Postpartum depression in Ecuadorian women: does the quality of health care during childbirth matter?

Poor quality obstetric care can harm women's mental health, especially after childbirth. This study examines how the perceived quality of health services during childbirth is related to postpartum depression in Ecuador. Using data from 16,451 women in the 2018 National Health and Nutrition Survey, we applied probit and latent class probit models. We find that higher perceived quality of care during childbirth decreases the likelihood of postpartum depression, with stronger effects in intense and long-lasting cases. The results of the instrumental variables model show that, in the most representative class, comprising 68.15% of the sample, a one-point increase in perceived quality reduces the probability of postpartum depression by 9.1% (CI_95% : -15.2%, -3.0%). This group includes mainly indigenous women, mothers of multiple children, and users of the public health system. These results underscore the urgency of integrating mental health support into maternal care and strengthening policies that improve women's experiences during childbirth in public health facilities.