Mother's Time - A Cognitive Behavioural Therapy Intervention

The Mother's Time approach is based on cognitive behavioural therapy (CBT), which is an evidence-based psychological treatment approach considered by many to be the "gold standard" currently available in the field of psychological treatments for supporting mental health and positive behaviour change, especially in low-resource settings. CBT's core premise is that modifying beliefs and assumptions can lead to positive changes in behaviour and overall improvements in mental health.



Breakthrough ACTION developed Mother's Time by working with a mental health expert in Ethiopia and drawing heavily on existing CBT materials. Mother's Time teaches CBT concepts by using stories of a new mother, Birhan, who struggles with sad and anxious thoughts as she navigates life with a new baby, relationships, and FP decision-making. Each story about Birhan is designed to provoke discussion on specific examples of anxious or depressive thoughts that may be important for FP decision-making.



In particular, stories are meant to provoke discussion on "healthy" and "unhelpful" thinking around a specific area important for FP, such as planning for the future or couple communication. The intervention defines "healthy thinking" as thinking that helps a person feel her best and take action for herself and her family, while "unhelpful" thoughts lead a person to feel overly stressed, powerless, and out of control and can lead to inaction or avoidable outcomes.



HEWs conduct four health sessions, each approximately 60-90 minutes, delivered in small groups of four to six women. Each session deals with a different topic relevant to mental health and FP:

• Session 1: Healthy thinking on care seeking
• Session 2: Thinking about the future
• Session 3: Family planning
• Session 4: Thinking about your family

During the sessions, HEW are supported by a Mother's Time tool, which is designed for women with no or very low literacy skills and includes icons and images representing moods and activities. The intervention also includes homework worksheets that prompt mothers to notice and record their moods for each day and make time for activities that make them feel good, such as visiting friends or resting. In subsequent intervention sessions, mothers revisit the homework and discuss the types of activities that are helpful for their own wellbeing and health.



The Mother's Time tool is available in English and Amharic and includes the facilitation guide, accompanying visual aids, and homework worksheets.

• Click here to download the Mother Time Tool in English (PDF, 76 pages).
• Click here to download the Mother's Time Tool in Amharic (77 pages).

Mother's Time was developed through a series of research steps. The initial iteration started as a pilot to assess the feasibility and acceptability of using simplified CBT to address postpartum depression and anxiety symptoms and associated barriers to postpartum FP. After the pilot study was completed, a human-centred design workshop was conducted in Ethiopia with national and regional stakeholders, including mothers from the community, to enhance the relatability of the content and capture the unique social and cultural norms that postpartum mothers face in the Amhara region. Based on the findings, the intervention materials were adapted to clarify the stories and messages, the language around mental health symptoms was changed to reduce stigma (e.g., using words like "stress" as opposed to "anxiety"), examples and activities were updated to be more contextually relevant, and a fourth session was added to support further understanding and application of concepts. Click here to download the case study "Testing an Approach to Address Barriers to Family Planning for Postpartum Women Experiencing Depression and Anxiety" [PDF], which explores the initial research step on the feasibility and acceptability of the intervention.  



In 2023, a study was conducted to evaluate the impact of the intervention. The evaluation provides positive evidence for the use of CBT tools to improve postpartum mental health and support women in low-resource settings to realise their reproductive health intentions. (See Related Summaries, below, for more information on the study and the results.)

As Breakthrough ACTION explains, "The impact of mental health on family planning (FP) is a complex issue that affects various aspects of reproductive health and family dynamics. Women with mental illness are particularly vulnerable to unplanned pregnancy, mental health relapse during childbearing, and psychological and economic burdens associated with unplanned pregnancies. In addition, postpartum depression can have a significant influence on FP intentions, impacting the health and well-being of new mothers, their infants, and their families."