“When I became a mother, it was a huge shock to me how alone I felt. I thought nothing had changed, that I would just have a child with me but would still be the same person as before.”

Trupi, 38, is an elementary school teacher in Slovenia with three children. We meet her at the University of Ljubljana where she graduated – familiar corridors, a history she knows by heart. She knows her way around children in class. But returning home to her own was the hardest thing she’d ever done. She didn’t talk about it. She thought she was the only one. She wasn’t. And no one is.

16-20% of European mothers suffer from postpartum depression – data from the European Institute for Perinatal Mental Health. But that figure is already a falsehood: it only counts those who have been diagnosed, not those who suffer in silence, those who have nowhere to go, those who aren’t even asked.

Maternal mental health includes depression, anxiety, post-traumatic stress disorder related to childbirth, postpartum psychosis – everything that can emerge during pregnancy and after childbirth (WHO). The European Union has recently authorized the marketing of brexanolone, the first drug specifically designed for postpartum depression. Good. But a drug doesn’t solve a system that doesn’t ask the question. And the question is a single, elementary, almost offensive in its simplicity: how are you? When you meet with those who should answer, you discover that the system often doesn’t ask.

Slovenia: the numbers the government didn’t want to know

Slovenia has a year of maternity leave, regular gynecological checkups, a midwife in the delivery room. All good, on paper. But six weeks after giving birth, there’s only one visit – the body is healed, the baby is growing, good luck. For the mother’s psyche, there’s no screening, no path, no mandatory application. It’s in this void that Trupi, from a small town on the outskirts of Slovenia, did the only sensible thing: she invented what wasn’t there. During Covid, she opened a “mothers’ circle” on Zoom – no lectures, no instructions, just a space to talk without judgment. Four years later, it’s a network of 20 cities across Slovenia, with groups of five to ten people meeting once a month in libraries and community centers. Organizers are paid between 30 and 50 euros per meeting. It’s not an income. It’s a start. “If you don’t build economic stability, you’ll be tired, angry, forgotten. And quality declines.”

While Trupi works from the bottom, Špela Šloša works from the top – and what she found is worse than anyone suspected. We meet her in a café in the center of Ljubljana: she works remotely, and Umbilica doesn’t have a permanent office, which says something about how the third sector works in this country. Šloša leads Umbilica, a Slovenian NGO participating in the Mind the Mum project, funded by EU4Health together with the Cyprus University of Technology, the University of Gdansk, and the European Institute for Perinatal Mental Health.

The goal: to measure, prevent, and then force the government to act with the data in hand. The preliminary results are, in her words, “horrifying”: a third of Slovenian mothers meet the clinical criteria for postpartum depression. A further 25% are in the gray area. Only 40% of women feel as they did before giving birth. And only 2% are currently receiving help.

This is the first study with real numbers for Slovenia – until now, the National Institute of Public Health cited generic estimates from the Western world, ranging between 10% and 20%. Now we know that Slovenia is well beyond that. “The system offers no help,” says Šloša, also citing her personal experience: “Just antidepressants and that’s it. No psychotherapy, no resolution of real problems.” There’s a further paradox: if a woman develops childbirth-related trauma and is referred to a psychologist at the same hospital, that psychologist will never be able to validate that trauma. The complaints system doesn’t work. Obstetric violence exists, it’s widespread, and it has no consequences.

Connecting research and community is Kastelic – facilitator, illustrator, and author of one of the first Slovenian podcasts dedicated to the real stories of ordinary mothers. We join her at home, where she works surrounded by the materials for her illustrations and a quiet that contrasts with the multitude of things she manages to set in motion. In 2016, she answered a Facebook call from a Hungarian organization looking for partners for a project on mothers. She didn’t have any children, she didn’t have an organization. She said yes anyway. The women’s circle project that resulted from it reached hundreds of women in just a few months – each woman trained created her own circle, a cascade effect.

The podcast launched in 2020 – ordinary mothers sharing their stories as if they were talking in a barroom, unfiltered, without instructions – is still a resource passed on to women today. “Some tell me they listened to all 50 episodes. Because it was the first time they felt the reality of motherhood without someone instructing them on how to live it.” Now she’s preparing a new series: a practical guide to the myriad daily decisions that no one explains to mothers- which cream, which car seat, how to navigate the chaos. “These seem like silly details. They’re not. Relieving mental burdens is already taking care of a mother’s mental health.”

