When someone says the words ‘Maternal Mental Health’, most minds envision a woman fresh out of delivery dealing with postpartum depression. However, maternal mental health includes so much more. Today’s families are moving further and further away from the traditional nuclear model. Families are becoming more diverse in how they combine people from all religions, genders, sexual orientations, races, and incomes. Much like the term motherhood, mental health and its impact on daily life has expanded over the years. Although women of all backgrounds deal with mental health disorders, the impact of stigma can be multiplied by other factors like gender, race, and socioeconomic status. to learn more about stigma and how it amplifies mental health symptoms.
How stigma impacts maternal mental health in the LGBTQ+ community
In the past, same sex families have had a uniquely stigmatized experience. Parenting is often confused with fertility, associating LGBTQ+ people with sterility. This line of thinking encourages the stereotype that a couple formed by LGBTQ+ people cannot reproduce “naturally”, could not experience maternity/paternity and, therefore, are exempt from mental health challenges related to parenthood. This couldn’t be further from the truth.
Stigma, prejudice, and discrimination create a hostile and stressful social environment for LGBTQ+ families that can cause mental health problems, expectations of rejection, and hiding/camouflaging for all members of the family.
Policies, laws, and governmental programs have perpetuated violations of queer people’s rights. For instance, restricting the access of LGBTQ+ people to reproductive techniques provided by public health systems. LGBTQ+ people experience a system of discrimination that promotes the development of internalized stigma, and the incorporation of prejudice. This internalized stigma results in the expression of rejection towards themselves and other people in the community.1
Internalized stigma impacts LGBTQ+ parenting in four ways:
- the impossibility of thinking of oneself as a parent
- fear of violating children’s rights
- fear of passing on the stigma
- fear of introducing their LGBTQ+ partner
How Stigma Surrounding Maternal Mental Health Effect Women of Color
Race is another factor than can amplify the effects of mental health stigma, specifically during pregnancy. Women of color experiencing mental illness often suffer in silence and lack access to mental health care. Studies have shown that women of color experience postpartum depression at a rate close to 2 times higher than the rate for all postpartum women. This wide gap mirrors trends seen in the screening and treatment for mental health disorders among women.
Women of color often suffer simultaneously from distinct and multifactorial effects. Pregnant women of color are underserved by the mental health profession and relevant support services. Women of color are typically unaware that the mental health symptoms they experience are the result of pregnancy or childbirth, which also means that the symptoms often go unaddressed both by black woman and their medical providers.2 When women of color do access mental health care, the services and supports they find are often severely inadequate. Women of color who have experienced postpartum depression report seeing health professionals yet remain undiagnosed, even after multiple visits.
A study of the rates and risks of maternal depression in the United States, identified higher rates of challenges including poverty, employment issues, issues related to personal relationships, and marital problems in women of color who experience maternal depression. Women of color are also more likely to report experiencing workplace discrimination. These women often feel that disclosing a mood disorder could increase the risk of losing a job. Facing racism and gender discrimination in the workplace, in the health care system, and in broader society negatively affects the mental and physical health of women of color while also inhibiting their financial independence.2
Studies have shown a variety of trends among different racial groups.
Black women experience significantly higher rates of depression. This is particularly troublesome considering the strong stigma around mental health in the Black community. Across the culture, there is a belief to “tough it out” or be a strong Black woman, discouraging black women from seeking treatment. Many in the Black community believe that depression is preventable and resolvable through strength and religious faith.2 Mental health stigma often deters Black people from seeking much-needed treatment and support services. Despite being more likely to experience mental health issues, Black women often do not recognize their symptoms due to a lack of knowledge or familiarity.
The rate of depressive symptoms for single Black mothers is six times higher than the general population and double the rate of non-pregnant Black women. Black women are more likely to be the primary or sole head of household, and 72 percent of Black mothers are single. The added stress of running a household increases the likelihood that single Black women will experience postpartum mood disorders.2
However, these inequities are not unique to Black women. The prevalence of depression is 4 times higher in Latinx women, who also face challenges in finding accessible and culturally competent mental health care. Latinx women are an important group because of their high fertility rates and high psychosocial risk factors.
Many Hispanic immigrants live with the fear their citizenship status within this country could be challenge at any moment. When pregnant, Latinx women with mental health concerns may worry about losing their child should they disclose depressive symptoms to health care professionals. The fear of losing their child increases with poverty and immigration status. Among Latinas, concerns about stigma might be further complicated by the practice of Marianismo — this is the cultural notion that a mother must put her children and family first and sacrifice herself for the well-being of her family — which has been shown to limit treatment-seeking behaviors. Discrepancies in the descriptions of symptoms can also lead to lower rates of diagnosis and treatment.
