Co-Designing Postpartum Support In San Cristóbal, Galápagos

Background and Purpose: The postpartum period is a high-risk and often under-supported transition, especially in geographically isolated settings where access to follow-up care, material resources, and social support may be limited. On San Cristóbal Island in the Galápagos, postpartum families navigate the shift from hospital to home within a context shaped by service scarcity, intra-island transportation barriers, weather-related disruptions, and uneven access to community resources. This study used a community-engaged human-centered design (HCD) approach to examine postpartum support needs during the hospital-to-home transition and to identify locally feasible strategies to strengthen support.

Methods: We conducted a formative, sequential multi-phase study between March and July 2025. First, we completed rapid resource mapping of postpartum-relevant services and supports. Second, we administered parallel needs assessment surveys with postpartum mothers and hospital providers and staff using purposive sampling. Third, we convened a participatory human-centered design workshop with mothers, providers, and community partners. Fourth, we collected brief pre/post workshop surveys to assess the perceived usefulness and feasibility of prototype concepts. Quantitative data were analyzed descriptively. Qualitative responses and workshop outputs were synthesized using rapid thematic approaches, including journey mapping, affinity clustering, and participatory prototyping.

Results: Unmet needs centered on breastfeeding support, emotional wellbeing, postpartum self-care, and uncertainty about where to seek help after discharge. Resource mapping showed that while some clinical and referral resources were available, major structural gaps remained in transportation, baby supplies, household support, childcare, safe water access, housing, and digital connectivity. Across data sources, the first days after discharge emerged as the most vulnerable period. Through the HCD process, participants identified emotional wellbeing as a shared cross-stakeholder priority and generated two complementary prototype directions: a web based community-based peer support model for new mothers and a nurse-guided information channel offering structured postpartum guidance. Participants viewed both approaches as feasible, low-cost, and responsive to local realities.

Conclusions and Implications: Findings position the hospital-to-home transition as a critical point for intervention in postpartum care. In geographically constrained and resource-limited settings, low-cost, community-grounded supports developed through human-centered design may improve continuity, navigation, and emotional support after discharge. At the same time, community-designed solutions cannot fully compensate for structural absences in the service environment. This study demonstrates the value of HCD for identifying contextually relevant postpartum support strategies and offers implications for social work research, maternal health practice, and future intervention development in underserved settings.