First to Listen, Last to Be Trained: A Pathway Analysis of Midwives’ Role in Perinatal Mental Health in Indonesia

Rufidah Maulina; Siti Khuzaiyah; Agustina Catur Setyaningrum; Atriany Nilam  Sari; Revi Gama Hatta Novika; Nurul Jannatul Wahidah; Siti  Nurhidayati; Luluk Fajria Maulida; Elsa Tursina

doi:10.35730/jk.v16i2.1330

Authors

Rufidah Maulina Universitas Sebelas Maret
Siti Khuzaiyah Universitas Muhammadiyah Pekajangan Pekalongan https://orcid.org/0000-0002-3271-453X
Agustina Catur Setyaningrum semarang health training center ministry of health
Atriany Nilam Sari Midwifery Study Program, Faculty of Medicine, Universitas Sebelas Maret https://orcid.org/0000-0002-7778-9850
Revi Gama Hatta Novika Midwifery Study Program, Faculty of Medicine, Universitas Sebelas Maret and Master's Program of Public Health, Graduate School, Universitas Sebelas Maret
Nurul Jannatul Wahidah Midwifery Study Program, Universitas Sebelas Maret https://orcid.org/0000-0002-6783-3299
Siti Nurhidayati Midwifery Study Program, Universitas Sebelas Maret https://orcid.org/0000-0001-7165-1319
Luluk Fajria Maulida Midwifery Study Program, Faculty of Medicine, Universitas Sebelas Maret https://orcid.org/0000-0002-7473-8943
Elsa Tursina Master's Program of Public Health, Graduate School, Universitas Sebelas Maret https://orcid.org/0009-0005-5224-7579

DOI:

https://doi.org/10.35730/jk.v16i2.1330

Abstract

Background: Perinatal mental health disorders significantly contribute to maternal and neonatal morbidity, particularly in low- and middle-income countries (LMICs) such as Indonesia. Midwives, as frontline maternal healthcare providers, are uniquely positioned to screen for and support women experiencing mental health disorders. However, their involvement remains limited due to systemic, educational, and institutional barriers.

Purpose: This study aims to understand the factors influencing midwives' knowledge and utilization of perinatal mental health screening services in Indonesia.

Methods: A secondary analysis was conducted using cross-sectional data from an online survey of 300 midwives across Indonesia between June-August 2024. Variables included demographic characteristics, training experience, access to mental health resources, screening knowledge, and utilization behavior. Descriptive statistics and path analysis were used to examine direct and indirect influences on screening utilization.

Results: Despite an average of 15 years of clinical experience, only 9.7% of midwives had used mental health screening tools. Just 8.7% had received formal mental health training, and only one-third had access to relevant guidelines. Screening knowledge was significantly predicted by access to structured information sources (β = 1.42; p < 0.001) and directly influenced screening utilization (β = 3.05; p < 0.001). Indirect factors, such as duration of service or interest in training, had no significant effect. Public health outreach and structured training improved access to learning materials.

Conclusion: Despite strong interest among midwives, gaps in training, resources, and institutional support hinder effective mental health screening. Strengthening structured training programs and improving access to information are essential steps toward empowering midwives in perinatal mental health care. However, as most participants were from Western Indonesia, these findings should be interpreted with caution, and future studies should include broader geographic representation to better capture the national context