The United States has the highest maternal mortality rate among developed nations. The health and well-being of women on their maternal journey – before, during and after childbirth are critical aspects of equitable health care. Approximately 700 women die from pregnancy or childbirth-related complications each year in the United States (CDC). Furthermore, racial disparities exist within that statistic. Black women are three to four times more likely to experience a pregnancy or childbirth-related death than White women. Recognizing these issues increases the feelings of depression and anxiety, which can increase Black women’s risk of developing postpartum depression.
Postpartum depression (PPD) affects one in eight women; however, the risk is 1.6 times higher for Black women than White women. While the risk may be higher, Black women are less likely to receive help due to factors such as financial barriers, stigma associated with mental health struggles, structural racism and a historical mistrust of the health care system. Maternal mental health symptoms and issues among Black women are often overlooked and under addressed.
Here are four ways hospitals and health systems can support Black Women’s Maternal Mental Health:
1. Listen to Black women.
- Create a safe space where Black women have their voices and concerns heard, especially when it involves their safety during pregnancy and delivery in childbirth. Be an open and active listener and refrain from being dismissive. Effective verbal and non-verbal communication such as maintaining eye contact, using a calm and respectful tone and practicing cultural humility are essential to successful interactions in maternity care settings. It is important to not invalidate Black women’s expression of pain or concern, because the failures can have detrimental consequences. In 2020, the maternal mortality rate for Black women was 55.3 deaths per 100,000 live births – 2.9 times the rate for non-Hispanic White women, and a significant increase from previous years. In 2019, Black women’s mortality rate was 44.0 deaths per 100,00 live births and 37.3 deaths per 100,00 live births in 2018.
2. Implement and prioritize postpartum education and support during healthcare visits.
- Prioritize and emphasize postpartum education during health care visits. Prepare all mothers for what to expect, ask thoughtful follow-up questions and use an approach that integrates culturally supportive care. Identify and address social factors such as food insecurity, housing and income that may be a stressor in their lives. Provide mothers with resources within your organization and the community that can help alleviate this stress.
- Establish social support networks during pregnancy and the postpartum period. Consider investing in models like the Centering Pregnancy Model, which brings a group of pregnant women who due at the same time together in a group setting. Women experience community and support, receive more time with their provider, increase self-efficacy and much more.
3. Incorporate robust postpartum depression and anxiety screening during appointments.
- The American College of Obstetricians and Gynecologists (ACOG) recommends all OB/GYN providers complete a full mood and emotional well-being assessment, which includes screening for postpartum depression and anxiety. Given the disparities in incidences of PPD and anxiety in Black women, it’s imperative that this assessment is comprehensive and culturally appropriate.
4. Partner with Black Maternal Health Organizations.
- Collaborate with organizations who have already made substantial progress leading change in Black maternal health such as the Black Mamas Matter Alliance and National Birth Equity Collaborative (NBEC). Both organizations are catalyzing efforts to improve Black maternal health through advocacy and policy, research and strategy and culture shifting. Consider partnering with these organizations to understand how to best position your hospital and health care system to address these issues.
As we raise awareness and reflect on Black Maternal Mental Health week, hospitals are encouraged to survey their own maternal health practices and identify areas to improve Black maternal mental health in their communities. The lives of Black women depend on it.
Crysta Meekins is a program manager for the Institute for Diversity and Health Equity (IFDHE).