Why Mental Health Must Be a Central Pillar of Maternal Health Programs and Policies
Dinys Luciano
Introduction
Despite notable progress in reducing maternal mortality across Latin America and the Caribbean (LAC) over the past three decades, a critical and often overlooked dimension remains: maternal mental health. Conditions such as anxiety, depression, trauma from gender-based violence, food insecurity, and psychosocial stressors are significant yet underrecognized contributors to maternal morbidity and mortality. A growing body of evidence highlights the potential of systemic responses that prioritize maternal mental well-being alongside physical health and survival. These responses, if implemented effectively, could bring about a significant positive change in the region.
1. Mental Health: A Core Determinant of Maternal Risk
Maternal mental health is a major, underdiagnosed determinant of maternal outcomes. Perinatal depression and psychological trauma are widespread but seldom addressed through routine maternal care. Health systems in the region often compartmentalize psychological support and obstetric services, resulting in gaps in care. Only a few countries have adopted formal protocols for perinatal mental health screening or intervention, leaving a substantial proportion of at-risk mothers without support.
2. Intersecting Inequities, Psychosocial Harm, and Systemic Risk
Specific populations in the region—particularly Indigenous and Afro-descendant women—face intersecting structural inequities that intensify both psychological stress and poor maternal outcomes. These disparities persist even when controlling for income, education, or urban-rural residence.[1] Migrant and refugee women, especially those fleeing violence or economic collapse, face heightened risks of perinatal depression due to migration trauma.[2]
Climate-related displacement, underfunded health infrastructure, and HIV-related stigma further undermine maternal mental health. In Brazil and the Caribbean, mothers of children born with congenital Zika syndrome have reported prolonged psychological distress. [3]Research by Tavares et al. (2024) reveals that nearly half of these women suffer from untreated anxiety or depression.[4],[5]
3. The Triple Burden of Violence, Mental Illness, and Maternal Risk
Gender-based violence (GBV), including intimate partner violence (IPV), remains a potent driver of adverse maternal and mental health outcomes. IPV during pregnancy is associated with a cascade of adverse effects: unintended pregnancies, prenatal depression, insufficient antenatal care, spontaneous abortion, hypertension, and even maternal mortality.[6] Children born under such conditions face greater risks of low birth weight, neonatal complications, and long-term developmental deficits. Forced pregnancies, often due to sexual violence, subject young girls to compounded trauma, violating both their mental health and reproductive rights.[7]
Despite the high prevalence, few LAC countries include GBV (IPV, sexual violence by someone other than a partner, other types of GBV) screening protocols in their maternal health services.
4. Food Insecurity: A Toxic Stressor for Expectant Mothers
Food insecurity (FI) significantly exacerbates both emotional distress and physical risk during pregnancy.[8] A 2024 systematic review by Basurko et al. found a high prevalence of FI among pregnant women in low-income settings throughout the region, linking it to preeclampsia, low birth weight, and perinatal depression. Chronic hunger functions as a “toxic stressor” that amplifies vulnerability throughout the reproductive cycle.[9]
5. Policy Recommendations for Transformative Action
To effectively integrate maternal mental health into national and regional strategies, the following actions are recommended:
a. Systematic Integration: Embed perinatal mental health screening into antenatal, intrapartum, and postnatal care.
b. Capacity Building: Train frontline health workers in trauma-informed, gender-sensitive, and culturally appropriate mental health interventions.
c. Social Protection: Expand food security and conditional cash transfer programs to alleviate stress during pregnancy.
d. Legal Protections and Autonomy: Enforce and expand policies that uphold reproductive autonomy, especially in cases involving violence, underage pregnancy, or displacement.
Conclusion
Maternal mental health must be reframed as a cornerstone of maternal health policy across Latin America and the Caribbean. Structural inequities—spanning ethnicity, gender, socioeconomic status, nutrition, and migration—shape not only health service delivery but also the lived mental health experiences of pregnant and postpartum women. Without urgent, integrated, and intersectional strategies, preventable maternal deaths and psychosocial harms will persist. An inclusive and trauma-informed policy framework is imperative to advance maternal dignity, health equity, and long-term societal resilience.
How to Cite:
Luciano, D. (2025). Beyond survival: Unveiling the mental health crisis behind maternal outcomes in Latin America and the Caribbean. Integrativa Online DVCN.
[1] AJ, Victora CG. Ethnic group inequalities in coverage with reproductive, maternal, and child health interventions: cross-sectional analyses of national surveys in 16 Latin American and Caribbean countries. Lancet Glob Health. 2018 Aug;6(8):e902-e913. doi: 10.1016/S2214-109X(18)30300-0. PMID: 30012271; PMCID: PMC6057134.
[2] Aranda, Z., Bonz, A., Armijos, A., et al. (2025). Mental distress among migrant and refugee women in Ecuador and Panama: A qualitative study. International Journal for Equity in Health
[3] Flores, E. C., Flores, A. F., Abarca-Diaz, B., et al. (2025). Fostering leadership and gender equality in climate action among underserved, rural, and Indigenous women: A qualitative exploration. The Lancet Regional Health – Americas.
[4] Lowe, M., Jacobs, C., & Oladele, R. (2025). Inequities in reproductive health: HIV and STIs. Frontiers in Reproductive Health.
[5] Tavares, C. S. S., Marques, R. S., & Martins-Filho, P. R. (2024). High prevalence of common mental disorders in mothers of children with congenital Zika syndrome. EXCLI Journal, 23, 1020–1032. https://doi.org/10.17179/excli2024-1020
[6] Han A, Stewart DE. Maternal and fetal outcomes of intimate partner violence associated with pregnancy in the Latin American and Caribbean region. Int J Gynaecol Obstet. 2014 Jan;124(1):6–11. doi: 10.1016/j.ijgo.2013.06.037. Epub 2013 Oct 5. PMID: 24182684.
[7] Casas, X. (2019). They are girls, not mothers: The violence of forcing motherhood on young girls in Latin America. Health and Human Rights, 21(2), 157-168.
[8] Pérez-Escamilla, R. (2025). Food insecurity during pregnancy: Where do we go from here? The Journal of Nutrition, 155(1), 1–4. https://doi.org/10.1016/j.jn.2024.12.005
[9] Basurko, C., Savy, M., Galindo, M. S., Gatti, C., & Osei, L. (2024). Prevalence of food insecurity during pregnancy in Latin American and Caribbean countries: A systematic review. The Journal of Obstetrics and Gynaecology Research, 50(2). https://doi.org/10.1016/j.jogoh.2024.01.021