Women of Color Struggle to Receive Proper Care for Postpartum Depression

African American women are more than twice as likely to experience postpartum depressive symptoms as white women, according to research done at the Icahn School of Medicine at Mount Sinai in New York. The risk for Hispanic women was also almost twice as high. (Photo courtesy: Pexels.com)

Four days after bringing her newborn son home from the hospital, Maci Nelson began experiencing negative thoughts. “You aren’t a great mom and you aren’t adjusting well…” she told herself.

Sometimes she thought of suicide.

Four years later, Nelson a Black and Southeast Asian woman from Cleveland, Ohio, feels fortunate because both her obstetrician and her son’s pediatrician mentioned depression and suggested that she see a psychiatrist when her son was a newborn. However, despite the early recognition of her symptoms, Nelson didn’t seek medical help for her mental health for two years.

The Centers for Disease Control and Prevention research shows that nationally about one in eight women experience symptoms of postpartum depression. According to an article in The Journal of Perinatal Education, the numbers are likely much higher because many women don’t report their symptoms. Also, these statistics only represent mothers who are diagnosed with postpartum depression after live births. Women who miscarry or have stillbirths often experience postpartum depressive symptoms but aren’t included in the data.

According to research done at the Icahn School of Medicine at Mount Sinai in New York, African American women are more than twice as likely to experience postpartum depressive symptoms as white women. The risk for Hispanic women was also almost twice as high. However, a retrospective cohort study of 29,601 women from New Jersey’s Medicaid program, revealed that Black and Latina women are also less likely to seek treatment.

Studies often point to low income as a risk factor for postpartum depression. While suboptimal medical treatment is rampant in low-income women, research shows racial and ethnic disparities are particularly troubling. Kelli Blinn, program coordinator for Perinatal Outreach and Encouragement for Moms (POEM) in Ohio, recognizes that income is a factor, but she believes disparities in mental health for Black women are more complex.

Both Nelson and Blinn say there is a stigma in their cultures around having mental health needs. “It's swept under the rug,” says Blinn. “You pull yourself up by the bootstraps, you pray more, you get to church more…Your auntie and your grandma and your sister and everybody, all these women in your family had babies and did just fine, and they didn't have any depression or anxiety. So, what's wrong with you, is the kind of approach that's taken far too often.” A national survey conducted by the National Mental Health Association found that 63 percent of African Americans believed depression is a personal weakness.

In addition to cultural stigma, research published in Health Psychology showed that Black patients were less likely to trust their physicians than white patients. Nelson has a difficult time imagining where she would be if she hadn’t had people of color on her medical team from during pregnancy and postpartum. “It made me more honest,” she said, “and open and willing to seek out help and ask questions.” Blinn and Nelson said they personally felt more comfortable with doctors of color.

Maci Nelson with her 4-year-old son. (Photo courtesy: Maci Nelson)

Nelson had to experience her labor being induced for urgent medical reasons, which caused her to panic. Although a childhood classmate was part of the medical team, Nelson was still anxious. “I felt like I was at the mercy of a medical team that I didn't know,” she said, “because you hear about a lot of horror stories of women of color, who have terrible and near-fatal birthing experiences. And the fact that it happened to me was terrifying.” According to the Ohio Department of Health, Black women died from a pregnancy-related death at a rate of more than two and a half times that of white women between 2008 and 2016.

Nelson remembers being wheeled out of the birthing room, and everything in the room had been cleaned except for pool of blood on the floor. Despite bleeding being a routine part of birth, Nelson felt left out of the loop. What had been a typical day for medical staff had been a traumatic experience for her. “And it seemed like no one had seen it, right? Like no one was really paying attention. So, it was like, I don't know who to trust here,” she said.

Some evidence suggests that a negative birth experience is associated with a slightly increased risk for postpartum depression.

Two years after giving birth, Nelson was dealing with postpartum depressive symptoms and an unrelated crisis. She decided to see a psychiatrist and was diagnosed with postpartum depression and post-traumatic stress disorder from childbirth. Nelson began Eye Movement Desensitization and Reprocessing (EMDR)—reliving traumatic events while a therapist directs eye movements—and talk therapy. During her pregnancy Nelson relied on Medicaid and couldn’t afford expensive therapy bills. Once she was able to join her husband’s health insurance, therapy became a possibility.

For women in Columbus, Ohio, there are additional resources available. At POEM, Blinn runs an equity initiative, Rise, which supports Black and African American women in Ohio. POEM provides peer support groups, education on pregnancy and postpartum mental health disorders, and information and referrals to appropriate resources in the Columbus area.

Blinn is a Black woman and a mom who struggled with her mental health after having her children. Through her work as a doula (a trained support person for a mother during pregnancy and birth) she learned about POEM. Blinn initiated the Rise program which provides services exclusively by and for Black mothers, including a providers of color network. Blinn says there are various reasons women of color are suffering from postpartum depression at a higher rate than white women.

Recently, there was a win for Ohio moms; Medicaid will expand the length of time that moms who meet Medicaid criteria remain eligible. Currently, Medicaid coverage for moms revert back to typical eligibility after 60 days. This meant that many mothers lost health insurance shortly after giving birth because their income was considered too high to remain on Medicaid. The extension would allow mothers to access mental health care during the postpartum period. The expansion should go into effect in April 2022 after it receives federal approval.

Another solution that Ohio is looking towards is piloting a Medicaid program that would allow moms to utilize doula services. Several studies done so far indicate that postpartum depression could be lower in women who were supported in labor.

Nelson hopes for a societal shift; she wants medical professionals to help women learn to take care of themselves after their babies are born. “Be honest,” she said, “Just as we accept that childbirth is messy, we should accept that the mental change is messy, too.”