Psychosocial and structural factors associated with postpartum depressive symptoms and maternal continuum of care in Borama, Somaliland: a cross-sectional study

Background Postpartum depression (PPD) and fragmented maternal care are critical public health challenges in sub-Saharan Africa.Objective To examine the associations of psychosocial, structural, clinical, and health-system factors with self-reported postpartum depressive symptoms and maternal continuum-of-care (CoC) completion in Borama, Somaliland.Methods A community-based cross-sectional study analyzed 442 postnatal women. Postpartum depressive symptoms were assessed via binary self-report, and CoC was summarized using a 0–3 index (ANC4+, facility delivery, and postnatal care). Multivariable logistic regression estimated adjusted odds ratios (aORs) for depressive symptoms; robust multiple linear regression estimated adjusted CoC-score differences (N=442).Results Depressive symptoms were reported by 109/442 women (24.7%), and 152/442 (34.4%) completed all three CoC components. Higher adjusted odds of symptoms were observed among single mothers (aOR = 2.27, 95% CI 1.11–4.65), women with labor complications (aOR = 2.06, 95% CI 1.10–3.87), university/technical education (aOR = 2.49, 95% CI 1.16–5.33), and fair/poor self-rated health (aOR = 6.66, 95% CI 2.62–16.90). Among symptom-positive women, 37.6% spoke to no one about their distress. Adjusted symptom probabilities declined across increasing spousal-support categories, but the overall association was not statistically significant (p=.430). Early ANC initiation (B=0.345, 95% CI 0.205–0.486) and university/technical education (B=0.382, 95% CI 0.182–0.582) were positively associated with the CoC score.Conclusions Postpartum depressive symptoms and incomplete continuity of care were prevalent in this sample. Maternal-health planning should consider integrating routine emotional symptom enquiry with strategies that strengthen early ANC engagement and postnatal follow-up.