Is mistreatment of women during facility-based childbirth an independent risk factor for postpartum depression? A mixed methods prospective study in Ethiopia and Guinea

In sub-Saharan Africa, 17% of postpartum women experience a
postpartum mental disorder, mainly postpartum depression, which
can lead to self-harm, harm to the baby, compromised child health
and development, and suicide. As 48% of women in the region do not
receive postnatal care (81% in Ethiopia and 51% in Guinea),
postpartum depression remains undiagnosed and untreated.
Globally, despite a critical evidence gap, there are growing reports of
postpartum depression among women mistreated during facilitybased
childbirth. Recent studies from Ethiopia and Guinea show that
the prevalence of both mistreatment (28% - 83%) and postpartum
depression is high, making a strong case to examine the association
between the two. This study—one of the first in the field—uses a
novel design to 1) examine the link between mistreatment and
postpartum depression and 2) to explore health system capacity to
improve respectful maternity care and maternal mental health
services in urban settings. I will conduct a prospective longitudinal
survey of women from the third trimester of pregnancy to eight weeks
postpartum and in-depth interviews with key health system
informants. Data from the women’s survey will be analysed using a
multilevel mixed-effects model; data from in-depth interviews by
using a hybrid thematic analysis approach. The findings will inform
actions aimed at mitigating mistreatment and providing care for
postpartum depression in low-resource settings.