Beyond Baby Blues: Understanding and Supporting the Mental Health Challenges of Black Women and Birthing People 

Published Jul 22, 2024

Kendra Copanas, Executive Director, Generate Health STL 

Mental illness occurs a lot more than we normally recognize. As one of the most common mental illnesses, depression affects more than 280 million people worldwide.¹ Depression can greatly impact one’s pregnancy and first year after giving birth. 

Postpartum depression, in particular, affects one in eight women and birthing people in the United States. It is different than the average sadness that can occur after birth when it lasts for more than two weeks. Some of the symptoms specific to postpartum depression are being disinterested in the baby, being unable to bond with the baby, experiencing fear of being a bad mother, and concerns of harming the baby or self. ² In the United States, postpartum depression is the leading cause of maternal death within the first year after birth as a result of maternal suicide.³ 

Black women and birthing people in the United States are at a higher risk of experiencing postpartum depression and other maternal mental health conditions. They are two times more likely than white women to experience poor maternal mental health, but half as likely to receive treatment.⁴ 

According to the Maternal Mental Health Leadership Alliance, there are contributing factors that may increase this risk among Black women and birthing people, such as systemic racism, lack of access to high-quality medical and mental health care, higher risk of pregnancy and childbirth complications, distrust of the healthcare system, and shame and stigma.⁵ 

Stigma plays a huge role in whether people seek out help.⁶ Many pregnant and postpartum people dealing with mental health concerns worry about being seen as “crazy” or scared of losing their child if it becomes known to health care professionals that they are experiencing depressive symptoms.⁷ Black women specifically tend to believe they should “tough out” their symptoms or circumstances to be a strong Black woman; this aligns with certain cultural beliefs that depression can be prevented and resolved through strength and religious faith.⁸ This idea that Black women have to be strong can lead them to deny symptoms of depression and do without mental health treatment and self-care. There also is an expectation that they must push through depression and stress without allowing negative symptoms to impact their family and job responsibilities.⁹ 

Policymakers and employers can play a role in improving mental health by ensuring access to comprehensive health insurance coverage that includes behavioral health services and providing paid family and sick leave.   

In addition, we recommend improving access to culturally competent and well-trained mental health care and providers, making treatment more affordable and accessible, and launching public education campaigns to show women, birthing people, and their families how to notice their symptoms and seek out help.¹² We also can address cultural beliefs and dismantle the idea of always needing to be a strong Black woman.¹³   

Hospitals and systems can support the maternal mental health of Black women by listening and creating spaces where they feel comfortable voicing their concerns.¹⁰ Mental health screenings and postpartum education should be incorporated into routine appointments.¹¹   

We recommend providers and provider organizations serving Black pregnant and parenting families adopt holistic, barrier-free, culturally congruent approaches to care and to operate in a coordinated service delivery system. Increasing cultural congruence will lead to greater trust among community members and providers and increase engagement in services. Further, providers can acknowledge cultural beliefs and normalize seeking mental health care.   

Having a child is a life-changing event, and it is normal to struggle with one’s mental health. Learn more about some of the signs and symptoms of postpartum depression and share any concerns with a trusted provider, family member or friend.   

Contact the National Maternal Mental Health Hotline online or by phone (1-833-TLC-MAMA) for information and support. If you are in crisis, you can call or text 988 for the Suicide & Crisis Lifeline.  

Check in with women and birthing people regularly. Listen openly and without judgement to their concerns. Help connect them with information and mental health resources, such as the National Maternal Mental Health Hotline.   

About Generate Health 

Generate Health formed 25 years ago as the maternal and child health coalition in St. Louis. Today, we are an organization that seeks to eliminate racial disparities in maternal and infant health by building collective power to advocate for racially equitable policies and programs that center, support and celebrate Black families throughout their pregnancy and parenthood journeys. Since 2012, we have convened and coordinated the Perinatal Behavioral Health Initiative, which increased and standardized screening, referral, and treatment for maternal mental and behavioral health concerns through a network of providers. We expanded the network in 2019 to include home visiting services.    

References 

1. “Depressive Disorder (Depression).” World Health Organization, March 31, 2023. https://www.who.int/news-room/fact-sheets/detail/depression.  
2. December Maxwell, Sarah R. Robinson, and Kelli Rogers, “‘I Keep It to Myself’: A Qualitative Meta‐Interpretive Synthesis of Experiences of Postpartum Depression among Marginalised Women,” Health & Social Care in the Community 27, no. 3 (April 2018), https://doi.org/10.1111/hsc.12645. 
3. Maxwell, Robinson, and Rogers, “I Keep It to Myself” 
4. “Maternal Mental Health: Black Women and Birthing People.” Maternal Mental Health Leadership Alliance (MMHLA), November 2021, https://static1.squarespace.com/static/637b72cb2e3c555fa412eaf0/t/63da5d28d1a1dd20ff42bba7/1675255082829/Fact-Sheet-MMHLA-Black-Women-Birthing-People.pdf 
5. “Maternal Mental Health: Black Women and Birthing People.” 
6. “Stigma, Prejudice and Discrimination against People with Mental Illness,” Psychiatry.org (American Psychiatric Association, August 2020), https://www.psychiatry.org/patients-families/stigma-and-discrimination. 
7. Sandraluz Lara-Cinisomo, Crystal T. Clark, and Jayme Wood, “Increasing Diagnosis and Treatment of Perinatal Depression in Latinas and African American Women: Addressing Stigma Is Not Enough,” Women’s Health Issues 28, no. 3 (February 19, 2018): pp. 201-204, https://doi.org/10.1016/j.whi.2018.01.003. 
8. Lara-Cinisomo, Clark, and Wood. “Increasing Diagnosis and Treatment” 
9. Jamila Taylor and Christy M Gamble, “Suffering in Silence,” Center for American Progress, May 1, 2023, https://www.americanprogress.org/article/suffering-in-silence/. 
10. Crysta Meekins, “Supporting Black Women’s Maternal Mental Health Journey,” IFDHE (American Hospital Association, July 19, 2022), https://ifdhe.aha.org/news/news/2022-07-19-supporting-black-womens-maternal-mental-health-journey. 
11. Meekins, “Supporting Black Women’s Maternal Mental Health Journey.” 
12. Taylor and Gamble, “Suffering in Silence.” 
13. Taylor and Gamble, “Suffering in Silence.”