In Pakistan, studies show that 37 percent of pregnant women experience depression – nearly four times the global average. Financial strain and challenging family relationships, combined with limited access to mental health care, all contribute. The risk can persist for up to a year after childbirth, affecting both mothers and infants.

This week, the AKDN Integrated Mental Health Programme launched in Gilgit-Baltistan and Chitral, with AKHS, Aga Khan University (AKU), Aga Khan Education Services (AKES) and the Aga Khan Foundation (AKF) partnering with local governments to provide services to over 226,000 people.

“From cities to mountain villages, loneliness is a universal challenge and remains a major driver of poor well-being,” says Nabihah Kara of AKHS. “Our collaborative work is about helping people connect, develop a shared understanding, and build supportive social networks and services that nurture well-being.”

The programme builds on a three-year project targeting perinatal depression and maternal wellbeing in northern Pakistan. “We found that people defined good mental health by whether someone was able to do everything they were asked to do for their family or community. Meeting the expectations of society – performing academically, being financially stable, smiling at public gatherings – can be a big factor in depression,” says Falak Madhani, who leads on establishing living labs for AKU’s brain and mind research in northern Pakistan.

In Gilgit-Baltistan and Chitral, the maternal well-being intervention’s six-week courses reached 3,000 participants. Using a stepped care approach, most resources focused on mental wellness building to reach the greatest number at the lowest cost. At this level, community volunteers trained by the programme ran peer-led parenting support groups for young mothers and, separately, their partners. The next step involved early identification of those ill or at risk, and establishing referral pathways to mental health specialists.

“Attendance was over 84 percent, and, unusually, higher for men than women. We've seen significant drops in depression as well as anxiety,” Falak says.

Bringing parents together

“Women said that participating in the peer support programme has given them a feeling that they're not alone,” says Falak. “There aren't many activities for women of childbearing age, so this legitimised them coming out of the home and hanging out with their friends.”

Adding men’s groups was initially to widen the participant base and avoid stigma. But they showed fathers the importance of their contribution. “It felt really powerful to be able to impact my child’s neurodevelopment,” one participant told Falak after learning he could talk to his child in the womb. He was keen to support his wife and not have a role solely out of the home.

“We started to talk about how partners could support each other's mental health as well as bringing up the child together,” says Falak. “We did a session on gender-based violence where we told the same story from the perspective of both the husband and the wife, getting participants to reflect on the issue from the other person's angle. It showed the men their vital role in the family’s mental health.”

Creating a cascade of change

“We interviewed the families of participants too. In-laws and parents were talking about how children should be treated and the importance of good nutrition, or how to replace negative thoughts with positive ones. The content of the manual had really filtered down.”

The volunteer health promoters, almost 200 young people from rural areas, benefitted too. “We trained them in communicating clearly, being non-judgmental, offering unconditional positive regard, confidentiality and empathy. We had pairs tell each other their life stories, and the listener then told it to the group, practising active listening. There was a lot of life skill building too.

“Running these courses, they felt respected. They were often parents who were learning themselves. They felt they could bring this knowledge back to their community and their families.”

Feeding into the new Integrated Mental Health Programme, this approach will reach more families and communities across the region, strengthening mental health and well-being where it’s most needed.