Postpartum Depression and Race: What We All Should Know

By Tanya Burrwell (Assistant Director, APA Women’s Programs Office)

“… Mothers are made to feel that a child is the pinnacle of achievement, and the only appropriate feeling on the birth of a child is joy. We’re expected to perform a certain femininity: to nurture and transmit traditions, to uphold honor” – Pooja Makhijani

While the birth of a child can be a wonderful and joyous time for many women, for some women it is a time of sadness, anxiety, loneliness, and worry that does not go away. In fact, up to 1 in 7 women experience postpartum depression, a very real and serious mood disorder (Wisner, et al., 2013).

What if I were to tell you that women of color experience postpartum depression at double the rate of the general population? Studies show that new mothers of color have rates of postpartum depression soaring close to 38% compared with the 13 – 19% rate for all new mothers (Keefe, Brownstein-Evans, & Rouland Polmateer, 2016).

This is because a disproportionate number of women of color are not screened for depression and do not receive the necessary treatment and services. In fact, it is estimated that up to 60% of women of color do not receive any services! Think about the devastating impact this can have on them and their families.

Research tells us that screening pregnant and postpartum women for depression can significantly reduce the symptoms of depression. In fact, the U.S. Preventive Services Task Force (USPSTF) just included pregnant and postpartum women in the new depression screening guidelines. If we know that screening works, we must ask ourselves why young moms of color experience this disparity.

Historically, studies show that women of color are less likely to seek mental health treatment due to cultural barriers and stigma surrounding mental illness. For many women of color, seeking the help of a mental health professional is seen as a sign of weakness.

“… No one talks about mental instability in the black community. The idea of seeking treatment never crossed my mind. I wasn’t some hysterical white woman with the privilege to lie in bed for days crippled by my emotions. There was nothing wrong with me, and besides, black people don’t do therapy.” – Tyrese Coleman

 

“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” – A’Driane Nieves

In addition, there are documented racial and ethnic differences in the perceptions and treatment experiences of low-income women of color vs. White women (Doulbier et al., 2013; Kozhimannil et al., 2011). These include:

• limited access to health care services,
• a disconnection with providers,
• a lack of access to providers that look like them, and
• unavailability of culturally/linguistically appropriate services.

A new study directly questioned low-income mothers of color about what they needed in order to access screening and treatment (Keefe, Brownstein-Evans, & Rouland Polmateer, 2016). Here’s what they found:

• Access to Information and Resources: Educational campaigns must include women in all of their diversity. Information must be available in multiple languages (i.e., pamphlets, brochures, PSAs) and highly visible and accessible in communities (i.e., schools, doctor’s offices, grocery stores). They should also provide tip cards identifying local resources or national hotlines.
• Access to Services: Women need insurance coverage; transportation to and from the doctor’s appointments. Childcare services should be made available and/or the availability of child-friendly offices and doctor’s appointments.   
• Flexibility: Women need flexibility when making appointments. The choice to go to the doctor may mean not going to work, and vice versa, going to work may mean missing an appointment. Women need flexibility among health care providers, as well as sick leave benefits to allow time off for appointments.
• Community-based Support Services: Providers should develop partnerships to establish local community-based services and/or peer-support groups in community centers, churches, and schools to increase awareness and dispel the myths and stigma about mental illness.

While it is critical that we advocate for screening for postpartum depression to identify women who are at risk, that is only half the battle. It is equally imperative that providers break down these barriers so that low-income women of color can successfully seek the treatment that they need.

In addition to supporting family friendly legislation, policymakers should recognize racial and ethnic disparities in access to care and incentivize programs that train women and men of color to become medical and mental health providers.

“The essays I found online by women with postpartum mood disorders were either by celebrities or white women. And while I truly appreciated these new parents shedding light on these issues, I never found a mirror to my experience.” – Pooja Makhijani

Postpartum depression knows no color, it can affect any woman regardless of age, race, ethnicity, or economic status. Primary care providers, social services agencies and mental health professionals must work together to educate, communicate and provide services that enable and empower ALL women. The time is now!

 

Resources:

APA Help Center – or call 1-800-964-2000

APA Postpartum Depression Resource (available in English, Spanish, French, and Simplified Chinese)

Black Women Birthing Justice

Black Women’s Health Imperative

National Institute of Child Health and Development – Info for Moms and Moms-to-Be

Postpartum Support International

Postpartum Progress

Postpartum Depression Facts

National Suicide Prevention Lifeline

SISTERSONG, Women of Color Reproductive Justice Collective

 

References included:

Breland-Noble, A. (2014, May 13). When our sisters are hurting… [Blog post]. Retrieved from https://psychologybenefits.org/2014/05/13/when-our-sisters-are-hurting/

Coleman, T. (2015, October 21). What it’s like having PPD as a Black woman. [Blog post]. Retrieved from https://www.buzzfeed.com/tyresecoleman/what-its-like-having-post-partum-depression-when-youre-black?utm_term=.hrRJ3BnZp#.rreWpJZA1.

Corby-Edwards, A. (2016, February 11). Depression screening works and now it can work for pregnant and postpartum women. [Blog post]. Retrieved from https://psychologybenefits.org/2016/02/11/depression-screening-works-and-now-it-can-work-for-pregnant-and-postpartum-women/

Dolbier, C.L., Rush, T.E., Sahadeo, L.S., Shaffer, M.L., Thorp, J., and the Community Child Health Network Investigators. (2013).Relationships of race and socioeconomic status to postpartum depressive symptoms in rural African American and Non-Hispanic White women. Maternal Child Health Journal, 17(7), 1277-1287.

Howell, E.A., Balbierz, A, Wang, J., Parides, M., Zlotnick, C., % Leventah, H. (2012). Reducing postpartum depressive symptoms among Black and Latina mothers: A randomized controlled trial. Obstetrics & Gynecology, 119(5), 942-949.

Keefe, R.H., Brownstein-Evans, C. & Rouland Polmanteer, R.S. (2015). Having our say: African-American and Latina mothers provide recommendations to health and mental health providers working with new mothers living with postpartum depression. Social Work in Mental Health, 1 -11.

Kozhimannil, K.B., Trinacty, C.M., Busch, A.B., Huskamp, H.A, & Adams, A.S. (2011). Racial and ethnic disparities in postpartum depression care among low-income women. Psychiatric Services, 62(6), 619-625.

Makhijani, P. (2015, December 7). We can save one another’s lives: A conversation with women of color about postpartum mood disorders. [Blog post]. Retrieved from https://www.buzzfeed.com/poojamakhijani/we-can-save-one-anothers-lives?utm_term=.eber1PGqX#.vu4pZPNXV.

Nieves, A. (2015, January 6) Women of color and maternal mental health: Why are we so underserved? [Blog post]. Retrieved from http://www.postpartumprogress.com/women-color-maternal-mental-health-underserved.

Wisner, K.L., Sit, D.K., McShea, M.C., Rizzo, D.M., Zoretich, R.A., Hughes, …, & Hanusa, B.H. (2013). Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry, 70(5):490-498.