There was a time when Jackline Wanjiru’s world became very small. Some days were reduced to taking tea or uji, feeding her baby and gathering enough strength to get through another day.

From the outside, she was doing what mothers do. She was caring for her child and trying to move forward with life. Inside, however, she was struggling.

Her difficult journey into motherhood had started years earlier. After becoming pregnant with her first daughter, Jackline returned to Kenya after living abroad and eventually went back to her rural home, where she gave birth. The change was overwhelming. The life she had known had suddenly been replaced by pregnancy, a newborn and uncertainty about her future.

She remembers constantly feeling unwell and repeatedly visiting a family-friend doctor.

“During one visit, the doctor sat me down and told me I needed to accept where I was, settle my mind in the present and regain enough strength to care for myself and my baby,” she recalls.

Looking back, Jackline believes she was experiencing postpartum depression. She tried to rebuild her life. She explored acting, creative projects and other opportunities. She kept moving.

Years later, however, she unexpectedly became pregnant with her second child. She moved to Nairobi while pregnant, together with her daughter and with very little to start with. After the baby arrived, life became even harder.A close friend noticed the change. She kept telling her, “Jackie, you’re not okay. You need help.”

Eventually, Jackline listened. She went for therapy at Citam and remembers crying through much of her first sessions. For the first time in a long while, some of the things she had carried quietly were coming out.The therapy helped, but then her therapist left the country. Continuing meant sitting in front of another stranger and starting her story again from the beginning. Jackline could not bring herself to do it. She stopped going.

DROP-OFF TREND

It sounds like a small detail, but it points to a much bigger problem in mental healthcare. We spend a lot of time talking about getting people into care. We ask whether therapy is available, affordable and close enough to where people live.

We talk less about what happens after someone finally asks for help. Do they come back?For Maisha Mothers, a maternal mental health programme run by Thalia Psychotherapy, that question has become increasingly important.

The programme supports women during pregnancy and after childbirth, a period that is often presented as one of the happiest times in a woman’s life but can also be one of the most difficult.

Behind the congratulations and pictures of newborn babies are mothers dealing with sleepless nights, money problems, grief, difficult relationships, loneliness and the pressure of caring for another human being when they themselves may be struggling.

For a single mother, these pressures can come with another layer. She may be worrying about rent, food or school fees without another parent to share the burden.

She may be answering questions about the father of her child. She may be dealing with a failed relationship, while still trying to provide stability for her children.

In some families and communities, she may also be carrying judgment about how she became a single mother in the first place.

Yet she still has to wake up.

The child still needs breakfast. School fees still have to be found. Work still expects her to arrive. The landlord still expects rent. Life does not stop because she is emotionally exhausted.

This is one of the challenges Maisha Mothers is trying to address as Thalia Psychotherapy works towards a larger ambition of partnering with the Kenyan government to make psychological support available to more mothers through the existing health system.

But the programme encountered a problem. Some mothers were entering care and then disappearing. Others attended one or two sessions but did not continue.

For a small programme, that can be described simply as drop-off. For a programme that hopes to serve mothers at a much larger scale, it becomes a much more serious question.

A mother may be screened, identified as needing support and referred for care. She may even attend her first session. On paper, she has been reached. But if she leaves before she receives the support she needs, has the health system really succeeded?

‘YOU ARE NOT ALONE’

To understand why women were leaving, Maisha Mothers began working with Pathways segmentation, an approach managed by the team at Sonder Collective.

Pathways encourages organisations to look beyond broad categories, such as age, income or location, and examine the different social, cultural, economic and personal realities shaping people’s behaviour.

For the Maisha Mothers team, it challenged a simple assumption. Mothers may share the experience of having children, but they are not one group.

Two women can be the same age, attend the same hospital and have children of a similar age, yet their lives outside the hospital can be completely different.

One may go home to a supportive partner and extended family. Another may be raising her children alone. One may have very little money. Another may have a stable income but be quietly grieving the loss of a baby. One may be comfortable speaking to a therapist. Another may have spent years learning not to trust anyone with her problems.

This changed the question Thalia was asking. It was no longer simply, “Why are mothers leaving?” The more useful question became, “Which mothers are leaving, what is happening in their lives, and what would make them feel comfortable enough to stay?”

Single mothers became particularly important in that conversation. 

What emerged was surprisingly simple. Some women did not only need access to a therapist. They needed to know they were not alone.

“I realised I was not alone.” That feeling comes through strongly in another conversation I listened to with a mother participating in Maisha Mothers. Her story is different from Jackline’s, but the emotions are familiar. She speaks about depression and the difficulty of carrying problems quietly, while continuing with life as a mother.What changed for her was finding other women.

As she talks about the experience, one idea keeps returning. She discovered that she was not alone. Other mothers were dealing with their own pain, fears and struggles. Being around women who understood some of those experiences made talking easier.

