Rehema K. Rajab^{1, 2,}, Getrud Joseph Mollel³, Felister Kiwelu⁴, Kioneneema Koshuma⁵, Fahad S. Mwakalebela^{1, 2}, Ramadhani M. Bofu⁶, Josephine Mkunda⁷, Marceline F. Finda^1,

Introduction: Postpartum depression affects 15-20% of mothers globally, yet remains under-researched in low-resource settings like rural Tanzania, where maternal health efforts prioritize physical over mental well-being. Cultural stigma, limited healthcare access, and socioeconomic hardships aggravate PPD, yet women’s lived experiences are rarely documented. This study aimed to explore the narratives of mothers with PPD in southern Tanzania to uncover the challenges, coping mechanisms, and unmet needs, which are crucial in informing tailored interventions and policies. Methods: A qualitative approach was used, involving ten semi-structured in-depth interviews with purposively selected mothers of infants less than 24 weeks, scoring ≥ 26 on the Edinburgh Postnatal Depression Scale, indicating severe depression. The study explored the lived experiences, community interactions, and perceived drivers of mental health disorders in this context. Results: Four major themes emerged: Parenting while dealing with depression, including difficulties bonding with the baby, suicidal thoughts, attempts, and consideration of harming or abandoning the baby; Factors that trigger depression episodes, such as lack of support, difficult livelihoods, early marriage, unplanned pregnancies, difficult pregnancies and deliveries, and domestic violence; Coping mechanisms include primary confiding in trusted friends; and Recommendations for services and support systems including awareness campaigns, strengthening healthcare capacity, providing targeted support, and involving both the government and community structures. Conclusion: Findings highlight a critical gap in awareness and support for PPD among women in low-income settings. Despite enduring profound sadness, alarming thoughts, and challenging circumstances, many women lacked knowledge that PPD is a health condition, reflecting broader societal neglect and stigma surrounding mental health. Addressing these gaps requires urgent efforts to raise awareness, ensure accessible interventions, and foster supportive environments within families and communities.

Postpartum depression, Lived experiences, Rural Tanzania, Maternal mental health, Mental health support