Study of THET funded mental health training on auxiliary nurse midwives in Nepal

What is it about?

Background and Objectives: Mental health is increasingly recognized as key global health problem. In many countries, including Nepal, it is difficult to talk about mental health due to the stigma associated with it. Hence a training programme was developed to train auxiliary nurse midwives (ANMs) in rural Nepal on issues related to maternal mental health. After completing the training programme a selection of ANMs were interviewed to establish their views on the training, its usefulness and ways to improve it. Methods: This qualitative study reports on the analysis of interviews conducted with ANMs who participated in the intervention. The interviews addressed issues associated with the training programme as well the current situation with regards to mental health issues in rural Nepali society. Results: The analysis suggested three key themes: (a) issues related to training; (b) societal attitudes; and (c) support for women. The ‘training’ theme describes the benefits and limitations of the training sessions. ‘Societal attitudes’ towards mental health talks mainly society’s regarding attitude towards mental health which is largely negative. ‘Support’ describes the positive behaviour and attitude towards pregnant women and new mothers in the society. Conclusion: The study indicates the need for more training for ANMs in order to identify and treat women suffering from mental ill health during pregnancy and in the post-partum period. There is still stigma around giving birth to a female child which can lead to mental problems. It is imperative to increase awareness and educate the general public regarding mental health illnesses especially involving family members of those who are affected.

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Why is it important?

Nepal as a low-income country, does have many midwives trained to international standards [ICM] at the same time mental health and mental illness are culturally difficult topics to discuss. The training had a positive impact on the ANMs (auxiliary nurse midwives), who expressed a need and desire for further and repeated training to improve their skills and competence. Moreover, they perceived the need for a referral pathway for the pregnant women and new mothers they may identify as in need of further mental health treatment and support. Presence of stigma against such group of women suffering from mental health problems still exists and self-stigma related to giving birth to a female child is again a grave problem in Nepalese society. They also supported the concept of anti-stigma activities which raise public awareness and knowledge of mental health issues. Mental health globally is more and more a health priority. Maternal mental health is a specific sub-field that is important for nurses and midwives to engage with. In countries where mental health is stigmatised and the role and position of women is lower than that of men, training ANMs cannot just be focused on the knowledge and skills needed to identify and treat (or refer) mental illness. We argue that it also needs skill to raise such sensitive issues with the wider society, especially the family of the affected woman.