Over the past year, I’ve made it a point in my advocacy efforts to focus more on women of color, talking with them about their mental health experiences during pregnancy and the postpartum period. Based on those conversations and my own personal experience, I’ve become especially interested in how perinatal mood disorders and their symptoms impact and manifest in our lives, what culturally specific barriers to support and treatment we encounter, and what mental health advocacy efforts are being made to remove those barriers for us. Here’s what I’ve learned from research, Postpartum Progress’ current survey on mothers of color and their experience with perinatal mental health, conversations I’ve had with fellow mothers of color, and from what I’ve seen in the mental health advocacy space.
- We are woefully underserved by mental health professionals and social services that reside in our communities-for a variety of reasons. Many of the women I spoke to were dismissed, rebuffed, or had their mental health concerns during pregnancy and the postpartum period downplayed by their doctor, pediatrician, pastor, and/or social worker.
- Women of color are either without health insurance, or have insurance plans that do not cover mental health services, especially during pregnancy. Medicaid, for example, often lapses in many states six weeks after pregnancy, leaving many without continued coverage and access to mental health care.
- We are not informed or aware of what places us at a particular risk for developing one of these illnesses compared to Whites.
- We simply aren’t aware of the symptoms of perinatal mood disorders.
- Stigma around mental illness is prevalent in our cultures but this is especially true when it comes to motherhood. Our cultures place a significant emphasis on us being silent about our struggles, taking care of everyone else before ourselves, turning to religion in an effort to overcome, and on being strong in the face of adversity-particularly in the face of oppression, racism and other socioeconomic stressors. Seeking the help of a professional, and disclosing our symptoms is seen as a sign of weakness so much so that we ignore the need to make our mental health a priority. Health advocacy efforts focus solely on physical illnesses such as diabetes, heart disease, stroke, infant mortality, and cultural disparities in breastfeeding rates. The latest statistics show that women of color and those living at or below the poverty line have a higher rate of occurrence, yet none of the national organizations dedicated to empowering and serving minorities discuss maternal mental health and the disparities that exist in regards to diagnosis, support, and treatment. This is preposterous and negligent considering our rate of occurrence is 1 in 4.
- Our reasons for not discussing it publicly are a significant barrier to raising awareness and seeking treatment. We face racial and gender discrimination in our places of employment so as you can imagine, disclosure of a postpartum mood disorder can increase the risk of losing our jobs significantly. Many of the women I’ve spoken with have expressed this fear, with several stating it was the sole reason they didn’t seek treatment either during pregnancy or when their symptoms peaked during their child’s first year. Support from family and friends is often minimal due to culture specific stigma and ignorance surrounding mental illness. Many of us living at the poverty line or who are in the lower-income bracket utilize the help of social services such as SNAP, WIC, and TANF; speaking from personal experience, I can say being under scrutiny from social workers and the state triggers fears of losing your children for being seen as unfit to care for them.
- Lack of research. I’ve grown incredibly frustrated in my efforts to find consistent research on this issue because, quite frankly, it’s pretty scant. Most of the research that focuses solely on women of color and perinatal mental health is also out of date, with data from the late 90’s and early 2000’s.
- Lack of targeted advocacy. We do not see women who look like us in literature doctor’s offices, or on websites that talk about perinatal mental health. There are very few if any advocacy campaigns or outreach targeted specifically towards us, like there are for other health issues and breastfeeding. Advocacy organizations often focus on minority mental health only during designated months once or twice a year, instead of on a consistent basis. Many organizations simply focus on all pregnant and new mothers, which is fine, but such a general scope ignores our unique experiences with mental health. Our disparities in support and treatment due to socioeconomic stressors, our particular needs, the risk factors we face, as well as the role culturally specific stigma plays as a barrier are not taken into consideration when calls to action are given. They are mentioned as an afterthought, a sentence or two in a post or article. The results of such inattentiveness are programs and initiatives that are not inclusive of our unique needs. Finally, we lack support groups in our own communities as well as safe spaces online to talk with other women like us who understand our unique struggles as mothers, which for many of us creates a very isolated existence.
This has to change. It’s unacceptable and as a woman of color and survivor of postpartum depression and anxiety, it hurts my heart to know our maternal mental health isn’t being actively prioritized, much less thought of. While I fully understand that postpartum mood disorders don’t discriminate in terms of who they impact, and that the need to help pregnant and new moms is great all across the board, I also know that efforts are seriously lagging behind when it comes to the maternal mental health of women of color. We MUST do better. Later this week, I will talk about how we can but for now, I’m interested to hear your thoughts. Mothers of color, what has your experience been, and what kinds of supports and programs do you think would serve us better? What kind of improvements would YOU like to see?
