Moms of color have an increased risk of experiencing PPD and related disorders than women in other ethnic groups, but fear is keeping them from getting the treatment they need. Here’s why, and how black families can get the right mental health support.
During her first year as a mom, Karen Flores, then 31 years old, was afraid she was not emotionally stable enough to take care of her daughter. On the particularly hard days, Flores would take a walk with her daughter on the beach. “Out of nowhere, this bizarre thought came to my mind ‘push the stroller over the rocks and see what happens,’” she wrote on the site Maternal Mental Health Now. “I was paralyzed by the thought but forced myself to keep on walking while wondering where it had come from—’Oh, My God, am I crazy?’ I wondered.”
Flores, now 50, was not crazy. She was suffering from postpartum depression, a condition that affects up to one in seven women, according to the American Psychological Association. Flores didn’t immediately seek out help. “I was extremely anxious and ashamed thinking that I was losing my mind and that my baby would be taken from me,” she says. “I tried praying and did a lot of cardio.” Before her daughter’s second birthday, she began working with a therapist to manage the symptoms of her depression.
Black women like Flores are less likely to get help for postpartum mental health issues compared to both white women and Latinas, according to a study published in the journal Psychiatric Services. Part of this hesitation is caused by fear—these women fear they will be considered unfit and have their children taken away from them by Child Protective Services. These fears are not unwarranted since one in nine black children will spend time in foster care by the time they’re 18, according to data from the Adoption and Foster Care Analysis and Reporting System. This is the second-highest risk racial/ethnic group to end up in the foster care system behind Native American children.
“There’s a lack of trust of medical practitioners within the black mom community nationwide,” explains Shivonne Odom, LCPC, LPC, founder of Akoma Counseling Concepts, LLC, in Silver Spring, Maryland, who specializes in maternal mental health counseling for mothers with perinatal disorders. “Many medical practitioners are not trained to refer or treat perinatal mood disorders so when they hear patients report typical symptoms of postpartum depression, practitioners mistake the severity of the symptoms for abuse.” Odom, who is black herself, adds that many practitioners do not recognize a difference in how perinatal mood disorders present among ethnic groups. “This leads to improper treatment or poor rapport between practitioner and client,” she says.
Postpartum depression, anxiety, and other perinatal mood and anxiety disorders can affect any mother and can manifest up to one year after delivery. However, there are cultural nuances during pregnancy, labor, and delivery that can increase the risks of experiencing PPD for black mothers. Statistics show that black women are three to four times more likely to die during or after delivery than white women. From 2011 to 2015, there were 42.8 deaths per 100,000 live births for black non-Hispanic women—a higher ratio than any other ethnic group. “These statistics along with birth trauma and untreated mental health issues prior to and during pregnancy may lead to postpartum depression,” Odom says.
Suffering in silence
Odom says she often sees the same themes preventing black mothers from seeking mental health therapy. First, there’s the fear of losing control, independence, respect from others, or mental sanity. “Sometimes holding in this fear leads to a manifestation of irrational thoughts—’I’m not a good mom,’ ‘I feel empty,’ ‘I’m not emotionally connecting to my baby,’” she says. “The belief that something is wrong, which must mean I’m doing something wrong and I’m a bad mom is an extension of these irrational thoughts.”
Then she often hears that these women would prefer to seek help from their friends, family, and church rather than a mental health professional. “There’s definitely a cultural stigma discouraging mental health counseling in the black community,” Odom explains. “Some believe that if you go to therapy you have to be admitted to a psychiatric hospital or will be required to take addictive prescription medications. Some people’s religious beliefs also shape their views on mental health and can impact their help-seeking behaviors.” There’s also concern passed down from generation to generation that mental health practitioners are suspicious of black mothers.
“Similar to how implicit biases affect the professional decisions and behaviors of medical doctors, teachers, and police officers, mental health practitioners are not immune to their own implicit biases which eventually translates to their work with people of color,” says Yuvelqui Rattigan, a licensed clinical social worker and mental health therapist practicing in Prince George’s County and Baltimore, Maryland, who self identifies as Afro-Latina.
Help comes with a risk
In her professional career, Rattigan has observed well-intended agencies and clinicians overlook entire communities that could benefit from mental healthcare-related prevention and early intervention services. She’s also seen disproportionate reporting of suspected maltreatment or neglect in these same communities. Her observations are supported by a 2016 report from the Child Welfare Information Gateway titled “Racial Disproportionality and Disparity in Child Welfare,” that noted families of color were disproportionately reported for abuse and neglect than white, non-Hispanic families. Several studies referenced in this report showed that cases involving black children were also more frequently assigned for investigation.
“I have observed well-intentioned clinicians be quick to pathologize normal developmental behaviors and/or normal reactions to trauma and stress in children,” she says. “I have observed practitioners be quicker to judge or dismiss parents of color.” Rattigan partially attributes this to the scarce amount of continuing education courses offered to improve cultural competence and racial awareness in the mental health industry. “While it is getting better, in the rare occasion that the training is offered, I have observed low attendance rates by white clinicians,” she says.
Rattigan, a mandated reporter in her community, says she is heartbroken when a report she makes exposes a black or brown family to a system that may not fairly evaluate the need to remove the children due to racial bias and discrimination. Not all reports Rattigan makes are for children in immediate danger. For example, under Maryland law, Rattigan must report a parent who leaves a child younger than 8 years old at home alone. If Rattigan learns at an appointment on a Tuesday that a mom left her 7-year-old child home alone the previous Sunday, she is legally required to report the event, even if she does not personally suspect neglect or mistreatment.
Services available to black moms
While there is a clear gap in access to competent maternal healthcare across the country, there are individuals and organizations working to fill the void. The Perinatal Mental Health Alliance for People of Color provides education, resources, and support for individuals, families, and communities of color around perinatal mental health and wellness. Better Postpartum teaches mothers ways to avoid or alleviate these mental health disorders, and Postpartum Support Virginia encourages pregnant mothers to take birthing classes that include information on depression and anxiety. Postpartum Support International offers a free helpline that moms can call 24 hours a day. Through this service, moms leave a confidential message and trained volunteers return the call or text and answer questions, offer encouragement, and connect callers with local resources as needed.
When MTV teamed up with Every Mother Counts and the Black Mamas Matter Alliance in May 2019, it gave hope that future generations of black women will have better maternal health care than what is available today. This #SaveOurMoms campaign sheds light on the fact that every day two to three women in the U.S. die from pregnancy-related complications and black women are at the greatest risk.
“If all women receive the same quality of care, then there would be no need to have specific care for black women in the future,” says Kay Matthews, the founder of the Shades of Blue Project, an organization dedicated to helping minority women with PPD. “Acknowledgment, respect, and support are the three things that must be present in our care treatment because without it we continue to experience racism and lack of care every time we go into clinics and hospitals seeking treatment.”
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