was conducted by Dr. Najia Atif, co-developer of the Thinking Healthy program. The project is expected to train over 500 registered nurses, midwives, and mental health clinicians by 2023, to be available to pregnant women across the country.

The Open Society Foundations provided a $100,000 grant to The Carter Center in early 2020. Open Society strives to address gaps in the field of caregiver mental health in the context of early child development by assisting organizations that contribute to the process of integrating caregiver mental health into the global field of early child development.

Additionally, Grand Challenges Canada (GCC) and Grand Challenges Africa (GCA) provided grant support to the Liberia Center for Outcomes Research in Mental Health, a partner who will be key in measuring impact and sustaining the initiative. The Grand Challenges global mental health initiatives focus on high-impact innovations that improve treatments, increase access to care, and bolster the world’s health workforce.

Financial support from Open Society Foundations and GCC allows The Carter Center and the Liberia Center for Outcomes Research in Mental Health to leverage the commitment of the Liberian government to improve perinatal outcomes, provide technical and advisory support for training in perinatal mental health, scale up the data-driven intervention, and measure the impact of the intervention in Liberia. This collective effort to implement the Thinking Healthy program is a critical step toward strengthening the health system to address a Liberian health priority. Lessons learned will be applied to other low- and middle-income countries also working to improve maternal and child health.

Bolstering services that address maternal mental health may prove critical in addressing Liberia’s maternal child morbidity and mortality. Along with Open Society Foundations, GCC, GCA, and other new partners, the Carter Center’s Mental Health Program will continue to shape behavioral health systems globally. Together, we can improve the health and well-being of women and future generations.

The Carter Center is funded by the Grand Challenges Africa program, African Academy of Sciences (AAS). This work is further supported through the Alliance for Accelerating Excellence in Science in Africa platform, the AAS and the African Union Development Agency initiative. Grand Challenges Africa is supported by the Bill & Melinda Gates Foundation, Swedish International Development Cooperation Agency, and German Federal Ministry of Education and Research. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The content of this publication is solely the responsibility of the authors and does not necessarily represent the official views of the funders.

This project is supported by Grand Challenges Canada, funded by the National Institute for Health Research using UK Aid from the U.K. government.


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