That may sound ordinary, but anyone who has struggled with depression or emotional distress knows how difficult talking can become. Sometimes the hardest sentence is the first one.

A woman may not know how to tell a therapist everything during a first appointment. She may fear being judged. She may not even have the language to explain what is wrong. She just knows that she is tired, angry, scared, unhappy or no longer feels like herself.

Sitting with other mothers can change that conversation. One woman begins telling her story and another recognises herself in it. Somebody talks about a relationship, a child, money, loneliness or depression, and another woman realises that the thing she has been hiding is not hers alone.

FROM ISOLATION TO BELONGING

The mother in the interview describes becoming more comfortable talking about what she was going through. By the end of her story, what stands out most is not depression. It is how she now speaks about being a mother with pride.

That movement from isolation to belonging is important. It does not mean a group of mothers can replace psychologists, counsellors or psychiatrists. They cannot. Women experiencing serious depression, trauma, suicidal thoughts or other high-risk conditions need professional support.

But another mother can sometimes help open the door to that support. She can say, in her own way, “I have also struggled.” She can notice when another woman stops attending. She can encourage her to return.Most importantly, she can offer something that is difficult to prescribe in a clinic: the feeling of being understood.

Years after she had stopped therapy, Jackline met another mother during a hospital visit, who told her about Maisha Mothers. She decided to try again.

This time, there was a difference. She could attend one-on-one therapy, but she could also sit with other mothers in group sessions.

The individual sessions gave her room to deal privately with experiences she had carried for years. The group sessions offered something else. They showed her that healing did not have to happen in isolation.

The women came from different backgrounds and carried different stories. Some of what Jackline heard was deeply painful. Yet motherhood gave them common ground. They could talk about relationships, disappointments, children, fear, money and their hopes for the future without needing to pretend that everything was fine.

“One of the biggest lessons I have learnt is that healing is not always a straight line,” Jackline says.

Sometimes people convince themselves that they have moved on, only for an experience or a trigger to bring old emotions back to the surface. Having support when that happens can make the difference between withdrawing again and continuing to heal.

SINGLE MOTHERS’ STRENGTH

There is something else worth noticing in these women’s stories. We often talk about single mothers only in terms of what they lack. A partner. Money. Support. Stability.

That can make us overlook what they already have. Experience.

A woman who has raised a child alone knows things that cannot be learnt from a textbook. She knows what it means to make difficult decisions when there is nobody else to make them. She knows the fear that can come when money is running out. She may know what it is like to smile at work, church or a family gathering when she is falling apart inside.

That lived experience can become useful to another woman.

A mother who survived a difficult postpartum period may notice distress in another mother. A woman who once resisted therapy may be the person who persuades somebody else to give it a chance. Someone who knows what loneliness feels like may recognise when another woman begins pulling away.

This does not turn single mothers into therapists. It turns community into part of the support around therapy.For Thalia Psychotherapy, that lesson matters as it considers how Maisha Mothers can grow. Scale in healthcare is often discussed using big numbers: how many people were screened, how many hospitals participated, how many professionals were trained and how many sessions were completed.

Those numbers are important, but Pathways has pushed the Maisha Mothers team to look at what is hidden inside them.

If 1,000 women enter a service, what happens to the woman who never comes back after her first session? What happened in her life that the programme failed to see? Would another form of support have helped her stay?

There may never be one answer.

One mother may need a psychologist. Another may need grief support after losing a baby. Another may need help escaping violence. Another may need practical support. And another may first need a room with women who make her feel safe enough to finally say, “I am not okay.”

Today, Jackline is a mother and entrepreneur building Little Star Leaders Academy and Wakart House. Someone meeting her now might see a confident woman raising children and creating opportunities for others. They may never imagine that there were days when her world had narrowed to tea, uji, feeding her baby and simply trying to survive.

That is perhaps the most powerful part of her story.

People can look strong and still be struggling. Mothers can go to work, prepare meals, pay bills and laugh with their children, while carrying pain nobody around them can see.

In Kenya, we often praise women for being strong. But perhaps strength should not always mean carrying everything alone. 

Sometimes strength is telling a friend that you are not okay. Sometimes it is sitting in front of a therapist and crying. Sometimes it is returning after you once stopped. And sometimes it is sitting beside another mother and discovering that your story is not as lonely as you thought.

Maisha Mothers is still learning how to help more women enter psychological care and, just as importantly, how to help them stay. Pathways segmentation has helped Thalia look beyond the word ‘mother’ and see the very different women hidden inside that label.

The lesson emerging from those women is simple. Sometimes healing starts with professional care. Sometimes it starts with being heard.

And sometimes it starts when one mother looks at another and, without judgment or explanation, lets her know: You are not the only one.