Pregnant People’s Mental Health Care Access Depends On Levels Of Stigma

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Across all socioeconomic ranges, the weeks immediately before and after people give birth are particularly dangerous for people of color. The racial disparities in perinatal healthcare too often have fatal or near-fatal results for women of color, according to the National Partnership for Women and Families. And it's not just mortality rates that are alarming: racial inequities in perinatal mental health care are also pervasive.

Discussions about mortality rates in the weeks before and after someone gives birth often eclipse the fact that mental health concerns can be significant contributors to maternal mortality, according to a 2018 report published by the Nine Maternal Mortality Review Committees. The report found that 27% of deaths where the primary factor was mental health are directly related to people receiving ineffective treatments, or failures to screen for illnesses like postpartum depression by their healthcare provider; 42% of these deaths were attributable to "patient factors" like not adhering to treatment plans, abusive relationships or unstable housing, or not recognizing warning signs of mental health crisis.

Desirée L. Israel, LGSW, is a perinatal psychotherapist and trained birth doula who sits on the advisory board of 2020 Mom, an organization that focuses on closing the perinatal mental health care gap. "The most under-discussed and undertreated experiences of people of color after giving birth would be anxiety and race-based trauma," she tells Bustle. "Many families are even more scared to parent after giving birth due to the climate of today’s society. From police brutality and racial and trans hate crimes, families are often experiencing untreated PTSD due to their surroundings, whether environmental or via social media."

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And as the Center for American Progress (CAR) put it in a 2019 policy blueprint regarding inequities in maternal health care, the racial disparity in treatment hugely impacts the mental health of people of color before and after giving birth. "Structural racism in health care and social service delivery," the report said, "means that African American women often receive poorer quality care than white women."

This structural racism is written into the education of doctors around the western world, according to a 2019 report published in the journal PLOS One. This report concluded that even across Europe, pregnant people of color lack adequate mental health access due largely to stigma and "culturally insensitive and fragmented health services and interactions with culturally incompetent and dismissive health providers." And a 2011 study published in the journal Psychiatric Services noted that among low-income white women and low-income women of color with similar clinical profiles, Black and Latinx women are significantly less likely to receive adequate treatment for postpartum depression.

And of course, it's not just women of color being denied access to adequate pre- and perinatal health care. Trans men and nonbinary people of all races who are interested in becoming or have been pregnant face barriers to receiving adequate care. According to a 2018 study published in the journal Annals of Emergency Medicine, nearly half of all trans men and gender non-conforming people avoid seeking treatment when they need medical attention due to pervasive transphobia in the medical industry. It is therefore unsurprising that as many as 44% of pregnant trans men seek medical care outside of the established medical care system, according to the 2015 U.S. Transgender Survey.

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For many, finding POC and queer mental health providers is of utmost importance when grappling with depression and anxiety surrounding birth. The organization Postpartum Progress, which emphasizes postpartum mental health recovery and which granted Israel a scholarship for their Mental Health In Color Initiative, has compiled a list of Black mental health providers to help people in their search for affirming care.

In this kind of hostile environment, if you're giving birth or have given birth, Israel advises you to form community with others going through similar journeys. And ultimately, she says, you're going to need to "Be gentle with yourself, unplug, seek help and inherit safe spaces." Because you deserve as much care, affirmation, and safety as your child does.

If you or someone you know is experiencing depression or anxiety during pregnancy, or in the postpartum period, contact the Postpartum Health Alliance warmline at (888) 724-7240, or Postpartum Support International at (800) 944-4773. If you are thinking of harming yourself or your baby, get help right away by calling the National Suicide Prevention Lifeline at 1-800-273-8255, or dialing 911. For more resources, you can visit Postpartum Support International.

Studies Referenced:

Nine Maternal Mortality Review. (2018) Building U.S. Capacity to Review and Prevent Maternal Deaths, https://www.cdcfoundation.org/sites/default/files/files/ReportfromNineMMRCs.pdf.

Roberts, A.L. (2012) Race/ethnic differences in exposure to traumatic events, development of post-traumatic stress disorder, and treatment-seeking for post-traumatic stress disorder in the United States. Psychological Medicine, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3097040/.

Taylor, J. (2019) Eliminating Racial Disparities in Maternal and Infant Mortality. Center for American Progress, https://www.americanprogress.org/issues/women/reports/2019/05/02/469186/eliminating-racial-disparities-maternal-infant-mortality/.

Watson, H. (2019) A systematic review of ethnic minority women’s experiences of perinatal mental health conditions and services in Europe. PLOS One, https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0210587.

Kozhimannil, K.B. (2011) Racial and Ethnic Disparities in Postpartum Depression Care Among Low-Income Women. Psychiatry Services, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3733216/.

Samuels, E.A. (2018) “Sometimes You Feel Like the Freak Show”: A Qualitative Assessment of Emergency Care Experiences Among Transgender and Gender-Nonconforming Patients. Annals of Emergency Medicine, https://www.sciencedirect.com/science/article/abs/pii/S0196064417305838.

Experts:

Desirée L. Israel, LGSW, perinatal psychotherapist and trained birth doula, Advisory Board of 2020 Mom.