Many Asian cultures have a strong emphasis on honor and shame that strengthen negative stigmas. Typically, strength and independence are considered to be honorable. Admitting that help is needed to manage life’s challenges is often perceived as weak. Asian women often report experiencing a lack of emotional support from their support system (i.e., partners, parents and extended family) and struggle to manage high cultural expectations. These are some of the many reasons Asian women are at a higher risk for maternal mental health issues. In fact, Asian women are the racial group LEAST likely to seek help for mental health disorders. When compared to White women, Asian women are three times less likely to seek mental health services.5
In 2010, participants in a study on discrimination and mental health service use among Asian Americans stated the negative stigma as the biggest obstacle when seeking professional help with mental health.5 Because this is not a commonly discussed topic, many Asian Americans are not aware of the resources and services available to them. Study participants also noted difficulty accessing mental health services due to a language barrier.5
We don’t know much about maternal mental health in Asian communities because there is a lack of research. The communal beliefs about mental health within Asian communities and hesitations for community members to participate make it challenging to execute. The reported rates of mental health issues demonstrate a clear need to learn more. Peer-led interventions have been suggested to address the burden of maternal depression in a culturally appropriate way. Peer-led interventions have many positives. They are generally cost-effective, and peers are usually seen as more approachable. This could ease some of the barriers that currently prevent proper mental health care.
South Asian Women
Although they are often lumped together, South Asian people have a nuance experience of mental health. Depression affects 86 million people in Southeast Asia. According to the World Health Organization, South Asia is home to one third of the world’s depressed population. Like Asian cultures, South Asian cultures, like Bangladeshi, Indian and Pakistani, traditionally do not recognize mental health as a medical issue.4 These cultures highly value collectivism meaning social controls like family, culture, religion, and community usually lead individual attitudes and decision-making.10 A 2010 study by the campaign Time to Change found that South Asians rarely discuss mental health because of the risk the subject poses to their reputation and status. Discussing mental health in South Asia has yet to be socially normalized.4
South Asian people are at a higher risk due to a lack of education and conversation about maternal mental health disorders.10 Like other racial and ethnic groups, South Asian American women have barriers to recognizing their mental health needs caused by stigma:
- Traditional physicians fail to recognize maternal mental health issues within South Asian culture
- Very little understanding or research of mental health issues outside of Western clinical medicine
- Negative attitudes that prevent proper navigation of challenges in the postpartum period for those in isolation or with physically distant extended family
- Physical symptoms (headaches, insomnia, nausea, appetite changes, fatigue) may be misdiagnosed8
Language barriers are a common challenge in mental health diagnosis and treatment within South Asian communities. In some languages, words to describe the condition mental illness do not translate. The few that do seek help may find it difficult to communicate their symptoms and vice versa. This can also pose a problem for those who migrate away from their native country, making it hard to adequately deliver information regarding resources.4
How do we change the stigma surrounding maternal mental health that is affecting communities that are discriminated against?
Although there are several factors that can impact the individual experience, many minority groups suffer disproportionately from mental health disorders. This gap is in large part due to a lack of awareness around mental and emotional health. Again, the gap is increased by higher amounts of negative stigma.
Mental health stigma can be changed through policies and the provision of services that meet the needs of the communities.11 Efforts to dismantle the stigma and shame associated with mental health in minority groups must be a priority within professional mental health care should be promoted and supported. Better support for mental health screening and treatment is drastically needed.
The recommended treatment for most pregnancy related mental health disorders is psychotherapy and/or pharmacotherapy.12
Psychotherapy (a.k.a. talk therapy) is the use of psychological methods to help change behavior, increase happiness, or overcome problems.
Pharmacotherapy refers to the use of pharmaceutical drugs.
The choice to obtain treatment should be based on a discussion between the patient and their health care provider. These relationships can be a driving force behind increasing help-seeking behaviors in women. Health care professionals can increase patient trust by following these practices:
- Describing the symptoms
- Normalizing the condition by sharing statistics on the condition’s high prevalence
- Informing patients that it is treatable
- Reminding women that any mental health disorder is not their fault and can be treated will also reduce shame and stigma 12
Mental health care for women of color must be culturally sensitive and culturally appropriate.11 Providers and trusted organizations should deliver educational campaigns that tell lived experiences of women of color. This will help mothers within those communities easily recognize the symptoms.11
While health care settings and public health agencies that serve high-risk women (e.g., low income, discriminated against) are ideal candidates to deliver this much needed education, all community members play a role in reducing stigma and can help share information with those who need it.12 These conversations should happen frequently throughout pregnancy and after delivery. Be sure to ask your health care provider for treatment options that are affordable and suite your needs. For more detailed information about common maternal mental health disorders click here.
Writer: Candace Page
Reviewer: Kim Roberts
- Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8158111/
- Source: https://www.americanprogress.org/article/suffering-in-silence/
- Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7067456/
- Source: https://borgenproject.org/depression-and-mental-health-in-south-asia/
- Source: Mental Health Among Asian-Americans (apa.org)
- Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6038800/
- Source: https://www.publichealth.columbia.edu/sites/default/files/reducing_stigma_around_postpartum_depression_.pdf
- Source: https://www.2020mom.org/blog/2022/5/26/lets-talk-about-maternal-mental-health-amp-asian-americanpacific-islander-moms\
- Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4157588/
- Source: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-022-04642-x
- Source: https://www.americanprogress.org/article/suffering-in-silence/
- Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6038800/