Community Health Interventions through Musical Engagement for Perinatal Mental Health

Mental health problems during pregnancy and after birth (the perinatal period) are of global concern. They affect up to 1 in 5 women worldwide and can be twice as frequent in low- and middle-income countries (LMICs) (Fisher et al., 2012). Maternal stress, anxiety and depression pose health risks, not only to the mother but also to her developing infant, including increased risk of premature birth and emotional, behavioural and cognitive problems later in life (Stein et al., 2014). In many LMICs mental health services are minimal, services for perinatal mental health are non-existent and high levels of stigma impede recognition and prevent help-seeking behaviour.

In my PhD work, I developed and piloted a low-cost, non-stigmatizing and culturally-embedded intervention: CHIME (Community Health Intervention through Music Engagement), to support the mental health of pregnant women in The Gambia. There is good evidence from high-income countries that engaging with music can have substantial health benefits including improving symptoms of anxiety and depression and sense of belonging (Williams et al., 2018). My PhD work explored how these findings could be applied in a low-income context, The Gambia, where existing musical practices around health provided a strong foundation. We co-developed a brief intervention where community-based women's groups led 6 music sessions with local pregnant women. We evaluated the intervention in terms of its feasibility, acceptability and potential benefit for anxiety and depression, finding positive outcomes in all areas. While the potential for women's groups to improve maternal and newborn health in low-resource contexts is well recognized, the use of participatory music for this purpose is novel and potentially highly impactful, addressing a gap in recommendations for mental health interventions in LMICs (Rahman et al., 2013; World Health Organization, 2008).

In the fellowship year I will conduct a scoping study to ascertain whether the intervention we developed to support perinatal mental health can be generalized to two other LMICs: Ethiopia and India. The questions I will ask include: What existing community music practices/women's groups already exist? How might they intersect with maternal mental health care? In what form might participatory music making be implemented in care? To do this I will synthesize any existing literature in this area, interview experts in psychiatry, health systems and ethnomusicology within these two settings, and perform a qualitative analysis leading to a journal article presenting the challenges, considerations and necessary adaptations that would be required for community music interventions for perinatal mental health to be implemented in LMICs.

I will also examine what principles can be drawn from research in these LMICs (including The Gambia) to inform UK-based initiatives around the use of community and cultural assets to support women's perinatal mental health. For this, I will bring together stakeholders from the academic, charity and public sectors through a symposium held at Goldsmiths. The discussion and collaborations emerging from this symposium will provide a unique and multi-disciplinary perspective on how models of community mental health care in LMICs can contribute to frameworks of relevance to high-income contexts, which are under increasing strain.

I will also consolidate and extend the impact of my PhD by visiting The Gambia to help launch a Gambian Alliance for Maternal Mental Health. This will mobilize key stakeholders to work in a coordinated way to disseminate key messages around perinatal mental health and to lobby the government to include this as a priority in future policies. Finally, I will build upon my existing publications and academic presentations by producing two academic papers based on my PhD research and present this research at two conferences (one national, one international).