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Peer-reviewedCC BY-NC 4.0BMJ Open

Association between personal birth companion and maternal mental health in low- and middle-income countries: a systematic review

  • Waqas Hameed1,2,3
  • Bilal Iqbal Avan4
4 affiliations
  1. 1Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, London, UK
  2. 2Department of Health Service and Population Research, Institute of Psychiatry Psychology & Neuroscience, Kings College London, London, UK
  3. 3Department of Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
  4. 4Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Abstract

Objectives: To examine the relationship between personal birth companions and maternal mental health during labour and the postpartum period in low- and middle-income countries.

Design: Systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines.

Data sources: We performed a systematic search of Embase, Medline, PsycINFO, Global Health and Scopus from inception to 24 September 2024.

Eligibility criteria: Peer-reviewed studies—either observational or experimental—that reported an association between personal birth companions and maternal mental health were included.

Data extraction and synthesis: Data were extracted using a structured template and Joanna Briggs Institute tools were used for quality assessment. Due to heterogeneity across studies, a narrative synthesis was conducted.

Results: Our review included 10 studies (6 observational, 4 experimental) conducted across seven countries, primarily in South Asia. Overall, we found promising evidence from experimental studies—conducted primarily on primigravida women and those with uncomplicated pregnancies—that the presence of birth companions from personal networks (particularly husbands) positively affects maternal mental health. The relative change in maternal anxiety between intervention and control groups ranged from −0.85% to 120% with most p values <0.001 favouring the intervention effect, while for depressive symptoms the relative changes were 4.5% and 22.8% with statistically insignificant effects. However, with the exception of two studies, none of the observational studies showed a statistically significant relationship, although the direction of effect supported a positive association. One observational study also found that characteristics of birth companionship (ie, type and level of support) increased the odds of postpartum anxiety and depression (2.86 (95% CI 1.52 to 5.39)).

Conclusions: Our review indicates promising evidence that birth companions from a woman’s personal network may have a positive effect on maternal mental health and well-being, especially for nulliparous women and those with uncomplicated pregnancies. However, there is a dire need for more rigorous experimental research across countries in different regions and income strata.

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Cite

BibTeXRIS
BibTeX
@article{hameed2026association,
  title = {{Association between personal birth companion and maternal mental health in low- and middle-income countries: a systematic review}},
  author = {Waqas Hameed and Bilal Iqbal Avan},
  journal = {BMJ Open},
  year = {2026},
  month = sep,
  doi = {10.1136/bmjopen-2025-102597},
  url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2025-102597},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Association between personal birth companion and maternal mental health in low- and middle-income countries: a systematic review
AU  - Waqas Hameed
AU  - Bilal Iqbal Avan
PY  - 2026
DA  - 2026/09/30
JO  - BMJ Open
DO  - 10.1136/bmjopen-2025-102597
UR  - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2025-102597
AB  - Objectives: To examine the relationship between personal birth companions and maternal mental health during labour and the postpartum period in low- and middle-income countries.  Design: Systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines.  Data sources: We performed a systematic search of Embase, Medline, PsycINFO, Global Health and Scopus from inception to 24 September 2024.  Eligibility criteria: Peer-reviewed studies—either observational or experimental—that reported an association between personal birth companions and maternal mental health were included.  Data extraction and synthesis: Data were extracted using a structured template and Joanna Briggs Institute tools were used for quality assessment. Due to heterogeneity across studies, a narrative synthesis was conducted.  Results: Our review included 10 studies (6 observational, 4 experimental) conducted across seven countries, primarily in South Asia. Overall, we found promising evidence from experimental studies—conducted primarily on primigravida women and those with uncomplicated pregnancies—that the presence of birth companions from personal networks (particularly husbands) positively affects maternal mental health. The relative change in maternal anxiety between intervention and control groups ranged from −0.85% to 120% with most p values <0.001 favouring the intervention effect, while for depressive symptoms the relative changes were 4.5% and 22.8% with statistically insignificant effects. However, with the exception of two studies, none of the observational studies showed a statistically significant relationship, although the direction of effect supported a positive association. One observational study also found that characteristics of birth companionship (ie, type and level of support) increased the odds of postpartum anxiety and depression (2.86 (95% CI 1.52 to 5.39)).  Conclusions: Our review indicates promising evidence that birth companions from a woman’s personal network may have a positive effect on maternal mental health and well-being, especially for nulliparous women and those with uncomplicated pregnancies. However, there is a dire need for more rigorous experimental research across countries in different regions and income strata.
SN  - 2044-6055
SN  - 2044-6055
ER  -