{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T09:04:00Z","timestamp":1784711040796,"version":"3.55.0"},"reference-count":53,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"unspecified","delay-in-days":49,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Camb. prisms Glob. ment. health"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Perinatal mental health disorders are prevalent in Ecuador and Peru. Despite national health policies supporting maternal mental health care, service provision remains fragmented, relying on a mix of public, private, and nongovernmental actors. This study examined professional interest holders\u2019 perceptions of barriers to perinatal mental health care and the solutions they propose. We employed a mixed-methods approach. First, a systematic review of publicly available data was conducted to identify organizations engaged in maternal and mental health care in Ecuador and Peru. Following this, in-depth, semistructured interviews were conducted with 17 key informants representing research institutions, nongovernmental organizations (NGOs), government agencies, and private sector entities. Thematic analysis was applied to identify structural barriers, institutional challenges, and proposed solutions. Findings revealed multilevel barriers to perinatal mental health care, including stigma, financial constraints, limited provider training, fragmented health services, and bureaucratic inefficiencies. Community-based interventions, task-shifting strategies, and increased public education were identified as effective approaches to addressing these challenges. Participants also emphasized the need for intersectoral collaboration, increased governmental investment, and policy reforms to strengthen maternal mental health services. Efforts to improve perinatal mental health care in Ecuador and Peru require a combination of culturally sensitive, community-driven interventions, as well as sustainable government investment and commitment.<\/jats:p>","DOI":"10.1017\/gmh.2025.10090","type":"journal-article","created":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T06:00:34Z","timestamp":1771480834000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["A landscape analysis of perinatal mental health delivery among stakeholders in Ecuador and Peru"],"prefix":"10.1017","volume":"13","author":[{"given":"Oriana","family":"Culbert","sequence":"first","affiliation":[{"name":"Rutgers The State University of New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Itziar","family":"Familiar-Lopez","sequence":"additional","affiliation":[{"name":"Michigan State University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joaqu\u00edn","family":"Castro Vergara","sequence":"additional","affiliation":[{"name":"Universidad San Francisco de Quito"},{"name":"Universidad San Francisco de Quito"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nergiz","family":"Turgut","sequence":"additional","affiliation":[{"name":"Universidad San Francisco de Quito"},{"name":"Universidad San Francisco de Quito"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Sol","family":"Garc\u00e9s Espinosa","sequence":"additional","affiliation":[{"name":"Universidad San Francisco de Quito"},{"name":"Universidad San Francisco de Quito"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor Orlando","family":"Cruz","sequence":"additional","affiliation":[{"name":"Universidad de San Mart\u00edn de Porres"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Foot","sequence":"additional","affiliation":[{"name":"University of Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Halpern Lagos","sequence":"additional","affiliation":[{"name":"University of Michigan-Michigan Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela Marie","family":"Johnson","sequence":"additional","affiliation":[{"name":"University of Michigan-Michigan Medicine and Program for Multicultural Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Muzik","sequence":"additional","affiliation":[{"name":"University of Michigan-Michigan Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7889-3852","authenticated-orcid":false,"given":"Gwenyth O.","family":"Lee","sequence":"additional","affiliation":[{"name":"Rutgers The State University of New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,2,19]]},"reference":[{"key":"S2054425125100903_r51","unstructured":"World Health Organization, n.d. Perinatal mental health. Available at https:\/\/www.who.int\/teams\/mental-health-and-substance-use\/promotion-prevention\/maternal-mental-health (accessed 5 January 25)."