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Postnatal depression occurs following 10-15% of pregnancies and in low-middle income countries (LMIC), the rates can be doubled. In order to prioritise interventions it is critical to identify women most at risk and they include those with persistent postnatal depression, and those living in socio-economic disadvantaged circumstances. We describe two treatment trials, one  in a high income context which was recently completed, and one in a LMIC context, in an area with high rates of HIV which is on-going. The implications for policy will be discussed.