I’m so glad you pointed out the issue with Medicaid. I faced that issue myself. While I’m not a WOC, it interfered with my ability to receive quality care and therapy for my Perinatal Mood & Anxiety Disorders. It is extremely dismissive of mothers as a person and directly impacts the quality of care available to the child from the mother. It is a situation which greatly needs to be remedied. In my humble opinion, a new mother, on Medicaid for pregnancy, should be able to remain on Medicaid for a minimum of 6 months – 12 months after the birth of a child in case of any issues. Or should be able to re-qualify should there be any indication of complications (psychiatric or physical) post-birth.
YES. Lauren I fully agree. The Medicaid issue is awful. It dictates what level of care you receive from providers and doesn’t last long enough after pregnancy at all. It pretty much leaves mothers on their own. It was very frustrating for me to push for continuation of my coverage with Alex post pregnancy AND when I finally started seeking treatment? Many mental health providers wouldn’t accept it as insurance. If Medicaid doesn’t last past 6 weeks, and MH providers don’t accept it even if it did-how does this support new mothers? Especially those in lower-income areas? How are they supposed to receive help? It’s incredibly restrictive and erases access to care. I hear you. While ACA has tried to encourage states to adopt a Medicaid expansion that would increase services for many, many still aren’t and that directly impacts lower-income mothers. We definitely need to push & lobby for better policy and programs. Thank you so much for offering your insight and experience into this issue as well.
Thank you, A’Driane for never growing weary of issues that receive little national attention. Thank you, PPP, for sharing the reach of your audience so that all women are served. I know there is someone logging on today, hoping they find somewhere, something, a place where they can look for answers and find community. Articles like this will help PPP grow into a site where all women can find someone like them.
YES Alexandra. That is my hope, because I desperately searched for that when I was going through it and even during recovery. There’s something about that specific kind of sisterhood and commonality that really builds you up as a woman of color. More of us need spaces that are inclusive and where all women can find someone who is like them. You are 100% right and I know PP is working to try and grow in this area.
Thank you A’Driane so much for sharing this and for your passionate advocacy always. I have a question for you. Who are considered Women of Color? I think it’s an important question for those of us who aren’t to fully understand.
Women of color are exactly that: women who are not White. Hispanic/Latina, Black, Asian/Pacific Islander, Native American, Indian, etc. “Of color”, “mothers of color”, “people/person of color”, etc all refer to people who are not considered White. Those are all widely used and understood terms when referring to race.
Thanks! I honestly wasn’t sure. In my neighborhood and our school we have many friends/families of Asian, Indian, Middle Eastern, and Hispanic/Latina decent/heritage, as well as Black so I just wanted to clarify. I was having this discussion with two of my best friends this weekend who are from Singapore and Jordan and they didn’t necessarily identify as women of color so I really wanted to ask your perspective.
That makes sense and I can understand that. However, while your friends may not identify themselves as women of color, here in the United States it’s highly probable they are identified as such by our society.
Dear A’Driane Nieves, a very poignant and truly honest article. In the UK there are similar issues surrounding Maternal Mental Health in particular understanding ,recognising and treatment of Postnatal Depression for women we refer to as black and ethnic minorities (BME). Concerns about access to services, racism, talking therapies, etc etc. along with the cultural meaning and rituals of child birth, gender of the baby, ( in some cultures boys has a greater value than girls) role of families, language etc are not fully understood nor considered. ( drug, alcohol abuse, domestic violence are also avoided ) indeed my study on PND and BME women in Rural areas in England remains the only study of its kind. I present a number of papers around the world on this subject. it is truly a global issue. Willing to discuss further.
Thanks
Albert
This is very relevant to South Africa where mental health resources are scarce and extreme poverty and other challenges is leading to maternal depression and lack of bonding of moms and babies.
A’Driane — Thank you so much for this article. Everything you write rings true. You and PP are making a real difference. Please keep writing, talking, asking questions. I am sharing, far and wide.
Amazing article!!!!!!!
As a social worker, I agree with all of the points here. In my experience with women of color there is a very big trust issue when it comes to discussing mental health especially related to having their children taken away from them. I learned so much from my clients about their fears and what makes them not seek help. The ‘system’ that they have available to them is not friendly and empathetic, it is very judgmental. Gaining trust is so important but it is something that takes time to earn. Yes we do have a long way to go…one system does not fit all that is for sure. Cultural competency requirements is one step in the right direction.
I agree more should be done. I lost my 19 year old daughter two years ago. She committed suicide. I took her to a mental health hospital, because she was over 18 I could not go back with her. A month later she was gone. She was my only child. I think the law should be changed to allow the parent to acompany there child. Because they aren’t going to tell whats going on so they van get the treatment they need.
Grieving in Indianapolis, Indiana