February 15, 2022

Developing equitable policies to support mental health during the perinatal period — the months/years before and after birth — requires addressing the intersecting effects of racism, poverty, lack of childcare and inadequate postpartum support.

Structural racism causes significant inequities in the diagnosis of perinatal and maternal mental health disorders and access to treatment. Black birthing populations are particularly burdened by disjointed systems of mental health care.

A recent issue of the journal Health Affairs featured two articles on this topic co-authored by students in the Department of Maternal and Child Health at the UNC Gillings School of Global Public Health.

Black women know how to address inequities in mental health care

Isabel Morgan

Isabel Morgan

Doctoral candidate Isabel Morgan, MSPH, who is minoring in epidemiology, co-authored the study, “Pathways To Equitable And Antiracist Maternal Mental Health Care: Insights From Black Women Stakeholders.” A former Centers for Disease Control and Prevention staff member, she now directs the Birth Equity Research Scholars Program, part of the National Birth Equity Collaborative in New Orleans, Louisiana.

To identify strategies to address racism and inequities in maternal and infant mental health care, Morgan and two other public health professionals — all three of whom are Black women — interviewed ten Black women who support Black birthing people. Interviewees included mental health practitioners, researchers and activists. From these stakeholder interviews, they identified five key pathways to address racism and inequities:

1. Educating and training practitioners;
2. Investing in the Black women mental health workforce;
3. Investing in Black women-led community-based organizations;
4. Valuing, honoring and investing in community and traditional healing practices; and
5. Promoting integrated care and shared decision making.

Reimagining perinatal mental health through structural change

Caitlin Williams

Caitlin Williams

Doctoral candidate Caitlin R. Williams co-authored the commentary, “Reimagining Perinatal Mental Health: An Expansive Vision For Structural Change.” A public policy minor, Williams’ research focuses on driving policy change to improve the health and wellbeing of pregnant and birthing people.

Williams and an interdisciplinary team of co-authors use a human rights framework to articulate how and why policy makers must act to facilitate well-being in the perinatal period. They employ personal and professional expertise to disrupt underlying assumptions about the perinatal experience, highlight the inadequacies of the current system’s approach and describe the types of policy changes needed to address identified gaps.

“[The narrow scope of ‘perinatal mental health’ as currently practiced] maintains a distinction between the physiologic and psychosocial aspects of pregnancy, effectively consigning social and emotional perinatal experiences to a highly stigmatized and underresourced arena of health and health care,” the co-authors write. “However, no pregnancy exists in a vacuum. […] For example, stressful life events degrade physical well-being, and poor health (or health care) experiences can induce posttraumatic stress disorder or other types of anxiety.”

“It’s not enough to get everyone into talk therapy — we really need to rethink the way our society is organized so that that birthing people, families and communities can thrive,” Williams adds. “Biomedical approaches can help, but there are also deeply rooted spiritual and cultural practices in many of our communities that support well-being. We can and should celebrate and uplift those traditions.”

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