Mochammad Besari Adi Pramono, Wiku Andonotopo, Muhammad Adrianes Bachnas, Wisnu Prabowo, Eric Edwin Yuliantara, Julian Dewantiningrum, Efendi Lukas, I Nyoman Hariyasa Sanjaya, Anak Agung Gede Putra Wiradnyana, Anak Agung Ngurah Jaya Kusuma, Ryan Saktika Mulyana, Khanisyah Erza Gumilar, Ernawati Darmawan, Muhammad Ilham Aldika Akbar, Dudy Aldiansyah, Dovy Djanas, Aloysius Suryawan, Ridwan Abdullah Putra, Anita Deborah Anwar, Cut Meurah Yeni, Nuswil Bernolian, Harry Kurniawan Gondo, Laksmana Adi Krista Nugraha, Waskita Ekamaheswara Kasumba Andanaputra, Wibisana Andika Krista Dharma, Sri Sulistyowati, Milan Stanojevic, Asim Kurjak
Perinatal mental health has long been acknowledged as fundamental to the well-being of mothers and infants, yet the recognition of disorders such as postpartum depression, anxiety, and - far less commonly - psychosis still lags behind clinical need. Even where validated screening tools exist, detection remains inconsistent, and many women navigate pregnancy and the postpartum period with symptoms that go unspoken or unnoticed. In some high-income settings, suicide has emerged as a leading contributor to maternal mortality, a reminder that the health consequences of these conditions extend beyond emotional distress and reflect deeper systemic failings. In this opinion paper, we draw on recent developments across epidemiology, neuroscience, psychology, and health-system research to consider why perinatal mental health continues to occupy an uncertain place in routine care. Fragmented service pathways, variability in provider training, and uneven adoption of evidence-supported interventions create persistent gaps between what is known and what is practiced. We highlight examples - stepped-care models, collaborative teams, and digital supports - that illustrate how more coherent systems could function, even if implementation remains uneven. Although a wide range of effective interventions exists, their practical reach is limited by sociocultural norms, structural constraints, and resource imbalances. Understanding these influences together - not in isolation - helps clarify why progress has been slower than the evidence might suggest. Meaningful improvement will depend on strengthening cross-sector integration, expanding scalable technologies, and tailoring policy responses to local realities. Sustained investment in perinatal mental health offers long-term benefits for families and communities and should be regarded as central to modern maternal care. © 2026 the author(s), published by De Gruyter, Berlin/Boston.
Department of Obstetrics and Gynecology, Fetomaternal Division, Medical Faculty of Diponegoro University, Dr. Kariadi Hospital, Semarang, Indonesia; Department of Obstetrics and Gynecology, Fetomaternal Division, Women Health Center, Ekahospital BSD City, Banten, Tangerang, Indonesia; Department of Obstetrics and Gynecology, Fetomaternal Division, Medical Faculty of Sebelas Maret University, Dr. Moewardi Hospital, Solo, Surakarta, Indonesia; Department of Obstetrics and Gynecology, Fetomaternal Division, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Division, Faculty of Medicine, Udayana University, Prof. Dr. I.G.N.G Ngoerah General Hospital, Bali, Indonesia; Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Division, Faculty of Medicine, Airlangga University, Dr. Soetomo Hospital, Surabaya, Indonesia; Department of Obstetrics and Gynecology, Fetomaternal Division, Faculty of Medicine, Sumatera Utara University, H. Adam Malik General Hospital, North Sumatera, Medan, Indonesia; Department of Obstetrics and Gynecology, Fetomaternal Division, Faculty of Medicine, Andalas University, M. Djamil General Hospital, West Sumatera, Padang, Indonesia; Department of Obstetrics and Gynecology, Fetomaternal Division, Faculty of Medicine, Maranatha Christian University, West Java, Bandung, Indonesia; Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Division, Faculty of Medicine, Padjajaran University, Hasan Sadikin General Hospital, West Java, Bandung, Indonesia; Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Division, Faculty of Medicine, Syiah Kuala University, Dr. Zainoel Abidin General Hospital, Aceh, Indonesia; Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Division, Faculty of Medicine, Sriwijaya University, Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia; Department of Obstetrics & Gynecology, Wijaya Kusuma University, East Java, Surabaya, Indonesia; Department of Medicine, Faculty of Medicine, Universitas Diponegoro, Central Java, Semarang, Indonesia; Department of Medicine, Undergraduate Program in Medical Science, Faculty of Medicine, Padjajaran University, West Java, Bandung, Indonesia; Department of Medicine, Undergraduate Program in Medical Science, Faculty of Medicine, Gajah Mada University, Yogyakarta, Indonesia; Department of Neonatology and Rare Diseases, Medical University of Warsaw, Warsaw, Poland; Department of Obstetrics and Gynecology, Medical School, University of Zagreb, Zagreb, Croatia
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