On the first morning of the training, an ASHA worker quietly passed her questionnaire to the woman sitting beside her, helping her read and make sense of the questions. She then paused, looked up, and asked, almost hesitantly, “Madam, is this also an illness?” Her finger rested on a question about persistent worry during pregnancy.
The room fell briefly silent. It was a small, ordinary moment, yet it captured exactly why the training had been organised.
When i asked the group as part of evaluation model for pre and post questionnaire and try to know what they understood by mental health, and whether they encountered women experiencing mental distress during pregnancy, the response was almost unanimous. “No,” several ASHAs replied. “Hamare field mein sab achha hai.” In their daily work, emotional suffering was either invisible or unnamed.
As the session progressed, a slide flashed the words MENTAL HEALTH across the screen. For many participants, the term immediately evoked images of severe illness which is something related to the brain, something associated with being “mad.” I paused there, unpacking these assumptions slowly and carefully. Mental health explained in way which was not separate from maternal care but an integral part of comprehensive primary health care and a woman’s overall well-being.
When the discussion shifted to identifying signs of mental distress (mansik tanav) and the risk factors that contribute to it, recognition began to surface. Some ASHAs spoke about their own pregnancies, recalling periods of unexplained sadness or baby blues they had struggled to understand at their time of pregnancy. Others reflected on women from their field areas, those anxious about the sex of the child, distressed by a husband’s alcohol use, or weighed down by financial uncertainty or domestic violence. Stories emerged hesitantly at first, then with growing ease. Lived experiences began to align with the concepts being introduced, and the training room felt less one way it started with conversation, sharing stories and questions. This training attempted to shift that silence.
For me, it was the first time being actively involved in a programme focused specifically on mental health during pregnancy and after childbirth. While I had worked in community and maternal–child health settings before, translating mental health concepts into something meaningful at the field level was new. Sitting in the training room, I found myself as much a learner as a facilitator observing how stigma around the term “mental health” surfaced, and how carefully chosen words could begin to soften it. Breaking down complex ideas into the simplest, most familiar language like man ki chinta, man mein pareshani, anxiety, depression.
As the sessions progressed, something shifted in the room. Early discussions focused on definitions and distinctions between stress, anxiety, and depression. Case vignettes helped ground abstract ideas in everyday realities. By the second day, participation grew more confident. The questions changed from What is mental health? to How do we identify it? What do we do when we see it? Health workers brought up cases from their villages, trying to understand whether a woman’s behaviour reflected distress, anxiety, or depression, and what kind of support was possible.
Gradually, conversations began linking women’s emotional experiences to broader realities like financial insecurity, domestic violence, family conflict, and pressure to bear a male child. Some participants asked for guidance on specific cases; others requested mental health counsellor visits to their field areas. The growing awareness was accompanied by an honest recognition of their own limitations.
Being involved in both facilitation and evaluation underscored the critical role frontline health workers play in perinatal mental health. They are often the first to notice subtle changes, the first to listen, and the first trusted link between families and the health system. At the same time, the training made one reality clear: a single programme is not enough. Meaningful capacity-building in mental health requires continuity ongoing mentoring, supportive supervision, and systems that allow learning to translate into sustained practice.
This training was not merely about transferring knowledge. It was about shifting perspectives learning to notice, name, and respond to emotional distress that has long been normalised or ignored. Most importantly, it reaffirmed that change in public health often begins in quiet moments: a question asked softly in a training room, finally finding space to be heard.
