Background: Literature highlights barriers to mental healthcare access in the perinatal period, but none specific to Rwanda. The unique historical context of the genocide against the Tutsi may present distinct challenges. This study aimed to identify these barriers in Rwanda. Methods: This study employed a qualitative interpretive descriptive approach as part of a multimethod investigation. Four focus group discussions were conducted with 31 perinatal women, and 32 individual interviews were conducted with healthcare providers, including community health workers. Data were analysed thematically. Results: Barriers were identified at multiple levels. At the individual level, barriers included low literacy about perinatal mental health symptoms, minimizing negative experiences, fear of being stigmatized, ignorance about the availability of mental health services in the perinatal period, and economic challenges. Family and social-cultural barriers included stigmatization of people with mental health problems, minimization of what happened by friends and family, and lack of support from partners and friends. Institutional and structural barriers included limited services, misdiagnosis, heavy workloads, staff unawareness, and lack of training and guidelines for screening and reporting. Conclusion: This study identified barriers to perinatal mental healthcare at individual, family and social-cultural, institutional and structural levels. Addressing these barriers requires targeted strategies to improve perinatal mental healthcare access across all identified levels.