Mistreatment during health facility-based childbirth and symptoms suggestive of postpartum depression in low resource settings

Introduction Postpartum depression (PPD) is a substantial public health concern among mothers in sub-Saharan Africa but may be underestimated due to limited screening and treatment. Mistreatment during facility-based childbirth has been associated with PPD in prior studies, yet evidence on which mistreatment types are linked to greater PPD symptom severity remains limited. This study assessed the association between mistreatment during facility childbirth and PPD symptoms. Methods A multi-center, cross-sectional study was conducted among 414 postpartum women recruited from selected urban public health facilities using stratified systematic random sampling. Binary logistic regression model was used to estimate adjusted odds of symptoms suggestive of PPD among women reporting mistreatment during childbirth. Poisson regression with robust standard errors was used to assess differences in Edinburgh Postnatal Depression Scale (EPDS) total scores according to reported exposure to specific forms of mistreatment. Adjusted measures with 95% confidence intervals (CIs) were reported, with statistical significance set at p < 0.05. Results Among the 400 postpartum women included in the final analysis, 15.00% (95% CI: 11.65%–18.88%) had symptoms suggestive of PPD. In adjusted analyses, expressed as adjusted mean ratios (aMRs), physical abuse (aMR = 1.37; 95% CI: 1.07–1.74), stigma and discrimination (aMR = 1.28; 95% CI: 1.06–1.54), verbal abuse (aMR = 1.12; 95% CI: 1.01–1.24), and poor provider rapport (aMR = 1.12; 95% CI: 1.00–1.25) were significantly associated with higher expected EPDS total scores. Physical restraint was not significantly associated with expected EPDS total scores (aMR = 1.34; 95% CI: 1.00–1.81). Conclusions PPD symptoms were more prevalent among women who reported mistreatment during facility-based childbirth, and symptom severity differed by type of mistreatment. Strengthening respectful maternity care, addressing inequities, and fostering supportive community environments may help reduce institutional violence and the burden of PPD symptoms.