Every mother — and father — experiences postpartum depression differently. For Nakita Austin, the condition felt like “drowning and grasping onto everything for help.” Sol DiFrancesco felt like she was “constantly sad, tired and overwhelmed."
Austin, of London, and DiFrancesco, who lives in New Jersey, are two of the estimated 15 percent of women who develop postpartum depression (PPD) in the weeks or months after giving birth.
Postpartum depression is a serious mood disorder that can have a profound effect on all aspects of a new mom's life — symptoms may include feelings of overwhelming sadness or worthlessness, severe anxiety, irritability, insomnia and social isolation.
Thankfully, the condition is treatable, usually through a combination of talk therapy and medication.
But unlike Austin and DiFrancesco, who were diagnosed with PPD and received care, a disproportionate number of BIPOC (Black, Indigenous and People of Color) moms don't get the postpartum mental health support they need.
BIPOC women are at greater risk for PPD and similar conditions than white mothers, but far less likely to receive treatment — and the COVID-19 pandemic only exacerbated these disparities.
Why are BIPOC mothers more at risk for PPD?
Research suggests that BIPOC moms are more at risk for developing postpartum depression and related conditions. In one small study, Black and Hispanic mothers were more likely to report depressive symptoms than white mothers at three months postpartum.
A number of factors may play a role, including socioeconomic disparities and lack of insurance coverage. BIPOC women and women of all races who have lower incomes, have less than a college education, and are unmarried and unemployed are significantly more likely to develop postpartum depression, research finds.
Medical complications during pregnancy and postpartum can also be a risk factor for PPD. BIPOC mothers have higher rates of gestational diabetes and type 1 or 2 diabetes during pregnancy, according to the Centers for Disease Control and Prevention (CDC).
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Then there's the fact that BIPOC mothers are more likely to die during childbirth, which likely only heightens the anxiety many expecting mothers feel in the final stages of pregnancy.
Lack of support, a known risk factor for PPD, may also play a role.
“More than likely, the support piece is of greatest consequence in racial and ethnic disparities in postpartum depression," says Los Angeles-based psychologist Cleopatra Kamperveen, Ph.D., an associate professor at the University of Southern California. "Society as a whole is not as supportive of moms of color as it is of moms in general.”
DiFrancesco, who was born in Mexico, believes cultural differences in the U.S. also exacerbated her postpartum depression, especially after the birth of her second baby.
“My son Mario was more demanding because he had allergies that we didn’t know about, and he was struggling to sleep at night," she says. When her husband went back to work, DiFrancesco would wake up every hour to feed Mario, and she started to feel increasingly exhausted and alone.
Growing up, DiFrancesco says her grandmother would help the new parents in their family.
“She'd go cook and clean the house and make sure the mom was taken care of, and she took care of the baby while the mom was recovering,” the mom of two remembers. DiFrancesco believes that family support like what was available in Mexico would have been hugely helpful for her in those early days.
Once she told her doctor about her symptoms, DiFrancesco was prescribed medication. Soon after, she opened up to her friends, who helped set up a meal delivery service so she wouldn't have to worry about feeding herself or her older son. Unfortunately, many other moms don't end up getting the treatment they need.
Why aren't BIPOC moms getting treatment for PPD?
BIPOC mothers face a number of barriers both in terms of getting a diagnosis for postpartum depression and related mental health conditions, as well as receiving treatment.
Simply being diagnosed with PPD is a hurdle for many new moms. Some research suggests that traditional screening tools such as the 10-question Edinburgh Postnatal Depression Scale (EDPS) survey may be less likely to deliver accurate results for BIPOC women. One study that looked into the accuracy of traditional depression screening tools among low-income Black mothers found that they may not always correctly identify Black women with depression symptoms.
Black communities may also use different terms to describe mental health challenges. In another study of depression in people with cancer, for example, Black breast cancer and prostate cancer patients with depressive symptoms were more reluctant to use the word "depression," but more likely to admit to “feeling low, blue or down."
Women who are diagnosed or suspect that they may have PPD also face barriers in getting care, and systemic racism in the medical community may partly be to blame.
Racism and implicit bias have been linked to the disproportionately higher maternal mortality rate for Black moms — studies have shown that Black patients are less likely to be treated for pain than white patients, for example — and research has found that some doctors continue to hold outdated and untrue beliefs.
"Black women’s concerns about their mental health are routinely dismissed because of implicit biases within the health care system,” says Quantrilla Ard, Ph.D., an Atlanta-based psychologist and advisory board member at Abide Women's Health Center who specializes in Black maternal and infant health. “This is also true within the sphere of Black maternal mental health, causing gaps in and lack of treatment."
And although stigmas about postpartum depression exist everywhere, people in BIPOC communities may be more likely to feel ashamed or conceal symptoms, in turn delaying or preventing them from getting care.
