Advocating for better perinatal mental health around the globe
A WRH Research Group operates within our department's Global Health theme and is run by Dr. Nicole Votruba.
The SMARThealth Perinatal Mental Health project (PRAMH)
Why this project is important?
During pregnancy, and in the year after birth (i.e. the ‘perinatal period’), women can frequently experience poor mental health. This can range from mild time-limited psychological distress, to chronic and severely disabling conditions.
Globally, 1 in 5 women experience common mental health problems (CPMDs) during the perinatal phase. And the rates are even higher for women in low-to middle-income countries (LMICs). Yet, most women with CPMDs do not receive the care they need.
In rural India, women are more strongly affected by social determinants of CPMDs and intersecting issues, (such as gender inequity, poverty, domestic violence, caste, and stigma). However, little is known on how to best address these social determinants of perinatal mental health and how to integrate them within a mental health intervention in rural communities.
How the PRAMH study can help
The SMARThealth Perinatal Mental Health project (PRAMH) aims to develop a complex intervention to address the significant challenge of preventing, detecting and supporting women with CPMDs in rural India, by integrating mental health into maternity care and the communities.
PRAMH is led by PI Dr Nicole Votruba and funded by the Medical Research Council UK.
Video: Transforming perinatal mental health
Dr Nicole Votruba from the University of Oxford's Nuffield Department of Women's & Reproductive Health shares how the research is transforming perinatal mental health for women living in rural India through Innovative Interventions.
THE PRAMH STUDY PHASE 1
This intervention study targets mental health challenges encountered by women during pregnancy and the initial year post-birth in rural India. PRAMH is being conducted in three phases over 36 months (1 January 2022 – 31 December 2024):
- Phase 1: Formative Phase (January 2022 - December 2023)
- Phase 2: Intervention development and pilot testing (January 2022 – June 2025),
- Phase 3: Future trial - piloting, implementation and evaluation of the intervention (June 2025 – December 2028)
The PRAMH study started with the first formative phase, which comprised a situational analysis and intervention hypotheses development. The formative phase analysed the context of perinatal mental health in India, focussing on Haryana and Telangana, and existing barriers, facilitators and gaps. It used a scoping review, interviews, focus groups, priority setting exercises, hypotheses formation and implementation framework.
PRAMH Phase 1 was integrated into the broader SMARThealth Pregnancy study, a significant cluster-randomized controlled trial aimed at enhancing community-level identification, diagnosis, referral, and management of women with anemia, diabetes, and hypertension during pregnancy and postpartum. The study is led by Professor Jane Hirst at Imperial College London.
Importantly, if we want to achieve sustainable impact for perinatal mental health, we also need to address the determinants that contribute to it, such as poverty, gender inequity, nutrition, domestic violence, or stigma. This is what the PRAMH project aims to achieve. - Dr Nicole Votruba
THE PRAMH STUDY PHASE 2
PRAMH Phase 2 is funded by the Medical Research Council UK. It uses the SMARThealth approach to improve community level identification, diagnosis, referral and management of women who are pregnant (and one year after birth) who are at risk, or experience, mental health problems. The Systematic Medical Appraisal, Referral and Treatment program for CVD prevention and management (SMART Health), was developed by The George Institute for Global Health (TGI) and draws on innovative e- and mobile- health technologies to promote evidence-based, decision support systems.
PRAMH is working closely with all stakeholders. Especially women with experience of CPMDs, families, community health workers, communities, policymakers and non-governmental organisations.
UPDATE: How our research is going?
January 2024
We are excited to announce that Phase 2 of the PRAMH project is underway.
Funded by the MRC, PRAMH is building on the previous two years of formative research in India. We are now developing the intervention for testing of feasibility and acceptability with service users and health care workers.
We're now gearing up with our project partners, TGI India, to kickstart PRAMH.
Useful links
Global Health theme
Nuffield Department of Women's and Reproductive Health manages over 30 research groups that fall within either Global Health, Cancer, Maternal & Fetal Health; Big data; and Reproductive Medicine & Genetics.
The George Institute
The George Institute is a leading independent medical research institute established in India in 2007. They are part of a global family with major centres in Australia, China, India and the UK, and an international network of experts and collaborators.
Medical Research Council
MRC funds research at the forefront of science to prevent illness, develop therapies and improve human health.
Latest publications
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GestaltMatcher Database - A global reference for facial phenotypic variability in rare human diseases.
Journal article
Lesmann H. et al, (2024), medRxiv
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Establishing the QResearch Pregnancy Register in the QResearch® database: methods and cohort description
Preprint
Snelling AJHL. et al, (2024)
The research team
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Nicole Votruba
Senior Research Fellow in Implementation Science
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Mohammad Ali
MSc by Research Student
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Ankita Sharma
DPhil Student
How can you help?
You can support the ongoing work of the PRAMH project through donations, collaborations and research support. If you wish to support our work, please contact us or email Dr Nicole Votruba using the button below.