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Postpartum Depression and Black Birthing People: Maternal Mental Health Awareness Week

Bintou Diarra, A.B Candidate | Medical Anthropology, Brown University | May 1, 2023

Depression is a common mental health disorder characterized by persistent feelings of sadness, hopelessness, or emptiness. Despite the prevalence of the condition, there is great variation in its manifestation. May is Mental Health Awareness Month and this month we also highlight mental health challenges that new mothers and birthing people face the first week of May (1-7) for Maternal Mental Health Awareness Week.

A New York University study suggests that Black women are among the demographics that experience symptoms different from the stereotypical appearances of depression, such as depressed mood. When coupled with the heightened rates of prevalence among Black women, this finding paints a disquieting picture. The difference in Black women’s experiences with depression means that Black women are more likely to go underdiagnosed and undertreated by providers, who most likely screen for the more typical symptoms. As we honor Maternal Mental Health Month, we should consider the implications for Black birthing people experiencing postpartum depression. 

Postpartum depression occurs after childbirth and generally impacts birthing people of all backgrounds. However, like with general major depression, research suggests a heightened prevalence among Black birthing people when compared to other racial and ethnic groups. Not only do Black birthing people experience postpartum depression at higher rates, but they are also less likely to receive help because of warranted distrust in our current medical system, financial barriers, structural racism, and the stigma attached to mental health struggles—which often accompanies notions of their unparalleled strength

Trauma specialist and mental health consultant Dr. Millicent Rose knows this all too well. In her twelve years of experience as a therapist, she noticed a pattern among Black women where depression presents as high functionality, paired with the major internalization of negative feelings. “What that means is that Black women are more likely to present as high functioning—excelling at work, effective parenting, and even showing up in service to others—while internally struggling with deep dysphoria that is shrouded in shame, maintained by silence, and perpetuated by a fear of not being able to uphold the ‘strong black woman’ trope that society prescribes to us, while also battling the stigma associated appearing to be weak if we admit to struggles with our mental health.”

Unfortunately, because Black women remain an understudied group within the sphere of mental health, researchers remain unclear on the source of treatment gaps beyond these general categories. Ironically, the failure to include Black women in research sets the foundation for a number of factors to play into their care. The screening tools and measures developed to detect depression were developed with white patients in mind, which means that symptoms that deviate from the ‘norm’ fly under the radar—leaving Black birthing people and other people of color to fall through the cracks. 

Dr. Millicent Rose not only acknowledges the necessity of screening, but she also urges the incorporation of tools that account for Black women’s unique experiences. “Screening for postpartum depression is essential on the part of all providers working with black mothers, and that screening must meet the three key requirements of being culturally sensitive, culturally adapted, and culturally responsive,” says Rose. She also underscores the significance of intentionality, and asserts that the creation of assessments that are intended to identify and bridge gaps is another method of accounting for the variability in experiences with depression. 

Additionally, providers must consider our maternal health conditions as they stand and their potential to impact maternal mental health. The reality of Black women’s heightened rates of maternal mortality and morbidity may shape their mental health through the postpartum period. “In the maternal space, we know that black women are more likely to lose their lives during childbirth, experience birth trauma, and ultimately go unseen and unheard by providers during what should be a transformative time in their lives. Both the knowledge and fear of the reality that black women face in the birthing space are likely to elicit feelings of helplessness, sadness, and panic which are gateway symptoms for the onset of depression, especially during a time of hormonal imbalance such as postpartum.”

When it comes to postpartum depression in Black birthing people, detection is just the tip of the iceberg. To Dr. Millicent Rose, mental health providers’ care for Black women could benefit from the deliberate structuring of questions. “It is important for us to pay special attention to the subjective experiences of our clients and lead with questions that are introspective and intended to reveal their internalized state,” she says. 

Questions that resonate with Black women are not only crucial, but also are a baseline for providers who look to provide optimal care. “Think about both the simplicity and power behind asking a black woman “how is your heart?” versus “have you been experiencing helplessness or hopelessness?” In this regard, offering emotional softness and safety to black women and listening to them with intention to alleviate their suffering should be the benchmark and bare minimum standard of any medical service provider who endeavors to support this high-value community.”

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