Women from ethnic minority backgrounds face more barriers in accessing mental healthcare in pregnancy and after giving birth than white women, according to a study.
The research focused on 123 women from Black, Asian and ethnic minority backgrounds who had experienced or were currently experiencing mental health problems related to pregnancy or new motherhood.
98% of women were willing to be treated for their mental health, but one third (32%) had not received any treatment – including talking therapies such as CBT or counselling.
One-fifth (20%) reported that they did not visit healthcare professionals to talk about their low mood and depression.
One of the major barriers to accessing perinatal mental health services was ‘wanting to solve the problem on my own’.
The research, by Elaine Amoah, assistant psychologist in South London and Maudsley NHS Foundation Trust, was conducted in 2019, but Elaine says the inequalities in accessing services for Black, Asian and minority ethnic women remain ongoing and urgently need addressing.
‘It’s paramount that the mental health needs of women from Black, Asian and minority ethnic communities are recognised and that they receive adequate treatment supporting their recovery in the perinatal period.’ Elaine tells Metro.co.uk.
‘Stigma remains a prevalent barrier for Black, Asian and minority ethnic women to receiving treatment.
‘In particular, internalised stigma, perceived public stigma, judgement from family or community, and treatment stigma – associated with seeking or receiving treatment.’
One in eight of the women surveyed were identified as having experienced alienation and social withdrawal. While one in 10 experienced ‘stereotype endorsement’ and discrimination.
Around one-third (30%) of the women surveyed felt, ‘receiving treatment for emotional or mental problems carries social stigma’.
The major treatment stigma-related barriers to accessing services were found to be concerns that they might be seen as ‘a bad parent’, not wanting mental health problems to be on medical records, concern that their children may be taken into care, and concern that they might be seen as ‘weak’.
‘This is significant as Black and Brown women may feel that they have to uphold the narrative of being a “Strong Black Woman“, or meet expectations to “deal with it”‘, says Elaine.
She adds that the sample of women she studied were all ‘well-educated’ with ‘middle-high incomes’, which she says suggests that the disparities in care are ‘more likely to concern race rather than class’.
How to reduce racial inequalities in postnatal mental healthcare
Postnatal depression or anxiety in Black, Asian and ethnic minority mothers is 13% higher than in white mothers.
A 2011 study found that Black women are the group least likely to initiate treatment for postnatal mental illness, and the least likely to receive follow-up treatment.
This racial disparity is putting the lives of Black mothers at risk. More recent research in 2018 found that 23% of women who died in the postnatal period suffered from mental health disorders, and suicide is now the second leading cause of maternal death in the UK.
Following on from Elaine’s research, she has suggested that interventions need to focus on reducing internalised, public, and treatment stigma.
‘A group-based intervention for Black, Asian and Minority ethnic women may allow a safe space for women and an opportunity to express their emotions about their mental health, in addition to, providing a space for a network of women with shared experiences to feel less alone,’ suggests Elaine.
Her findings showed that internalised stigma played a significant role in perinatal low mood and depression symptoms, and internalised, perceived public, and treatment stigma were found to have an association with one another.
‘Preventing forms of internalised stigma such as alienation, social withdrawal, stereotype endorsement and discrimination experience is more important than ever before with Covid-19,’ she adds.
Elaine says services need to ensure that any of the support networks of Black, Asian and minority ethnic women are included throughout the perinatal period so women have the support needed to recover and don’t feel that they need to do this alone.
‘Partners or families can also play an important role in identifying symptoms of perinatal mental health,’ she adds.
‘In addition, families can be supported to better understand mental health and wellbeing as a possible benefit to reducing perceived public and treatment stigma.
‘Social networks can be used as a foundation of support, allowing women to talk about their issues and access service provision.’
Meaningful clinical support
‘Services need to provide meaningful and helpful advice throughout the perinatal period,’ says Elaine.
‘There is an opportunity to use maternity services, voluntary organisations and available social networks and resources within the local community to improve awareness through social capital, social exchange, and community empowerment.
‘Services need to ensure early recognition of emotional difficulties and access to information and advice is provided ensuring suitable interventions are in place.’
Opening a conversation
Elaine says that it is vital that healthcare professionals, especially in primary care services, ensure they bring up the topic of mood, for example ‘upsetting feelings around birth’.
‘The women surveyed were found to be most comfortable answering questions about mood at home,’ she adds. ‘Then subsequently discussing their responses in their next visit with their health provider.
‘This suggests a safe space such as their home is preferable for expressing feelings as well as the opportunity to discuss responses.
‘Approaches that enable women to describe their feelings to healthcare professionals will have an effect on whether mental health difficulties are detected, and the timeliness and nature of the support that is offered.’
Co-production of services
‘Women from Black, Asian and minority ethnic communities can help with public health initiatives and NHS services to promote more helpful messages about mental health and seeking support,’ says Elaine.
‘This allows the collaborative discovery of solutions to mental health difficulties using the power of lived experience to better build on cultural sensitivity, understanding and knowledge.’
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