Editor’s Note: Today we bring you an important guest post by Divya Kumar, Sc.M., CLC, PPD. She praises all the talking we did about postpartum depression last week in light of celebrities sharing their struggles, but she warns us that there’s more work to be done. Listen. -Jenna
Last week, my social media feed was abuzz with folks discussing Hayden Panettiere’s disclosure of perinatal emotional complications. The young actor openly discussed her struggles and her decision to enter treatment. Shortly after, I read that Drew Barrymore discussed her own similar struggles after the birth of her second child.
When a celebrity publicly admits to struggling with a mood or anxiety disorder, an opportunity for a teachable moment presents itself, and, for the most part, we have taken advantage of this moment. I have seen so many constructive, informative, helpful discussions of perinatal emotional complications. More importantly, women who struggle or who have struggled with similar emotional challenges can look at these famous women and know that they are not alone and that they too are battling a similar illness.
Nearly 1 in 5 women will experience an emotional complication during pregnancy or the first year of their child’s life; emotional complications are the most common complication of childbirth. Even so, admitting to a mood/anxiety disorder is a courageous act, one that opens a mother up to scrutiny and criticism. Panettiere has received a great deal of praise and gratitude for speaking candidly, and, from what I have seen, folks are praising her honesty, courage, and willingness to speak openly about something that many women struggle with in silence.
While Panettiere should be commended for speaking out, it’s worth noting that speaking honestly about perinatal emotional complications is something not all women can do. Admitting to experiencing perinatal emotional complication—let alone having the ability to seek and receive treatment—is a privilege.
The rates of perinatal emotional complications are nearly twice as high among low-income women and women of color, compared to white, middle class women; yet, women in these populations receive screening and treatment for emotional complications at much lower rates.
For many mothers, the challenges of unstable housing, poverty, unsafe neighborhoods, and racism may eclipse the need for mental health services. Furthermore, women of color and/or women who are economically disenfranchised may face numerous barriers to seeking and receiving care, including cultural stigma, lack of mental health providers who accept Medicaid, lack of culturally or linguistically appropriate services, lack of childcare, lack of transportation, and fear of their children being taken away.
During the past week, while social media has been abuzz with Hayden Panettiere’s story, I have been remembering Miriam Carey, the woman who was shot and killed by police after a driving into a blocked gate at the White House and a subsequent high-speed car chase in Washington, DC in October of 2013. Articles written about Carey include statements about how she had suffered from “mental illness” (although it’s unclear if this was confirmed). Her mother stated that she had had postpartum depression following the birth of her daughter during the previous year and that she was hospitalized for this.
I cannot help but compare the two mothers: One of whom, Hayden Panettiere, is a white celebrity with access to resources, and another, Miriam Carey, is a black woman who was a dental hygienist. One is in treatment for postpartum depression; the other is dead. Why?
We can only speculate on how Carey’s life could have been different, and the “what if” questions are endless. What if she had access to different mental health services? What if she had been able to take unlimited medical leave from her job? Did she have a supportive community around her? Was she able to see a mental health provider of her own racial/ethnic background? The questions and speculation are limitless.
When discussing her struggles, Barrymore stated, “It was just really challenging and I felt overwhelmed. I made a lot of decisions and I definitely changed my work life to suit my parenthood.” What if Carey—and ALL women—had the ability to make these choices? What if new mothers didn’t have to worry about losing their jobs, jeopardizing their income, or fear having their children taken away from them?
Panettiere’s disclosure is encouraging women to speak up and is validating the struggles of so many parents. While we praise her courage, stand with her, and wish her well through her treatment and recovery, we must also look beyond the act of her speaking out and examine the larger systems of privilege and resources which support her ability to speak honestly and to seek and receive care.
What would it take to change systems of healthcare so that all women are supported like this? To de-stigmatize perinatal emotional complications, providers need to screen women early and often (during pregnancy and through the first year of their child’s life) as part of routine obstetric, primary, and pediatric care. To de-stigmatize the utilization of mental health services and to increase timely access to these services, we need to embed mental and behavioral healthcare into existing systems of care, such as primary care, obstetrics, and pediatrics. To provide culturally appropriate and accessible care, we need more mental health providers of color, more mental health providers in settings like community health centers, and more Medicaid coverage of mental health services.
Panettiere’s story has panned out to be a positive teachable moment, and many people are now discussing struggles with emotional complications more openly. But why wasn’t Miriam Carey’s story—and death—that teachable moment? Perhaps because, in many communities, speaking honestly is not enough or is not even an option. While the discussions of the past week are constructive, we also need to focus on building and bolstering systems of care that ensure that ALL women can disclose their struggles and seek and receive the care that they need.
Divya Kumar, Sc.M., CLC, PPD has a Masters in public health and is certified as a postpartum doula and lactation counselor. In 2013, she helped create a state-funded perinatal support pilot program in four community health centers in Massachusetts. She currently provides perinatal support for women and families at Southern Jamaica Plain Health Center, one of the four pilot sites. In addition, she facilitates support groups for new parents and conducts workshops about the transition to parenthood. Divya tells it like it is and brings honesty, compassion, camaraderie, and humor to her work with new families. She is also the mother of two children and a survivor of perinatal emotional complications.