Strategies for spreading, scaling, and sustaining perinatal mental health interventions in Low- and Middle-Income Countries (LMICs) – A scoping review and thematic synthesis

There is a significant global burden of common perinatal mental health conditions (CPMHC), the most common complications of childbearing, with about one in five women being affected in LMICs.Health systems in these settings have not scaled, spread or sustained perinatal mental health services despite the evidence for effectiveness of several interventions.This is, in part due to a range of systems-level factors.Previous work on perinatal mental health interventions has been limited in scope regarding strategies to scale, spread, and sustain perinatal mental health interventions in LMICs.Therefore, this scoping review provides a novel contribution by systematically examining the scale, spread, and sustainability strategies of perinatal mental health interventions in LMICs from 42 information sources.The strategies identified are interconnected and used concurrently across the sources.These strategies included workforce diversity, integration into other health services, tool and method development, adaptation of existing interventions, training, supervision and support, and stakeholder engagement.Unlike prior reviews, it includes both peer-reviewed and grey literature, allowing for a more comprehensive understanding of the evidence base.The study also identifies persistent gaps in the literature, particularly around how interventions move beyond early adaptation and implementation phases.Efforts to scale, spread, and sustain perinatal mental health interventions in LMICs rely on these coordinated strategies to embed interventions within complex health systems and achieve equitable, long-term impact.Interdisciplinary perspectives and coordination across various stakeholders are essential.By organising evidence around concrete strategy types and highlighting where evidence remains thin, the review supports informed decision-making for programme design, funding, and policy, and provides a foundation for comparative, interdisciplinary implementation research to strengthen long-term sustainability at scale.