Mothers Time: A Cluster Randomized Controlled Trial of the Effects of a Community-Based Cognitive Behavioral Therapy Intervention on Postpartum Mental Health and Family Planning in Northwest Ethiopia.

Depression and anxiety symptoms are associated with increased unmet need for family planning (FP) postpartum, yet solutions promoting the integration of mental health into FP service settings remain scarce. The aims of this study were to quantitatively examine the immediate and longer term effects of participation in a group-based cognitive behavioral therapy (CBT) intervention called Mothers Time on (1) symptoms of depression and anxiety, (2) the use of a modern family planning method, and (3) intermediate FP-related factors among postpartum women in Ethiopia. Building from lessons learned during a feasibility study, we implemented a cluster randomized controlled design, with structured interviews delivered before (baseline), immediately following (endline), and fourxst months after implementation of the intervention (follow-up). A total of 302 postpartum women were recruited from 10 health clusters in northwest Ethiopia. In comparison to control clusters where participants received standard of care, intervention clusters showed significantly greater reductions in symptoms for both depression and anxiety from baseline to follow-up. Modern FP use also increased significantly more in intervention clusters as compared to control clusters from baseline to follow-up. Results suggest that more holistic FP services that consider postpartum mental health can both reduce postpartum depression and anxiety and support women in fulfilling their reproductive intentions.