Ethical evaluation of urology specialists' knowledge and attitudes on the application of medical (chemical) castration for sexual offenders: a perspective from Turkey.

Globally, common perinatal mental disorders (CPMDs) approximately affect 15% of women during the antenatal period and 20% postnatally [], though these rates vary across the socioeconomic groups []. CPMDs are arguably socially determined and can vary along a spectrum, reflecting psychological, biological and social contexts, including rural residence, poverty, and exposure to violence [–]. CPMDs refer to common conditions like anxiety, depression and stress. However, in low and middle income countries (LMICs), CPMDs usually remain undetected and consequently untreated. While this may not always contribute to adverse obstetric outcomes, CPMDs are debilitating to women and can have adverse consequences for the child, including disrupting infant’s brain development [, ]. Yet, a comprehensive response to CPMDs is currently lacking in most LMICs, including lack of prevention and early intervention with insufficient screening, leading to lack of diagnosis, and limited treatment of mental health conditions amongst pregnant or postpartum women [, , ]. In Vietnam, mental and maternal health services are also organized and managed separately. Mental health services are provided at national and provincial specialized psychiatric hospitals, which primarily focus on severe illnesses such as schizophrenia and psychoses [–]. A major gap, therefore, exists in the management of CPMDs at the primary health care (PHC) level in Vietnam, reflected in the absence of coordinated screening, treatment, or referrals []. This gap results in a lack of necessary mental health care, and a health system that is not responsive to the needs of women experiencing CPMDs. Rather than expecting pregnant women to seek care at specialized psychiatric hospitals for common perinatal mental illnesses, integrating mental and maternal healthcare at the PHC level offers a more effective approach to closing this treatment gap [, ]. This can make the health system more responsive to the maternal mental health needs of vulnerable pregnant women at a PHC level []. Closely related to this is a knowledge gap concerning the perspectives of frontline health workers who would be expected to take on these additional roles and responsibilities. Despite the lack of training on mental health care during pre-service and in-service training, and a prevailing view that diagnosis and treatment fall within the remit of the specialists, PHC staff acknowledge the need to strengthen their knowledge and skills in this area and welcome new training opportunities that would better equip them to deal with referrals []. Taking these considerations into account, we co-produced with key stakeholders (policymakers, service providers and local communities), implemented, and evaluated a multicomponent integrated intervention aimed at improving health system responsiveness to perinatal mental health needs at the PHC level in Vietnam. The intervention was implemented by service providers at PHC facilities. While policymakers from the Ministry of Health were involved in its co-production and in reflecting on evaluation findings, they were not directly engaged in the day-to-day management of the intervention.