Black medical professionals are urging their colleagues to create an interdisciplinary approach to caring for Black pregnant patients in an effort to minimize maternal mortality rates, with a particular emphasis on providing high quality mental health care.
Black women are two to four times more likely to die from pregnancy-related issues than white women. In a majority of cases, the Centers for Disease Control and Prevention found, Black maternal deaths are preventable.
They endure pregnancies with more anxiety and depression than pregnant people who are white. And when experiencing mental health issues, Black women may unintentionally downplay their emotions.
“Black women have a tendency to want to present in such a way that they are expected to have it all together and that they continue to have it all together,” said Erika Dawkins, Psy.D., an assistant professor of clinical psychology at Widener University.
Dawkins said a “holistic perspective” is needed “on things that impact folks’ ability to have families.”
“You cannot look at a person in isolation, especially when they might be experiencing a combination of things … But if our medical professionals are not assessing for that, and then making the appropriate connections, that’s a missed opportunity to support mothers through this process.”
Challenges to maternal mental health
Dawkins said that there are a host of reasons why Black women face worse health outcomes than their white counterparts, many of which stem from systemic racism.
But another issue is that symptoms of health issues may present differently in Black patients than white patients.
For example, Black patients are more likely to attribute mental health issues to physical concerns, such as by describing body aches and pains when talking about depression, according to the National Alliance on Mental Health. Other times, they may describe themselves as being “irritable” rather than “depressed.”
Additionally, said Dr. Christine Crawford, an assistant professor of psychiatry at Boston University School of Medicine, the severity of mental health symptoms will often differ between Black and white people.
When it comes to pregnancy, Black women often begin their journey with higher levels of anxiety and depression than their white counterparts.
“Black women are well aware of the fact that they’re at higher risk for bad outcomes as it relates to the delivery of their child, and so they are entering into the pregnancy with some established anxiety just based on the statistics about how risky it is to be a Black woman and carry a child,” Crawford told The Hill.
“They also have seen it firsthand with people in their family, with their friends, themselves with a previous pregnancy in terms of experiencing a poor outcome,” she added. “Coming into the pregnancy with a certain level of stress and anxiety doesn’t contribute to a healthy pregnancy; We’re starting at a different baseline when we’re comparing the emotional experience of a Black woman versus someone who’s non-Black, right?”
The expectation that Black women “have it all together,” she added, persists even after a traumatic and life altering event — such as birth — and is the result of external forces as well.
“Black women oftentimes are the breadwinner within their families, and they are expected to move right back into life as it was before giving birth,” Dawkins explained. “That can bring on depressive symptoms that can be masked by the responsibilities that they hold.”
Lack of access to care
Though postpartum depression affects 1 in 8 women, Black women are nearly two times more likely than white women to experience the condition, according to the American Hospital Association Institute for Diversity and Health Equity.
Postpartum depression is often expressed as feelings of extreme sadness, anxiety or exhaustion. The illness can be debilitating, Crawford said, and it can make it hard for mothers to care for their newborns or even themselves.
A 2023 study found that though 29 percent to 44 percent of Black women experience postpartum depression symptoms, few are properly identified as having postpartum depression and receive mental health services.
Instead, Black women are more likely to end up in the hospital for postpartum depression than any other racial or ethnic group, another study found.
This is, in part, because Black women often lack access to the necessary resources to help address mental health concerns.
Only 2 percent of psychiatrists and 4 percent of psychologists in the United States are Black, which means Black patients might not have as much access to culturally competent care or providers who may understand their experience, explained Dr. Veronica Pimentel, a practicing maternal-fetal medicine specialist at Trinity Health Of New England
“The issues of racism and systemic racism and the impact that it has on you in general as a person of color — you’re dealing every day with all the microaggressions coming at you constantly,” said Pimentel, also an associate professor of obstetrics and gynecology at the Frank H. Netter MD School of Medicine at Quinnipiac University.
“Those are burdens that you’re dealing with, and the path to a healthy childbirth for a person of color is a lot more convoluted,” she continued. “Pregnancy is stressful, no matter who you are, but when you’re a person of color, especially a Black woman in the U.S., there’s so much more that you’re dealing with before you even got pregnant that makes the whole journey more stressful.”
Too much stress during pregnancy can lead to a host of health issues including difficulty sleeping, headaches, loss of appetite and a tendency to overeat. It can also cause high blood pressure, which increases the chance of preterm labor or a low-birth-weight infant — all of which disproportionately affect Black women during pregnancy.
But even for those who do have access to mental health professionals, the stigma around mental health that remains could keep them from seeking the help they need.
“Generally speaking, there’s a lot of undiagnosed mental health conditions or depression in the community,” explained Pimentel. “We’re just not used to going to a counselor. Definitely in the Black immigrant community, it is very much presented that Jesus will take care of it or you go to church and you talk to your pastor.”
Other barriers such as lack of insurance or financial ability or even child care could also keep Black women from accessing the care needed to stay mentally healthy both during and after pregnancy.
Solutions are possible
Many advocates call for increased funding for doula services to help end the Black maternal mortality crisis. For Crawford, this is a viable — though complex — solution, in part because most doulas would likely be white.
“People actually may be more responsive if there is a doula present,” she said. “The fact that there is someone else in the room of this profession may make it such that other people take this Black woman more seriously.”
“I think it’s a positive thing, but also, it’s just kind of frustrating that we need to have some of these other roles in place in order for people to better listen to Black women when they’re birthing,” Crawford added.
Pimentel also urges women who are either planning on becoming pregnant or who already are to take control of their pregnancy by researching who their providers are and making sure they feel they are listened to.
“We talk about Black women as being very resilient and, yes, Black women are resilient, but you’re still a person, you still have needs,” she said.
Identifying those needs and being able to clearly articulate them to someone who will listen can help alleviate the potential stress of going unheard.
But much of the responsibility also has to be on health care providers, Dawkins said. Medical professionals have to be invested in a multipronged care approach from the very beginning, she said.
“We’re talking about precare, making sure that we are assessing for things like mood, support, things that might need to be in place and making sure that folks will have those support systems in place post-care.”