},{"key":"S2054425125100903_r26","doi-asserted-by":"crossref","first-page":"4285","DOI":"10.1177\/08862605241234357","article-title":"Mental Health and quality of life in Ecuadorian women exposed to gender-based violence","volume":"39","author":"Meneses","year":"2024","journal-title":"Journal of Interpersonal Violence"},{"key":"S2054425125100903_r16","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyt.2021.674194","article-title":"One year into the pandemic: A systematic review of perinatal mental Health outcomes during COVID-19","volume":"12","author":"Iyengar","year":"2021","journal-title":"Frontiers in Psychiatry"},{"key":"S2054425125100903_r25","doi-asserted-by":"crossref","first-page":"1","DOI":"10.21522\/TIJAR.2014.09.02.Art001","article-title":"Strengths and challenges to the integration of mental health services into the primary health care system in developing countries: A systematic review","volume":"9","author":"Maloney","year":"2022","journal-title":"Texila International Journal of Academic Research"},{"key":"S2054425125100903_r29","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/S2215-0366(16)30350-9","article-title":"Transitioning mental health into primary care","volume":"4","author":"Miranda","year":"2017","journal-title":"Lancet Psychiatry"},{"key":"S2054425125100903_r24","first-page":"310","article-title":"Major depression in pregnant women served by the National Materno-Perinatal Institute in Lima [Peru]","volume":"26","author":"Luna Matos","year":"2009","journal-title":"Revista Panamericana de Salud P\u00fablica"},{"key":"S2054425125100903_r3","doi-asserted-by":"crossref","DOI":"10.1186\/s12939-025-02455-w","article-title":"Manifestation, causes and approach to mental distress among the population of migrant and refugee women in Ecuador and Panama: A qualitative study with key informants","volume":"24","author":"Aranda","year":"2025","journal-title":"International Journal for Equity in Health"},{"key":"S2054425125100903_r2","first-page":"1","article-title":"Prevalencia y factores asociados a depresi\u00f3n posparto en mujeres atendidas en establecimientos de salud del primer nivel de atenci\u00f3n en Lima Metropolitana, junio 2004","volume":"12","author":"Arambur\u00fa","year":"2008","journal-title":"Revista Peruana de Medicina Experimental y Salud P\u00fablica"},{"key":"S2054425125100903_r11","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1177\/160940690600500107","article-title":"Demonstrating rigor using thematic analysis: A hybrid approach of inductive and deductive coding and theme development","volume":"5","author":"Fereday","year":"2006","journal-title":"International Journal of Qualitative Methods"},{"key":"S2054425125100903_r21","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1111\/jmwh.12679","article-title":"Addressing the unmet need for maternal mental Health services in low- and middle-income countries: Integrating mental Health into maternal Health care","volume":"62","author":"Lasater","year":"2017","journal-title":"Journal of Midwifery and Women\u2019s Health"},{"key":"S2054425125100903_r37","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1192\/bji.2020.9","article-title":"Perinatal mental health around the world: Priorities for research and service development in South America","volume":"17","author":"Rondon","year":"2020","journal-title":"BJPsych International"},{"key":"S2054425125100903_r13","first-page":"105","article-title":"Discourse versus practice: Are traditional practices and beliefs in pregnancy and childbirth included or excluded in the Ecuadorian health care system?","volume":"9","author":"Gallegos","year":"2017","journal-title":"International Health"},{"key":"S2054425125100903_r17","doi-asserted-by":"crossref","DOI":"10.1177\/23333936211035747","article-title":"Uncovering burdens, examining needs, and shedding assumptions of evidence-based social support programs for mothers: A descriptive qualitative study in a remote community","volume":"8","author":"Jahnke","year":"2021","journal-title":"Global Qualitative Nursing Research"},{"key":"S2054425125100903_r12","volume-title":"Exploring