Intimate partner violence is a pervasive problem around the world. In many countries, including in Peru, women and children are at disproportionate risk of exposure to adversity. Recent work in the Lima metropolitan area with women of reproductive age has placed lifetime intimate partner violence prevalence for women between 38.7 and 45.1 percent.
So it’s good news that Kellogg Faculty Fellow and Professor of Psychology and Peace Studies Laura Miller-Graff, part of the Kroc Institute for International Peace Studies at the Keough School of Global Affairs, is wrapping up a study that suggests that low-intensity violence prevention and prenatal mental health interventions for pregnant women in Lima may help.
“The scale of the global mental health crisis is so huge that, yes, we need to be delivering in-person care, some people need really intensive care, but we also need to think more flexibly about how we can combine some kind of light-touch forms of care to hopefully reach as many people as we can in terms of getting them access to mental health resources at the times when they might need them,” she says.
Compounding exposure to community violence, poverty, and other forms of social and economic marginalization further elevates risk for women’s emotional, behavioral, social, and economic health difficulties. These parental traumas also pose intergenerational risks to children’s health and development. There are different types of intervention programs available for pregnant women, but few have been studied, and those that have been studied are typically resource intensive or haven’t shown effectiveness across multiple domains.
The study, “Low-intensity, psychoeducational interventions delivered to pregnant women via WhatsApp: Differential effectiveness of trauma-related versus general perinatal health content,” that Miller-Graff developed and executed in partnership with the Instituto de Pastoral de la Familia (INFAM), part of Holy Cross Family Ministries, showed that even brief supports for women in the perinatal period may have positive benefits for women’s parenting, and trauma-focused supports may also confer additional benefits in the domains of depression and resilience. Miller-Graff and the INFAM staff are still assessing the data on the outcomes for infant development.
The study, supported by Kellogg and the Ford Program in Human Development Studies and Solidarity, integrated multiple mental health topics. Participants were sent standardized text and video content on nutrition and exercise, violence and safety, mindfulness, and more that were adapted from the Pregnant Moms’ Empowerment Program, an in-person support group developed by Miller-Graff and her colleague Dr. Kathryn Howell that was trialed in the US before the COVID19 shutdown.
“We had some promising results from that program. As compared to women who didn’t participate in the program, women who participated had lower rates of violence re-victimization all the way out to one year postpartum, and they had significant improvements in depression, parenting attitudes, and observed parenting,” says Miller-Graff.
“Our hope had been to do a cultural adaptation of that program in Lima, but then the pandemic hit, and doing anything in person was off the table. So, we took those core components and distilled them into more of a light-touch text-based app. It was really well received. The participants really liked it and the INFAM staff felt positively about how it went.”
Seventy-seven percent of the 251 women in the WhatsApp study participated in all sessions and 96 percent participated in at least one session. The INFAM staff were available to answer questions or provide additional referrals or support as needed, all via text. The study followed the participants out one year postpartum.
“A little bit of service engagement goes a long way in building trust and opening the door for women and families to engage in other ways. So as the moms came to know the INFAM staff, and the program, and the kind of resources that were available, they continued on to receive other services from INFAM, like an early infant mother-baby class.”
Miller-Graff recently received a grant from Kellogg to develop the next stage of this long-term research project. She plans to evaluate the effectiveness of an existing transdiagnostic cognitive behavioral intervention program for low- and middle-income countries, the Common Elements Treatment Approach (CETA), in Lima. She wants to know if women in this program have improvements in depression, post-traumatic stress, and positive parenting.
“One of the core principles of peace studies and peacebuilding work is that we really need to take the long view when we’re trying to solve or make headway on major social problems, particularly violence –it’s really something that takes a sustained commitment,” says Miller-Graff. “When I start projects, I think about what’s the work of now, but also, what’s the future, what’s the trajectory for these organizations and the specific families. How do we take a long view on our research and how we support families?”
The next phase of the project will also study the intergenerational and economic impacts of the mental health care that CETA provides to women. Patrizio Piraino, the director of the Ford Program, is developing the economic integration portion of the study to look at outcomes for families and children and how various contextual factors may support or inhibit such effects. Together these results could inform a more comprehensive understanding of the sustainability and scalability of such approaches.
“We’ve been able to engage with economists both at and outside of Notre Dame as well to think about how we can integrate this research with other forms of livelihood supports and other supports we can provide women and children,” says Miller-Graff. “That’s one of the things that I’ve really valued about Kellogg and the Ford Program – they do a really good job of creating these interdisciplinary conversation spaces that facilitate projects like this.”
The Kellogg Institute for International Studies, part of the Keough School of Global Affairs at the University of Notre Dame, is an interdisciplinary community of scholars and students from across the University and around the globe that promotes research, provides educational opportunities, and builds partnerships throughout the world on the themes of global democracy and integral human development.