A landscape analysis of perinatal mental health delivery among stakeholders in Ecuador and Peru

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' 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.