Midwives’ Perceived Social Pressures in Addressing Prenatal Maternal Mental Health: A Qualitative Study in the Ashanti Region of Ghana

Abstract

Introduction: Prenatal maternal mental health (PMMH) is a critical yet under-addressed aspect of antenatal care in Ghana. Midwives, as care providers, often face social0020and institutional pressures when navigating mental health concerns, especially in contexts where stigma, silence, and role ambiguity persist. Objective: Guided by the Theory of Planned Behaviour, this study explored the social pressures midwives experience and the motivations that shape their responses to PMMH, highlighting the emotional and relational tensions they encounter. Methods: Nineteen midwives working in diverse settings were engaged in semi-structured interviews from April 10 to April 22, 2025, which were analysed by thematic analysis. Results: Three major themes and one minor theme emerged: Perceived Pregnant Women’s Expectations; Perceived Supervisors’ and Institutional Expectations; Midwives’ Responses to Expectations and Midwives as Cultural Gatekeepers. Findings highlight the complex circumstances midwives navigate to provide PMMH care. Conclusion: Midwives are influenced by a blend of relational sensitivity, contextual judgment, and personal ethics. Strengthening PMMH integration requires clear role definitions, audited screening metrics, stigma-free communication toolkits, facility-tiered support, and recognition of midwives’ emotional contributions to PMMH care.