Development of the PTOPEH Model: A Framework for Maternal Mental Health Post-Termination of Pregnancy

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Abstract Background Emotional adjustment after termination of pregnancy is clinically and socially consequential yet often under-addressed in routine ToP services. Existing care frequently omits structured psychological screening, culturally adapted support, and clear referral pathways, increasing the risk of undetected distress and impaired recovery. The present study aimed to develop an integrated psychological-emotional health model to inform practice at health facilities that provide termination of pregnancy services. Methods We developed the Post-Termination of Pregnancy Emotional Health model through a theory-informed, evidence synthesis, and stakeholder-engaged process. Steps included targeted literature synthesis, adaptation of Keyes’ Mental Health Continuum and Global Mental Health Assessment elements for ToP contexts, iterative expert consultation with clinicians (senior midwives, mental health professionals, and gynecologists and obstetricians) in Rwanda, and drafting of clinical tools (checklist, assessment report, risk flowchart). Results Post-Termination of Pregnancy Emotional Health model conceptualizes post-Termination of pregnancy emotional health across five zones (Flourishing; Moderate well-being; Languishing; Subclinical distress; Mental disorder). The model operationalizes screening, risk stratification, trauma-informed communication, stepped-care interventions, and urgent safety pathways. Suggested tools include a clinician checklist, a structured mental health assessment report, a risk-management flowchart, and suggested health management information system (HMIS) indicators for monitoring. Expert reviewers recommended simplified triage prompts, local language adaptation, and provider training to ensure the model’s fidelity. Conclusions Post-Termination of Pregnancy Emotional Health model provides a practical, stigma-sensitive framework for identifying and responding to emotional needs after ToP. Implementation requires provider training, integration into existing workflows and HMIS, and empirical validation through pilot testing and outcome evaluation.

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