The association between childbirth experience and postpartum depression among Muslim and Christian women living in Andalusia: a cross-sectional study.
Abstract
Background
Postpartum depression (PPD) is the most prevalent postnatal mental disorder, with major maternal and infant consequences. Its onset may be influenced by childbirth experience and sociocultural factors shaping perceptions and emotional adjustment, but cross-cultural evidence is limited. We aimed to determine the association between childbirth experience and postpartum depressive symptoms among women from Muslim and Christian cultural backgrounds in Andalusia, Spain.
Methods
Cross-sectional study of 291 women (168 Christian, 123 Muslim) who gave birth between April 2024 and June 2025 in two Andalusian hospitals. Sociodemographic and obstetric characteristics, including cultural background (not necessarily personal religious belief or practice), were collected by self-reported questionnaire. Childbirth experience was assessed with the Spanish Childbirth Experience Questionnaire (CEQ-E) before discharge and within 48 h postpartum; depressive symptoms were assessed at six weeks postpartum with the Edinburgh Postnatal Depression Scale (EPDS). Non-parametric tests and multivariable binary logistic regression were performed (SPSS v26.0; p < 0.05).
Results
Muslim women reported significantly lower CEQ-E and higher EPDS scores than Christian women (p = 0.001). In the adjusted model, Muslim cultural background increased depressive symptom likelihood (OR = 3.92; 95% CI 1.58-9.70; p = 0.003), while positive childbirth experience was protective (OR = 0.90; 95% CI 0.86-0.94; p = 0.001). Cultural background and childbirth experience appeared to jointly influence maternal emotional outcomes, reflecting differences in perceived autonomy, support, and care practices.
Conclusions
Negative childbirth experience is associated with higher postpartum depressive symptoms, highlighting the importance of humanised, culturally sensitive obstetric care to promote maternal mental health.