Amid limited attention to maternal mental health, a grassroots study conducted in two districts of East Nusa Tenggara (NTT) has uncovered a concerning reality. Research led by the Foundation for Mother and Child Health (FMCH) Indonesia reveals that many pregnant and breastfeeding women in Southwest Sumba (SBD) and South Central Timor (TTS) are experiencing severe to extreme psychological distress, often without any adequate support.
In the rural heartlands of NTT a quiet crisis has long unfolded in the shadows of health clinics and village homes – one that has remained largely invisible to policy, data, and even community health workers. Recognizing this critical gap, FMCH Indonesia designed and implemented self-funded study using internal resources and local partnerships.
The study conducted between January until March 2025 in 17 villages with total of 366 respondents participated, including pregnant women, nursing mothers, and cohabiting family members. Data was collected through structured interviews (qualitative) and a standardized screening tool, the Self Reporting Questionnaire (SRQ), recommended by the World Health Organization (WHO).
They are Vulnerable and Often Alone
The findings were alarming. As many as 37 percent of respondents showed symptoms of Post-Traumatic Stress Disorder (PTSD), 35 percent experienced anxiety or depression, and 22 percent had indications of psychotic disorders. Meanwhile, only six percent of breastfeeding mothers were found to have stable mental health.
Several factors were found to be driving this crisis. Many respondents under the age of 25 were pregnant outside of marriage (including unplanned pregnancies), or in some cases, were survivors of sexual violence. On the other end, older mothers (ages 40–45) expressed anxiety over their high-risk pregnancies, particularly those who had undergone multiple births or surgical procedures in the past.
From the data collected from pregnant and breastfeeding respondents, it was found that nearly the majority of respondents which was 57%, had never heard or read of mental health in pregnant and breastfeeding mothers. This lack of awareness increases the risk of psychological disorders, as many do not realize the importance of caring for their mental well-being during this vulnerable period.
This condition is worsened by the fact that women still face an old local tradition to hide pregnancy from husbands, families, midwifes, and other people until reached the age of second trimester of pregnancy. People believe that telling or revealing a young pregnancy to others can increase the risk of miscarriage. As a result, many pregnant women do not receive healthcare services for prenatal check-ups from the Posyandu (community health post).
In addition, the majority of women in these areas are carrying out unpaid heavy domestic responsibilities such as cooking, cleaning, caring for children, farming even often living alone because their spouses are away working in other regions. These mothers have little to no time to rest or care for their own emotional well-being.
The study also highlighted the vital role of close family members particularly husbands, in-laws, parents, and siblings in supporting mothers. Husbands often serve as primary companions, while in-laws and parents typically offer emotional support, guidance, and help with childcare. This strong family involvement reflects the cultural values of solidarity and shared responsibility. However, the findings also revealed that many families still lack awareness of maternal mental health.
“We Didn’t Know They Were Suffering”: Health Workers Left in the Dark
The crisis of maternal mental health in NTT is compounded by the limited capacity of health workers to address psychological issues, especially those related to maternal mental health. Many midwives and Posyandu volunteers admitted they had not received mental health training either during their formal education or through ongoing services.
“I meet these mothers at least once a month during antenatal and postnatal care. I didn’t realise they have been experiencing stress and some sort of depression.” – JL, a midwife from South Central Timor.
Several only became aware of symptoms of depression in the women they regularly assist after seeing the results of this survey. This highlights the urgent need to strengthen mental health training and support systems at the community level.
A Crisis That Can No Longer Be Ignored, We Had to Act
The study isn’t just a report. It’s a call to action. Based on these findings, FMCH Indonesia is recommending a number of essential steps. These include increasing the capacity of health workers such as Posyandu cadre and local midwife— and community volunteers to detect and respond to maternal mental health issues, educating families especially husbands to be more sensitive and supportive of mothers’ emotional well-being, and expanding access to mental health services in remote regions. Beyond that, maternal mental health must be recognized and prioritized within both national and local health agendas.
FMCH Indonesia is currently developing training modules and community-based interventions grounded in this research. These efforts are expected to lay the foundation for a sustainable support system for mothers in rural areas. Because maternal mental health is not a luxury. It is a fundamental need that cannot be delayed. Without mothers who are healthy in both body and mind, we cannot expect to raise a strong and resilient next generation.
Written by: Tutik Inayati
Media and Communication Officer
Foundation for Mother and Child Health Indonesia