"There is a pervasive, negative stigma associated with seeking mental health services in the Black community," says Ard. "This persists despite current advocacy and community efforts to increase mental health awareness and access for the Black community in general as well as for Black moms."
One study into how different racial and ethnic groups in California experience mental illness found that Spanish-speaking Latinos were more likely than other groups to feel embarrassed or ashamed about mental health problems. Asian Americans, Black Americans, and English- and Spanish-speaking Latinos were all more likely than white study participants to report feeling out of place in the world due to mental health challenges.
Black women may be less likely to accept prescription medication to treat their PPD, one study found, though it’s unclear whether the stigma around mental illness is the culprit. Researchers also found that Black women were slightly less likely to seek therapy, but more likely than white women to try spiritual counseling.
At first, Austin, who is Haitian and Filipino American, was hesitant to admit to loved ones that she'd been experiencing symptoms of postpartum depression. But when her partner's paternity leave ended, she had no choice but to address it.
“I remember the first day he went back to work after five weeks, and I just couldn’t think of anything worse than being stuck at home staring at the walls with a baby hanging onto me," she says. "I’d think ‘Here we go again.’”
When she eventually started seeing a therapist and was prescribed antidepressants, she told a few of her loved ones about her diagnosis and treatment, and they characterized her use of medication as “a 'slippery slope,’” Austin says. "At that point, that wasn't helpful. I really just wanted to feel like myself."
Some BIPOC women may also feel like they have to exhibit strength at all costs, Ard notes.
“There is the ‘superwoman’ trope or stereotype that many Black women subconsciously identify with and often carry into motherhood," she explains. "These unrealistic and unsustainable expectations... can influence postpartum Black mamas to feel guilty about their feelings. They may also feel a sense of failure for not living up to these standards, and these feelings can discourage them from seeking treatment.”
How has COVID-19 impacted postpartum care for BIPOC women?
Research suggests that the pandemic has been fueling an increase throughout the U.S. in the number of women who develop PPD. Not surprisingly, BIPOC women are especially at risk.
A small study conducted in Philadelphia during the beginning of the pandemic found that Black pregnant women were more likely to exhibit signs of depression and anxiety than white women. The mothers were particularly concerned about their upcoming birth experience, getting quality prenatal care and their postpartum needs.
Financial difficulties, lack of support and medical complications are all risk factors for PPD — and all have been hallmarks of the pandemic for BIPOC mothers.
A Pew Research Center survey found that BIPOC families were more likely to have to dig into savings or retirement funds during the pandemic, as well as more likely to rely on a food bank and have trouble paying their bills.
Another Pew study found that Black, Hispanic and Asian Americans experienced a steeper decline in employment during the pandemic than during the Great Recession.
For those still working, research has shown that BIPOC families have also been more likely to struggle with child care options during the pandemic, and Black women have been more likely to leave the workforce temporarily than any other group.
Then there are the heartbreaking statistics of how disproportionately COVID-19 has impacted BIPOC communities.
According to the latest data from the CDC, compared to white Americans, Black Americans are 1.7 times more likely to die from the virus and 2.8 times more likely to be hospitalized; Hispanic and Latino Americans are more than twice as likely to die and three times as likely to be hospitalized; and American Indian and Alaska Natives are 1.7 times more likely to die and 2.4 times more likely to be hospitalized.
How can BIPOC moms get the postpartum mental health care they need?
Though it can be hard to ask for help, there are resources available to all moms who may be grappling with PPD or another perinatal mood and anxiety disorder.
Some support services include:
- Office on Women's Health (800-994-9662)
- National Library of Medicine, Medline Plus
- Postpartum Support International (800-944-4PPD)
- National Alliance on Mental Illness (800-950-NAMI)
- Substance Abuse and Mental Health Services Administration (-800-662-HELP (4357))
- What to Expect's Postpartum Depression Group
- What to Expect’s Moms of Color Group
- Black Mamas Matter Alliance
- Perinatal Mental Health Alliance for People of Color
- Therapy for Black Girls
Christy Duan, M.D., a New York City-based psychiatrist who specializes in perinatal mental health, tells her patients that self care is also crucial and stresses how important it is not to suffer in silence.
“I remind mothers that happy moms can lead to happy babies,” says Dr. Duan. “For some, self care means taking medications during pregnancy and beyond."
Kamperveen also recommends tapping into resources we carry with us, such as affirmations (she likes "I feel appreciation for myself because I choose love over fear even when I’m scared,") as well as alternate nostril or belly breathing.
DiFrancesco, for her part, gradually began to feel more like herself after seeking treatment. She also fell in love with running and became certified to teach yoga, which helps her stave off negative feelings.
Austin, too, slowly recovered. She now encourages other women who are struggling with PPD to expand their reach and try to be persistent when seeking help — no easy feat when you’re depressed or anxious and caring for a new baby.
"We have to try to seek help in whatever way we can," Austin says. "Silence or being afraid of the stigma won’t help. But there are resources available if you open yourself up to them.”
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