Shakima Tozay, from Stanwood, Wash., held a portrait of her son, Jaxson, who passed away in the womb and was delivered by cesarean section. Credit…Chona Kasinger for The New York Times.
May 31, 2024 Story by: Editor
Black medical professionals are advocating for an interdisciplinary approach to caring for Black pregnant patients to address maternal mortality rates, emphasizing the need for high-quality mental health care.
Black women are disproportionately affected by pregnancy-related complications, being two to four times more likely to die from such issues compared to white women. The Centers for Disease Control and Prevention (CDC) notes that the majority of Black maternal deaths are preventable.
Mental Health Struggles During Pregnancy
Black women often endure higher levels of anxiety and depression during pregnancy than their white counterparts. This mental health burden can lead to them downplaying their emotions. Erika Dawkins, Psy.D., an assistant professor of clinical psychology at Widener University, explained, “Black women have a tendency to want to present in such a way that they are expected to have it all together and that they continue to have it all together.”
Dawkins emphasizes a “holistic perspective” on factors affecting the ability to have families, stressing the importance of not viewing patients in isolation, especially when they might be experiencing multiple stressors. She believes that missed opportunities to support mothers arise when medical professionals fail to assess and connect these factors.
Systemic and Diagnostic Challenges
Systemic racism contributes significantly to the adverse health outcomes faced by Black women. Additionally, symptoms of health issues can present differently in Black patients compared to white patients. For example, Black patients may describe mental health issues in terms of physical concerns like body aches and pains or label themselves as “irritable” rather than “depressed,” according to the National Alliance on Mental Illness.
Dr. Christine Crawford, an assistant professor of psychiatry at Boston University School of Medicine, noted that Black women often begin their pregnancies with higher levels of anxiety and depression due to awareness of their increased risk for adverse outcomes. This heightened anxiety, based on personal or observed experiences, does not contribute to a healthy pregnancy, placing Black women at a different emotional baseline compared to non-Black women.
Postpartum Depression and Lack of Access to Care
Postpartum depression affects approximately 1 in 8 women, but Black women are nearly twice as likely to experience it compared to white women, according to the American Hospital Association Institute for Diversity and Health Equity. Despite this, a significant percentage of Black women with postpartum depression are not properly identified or provided with mental health services. Consequently, they are more likely to end up in the hospital for postpartum depression than any other racial or ethnic group.
A 2023 study revealed that between 29% and 44% of Black women experience symptoms of postpartum depression, yet only a small number are accurately diagnosed and receive the necessary mental health services.
A key issue is the lack of access to culturally competent care. Only 2% of psychiatrists and 4% of psychologists in the U.S. are Black, which means Black patients may struggle to find providers who understand their experiences. Dr. Veronica Pimentel, a maternal-fetal medicine specialist at Trinity Health of New England, highlighted that dealing with systemic racism and daily microaggressions adds to the stress and complications of pregnancy for Black women.
Addressing the Challenges
Advocates are calling for increased funding for doula services as a step towards addressing the Black maternal mortality crisis. Dr. Crawford pointed out that having a doula present could make healthcare providers take Black women’s concerns more seriously. However, she also expressed frustration that such roles are necessary for Black women to receive the attention they deserve during childbirth.
Dr. Pimentel encourages Black women who are planning to become pregnant or are already pregnant to research their providers and ensure they feel heard and respected. She stresses that while Black women are often viewed as resilient, it is crucial to acknowledge their needs and ensure they are met.
Ultimately, much of the responsibility lies with healthcare providers. Dawkins advocates for a multipronged care approach that includes assessing mood, support systems, and other necessary factors from the very beginning to ensure comprehensive care throughout and after pregnancy. Source: The Hill
