Introduction As countries across Asia and the Pacific strive to build healthier, more resilient, and more inclusive societies, maternal mental health remains an overlooked development issue. Although countries have made significant progress in reducing maternal and newborn mortality, survival alone is no longer enough. Supporting mothers’ mental wellbeing during pregnancy and after childbirth contributes to healthier families, stronger communities, and sustainable economic growth, and is important for improving women's health outcomes. Mental health conditions during pregnancy and the year following childbirth are among the most common complications of pregnancy. The World Health Organization (WHO) estimates that around one in five women in low- and middle-income countries experience a common mental health condition during the perinatal period, most commonly depression or anxiety. Yet many women across Asia and the Pacific are never diagnosed or receive appropriate care. Why Maternal Mental Health Matters The first 1,000 days—from pregnancy until a child's second birthday—represent one of the most critical periods for lifelong development. A mother's mental wellbeing influences her own health, pregnancy outcomes, infant development, and the wellbeing of the entire household. Maternal depression can also negatively affect mothers’ emotional well-being, daily function, quality of life, and ability to provide responsive care to their children. Untreated maternal depression has been associated with preterm birth, low birth weight, reduced breastfeeding, poorer caregiver-infant attachment, and adverse cognitive, emotional, and behavioral outcomes in children. These disadvantages can persist throughout childhood and adolescence, affecting educational achievement, employment opportunities, and long-term economic productivity. Because maternal mental health affects outcomes across the life course, it is relevant to broader development priorities, including health, gender equality, education, decent work, and reduced inequalities. Why Health Systems Alone are Not Enough Pregnancy does not occur in isolation from the realities of daily life. Across Asia and the Pacific, many women balance unpaid caregiving responsibilities with paid employment while facing financial insecurity, gender inequality, gender-based violence, humanitarian emergencies, migration, and increasingly, climate-related disasters. These social determinants frequently shape mental wellbeing alongside the biological changes associated with pregnancy and childbirth. The COVID-19 pandemic illustrated this clearly. A global systematic review found significantly higher rates of depression and anxiety among pregnant and postpartum women compared with pre-pandemic estimates. A systematic review identified a connection between climate change, including extreme heat and air pollution, and maternal mental health. Women face greater risks of anxiety, depression, and post-traumatic stress disorders after extreme weather events—further exacerbating existing gender inequalities. These experiences show that mental health cannot be addressed through specialist care alone. It also requires stronger primary healthcare, social protection, gender-responsive policies, and community-based services. How Countries are Integrating Maternal Mental Health into Health Systems Experiences from Thailand, Indonesia, Nepal, and India illustrate how maternal mental health can be integrated into existing health and development agendas. Although the approaches differ, they highlight practical ways of embedding maternal mental health through routine care, community-based services, and early childhood development programs. Thailand shows how advocacy can be strengthened by pairing lived experience with economic evidence. The Perinatal Alliance for Mental Health Foundation worked with researchers and partners to estimate that untreated perinatal mental health conditions cost the country an estimated $2 billion for each annual birth cohort, with most losses occurring outside the health sector through reduced productivity, poorer educational outcomes, and broader social impacts. This has helped shift conversations beyond clinical care while building national momentum around screening, referral pathways, professional training, and stronger policy coordination. In Indonesia, initiatives focused on bringing mental health closer to where mothers already receive care. The BUNDA program, led by the Foundation of Mother and Child Health (FMCH) Indonesia, integrates psychosocial support into routine maternal and child health services delivered by midwives and community health workers. Recognizing that maternal wellbeing is shaped by the wider family, the program also actively involves husbands and caregivers while strengthening local ownership through community engagement. Rather than asking women to seek separate mental health services, support is embedded within trusted community platforms, making care more accessible and culturally acceptable. Nepal demonstrates the value of strengthening capacity for frontline health workers to provide mental health services to women. Through Possible Nepal, community health workers deliver the WHO Thinking Healthy Program during routine antenatal and postnatal home visits. Women receive screening, counseling, follow-up, and referral