Depression in pregnant women has increased by seven times from 2000 to 2015. Here in California, about one in seven women who gave birth experienced postpartum depression last year. Overall, women of color have a higher rate of 38% for postpartum depression, compared to 13-19% for all postpartum women. For Black women this is especially concerning as national studies have found that they are less likely to receive treatment and less likely to receive follow-up treatment even when initial treatment starts.
The reasons Black women do not seek follow-up treatment are often deeply rooted in their experiences of structural racism, and the legacies of slavery that continue to reverberate in modern medical practice. As a result, some Black women distrust the medical system, or worry that talking about their feelings of depression to a professional could result in child welfare involvement in their families or being judged as a bad parent. In addition, cultural stigma around depression and mental health may discourage Black women from seeking out mental health services they need. Black women in California are already significantly more likely to die from pregnancy-related complication, making it crucial to reduce disparities in mental health treatment and access for Black women during and after pregnancy.
In California, we have already started to take important steps to stop Black women from dying during childbirth. For example, starting this year, hospitals and clinics must provide training on implicit bias to their staff who provide care to pregnant people. This is particularly important because providers often do not believe Black women when they report their physical symptoms of pregnancy complications and pain levels, which can lead to mental health concerns. Further, research supports doulas as a method of reducing maternal mortality rates, including reducing postpartum depression rates. Just this year, the National Health Law Program introduced a bill to initiate a 3-year doula pilot program that would provide full-spectrum doula care to Medi-Cal beneficiaries including at least 4 prenatal appointments and at least 8 postpartum appointments. Starting later this year, California will also provide extended eligibility for Medi-Cal for individuals who are receiving ongoing treatment for a maternal mental health condition for up to 12 months, to ensure that people don’t lose access to mental health services they are receiving during the postpartum period.
But there is still more work to be done to address mental health for Black women during and after pregnancy. As we learn more about the chronic stress that racism causes for people of color and Black people in particular, we need to ensure that we provide access to more and earlier mental health evaluations and support. To address the mental health needs of pregnant and postpartum Black women, we must provide services and supports to help women understand the as they experience pregnancy and conceptualize what their role of mother will be.
Here in California, where over a million Medi-Cal beneficiaries are Black, the fragmented mental health delivery system in Medi-Cal exacerbates the barriers to accessing appropriate mental health services and supports during and after pregnancy. In its CalAIM proposal, California is looking to improve care coordination and integration throughout Medi-Cal to reduce some of these access barriers. California must ensure that whatever changes it makes account for the mental health needs of Black pregnant and postpartum women.