Maternal mental health is largely neglected in low- and middle-income countries. There is no routine screening or treatment of maternal mental disorders in primary care settings in South Africa. The Perinatal Mental Health Project (PMHP) developed an intervention to deliver mental health care to pregnant women in a collaborative, step-wise manner making use of existing resources in primary care. Over a three year period, 90% of all women attending antenatal care in the maternity clinic were offered mental health screening with 95% uptake. Of those screened, 32% qualified for referral to counselling. Through routine screening and referral, the PMHP model demonstrates the feasibility and acceptability of a stepped care approach to provision of mental health care at the primary care level.