Table 1 Recommendations to address barriers to early identification of CPMDs

Structural

• Provide guidelines for health professionals providing maternity care services on best practices for routine screening of CPMDs in maternity care settings.

• Expand MOMConnect mobile app mental health messaging supported by the National Department of Health [48].

• Continue expansion of psychosocial support via NurseConnect mobile health application supported by National Department of Health [49].

• Identify lessons learned from the CLEVER Maternity Care intervention, which aims to increase respectful, quality obstetric care [50].

Sociocultural

• Increase awareness and availability of support from doulas: trained professionals who provide culturally competent, continuous physical, emotional and informational support to mothers before, during and shortly after childbirth.

• Train perinatal care professionals in cross-cultural care and humility.

Organisational

• Designate clinic days devoted to mental health where dedicated perinatal mental health counselors are available to reduce stigma and avoid wait times typical of referral processes.

• Add required continuing education centred on social determinants of mental health and intersecting risk factors.

• Review how and when mental health is promoted and offered in health professions curriculum.

• Address issues underlying the chronic nursing shortage in South Africa and review approaches to task-sharing nurses’ roles with community health workers

Individual

• Improve mental health training to recognise underlying determinants of health that shape physical and mental health outcomes, especially for antenatal and postpartum women.

• Increase Employee Wellness opportunities for health professionals to seek counseling, support and opportunities to debrief.

• Expand peer mentorship programs, like The Mentor Mother programme, where peers are available to empower other women during pregnancy and breastfeeding, particularly for women without partners [51].