without needing to navigate separate mental health services. The experience also highlights the importance of supervision, confidentiality, and supporting the wellbeing of community health workers. In India's Meghalaya State, maternal mental health has been embedded into broader investments in early childhood development. Supported by the Asian Development Bank, the program integrates maternal mental health screening into routine antenatal care and home-based childcare services while linking women with specialist care when needed. It also combines maternal mental health with nutrition, positive parenting, early childhood learning, father engagement, home visits, and investments in community childcare centers and frontline workers. What Governments Can Build On The experiences highlighted in the article point to five actions governments and decisionmakers can take to strengthen maternal mental health: Embed maternal mental health services within health systems strengthening. Integrate screening, referral pathways, and psychosocial support into maternal, newborn, and child health, universal health coverage, and primary healthcare investments. Invest in the frontline workforce. Equip midwives, nurses, community health workers, and village health volunteers with practical skills to recognize and respond to common mental health conditions, as they are often the first—and sometimes only—point of contact for pregnant and postpartum women. Strengthen community-based care. Build on trusted community platforms (e.g., Indonesia's Posyandu, Nepal's female community health volunteers, and Thailand's village health volunteers) that already reach millions of families to improve access to support while reducing stigma. Harness digital innovation. Use telehealth, digital screening tools, and mobile platforms to complement face-to-face care, particularly in geographically dispersed settings, to ensure these remain equitable, person-centered, and integrated into routine health services. Strengthen data and implementation research. Improve measurement, implementation research, and economic evaluation to help governments build stronger investment cases and monitor progress over time. Resources E. Banzon and V. Yiengprugsawan. 2024. Key Strategies to Improve Mental Health Support Across Asia and the Pacific. Asian Development Blog. Maternal Mental Health Leadership Alliance. 2026. Maternal Mental Health Conditions and Statistics: An Overview. 27 March. United for Global Mental Health. Maternal Mental Health. A Right Not a Privilege: Prioritizing Maternal Mental Health. United for Global Mental Health and UNICEF. Surviving and Thriving: Maternal Mental Health as a Global Priority. World Health Organization. Perinatal Mental Health. Ask the Experts Yves Miel Hugo Zuñiga Policy and Advocacy Advisor, United for Global Mental Health Yves Miel Hugo Zuñiga works at the intersection of mental health and health systems strengthening. With nearly a decade of experience in policy and advocacy, he advances the integration of mental health into HIV, TB, and noncommunicable disease programs, particularly for young people. He led a three-year Elton John AIDS Foundation grant supporting communities in over 30 countries and chairs the board of #MentalHealthPH, a youth-led organization he co-founded. He is an Atlantic Fellow for Health Equity. Vasoontara S. Yiengprugsawan Senior Universal Health Coverage Specialist (Service Delivery), Human and Social Development Office, Sectors Department 3, Asian Development Bank Dr. Vasoontara Yiengprugsawan oversees ADB's health technical assistance, including noncommunicable diseases and mental health and regional cooperation in the Greater Mekong Subregion and BIMP-EAGA. She has held senior health research positions in Australia, a WHO Fellowship with the Asia Pacific Observatory on Health Systems and Policies, and worked in policy and research with a UN Migration Agency in Geneva. She holds a PhD in Epidemiology from Australian National University and an MA in International Development from Syracuse University. Follow Vasoontara S. Yiengprugsawan on Michelle Apostol Health Officer, Human and Social Development, ADB Sectors Department Dr. Michelle Apostol supports ADB’s health systems of member countries and advocates for the advancement of universal health coverage. Prior to joining ADB, she was a health specialist at the Korea International Cooperation Agency Philippine office and in charge of the implementation and evaluation of its health projects portfolio. She also worked for the Philippine Department of Health and USAID providing technical assistance and support to various health projects. Eduardo P. Banzon Director, Health Practice Team, Human and Social Development Office, Sectors Department 3, Asian Development Bank Dr. Eduardo Banzon champions universal health coverage and has long provided technical support to countries in Asia and the Pacific in their pursuit of this goal. Before joining ADB in 2014, he was President and CEO of the Philippine Health Insurance Corporation, World Health Organization (WHO) regional adviser for health financing for the Eastern Mediterranean region, WHO health economist in Bangladesh, and World Bank senior health specialist for the East Asia and Pacific region. Leave your question or comment in the section below: View the discussion thread.