As a nurse researcher I have had the privilege of listening to the voices of women from the highlands of Guatemala, to Russian birth houses, and to refugee camps in Jordan. I learned of the daunting challenges women face as they struggle with the social contexts in which they bear and rear children. Their stories document profound experiences of culturally diverse women. There is a greater recognition that we must listen to women and not disregard their questions, concerns, and requests. Women must be partners in their care and offered information so they can make decision about what is best for them and their babies. This makes a difference in outcomes. There is growing evidence about strengthening maternal mental health and wellbeing.

There is mounting concern about the increasing incidence of global common perinatal mental disorders and severe peripartum mental disorders in low- and middle-income countries (LMICs), described as "the silent burden" of childbearing and childrearing women (McNab et al., 2022, p. 342). In a synthesis of studies of the perceptions of peripartum women with mental health disorders, themes included: the relationship between social support and experiencing anxiety and depression; experiences of positive or negative health care, social norms and expectations that have an impact on coping; and maternal-newborn health factors (McNab et al., 2022). Identification of and attention to social determinants of health in peripartum women is critical. Social determinants of health include cultural and social context, race and ethnicity, lack of social support, financial and nutritional insecurity, substance use, gender inequities, intimate partner violence, and a paucity of appropriate health care resources (Kalra et al., 2022; McCarthy et al., 2021; McNab et al., 2022; Ruyak & Kivlighan, 2021).

Systematic reviews document current evidence and provide recommendations for interventions to strengthen health and wellbeing of peripartum women, especially those living in LMICs. In a systematic review of peripartum mental health issues, no assessment treatment guides were found to facilitate care for women living in LMICs (Kalra et al., 2022). Implementation of evidence-based interventions for reduction of common perinatal mental disorders is essential for women who are often suffering in silence (McNab et al., 2022). They should be integrated into peripartum health care (Kalra et al., 2022), with group care models such as Centering Pregnancy, which has shown to be an effective approach making an important difference. Midwife caseload models are proving effective globally, particularly for childbearing and childrearing women living in LMICs (Michel-Schuldt et al., 2020).

Community-based interventions recommended in multiple systematic reviews include pharmacotherapy, referral for stepped health care (progressive mental health services), detailed context assessments (evaluating the context of women's lives), task-sharing models, and talk therapy. Health facility interventions include mental health education and support for providers, sensitive referral and assessment, and most importantly respectful and culturally appropriate care for childbearing women and their families (McNab et al., 2022). Attention to the complex relationship between social determinants of health and the mental health of peripartum women is critical. Nurses and midwives are uniquely prepared to provide care as we listen to the voices of peripartum women experiencing mental health issues.

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