Understandings of Maternal Health and Wellbeing in Esmeraldas, Ecuador","author":"Forer","year":"2024"},{"key":"S2054425125100903_r18","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1136\/ebmental-2021-300254","article-title":"WHO mental health gap action programme (mhGAP) intervention guide: Updated systematic review on evidence and impact","volume":"24","author":"Keynejad","year":"2021","journal-title":"Evidence-Based Mental Health"},{"key":"S2054425125100903_r38","first-page":"1","article-title":"Barriers to accessing mental health services for women with perinatal mental illness: Systematic review and meta-synthesis of qualitative studies in the UK","volume":"9","author":"Smith","year":"2019","journal-title":"BMJ Open"},{"key":"S2054425125100903_r40","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1186\/1471-2431-14-185","article-title":"Early maternal depressive symptoms and child growth trajectories: A longitudinal analysis of a nationally representative US birth cohort","volume":"14","author":"Surkan","year":"2014","journal-title":"BMC pediatrics"},{"key":"S2054425125100903_r34","first-page":"121","article-title":"Protecting distress migrants\u2019 right to Health in Ecuador: Are legal commitments being fulfilled?","volume":"26","author":"Pinto-Alvarez","year":"2024","journal-title":"Health and Human Rights"},{"key":"S2054425125100903_r44","unstructured":"UNHCR, the UN Refugee Agency, 2025. Ecuador: UNHCR Data Portal. Available at https:\/\/data.unhcr.org\/en\/country\/ecu (accessed 5 December 2025)."},{"key":"S2054425125100903_r47","doi-asserted-by":"crossref","first-page":"1996","DOI":"10.1177\/00207640231185026","article-title":"Provision of community mental health care before and during the COVID-19 pandemic: A time series analysis in Peru","volume":"69","author":"Villarreal-Zegarra","year":"2023","journal-title":"The International Journal of Social Psychiatry"},{"key":"S2054425125100903_r48","doi-asserted-by":"crossref","first-page":"151942","DOI":"10.1016\/j.semperi.2024.151942","article-title":"A global perspective: Access to mental health care for perinatal populations","volume":"48","author":"Wilson","year":"2024","journal-title":"Seminars in Perinatology"},{"key":"S2054425125100903_r4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12906-021-03234-0","article-title":"Perceptions of Ecuadorian indigenous healers on their relationship with the formal health care system: Barriers and opportunities","volume":"21","author":"Bautista-Valarezo","year":"2021","journal-title":"BMC Complementary Medicine and Therapies"},{"key":"S2054425125100903_r27","volume-title":"Gu\u00eda t\u00e9cnica Para la Psicoprofilaxis obst\u00e9trica Y estimulaci\u00f3n Prenatal","year":"2011"},{"key":"S2054425125100903_r36","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1192\/S1749367600000230","article-title":"Peru: Mental health in a complex country","volume":"6","author":"Rondon","year":"2009","journal-title":"International Psychiatry"},{"key":"S2054425125100903_r5","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1097\/DBP.0000000000000510","article-title":"Effect of caregiver training on neurodevelopment of HIV-exposed uninfected children and caregiver mental health: A Ugandan cluster randomized controlled trial","volume":"38","author":"Boivin","year":"2018","journal-title":"Journal of Developmental and Behavioral Pediatrics"},{"key":"S2054425125100903_r6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12889-021-11954-8","article-title":"Health care providers\u2019 perceptions of barriers to perinatal mental healthcare in South Africa","volume":"21","author":"Brown","year":"2021","journal-title":"BMC Public Health"},{"key":"S2054425125100903_r10","article-title":"Preparing to launch the \u2018thinking healthy Programme\u2019 perinatal depression intervention in urban Lima, Peru: Experiences from the field","volume":"5","author":"Eappen","year":"2018","journal-title":"Global Mental Health"},{"key":"S2054425125100903_r35","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1001\/jamapsychiatry.2023.0069","article-title":"Prevalence of perinatal depression in low- and middle-income countries: A systematic review and meta-analysis","volume":"80","author":"Roddy Mitchell","year":"2023","journal-title":"JAMA Psychiatry"},{"key":"S2054425125100903_r43","first-page":"501","article-title":"Peruvian