Asari Ndem and Vivianne Ihekweazu (Lead writers)
“If you can talk you can sing, if you can walk you can dance.” — Zimbabwean Proverb
“She would spend almost the whole day lying on the mat asleep, she had stopped smiling or singing while she cooked, she now cried a lot and had ceased doing all of her household chores”. This line is from the article “People Don’t Get Depressed in Nigeria”, published in Granta magazine in 2012. It was written by Dr. Ike Anya, a Consultant in Public Health Medicine. At the time, Dr. Anya was a newly qualified medical doctor posted to northern Nigeria for his National Service. The passage portrays a new mother whose husband sought medical care after noticing significant changes in her behaviour following childbirth. This case highlights a common yet often unacknowledged issue: postpartum depression.
Theatre and the arts are powerful tools in health advocacy, offering unique ways to communicate complex issues, spark dialogue, and inspire behavioural change. Historically, the arts have supported health campaigns including vaccination campaigns, encouraging collaboration between public health and cultural initiatives. In 2023, events such as the Celebrating Womanhood Gala used entertainment to raise awareness about maternal healthcare challenges in Nigeria. Such artistic initiatives not only educate the public, but also advocate for policies to improve access to healthcare for women and highlight overlooked issues like postpartum mental health.
The Role of Arts in Advocating for Maternal Mental Health
Maternal healthcare in Nigeria faces numerous challenges, including inadequate infrastructure and a shortage of skilled birth attendants. The report Why Are Women Dying While Giving Birth in Nigeria, supported by funding from MSD for Mothers, highlights that maternal health risks extend beyond physical complications to mental health concerns related to childbirth.
These issues are often overlooked addressed leaving many women struggling in silence. Integrating health advocacy with creative platforms such as theatre and the arts offers a unique opportunity to raise awareness and address the critical but neglected area of mental health.
Recently, CNN As Equals collaborated with Danish playwright Katy Streek and Lagos-based QDance to produce M/Other, a theatrical performance that premiered at Afropolis 2024 in Lagos. The play explored the emotional and psychological struggles women face during and after pregnancy, spotlighting postpartum depression and postpartum psychosis. By raising awareness of these challenges, it advocated for urgent integration of comprehensive mental health support into maternal healthcare systems, emphasising the critical need to prioritise mothers’ mental well-being.
Through its central storyline, M/Other underscored the urgency of addressing maternal mental health. It is estimated that approximately 20% — 30% of Nigerians struggle with mental health issues, yet a limited portion of the government budget is allocated for the prevention and treatment of these conditions. Postpartum depression, a common maternal health issues, affects 19% — 25% of Nigerian women, however, very few receive the support they need.
The Hidden Impact: Maternal Mental Health in Rural Nigeria
The Why Women in Nigeria Dying While Giving Birth report found that many women, particularly in rural areas, face financial pressures, isolation, and cultural expectations that discourage them from seeking mental health support, which is often not even available. The 2023 Nigeria Demographic and Health Survey (NDHS) revealed that 53% of women attended at least 4 antenatal care visits, however, remain regional disparities. Looking at postnatal care, only 43% of women nationwide attend a postnatal check during the first 2 days after birth.
During a post-show discussion, following the theatre performance of M/Other, Professor Afolabi Bosede, Professor of Obstetrics and Gynaecology at the College of Medicine, University of Lagos highlighted that mental health issues often remain “invisible” and go unrecognised. While physical conditions like haemorrhage or obstructed labour receive more immediate attention, mental health struggles are overlooked, resulting in long-term consequences for mothers and families.
Post show discussion with Eliza Anyangwe, Prof. Bosede Afolabi, Dr. Tomi Coker and Vivianne Ihekweazu. Image credit: Nigeria Health Watch
Panelists, including Eliza Anyangwe, editor of CNN’s As Equals, Ogun State Health Commissioner Dr Tomi Coker, and Nigeria Health Watch Managing Director Vivianne Ihekweazu, emphasised the urgency of addressing maternal mental health to prevent the ongoing maternal health crisis in Nigeria.
Maternal Mortality and Mental Health
In regions like Kebbi and Bauchi, where the rate of deliveries with a skilled birth attendant is particularly low, at 10% and 28% respectively, accessing mental healthcare is especially challenging. Women in these areas often rely on traditional birth attendants (TBAs) due to limited healthcare facilities. However, TBAs typically lack the skills to recognise postpartum depression or psychosis and may not know how to support affected women effectively.
Providing TBAs with basic mental health training to identify and refer women with symptoms of postpartum depression or psychosis is essential. Integrating mental health assessments into primary healthcare systems would ensure that both physical and mental health issues are detected early. This would enable adequate care for women experiencing postpartum challenges, ultimately improving maternal health outcomes. Allocating resources to train healthcare workers and prioritising maternal mental health as an important element of reproductive health services will address broader issues and support women effectively after childbirth.
Cultural and Social Barriers to Maternal Mental Health Care
In many Nigerian communities, mental health is stigmatised. Women who experience depression or psychosis after childbirth may not understand the changes occurring in their bodies and feel isolated or ashamed, fearing judgment from their families or communities. This is where theatre productions and similar art outputs can play a significant role in educating and working to remove the stigma associated with mental health conditions.
During the post-show discussion, Vivianne Ihekweazu noted how cultural expectations can create additional pressure on mothers. In some communities, women are encouraged to be strong and “deliver like Hebrew women” (naturally and without assistance), creating a cultural stigma around seeking help. This aligns with findings from studies, where women often view caesarean sections or other medical interventions as a sign of weakness. Such beliefs deter mothers from accessing both physical and mental healthcare, reinforcing a dangerous cycle of neglect.
Community-based awareness campaigns and education programmes are essential to breaking down barriers to maternal health care. Culturally sensitive health education initiatives are needed that involve community leaders, religious figures, and family members to highlight many of challenges that women face. By normalising mental health discussions within communities, many of the cultural barriers can be dismantled, and so women do not feel stigmatised if they find they are not coping very well with their mental health, during pregnancy and after childbirth.
Support systems should involve family members in sustained maternal mental health education through awareness campaigns. Health workers, traditional birth attendants (TBAs), and community leaders can play active roles in educating families about the importance of maternal mental health and promoting supportive environments. By promoting empathy and understanding within family structures, communities can better ensure that mothers are able to thrive.
Solutions for a Brighter Future
During the discussion after the theatre performance, Dr Tomi Coker emphasised that it is apparent that change must start at the policy level, with the government prioritising mental health in its healthcare agenda. Building on this, Vivianne Ihekweazu noted Nigeria’s revised Mental Health Act of 2021 provides a framework for mental health care, but lacks specific guidelines for addressing maternal mental health.
By addressing the systemic gaps in the healthcare system, promoting cultural acceptance of mental health care, and prioritising maternal mental health in policy agendas, Nigeria can create a future where no mother suffers in silence. Through collaborative efforts among stakeholders, including policymakers, healthcare providers, communities, and the media, Nigeria has the opportunity to make maternal mental health an integral part of its healthcare landscape.