Breaking Ground in Maternal Mental Health Care in Nepal

Globally, 10% of pregnant women and 13% of postpartum women experience mental health disorders, primarily depression. In Nepal, these rates are even higher — 15.6% during pregnancy and 19.8% postpartum — making maternal suicide one of the leading causes of death among women of reproductive age. Intentional self harm accounts for 6% of maternal deaths.

In a landmark initiative, the Paropakar Maternity and Women’s Hospital (PMWH), Nepal’s only government-run tertiary care maternity hospital, has launched its first-ever Mental Health Outpatient Unit.

Dr Pratistha Ghimire conducting a mental health education session, specifically designed for new mothers, at the Mental Health Outpatient Unit in Paropakar Maternity and Women’s Hospital. Photo credit: WHO/S.G.Amatya

This effort, supported by the Ministry of Health and Population (MoHP) and WHO Country Office for Nepal, aims to tackle maternal mental health challenges, reduce mortality associated with mental health conditions and improve the overall well-being of mothers and their babies.

The newly established outpatient unit, Nepal’s first dedicated maternal mental health facility, offers services to pregnant and postpartum women, addressing a longstanding gap in care. Recognizing the stigma and lack of resources surrounding mental health, the hospital began integrating mental health care into its maternity services earlier this year.

New mothers participate in a mental health education session led by a psychiatrist at the Mental Health Outpatient Unit in Paropakar Maternity and Women’s Hospital. As part of the sessions mothers are taught breathing techniques to manage high anxiety levels. Photo credit: WHO/S.G.Amatya

With WHO’s assistance, over 150 clinical staff members were trained to identify and manage maternal mental health conditions, including depression, anxiety and psychosis. Additionally, WHO supported to develop Standard Operating Procedures and educational materials and refurbish the facility.

As of mid-December 2024, the outpatient unit has provided consultations to over 200 pregnant and postpartum women.

Dr Pratistha Ghimire conducting a psychiatric consultation at the Mental Health Outpatient Unit in Paropakar Maternity and Women’s Hospital. Photo credit: WHO/S.G.Amatya

“Privacy is one of the most critical factors during counseling, and this dedicated space has been an invaluable resource in creating a safe environment for mothers to share their thoughts without judgement. Since the unit’s establishment, more mothers are aware of the support available, with many engaging with our informational materials. It’s also encouraging to see patients recommending our services, reflecting growing trust,” said Dr Pratistha Ghimire, who has been managing the ward as the appointed psychiatrist.

Dr Pratistha Ghimire conducting a psychiatric consultation at the Mental Health Outpatient Unit in Paropakar Maternity and Women’s Hospital. Photo credit: WHO/S.G.Amatya

Starting this month, Dr Ghimire and her team of nursing staff have also begun group mental health education sessions for hospitalized mothers. Around 120 women have already benefitted from these sessions which focus on:

• the importance of mental well-being during pregnancy and the postpartum period,
• recognizing symptoms of mental health challenges,
• identifying contributing factors,
• addressing mental health concerns through self-care, available mental health services, and access to suicide prevention resources, and
• practicing stress management techniques such as deep breathing

Honorable Minister of Health and Population Pradip Paudel providing his remarks at the launch of the Mental Health Outpatient Ward in Paropakar Maternity and Women’s Hospital. Photo credit: WHO Nepal/S.G.Amatya

Speaking at the unit’s inauguration on 6 October, the Honorable Minister of Health and Population Pradip Paudel emphasized the initiative’s transformative potential.

“While this may be a modest beginning, it marks a crucial step forward. We remain committed to deploying specialists, supporting capacity building of existing staff and collaborating with the Mental Hospital to strengthen these vital services,” he said.

Dr Shree Prasad Adhikari, Director of Paropakar Maternity and Women’s Hospital, providing his remarks at the launch programme. Photo credit: WHO Nepal/S.G.Amatya

Dr Shree Prasad Adhikari, Director of PMWH, echoed this commitment: “We have launched the service and are committed to ensuring its continuity. While challenges may arise, we are prepared to address most maternal mental health cases at our facility.”

Dr Allison Gocotano, Acting WHO Representative to Nepal, providing his remarks at the launch programme. Photo credit: WHO Nepal/S.G.Amatya

Dr Rajesh Pandav, WHO Representative to Nepal, highlighted its broader significance: “Suboptimal mental health during pregnancy and postpartum can have profound effects on families. Paropakar Maternity and Women’s Hospital’s efforts to integrate maternal mental health services and newborn screening into their care represent a commendable commitment to holistic healthcare.”

The initiative aligns with Nepal’s National Maternal Mental Health Programme Implementation Framework 2024, being developed by the Family Welfare Division (FWD) and WHO. This framework envisions a dual approach: establishing specialized mental health care at tertiary and general hospitals and integrating mental health services into primary health-care facilities.

By early 2025, the National Maternal Mental Health Programme will be piloted in two districts, with WHO providing technical assistance to scale up and strengthen services nationwide.

Paropakar Hospital’s Mental Health service stands out as a model for other hospitals, marking a pivotal step toward comprehensive maternal health in Nepal.