mental health reform: A framework for scaling-up mental health services","volume":"6","author":"Toyama","year":"2017","journal-title":"International Journal\u00a0of\u00a0Health Policy\u00a0and\u00a0Management"},{"key":"S2054425125100903_r20","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1177\/1049732313519866","article-title":"Perinatal depression treatment preferences among Latina mothers","volume":"24","author":"Lara-Cinisomo","year":"2014","journal-title":"Qualitative Health Research"},{"key":"S2054425125100903_r32","unstructured":"World Health Organization (2017) Mental Health Atlas 2017 member state profile: Lima, Peru."},{"key":"S2054425125100903_r46","doi-asserted-by":"crossref","first-page":"319","DOI":"10.4324\/9781315311258-19","volume-title":"The Routledge Handbook of Translation and Technology","author":"Vieira","year":"2019"},{"key":"S2054425125100903_r1","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1007\/s00737-017-0723-z","article-title":"Prevalence and risk of mental disorders in the perinatal period among migrant women: A systematic review and meta-analysis","volume":"20","author":"Anderson","year":"2017","journal-title":"Archives of Women\u2019s Mental Health"},{"key":"S2054425125100903_r39","doi-asserted-by":"crossref","first-page":"e203","DOI":"10.1016\/S2468-2667(22)00342-5","article-title":"The global burden of perinatal common mental health disorders and substance use among migrant women: A systematic review and meta-analysis","volume":"8","author":"Stevenson","year":"2023","journal-title":"The Lancet Public Health"},{"key":"S2054425125100903_r8","doi-asserted-by":"crossref","first-page":"326","DOI":"10.17843\/rpmesp.2019.362.4624","article-title":"Implementation, initial results, and sustainability of the mental health services reform in Peru, 2013\u20132018","volume":"36","author":"Castillo-Martell","year":"2019","journal-title":"Revista Peruana de Medicina Experimental y Salud P\u00fablica"},{"key":"S2054425125100903_r30","first-page":"239","article-title":"Perinatal depression: Implications for child mental health","volume":"7","author":"Muzik","year":"2011","journal-title":"Mental Health in Family Medicine"},{"key":"S2054425125100903_r41","first-page":"349","article-title":"Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups","volume":"19","author":"Tong","year":"2007","journal-title":"International Journal\u00a0for\u00a0Quality\u00a0in\u00a0Health Care"},{"key":"S2054425125100903_r54","unstructured":"World Health Organization (2012) Assessing mental health and psychosocial needs and resources: Toolkit for humanitarian settings. World Health Organization."},{"key":"S2054425125100903_r28","volume-title":"Risk Factors Associated with Maternity Blues and Postpartum Depression in Ecuadorian Women Going through their Immediate Puerperium during 2021: A Cross-Sectional Study. Rev","author":"Mi\u00f1o","year":"2023"},{"key":"S2054425125100903_r22","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1007\/s10802-013-9766-4","article-title":"Associations between maternal mental health and child emotional and behavioral problems: Does prenatal mental health matter?","volume":"42","author":"Leis","year":"2014","journal-title":"Journal of Abnormal Child Psychology"},{"key":"S2054425125100903_r23","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1093\/heapol\/czp052","article-title":"Health care utilization in Ecuador: A multilevel analysis of socio-economic determinants and inequality issues","volume":"25","author":"L\u00f3pez-Cevallos","year":"2010","journal-title":"Health Policy and Planning"},{"key":"S2054425125100903_r9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.12688\/wellcomeopenres.13746.2","article-title":"Provision of mental health care within primary care in Peru: A qualitative study exploring the perspectives of psychologists, primary health care providers, and patients","volume":"3","author":"Cavero","year":"2018","journal-title":"Wellcome Open Research"},{"key":"S2054425125100903_r45","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12884-021-03586-y","article-title":"An exploration of patient-provider dynamics and childbirth experiences in rural and urban Peru: A qualitative study","volume":"21","author":"Vargas","year":"2021","journal-title":"BMC Pregnancy and Childbirth"},{"key":"S2054425125100903_r49","unstructured":"World Health Organization (2020) Mental Health Atlas 2020 Member State Profile: Ecuador."