Postnatal Depression Screening Uptake and Trauma Disclosure in South African Midwife-Led Clinics: A Difference-in-Differences Analysis of Mental Health Referral Pathways

South African midwife-led clinics screen for postnatal depression (PND) at high rates but refer few women to mental health services, and the role of trauma disclosure in this referral gap remains unexamined. The mean indicator value was 32.358 (SD = 15.598), ranging from 10.96 in Malawi to 62.05 in Guinea. The analysis treats the indicator as a proxy for gender-power asymmetry that conditions both screening behaviour and disclosure safety in midwife-led antenatal and postnatal care. The results indicate that screening uptake and trauma disclosure diverge systematically across country contexts, and that referral pathway completion is lowest where gender-power asymmetry is highest. The paper argues that PND screening programmes in South Africa should be evaluated not by screening coverage alone but by the conditional probability that a screened woman discloses trauma and is referred onward. The contribution is a reframing of screening uptake as a disclosure-dependent outcome rather than a coverage metric.