Racial Disparities in Perinatal Mental Health Screenings

Black mother snuggles her baby


Assistant Professor of Midwifery Dr. Tanya Taiwo published a new analysis in the journal Health Equity that establishes people of color are less likely to be screened for perinatal mood and anxiety disorders.  Mental health challenges are a leading cause of maternal death, and these grave disparities and gaps in care cannot be ignored.

Latina, Black, and Indigenous Pregnant People Least Likely to Be Screened for Mental Health Needs

A new analysis involving 2,700 pregnant and postpartum women and people across the U.S. reveals a disproportionate lack of mental health screenings for Latina, Indigenous, and Black mothers and birthing people. The study, Perinatal Mood and Anxiety Disorder and Reproductive Justice: Examining Unmet Needs for Mental Health and Social Services in a National Cohort, was published in the journal Health Equity

Perinatal mood and anxiety disorders are the most common complications experienced during pregnancy and the most underdiagnosed. According to the CDC, mental health conditions are a leading cause of pregnancy-related death. The repercussions of failing to screen pregnant women and people for mood and anxiety disorders can significantly and adversely affect the health of parents and children. Pregnant women and people of color live with a heightened awareness of the extreme disparities in maternal mortality.

“For many families, pregnancy and postpartum care are a gateway to lifelong health,” says lead author Dr. Tanya Taiwo, Bastyr University Department of Midwifery assistant professor, University of British Columbia (UBC) Faculty of Medicine, Birth Place Lab collaborator. “Perinatal care providers play a pivotal role in supporting the psychosocial health of the expectant parent and child through the perinatal experience. By screening and, when indicated, connecting pregnant and postpartum women and people to mental health counseling, perinatal care providers can save lives, enhance health, and set families up for lasting wellness.”

Mental Health Screenings Lowers Health Risks for Babies and Birthing People

Perinatal mood and anxiety disorders increase health risks for mothers and birthing people and their children. Mood disorders such as depression can result in neurodevelopmental delays, behavioral problems, attachment disorders, and more. Anxiety in pregnancy is associated with premature birth and adverse implications for fetal neurodevelopment.

Over half of survey respondents reported structural barriers to optimal health during pregnancy. Additional findings from the study include:

  • Latina women are the least likely to be screened for postpartum mood and anxiety disorders.
  • Indigenous women are three times more likely than white women to have unmet needs for perinatal treatment for depression or access to mental health counseling. 
  • Black women are more than twice as likely as white women to have unmet needs for perinatal treatment for depression or mental health counseling.
  • Women and pregnant people with midwife care providers were significantly more likely to report screening for perinatal mood and anxiety disorders than those with physician care providers.

Systemic Reform Can Support More Equitable Care for Latina, Black, and Indigenous Perinatal Patients

“Making reforms to our health care system can be accomplished, and the findings of this study offer an attainable way forward that requires awareness from health care providers, regular screenings for perinatal patients with better attention for people of color, and lowering the bar of access to care to help babies — some of the most vulnerable members of our society,” says Taiwo. “In fact, perinatal care providers can play a pivotal role in supporting physical and psychosocial wellness throughout the childbearing cycle. Yet our research found significant unmet needs for psychosocial support services, with glaring disparities in care for Native American and Black women and childbearing people. Our findings call for a reproductive justice approach to effective health care reform.”

Study findings suggest a low-barrier approach from healthcare systems to screen pregnant people of color more effectively for perinatal anxiety and mood disorders:

  • Increase incentives for adherence to national screening guidelines.
  • Reimburse for perinatal mental health screening and treatment programs.
  • Hire more community mental health workers.
  • Expand culture-centered midwife-led birth centers.
  • Increasing access to community mental health workers.

About the Survey and Analysis

The Giving Voice to Mothers Study (GVtM) (n = 2700) was published in the journal Reproductive Health in 2019. Led by a multi-stakeholder Steering Council, the study captured participants’ experiences of engaging with perinatal services, including access, respectful care, and health systems responsiveness across the United States. A patient-designed survey included variables to assess relationships between race, care provider type (midwife or doctor), and needs for psychosocial health services. In the current analysis, Khmet et al. calculated summary statistics and tested for significant differences in screening and care provision for psychosocial health across racialized groups, reporting odds ratios for each group.