Earlier this week, I shared my growing concern with women of color and their maternal mental health being underserved by professionals and those in the mental health advocacy space. (Note: “Women of color” refers to women who are not considered to be Caucasian: Hispanic/Latina, Black or African-American, Asian/Pacific Islander, Native American, Indian, of biracial heritage, etc) Today, I’d like to offer just a few ways in which I think we can improve our efforts, and make maternal mental health advocacy more inclusive of mothers of color, our experiences, and our needs.
I mentioned in my earlier post that many of the women I’ve spoken with expressed frustration and dismay that they were not taken seriously when they told their doctor, social worker, pastor, or a mental health professional that they were struggling. Their symptoms were minimized, their concerns and lack of awareness about what they were experiencing dismissed, and some even stated they were degraded by the professionals they reached out to. That’s unacceptable, and does more harm to women already suffering. One mother, who is African-American, described her experience to me as this:
Her experience mirrors my own. After the birth of my second child, I knew something was wrong but couldn’t identify what. I was depressed and anxious and my moods were out of control. When I mentioned it to my OB at 8 weeks postpartum, he said I just needed more sleep. When I told him how out of control I felt, he wrote me a prescription for an anti-depressant, said I should discontinue it in a few weeks once I was feeling better, and told me to follow up with my primary care doctor. The medicine didn’t work. I was still a wreck. I went to my primary care doctor and she just told me that again, I was just tired. When I finally realized what I was experiencing was PPD and anxiety (thanks to Postpartum Progress’ Plain Mama English Guides), I called the NJ state PPD hotline. It took two days for a call back, and I was told that because I was on Medicaid, I’d have to see a social worker who was also a therapist from the state’s mental health program. At that appointment, I unloaded everything to him: my swinging moods, rage, intrusive thoughts, depression, fear. He asked me questions about my “living situation” and his next words I remember to this day:
“Well, you know, I mean what you’re experiencing isn’t postpartum depression or anxiety. You’re just experiencing the stress of being an unwed mother to two children who’s in a rocky relationship. Women like you…in your type of situation…in your culture, experience it, you know? Of course you’re stressed. You’re young, with an infant and toddler, going to school and working full-time…there are plenty of other Black women like you who face these kinds of daily challenges, you know what I mean? You just have to shoulder it and keep going the best you can. I think you’re going to be alright once you figure out how to manage it all.”
Despite taking down my family and personal history where I detailed several things that placed me at risk for PPD (family history of mental illness, personal history of depression and anxiety, single, unexpected pregnancy, early childhood trauma, minimal support from family and friends), this therapist ignored all of it and said what I was experiencing was expected because of my cultural experience. This (White) man was not helpful nor was he culturally competent and a good match for my particular needs. I struggled to find adequate help for two more months.
Tell Us, Talk to Us, Become Culturally Competent
During my first and second pregnancies, I wasn’t screened for PPD or told anything about it, despite being at risk for developing it. I didn’t even know PPD was A Thing. Other mothers of color have told me they’ve had similar experiences:
“I wish my doctor had told me anything. I had no information whatsoever.”
“When I had my daughter I was 20 and unwed (but my boyfriend was present). I got lectured from a social worker about my elevated risk for shaken baby syndrome. But no one asked about my mental health, either at discharge or at my follow up appointments.”
” I was upfront about my bipolar disorder with staff at the birth center. In the office, they even said, “You know you’re at increased risk for postpartum depression, right?” Then after the birth, the midwife attending just went about her business doing paperwork and asked me to sign to accept financial responsibility. Another midwife came in to check on me and asked me how I was feeling in front of family and friends. I was NOT about to say that I was having intrusive thoughts (I didn’t even know what to call it then). A lady who wasn’t a midwife (I think she was in billing) called to ask how I was doing. I broke down in tears on the phone. She called me weekly for several weeks. She gave me more care and concern postpartum than any of the midwives did.”
“She (my doctor) mentioned it, I just wish maybe she talked about it more in depth with me- signs/symptoms, etc.”
We need those in charge of our pregnancy and postpartum care to do a better job of informing us about what the signs and symptoms of postpartum mood disorders are. We need to be made aware of how they can manifest in our lives, and what places us at particular risk for occurrence. Providers need to become more culturally competent on how issues such as racial and gender discrimination, racial profiling and harassment, the high rate of domestic violence in our communities, our high rates for chronic illness, violence, poverty, and other sociopolitical aspects of our lives impact our mental health. Treatment plans then need to stem from an understanding that takes all of these factors into consideration.
Advocate for Better Access, Better Quality of Care, More Awareness
Reports have shown that there are disparities in mental health treatment, quality of care, and access to services when it comes to minority mental health, especially for women of color. Aside from cultural stigma, barriers to treatment include lack of insurance coverage post pregnancy, the costs of mental health services, and very little community resources in neighborhoods with significant minority populations. Educational literature and books on maternal mental health are hardly written with our experiences and needs in mind. Research on women of color and maternal mental health does exist but it is not extensive. Many awareness campaigns lack a multi-cultural focus, despite pregnant mothers of color facing significant and unique physical and mental health risks .
How can we do better? I’d like to see more literature featuring women of color distributed in doctors offices and where social services are located. It would alleviate a huge burden if mental health offices had childcare so we could safely leave our children in the care of others while we are seeing a therapist. We should create more spaces for mothers of color to gather and discuss their struggles and experiences with each other to gain support. More mental health professionals should offer reduced rates or at least accept Medicaid. There should be collaboration between cultural institutions our neighborhoods trust and national mental health organizations to raise awareness and eradicate cultural stigma on an ongoing basis. I’d like to see the expansion of Medicaid so more mothers can have comprehensive and longer coverage that enables them to access mental health services.
I think while some strides have been made, we still have much further to go to help women like myself. I’d like to see a more concentrated effort made in advocating for better care, easier access, and more awareness that empowers mothers of color. Doing so will help us give our families and ourselves the strong starts we deserve.