Croatia: the problem exists, the system pretends it doesn’t

If Slovenia is – as Nina Cikеš Stegić says – “twenty years ahead,” Croatia is a country where the problem is visible to anyone who wants to look, and invisible to anyone with the power to address it. Cikеš Stegić comes from a medical background. After the birth of her third child, she left the hospital and started again as a doula, craniosacral therapist, and perinatal psychology consultant. We reach her by phone from Rijeka – she works extensively online, out of necessity rather than choice, because the territory she has to cover is vast and resources are limited.

With Martina Trboglav Podvorac, a psychologist from Zagreb, she has developed an integrated program that combines childbirth preparation, bodywork, and psychological support. None of this exists in the Croatian public system. “Even after pregnancy and birth – which doesn’t work well in our hospitals, too many interventions, too little support – you reach the postpartum period completely alone. That’s when everything falls apart.” They work in Rijeka and Zagreb, but also online with Croatian women scattered across Europe looking for someone who speaks their language. The limit is brutal: it’s not reimbursed by public insurance. Those who can’t pay are denied access. In all of Croatia, there are perhaps five psychologists working specifically in gynecology and obstetrics departments. Five, in a country of nearly four million people.

Sandra Nakić Radoš, an associate professor at the Catholic University of Croatia and founder of the Center for Reproductive Mental Health in Zagreb, is the voice often missing from this debate: someone within the system who doesn’t just defend it, but doesn’t just attack it either. In her office – shelves of scientific publications, the tidiness of someone who has learned to construct arguments that withstand objections – she has been researching peripartum mental health since 2008. Her data: one in five women experiences psychological problems in the peripartum period, in line with the European average. Not all of them need psychiatry, but almost all need something – and that something isn’t organized, isn’t funded, isn’t guaranteed. “Pregnant women, if they’re well, have more contact with the healthcare system than they’ve ever had in their lives. Yet we miss these opportunities. We don’t ask how they’re doing.” This is the simplest and most poignant statement in this investigation. A system that meets with every mother dozens of times during the nine months of pregnancy, and never bothers to ask.

Nakić Radoš, however, offers a position worth listening to in depth: “Implementing screening without clear treatment pathways is unethical. If you identify a woman at risk and don’t know where to send her, you do her even more harm – you leave her alone after telling her she might be depressed.” Change, she says, must also come from within, not just against the system. “When things that aren’t working are highlighted, institutions defend themselves. We need to find a way to work within them, not just accuse them.” She is participating in the Horizon Happy Moms project, led by the University of Milan, one of the few European attempts to develop evidence-based guidelines shared across countries.

European funds: still a partial opportunity

The question at this point is inevitable: where is the European money? The answer is complex. Neither Slovenia nor Croatia have ESF+ (European Social Fund Plus) programs specifically dedicated to maternal mental health. ESF+ has allocated €741 million for the 2021-2027 period in Slovenia for a “more social Slovenia” and approximately €2 billion in Croatia, with almost a third earmarked for social inclusion. Maternal mental health enters these programs obliquely – as a risk factor for exclusion, as a variable in vulnerable families. It is not the primary target. But it is not absent either.

The logic has its own coherence: the ESF+ was born to fight poverty and exclusion, and a mother who suffers in silence is at high risk on both fronts. Working on the context – reducing economic precariousness, strengthening community services, supporting vulnerable families – creates the conditions for the problem to emerge and be addressed. Umbilica’s Mind the Mum project, funded by EU4Health, shows what happens when European funds are used in a more targeted fashion: research, prevention, advocacy. It’s still a temporary project, not a system. But it points a direction.

Nakić Radoš, who has been working for years at the intersection of research and healthcare policy, sees European funds as a tool with untapped potential: “They are needed to conduct research, develop effective programs, and create networks between countries. European collaboration is essential – individual healthcare systems won’t move forward alone.” The key, she says, is the next step: “We need to translate everything into individual national contexts and find a way to make the programs sustainable after the funding ends. It’s not a problem with the funds per se – it’s a systemic challenge that can be addressed.” Radoš herself participates in the Horizon “Happy Moms” project, which works in exactly this direction: building shared guidelines between countries that outlast individual projects.

Kastelic knows the operational challenge well: “When your model depends on European funds, you have to get projects that fill your space, but you don’t have the capacity to do the work on the ground.” The organizations closest to mothers almost always lack the formal requirements to access calls for proposals – they don’t have a project office, they lack bureaucratic experience, and often they don’t even have the required legal form. The funds exist. The women who need them exist. The challenge is building the bridges that connect them.

A challenge that spans every country and every level: from the library in a small Slovenian town where Trupi opens a circle once a month, to the Zagreb study where Nakić Radoš accumulates data in the hope that someone in the ministries will actually listen. In between, hundreds of thousands of women in Europe become mothers every year, undergo physical examinations, and then are sent home. Without anyone bothering to ask the most basic question in the world.