},{"key":"S2054425125100903_r50","unstructured":"World Health Organization (2022) Guide for integration of perinatal mental health in maternal and child health services. https:\/\/www.who.int\/publications\/i\/item\/9789240057142 (accessed 5 December 2025)."},{"key":"S2054425125100903_r42","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1177\/0972063413492036","article-title":"Choosing between traditional medicine and allopathy during pregnancy: Health practices in prenatal and reproductive Health Care in Ecuador","volume":"15","author":"Torri","year":"2013","journal-title":"Journal of Health Management"},{"key":"S2054425125100903_r52","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12884-024-06334-0","article-title":"Experiences of pregnant Venezuelan migrants\/refugees in Brazil, Ecuador and Peru: A qualitative analysis","volume":"24","author":"Zaman","year":"2024","journal-title":"BMC Pregnancy and Childbirth"},{"key":"S2054425125100903_r31","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1192\/bji.2020.16","article-title":"Perinatal mental health around the world: Priorities for research and service development in Africa","volume":"17","author":"Ng\u2019oma","year":"2020","journal-title":"BJPsych International"},{"key":"S2054425125100903_r15","year":"2022"},{"key":"S2054425125100903_r33","first-page":"29","article-title":"What factors predispose to postpartum depression in Ecuadorian women? A cross-sectional analysis","volume":"11","author":"Parra-parra","year":"2022","journal-title":"IOSR\u00a0Journal of\u00a0Nursing\u00a0and\u00a0health Science"},{"key":"S2054425125100903_r7","first-page":"125","article-title":"A right-to-health lens on perinatal mental health care in South Africa","volume":"22","author":"Brown","year":"2020","journal-title":"Health and Human Rights"},{"key":"S2054425125100903_r19","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1007\/s11136-012-0122-x","article-title":"Best practices in mixed methods for quality of life research","volume":"21","author":"Klassen","year":"2016","journal-title":"Qualitative Life Research"},{"key":"S2054425125100903_r14","first-page":"1","article-title":"Correlates of maternal depression, anxiety and functioning across an urban-rural gradient in northern Ecuador","volume":"19","author":"Ghahyazi","year":"2023","journal-title":"Global Public Health"}],"container-title":["Cambridge Prisms: Global Mental Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S2054425125100903","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T08:46:37Z","timestamp":1784709997000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S2054425125100903\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":53,"alternative-id":["S2054425125100903"],"URL":"https:\/\/doi.org\/10.1017\/gmh.2025.10090","relation":{"has-review":[{"id-type":"doi","id":"10.1017\/gmh.2025.10090.pr15","asserted-by":"object"},{"id-type":"doi","id":"10.1017\/gmh.2025.10090.pr13","asserted-by":"object"},{"id-type":"doi","id":"10.1017\/gmh.2025.10090.pr14","asserted-by":"object"},{"id-type":"doi","id":"10.1017\/gmh.2025.10090.pr9","asserted-by":"object"},{"id-type":"doi","id":"10.1017\/gmh.2025.10090.pr8","asserted-by":"object"},{"id-type":"doi","id":"10.1017\/gmh.2025.10090.pr7","asserted-by":"object"},{"id-type":"doi","id":"10.1017\/gmh.2025.10090.pr6","asserted-by":"object"},{"id-type":"doi","id":"10.1017\/gmh.2025.10090.pr1","asserted-by":"object"},{"id-type":"doi","id":"10.1017\/gmh.2025.10090.pr5","asserted-by":"object"},{"id-type":"doi","id":"10.1017\/gmh.2025.10090.pr11","asserted-by":"object"},{"id-type":"doi","id":"10.1017\/gmh.2025.10090.pr4","asserted-by":"object"},{"id-type":"doi","id":"10.1017\/gmh.2025.10090.pr12","asserted-by":"object"},{"id-type":"doi","id":"10.1017\/gmh.2025.10090.pr3","asserted-by":"object"},{"id-type":"doi","id":"10.1017\/gmh.2025.10090.pr10","asserted-by":"object"},{"id-type":"doi","id":"10.1017\/gmh.2025.10090.pr2","asserted-by":"object"}]},"ISSN":["2054-4251"],"issn-type":[{"value":"2054-4251","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]},"assertion":[{"value":"\u00a9 The Author(s), 2026. Published by Cambridge University Press","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e42"}}