Research Articles A qualitativ A qualitative study e e study exploring the role of c xploring the role of communit ommunity health w y health work orkers in ers in promo promoting maternal postpartum mental health in Nicaragua ting maternal postpartum mental health in Nicaragua Anna Steeves-Reece * , Nicole Yuan † , Linda Green ‡ Keywords: maternal health, nicaragua, global health https://doi.org/10.29392/joghr.3.e2019089 Journal of Global Health Reports Vol. 3, 2019 Back Background ground The objectives of this qualitative study were to examine perceptions of maternal postpartum distress among community health workers and mothers living in rural Nicaragua; and to identify the role of community health workers (CHWs) in implementing locally relevant strategies to reduce maternal postpartum distress. Methods Methods The study was conducted between May and July 2015 with a small, rural community in the central highlands of Nicaragua. Primary data sources included two focus group interviews with 10 community health workers, and individual interviews with 12 mothers who had delivered their most recent child within roughly the previous year. Results esults Both community health workers and mothers identifed maternal distress following childbirth as a community concern. Identifed factors that contributed to postpartum distress were lack of people to confde in, experiences of intimate partner violence, and exposure to household poverty. Participants felt that community health workers might play an important role in ameliorating postpartum distress by providing social support to mothers and engaging intimate partners to offer assistance. However, results indicated that any community health worker interventions must also prioritize the well-being of CHWs. Conclusions onclusions Community health workers have the potential to address gaps in postpartum services for mothers living in rural Nicaraguan communities. However, such programs must consider the well-being of CHWs, and should be developed along with interventions and policies that address major social factors, such as poverty and interpersonal violence, to promote the mental health of mothers in rural Nicaragua. Postpartum mental health must be considered when pro- moting the well-being of mothers and children around the globe. It is well documented that some women experience distress following childbirth in the forms of postpartum de- pression, anxiety, or stress. 1 , 2 In addition to a mother’s suffering, postpartum distress may contribute to negative consequences for children. Postpartum depression is asso- ciated with impaired bonding between mothers and infants, which can lead to physical, emotional, and social problems. 3 - 4 Postpartum distress, including postpartum depression, is particularly concerning for low- and lower-middle-income countries (LMICs). A systematic review of perinatal mood disorders in LMICs found the prevalence of mood disorders after childbirth was 19.8% for the countries reviewed. 5 A systematic review of high-income countries documented lower prevalence rates, with major and minor depression after childbirth ranging from 6.5% to 12.9%. 6 Postpartum distress in LMICs is attributed to multiple factors, including poverty, intimate partner violence, inadequate practical or emotional support, and adverse life events. 5 Challenges of postpartum distress in LMICs may be ex- acerbated by few or inaccessible mental health services. 7 To address this problem, some mental health interventions have integrated community health workers (CHWs). 8 CHWs are often described as trusted community members who serve as liaisons between formal health services and com- munities. 9 Various global health systems have incorporated CHWs to prevent and/or mitigate maternal mental illnesses, including those in South Africa, Jamaica, Zimbabwe, and Pakistan. 10 - 11 Latin American countries have used CHWs for decades 12 , but little is known about how CHWs may pro- mote maternal mental health in the region. Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, USA University of Arizona, Mel & Enid Zuckerman School of Public Health, Tucson, Arizona, USA University of Arizona, School of Anthropology, Tucson, Arizona, USA * † ‡ Steeves-Reece A, Yuan N, Green L. A qualitative study exploring the role of community health workers in promoting maternal postpartum mental health in Nicaragua. Journal of Global Health Reports. 2019;3:e2019089. doi:10.29392/joghr.3.e2019089