Addressing the Increased Risk of Postpartum Depression for Black Women

I was 27 years old when I found out I was pregnant. Although the pregnancy was unexpected, I was excited. I was even happier when I learned I was having a girl after being an aunt to seven boys. I sang to my daughter, wrote to her daily in a journal and felt overwhelming joy any time she kicked.

A few months after I delivered, I started to feel less like myself. I stopped putting effort into my appearance, I lost interest in things I normally enjoyed, and I didn’t even want to be around my own child. I felt guilty and anxious, and I cried frequently. At times, I even found myself wishing she’d “go away.” Back then, I couldn’t name how I felt, but I knew I needed help.

Postpartum depression (PPD), also known as perinatal depression, is a mood disorder that occurs during pregnancy or after a recent birth. The condition can create bonding issues between a mother and her baby, contribute to sleep and feeding problems, and cause mental, emotional, developmental and verbal complications in children. PPD affects one in eight new mothers, but the risk is significantly higher for new mothers of color. Notably, while Black women are more likely to have PPD, they are less likely to receive help.

There are a number of factors that may contribute to increased rates of PPD among Black women and low levels of treatment, including lifestyle and living conditions.

Identifying and understanding these factors may be a lifesaving measure. Ultimately, accessing treatment that includes cultural understanding is critical in improving the health outcomes for expecting Black women and those that have recently given birth.

Symptoms of Postpartum Depression

According to the CDC, symptoms of PPD include:

• Guilt
• Fears of harming the baby
• Feeling angry
• Isolating from family
• Feeling disconnected from their baby
• Crying more than normal

While symptoms of postpartum depression have been widely documented, much of the research conducted and screening tools developed have been focused on white women. As a result, doctors may miss somatic symptoms that tend to present in nonwhite women, such as high blood pressure or unexplained body aches, pain and nausea. If a new mother is experiencing these symptoms, it’s important to discuss them with a provider.

Why Black Women Have a Higher Risk

Black women are three times more likely to have a maternal death than white women in the U.S. Awareness of this risk can heighten stress and anxiety during pregnancy, potentially placing women of color at risk for PPD. Many researchers suggest providers prioritize examining social factors to further understand and address these health disparities. Social factors that can place Black women at increased risk for PPD include:

• Low income or education
• High stress living environments
• Exposure to trauma
• Food insecurity
• Lack of access to quality care or health coverage

Obstacles to Receiving Mental Health Care

Personally, I was fortunate that my family openly discussed, and even suggested, therapy in my household. However, despite the support from my family, I could not bring myself to tell them I had thoughts of not wanting my daughter. Many Black women experiencing PPD are silenced by shame and stigma. In the Black community, seeking help is often viewed as a sign of weakness. Additionally, when someone makes the decision to seek guidance, they are likely to turn to family, friends or religious leaders rather than trained personnel. In the U.S., when it comes to mental illness, Black individuals are less likely to receive treatment than nearly all other racial and ethnic groups. Reasons many do not seek professional help can include:

• Stigma and perceptions of mental illness in the Black community
• Experience with inaccurate diagnoses
• Lack of representation or diversity in health care
• Distrust of the health care system
• Perceived racial discrimination

One common symptom of PPD is feeling hopeless. If such feelings become severe, a new mother could threaten her life and or die by suicide. It is important that Black mothers receive help as soon as possible to prevent symptoms from escalating.

Resources for Culturally Supportive Care

Below is a list of resources to assist women with finding providers and other sources of support.

Therapy Resources

Therapy has been shown to be effective in treating depression and reducing depression symptoms in women with PPD — when mental health providers are culturally sensitive and appropriately trained.

Listed below are websites with information on locating providers of color. You can enter your city, state, or zip code and available providers in your area will come up.

Therapy for Black Girls

Black Therapist Rock

Melanin and Mental Health

BlackDoctor.org

National Black Doula Association

Support Groups

Connection with local support groups and lactation consultants could be beneficial in curbing rates of PPD. Support groups are great ways to gain insight, link with other mothers and connect with community resources.

The Shades of Blue Project
Mothers can register to join weekly virtual meetings by submitting their names and email addresses. There are four different support groups offered: pregnancy and postpartum, teen mom, Spanish speaking and infant loss.

National Association of Professional and Peer Lactation Supporters of Color
Expecting and new mothers can go to this site and search the directory for lactation support. Assistance can be provided in person (if local) or electronically (telephone, email and video chat).

Nutritional Resources

PPD has been linked with lacking affordable and nutritious food. The Women, Infants and Children (WIC) program provides families with healthy food and nutritional education for mothers and their children. Mothers can contact their local WIC site online or by phone to complete an application. Name and birthdates of parent and child is required for application.

Moving Forward

PPD is a debilitating illness that can produce detrimental outcomes for mothers, families and communities. Education at the provider and community level is essential in combating the disparities in black maternal mental health. Many pediatric physicians observe PPD in mothers at baby wellness visits. Thus, training physicians to do screens that are inclusive of symptoms specific to African American women could help with early detection and treatment of PPD. Equipping providers with culturally appropriate resources can ensure mothers are receiving adequate care. Many women in underserved communities do not seek assistance simply because they are unaware it exists.

Ultimately, I turned to Therapy for Black Girls and was able to connect with a therapist that looked like me and understood the cultural factors that specifically impact Black maternal health. Seeking help was one of the best things I could have done. Through therapy, I was able to release the guilt that developed shortly after delivering my daughter.

Four years later, I still cry — not due to depression, but because I am in awe of the human I have the honor of raising.

Ashley Kilgoe, BSN, RN is a graduate student at the University of Delaware. She is currently enrolled in the Psychiatric Mental Health Nurse Practitioner (PMHNP) program with a focus on maternal mental health. She is also a survivor of Postpartum Depression and advocates for culturally appropriate screening and treatment of women of color in underserved communities.