Mental Health for Black Mothers: The True Cost

By: Ashley Bordenave, MHA, PMHNP

The journey of motherhood grants the new experience that few can define in words. For some women, pregnancy also unexpectedly brings up emotional discomfort along with the physical symptoms. Such emotional discomfort is most commonly described as depression and anxiety, but some other mood disorders such as bipolar types and psychosis may be seen. It is estimated that up to 20% of women, from pregnancy and postpartum, experience what is now categorized as “maternal mental health disorders” (Policy Center for Maternal Mental Health, 2023). That’s 1 in 5 mothers. For Black mothers, it’s 40% or, 2 in 5 mothers (March of Dimes, 2024)1. These ‘disorders’ are considered childbirth complications, and coupled with the associated alarming statistics, they are arguably crises to society. Credible estimates from a team of researchers determined that in the span of 5 years, untreated mental health disorders in mothers exceed $14 billion in societal costs (Policy Center for Maternal Mental Health, 2024). Radically improving this requires a receptive lens to both the barriers and opportunities to equitable care. 

Barriers to care

From chronic stress to social stigma, Black women have amounted risk factors that contribute to any array of pregnancy-related woes – including but not limited to, having preterm birth, cardiovascular issues such as preeclampsia, higher c-section risk, problems with labor, gestational diabetes, and mortality (Winny and Bervell, 2023). Homicide and suicide are unfortunately associated with postpartum mortality, with the highest incidences occurring within the first year of postpartum (Winny and Bervell, 2023). A study done from 1990-2020 indicated that suicide has disproportionately affected Black women, with a contributing factor of under-diagnosed or under-treated depression (Joseph et al., 2023; Policy Center for Maternal Mental Health, 2023). 

Further, Black women have a higher exposure to trauma compared to White women across the lifespan. Other intersectional impacts to these disparities are gender-related violence, systemic racism, and poverty, consequently setting barriers to quality care (Policy Center for Maternal Mental Health, 2023). Lesser known but perhaps the most poignant risk factors were expounded upon in a unique study that surveyed both Black and biracial adolescent and young women (Dwarakanath et al., 2023). These researchers distilled the identified barriers to care as follows:

  • Underreporting symptoms due to fear of judgment or mistreatment from healthcare provider
  • Lack of trust from healthcare provider/system
  • Sociocultural – some cultures do not recognize mental health at all
  • Intrapersonal strain – family conflict, limited support system, intimate partner violence, lowered self-esteem
  • Overt or implicit bias from healthcare workers or lack of cultural competence
  • Self-blame, self-doubt, normalizing struggle and/or feeling the need to “strong” – self-blame of mental struggles being expressly communicated as a feeling of personal failure or weakness 

Opportunities to improve care

Many of the recognized barriers lend themselves to the natural decision for many Black women to not self-disclose symptoms, initiate treatment, or follow-up appropriately even when treatment was established (Dwarakanath et al., 2023). Gaps in access add to the variables of the societal costs. 

For the mother, untreated postpartum depression affects her ability to function at home, at work, and within (Policy Center for Maternal Health, 2023; Dwarakanath et al., 2023). For the child(ren), untreated postpartum depression has an increased risk for impaired neurocognitive development, violent behavior, difficulty regulating emotions, maladaptive behaviors, and psychiatric and medical issues (Dwarakanath et al., 2023).  

Proposed strategies to improve care:

  • Revising and expanding existing depression screening tools to address adolescents, somatic symptoms, as well as screenings all expectant mothers for substance abuse risks
  • Lawmakers should increase funding to organizations and educational institutions in effort to create more Black and BIPOC obstetric and mental health professionals
  • Lawmakers mandating paid maternity leave
  • Expanding knowledge and access to midwives, doulas, and birthing centers
  • Healthcare systems acknowledging the impacts of systemic racism and initiating more quality measures to improve care delivery
  • Reforming healthcare systems’ policies that aim to reduce discriminatory practices
  • Implementing education and corrective actions on clinical bias in both maternal and mental health settings, and improving cultural competence and cultural humility
  • Policymakers and clinicians should seek to collaborate with community-based organizations for the enhanced advocacy of maternal care on a continuum
  • Providers educating themselves on The Black Maternal Health Momnibus Act of 2021 
  • Encouraging mothers to initiate care starting at preconception in effort to target any potential risks for pregnancy and prevent adverse postpartum outcomes

It is crucial that disparity gaps get closed so that there would be fewer opportunities for women to feel the need to be resilient. Equally important is for there to be careful consideration to not pathologize every complaint of a mother, but to approach her with compassionate and holistic care if the goal to end disparities is truly desired. 

References

Dwarakanath, M., Hossain, F., Balascio, P., Moore, M.C., Hill, A.V., De Genna, N.M. (2023). Experiences of postpartum mental health sequelae among black and biracial women during the covid-19 pandemic. BMC Pregnancy and Childbirth. 23.  Article number: 636. doi: 10.1186/s12884-023-05929-3

Howell, Elizabeth A. (2018). Reducing disparities in severe maternal morbidity and mortality. Clinical Obstetrics and Gynecology, 61(2). 387-399. doi: 10.1097/GRF.0000000000000349

Joseph, V.A., Martinez-Ales, G., Olfson, M., Shaman, J., Gould, M.S., Gimbrone, C., Keyes, K.M. (2023). Trends in suicide among black women in the United States, 1990-2020. The American Journal of Psychiatry, 180(12). 914-917. doi: 10.1176/appi.ajp.20230254

March of Dimes (2024). Black maternal mental health week. https://www.marchofdimes.org/black-maternal-mental-health-week (accessed June 24, 2024).

Policy Center for Maternal Mental Health (2024). Issue brief: Black maternal health. https://www.2020mom.org/blog/issue-brief-black-maternal-mental-health (accessed June 26, 2024).

Winny, A. and Bervell, R. (2023). How can we solve the black maternal health crisis? https://publichealth.jhu.edu/2023/solving-the-black-maternal-health-crisis (accessed June 24, 2024). 

Ashley Bordenave, also known as The Climate Psych NP, is an energetic psychiatric nurse practitioner specializing in climate and lifestyle psychiatry. She is also a published author, freelance health writer, and entrepreneur with an enduring passion to make quality mental health care more accessible to underserved populations. Her work is devoted to reducing mental health stigmas and empowering communities in sustainable means. Realizing the hope in people keeps her motivated to make every effort in creating meaningful impacts each day. More of her work can be seen on LinkedIn, Ashley Bordenave, MHA, PMHNP [The Climate Psych NP]