In planning my first blog post of 2018, I’ve been thinking a lot about intentions, and specifically about why I started Maternity Matters. My goal in penning this blog was to give voice to the many nuanced aspects of perinatal mental health that are often difficult, painful, or uncomfortable to discuss. To that end, I wanted to start the year in line with that intention by highlighting an issue that should make us all deeply uncomfortable and deserves attention. Specifically, I want to address the enormous racial disparities in perinatal health outcomes, and share some thoughts on how to tackle this problem.
This post was prompted by an excellent series of articles published by ProPublica and NPR which documents racial disparities in medical outcomes for black women during childbirth, as well as by Serena Williams’ revelations around her own horrifying birth experience. For me, one of the most jarring revelations of the series was the finding that regardless of level of education or socioeconomic status, women of color are at greater risk of dying during childbirth or experiencing a serious medical complication.
This finding stood out to me because racial disparities and discrepancies are often explained away by confounding variables. In this case what the data shows is that we can’t attribute these negative health outcomes to education level or income level, nor can we look to other variables such as health care access, quality of insurance, or health status to understand them. Ultimately, to understand these findings we have to acknowledge their root is in deeply entrenched systemic racism and we have to confront that fact head on.
We see the same problem in the perinatal mental health outcomes As I’ve discussed on my blog previously, there are significant racial disparities in perinatal mental health outcomes.
- Black women specifically, and women of color more generally, have a much higher risk of developing a perinatal mood or anxiety disorder (PMAD) than white women.
- Black women are screened for PMADS at lower rates then white women.
- Common screening tools used to assess PMADS may not accurately assess symptoms in women of color.
- 60% of women of color do not receive proper treatment or support for perinatal emotional concerns.
These disparities are the results of deeply entrenched racism which impacts everything from who we screen for PMADS, how we ask the questions, how we respond to symptoms, and what, if any, treatment we offer. To that end, I’ve been reflecting on what I, and other therapists who specialize in perinatal mental health, can do to chip away at this system and provide better care and support to the women of color who come to us for help. Below are some ideas on where to start:
- Education: It is our responsibility to educate our clients of color about their increased risk for developing PMADS. In doing so, we also need to speak to the role of racism and cultural biases in these factors. This information is vital and should be spoken about early and often. We need to have uncomfortable conversations about race, about culture, and about stigma. We need to explore all of this so that our clients are armed with accurate and complete information.
- Advocacy: We clinicians are often fierce advocates for our clients and it is of the utmost important that we fight even harder in this arena. This might mean advocating for a client of color who feels her medical team isn’t listening to her. Or perhaps working hard to remove barriers that are preventing a client from accessing care by connecting her with additional resources. We need to go the extra mile knowing that we are working against a system that is biased and deeply flawed.
- Community: We therapists, especially those of us in private practice, spend so much time in the confines of our own offices that we are not always engaged in our own communities. It makes a tremendous difference to get to know the resources, advocates, and leaders in your city. Find out what services exist or what programs are available that support women of color in your community. Or perhaps connect with community leaders and offer to provide trainings or information about PMADs.
- Empower providers of color: There is a dearth of people of color in the mental health field. This is even more pronounced when we look at a subspecialty such as perinatal mental health. To that end, it is important to address that gap by supporting and encouraging providers of color. Several months ago, I had the opportunity to interviewDivya B. Kumar, ScM, CPD, CLC; a co-founder of the Perinatal Mental Health Alliance for Women of Color (PMHA-WOC) who spoke to that point as one of theprimary reasons the PMHA-WOC was founded. I would encourage everyone to support her organization and to check out the resources and information on their website.
- Cultural Competency: I am continually shocked by the number of mental health providers who engage in what they refer to as “color blind counseling”, or the idea that we should work with all clients the same way, regardless of race, ethnicity, or cultural background. This is ineffective, inaccurate, harmful, and, in my opinion, is often rooted in the therapist’s own racial biases. Engage in opportunities for continued education in culturally competent psychotherapy, learn about intersectionality, and seek consultation and support. Ultimately, providing cultural competent therapy begins with your own self-examination so do the work.
The task of dismantling a racist and flawed system is enormously daunting and profoundly disquieting, which is of course why it is absolutely essential. My hope is that the ideas above, while small in scope, encourage you to be more thoughtful in your practice and hopefully to take steps toward change. We can and must do better.