Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)


Global Governance and Human Security

First Advisor

Courtenay Sprague

Second Advisor

Ana C. Lindsay

Third Advisor

Gillian MacNaughton


Perinatal mental disorders are a significant, global public health concern that disproportionately and negatively impact women in low- and middle-income countries (LMICs), including South Africa. The prevalence of common perinatal mood and anxiety disorders (CPMDs) is three times higher for South African women than women in high-income countries. These disorders remain a silent burden and a complex health, social, and policy problem. This dissertation research investigates barriers in policy responses, specifically access and identification, related to perinatal mental disorders in South Africa, applying governance and human rights perspectives to shed light on the problem, published as three papers. In the first paper, a right to mental health framework was paired with qualitative methods to investigate barriers to accessing perinatal mental health care in South Africa, and this research established the importance of addressing the mental health needs of health providers both as rights-holders themselves and to mitigate the impacts that their mental health care needs have on the quality of care they provide to perinatal women. In the second paper, qualitative research investigated providers’ perceptions of barriers to early identification and screening of CPMDs and identified how different types of barriers operate at different levels, including: structural; socio-cultural; organizational; and individual level. Drawing findings from the previous two papers on the fragmented perinatal mental health policy landscape, the third paper sought to explore key informant insights into policy responses and governance challenges. In its entirety, this dissertation research found that perinatal mental health is a largely preventable and treatable, yet overwhelming public health concern in South Africa; one insufficiently prioritized in policy responses. This dissertation research suggests an approach to reimagining the landscape of perinatal mental health policy responses and barriers to addressing CPMDs through applying governance and human rights perspectives. Across these papers, findings revealed the ad hoc and fragmented approach to perinatal mental health policy implementation, shaped by various actors at different levels, from local clinics to global institutions. This research offers recommendations for research, policy and practice to advance perinatal mental health in South Africa that may be relevant for other settings.


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