Imagine giving birth and caring for a newborn without support. During the coronavirus pandemic, mothers are doing exactly this amid changing hospital policies and social distancing guidelines. The experience is even more harrowing for women of color, particularly non-Hispanic Black women, who are more than three times as likely to experience maternal death as compared with non-Hispanic white women.
The postpartum period is filled with newborn snuggles but also sleep deprivation and hours of infant screams—two methods used to train Navy SEALs to withstand torture. Most new mothers will experience some form of the baby blues, but it is largely neurobiology and environment such as social support that affect whether a mother experiences postpartum mood disorders. These disorders may not only affect a child’s development; they can also be passed down for three generations. People of color are especially likely to experience this burden. In fact, new mothers of color experience postpartum mood disorders at twice the rate (38 percent) of white mothers in the U.S., and up to half of them do not receive any support or treatment.
Racial disparities are well documented in thediagnosis and treatment of maternal mental health issues. Since the onset of the pandemic, there has been a big push to address this problem. But a 2020 paper published in Archives of Women’s Mental Health shows these disparities are also entrenched in other aspects of the health care system. Women of color, including African-American, Asian-American, Native American, multiracial and other non-white individuals, are less likely to be screened for depression, compared with white women, during the postpartum period.
No previous papers had addressed the prevalence of racial disparities in postpartum screening, making this study, out of Allina Health, the first of its kind. Researchers examined 7,548 women who were part of Allina Health clinics, the largest provider of obstetric services in Minnesota. After accounting for other factors associated with postpartum depression screening—such as depression diagnosis prior to birth and income level—researchers still found racial disparities. Compared with white women, Asian women were 19 percent less likely to be screened. African-American women were 36 percent less likely, and Native American, Hawaiian, Alaska Native and multiracial women were 56 percent less likely. The findings are concerning because those who need postpartum mental health care the most are the least likely to receive it. The study also found that racial disparities in prenatal depression screening did not exist, so provider bias cannot be the only explanation for postpartum screening disparities. Further research is needed to fully understand these gaps.
Why does all of this matter? In 2017 untreated perinatal mood disorders cost $14 billion in the U.S., which amounts to $31,800 per mother-infant dyad. The costs stemmed from mothers being less productive economically, preterm births, and emotional and developmental delays in infants and children. Women of color experience a disproportionate burden, and decades of research have shown racial disparities in care. These gaps have yet to be addressed. Perinatal mood disorders are a significant contributor to maternal mortality. A 2019 study published in the American Journal of Obstetrics Gynecology showed that 14 to 30 percent of maternal deaths in California were from suicide or drug-related causes. They also have a ripple effect on future generations of people of color.
In the midst of racial uprisings across the country, a pandemic that has revealed even more racial inequality, and changing demographics that will soon make the U.S. a majority-minority country, the fabric of our society will begin to unravel if we do not find concrete solutions to this crisis.
A 2018 national survey showed that the most important factor associated with universal depression screening was whether a clinic prioritized screening. Could tech-based solutions such as text-based screening or virtual peer groups eliminate the need for a champion at each clinic? Tech-based solutions offer a double-edged sword. On the one hand, they could increase inequality because advantaged groups have better access. On the other hand, they could help women of color overcome barriers such as stigma, transportation, language and lack of childcare. Women could receive care out of the comfort and privacy of their home; they could choose culturally relevant care even if it was not available nearby; and they could receive support without missing work.
The pandemic offers an opportunity to shift tech design away from the most privileged groups to serve under-resourced ones. Medicaid is temporarily reimbursing some telehealth mental wellness services, allowing those in the space to experiment and learn what works for patients. Medicaid funds 43 percent of births nationally, which includes a large percentage of people of color as of 2018. The U.S. House of Representatives passed a bill in 2019 that would allow states to more easily extend postpartum care from 60 days to 12 months for mothers on Medicaid or CHIP (Children’s Health Insurance Program)—further bolstering the case for virtual postpartum care in traditionally overlooked and vulnerable groups.
Women of color need to become the focus of research and design efforts for tech-based prevention, screening, diagnosis and treatment. For researchers, this means including a greater proportion of women of color in their studies, collecting race and ethnicity data, and filling in the data gaps for particular races and ethnicities.
For the designers of tech-based solutions, this means accommodating language and cultural nuances. Women of color are a heterogenous group that includes immigrants, U.S.-born people, and people of different races and countries of origin. Existing research shows, for example, that racial and ethnic minorities born in the U.S. and foreign-born mothers are less likely to seek or believe they need to consult doctors for emotional problems, compared with non-Hispanic white mothers. Solutions other than, or in addition to, therapy—peer support groups or one-on-one peer mentors—might be more effective for these groups.Non-Hispanic Black mothers have higher rates of postpartum suicidal ideation than other mothers—a disparity that persists even after controlling for income, marital status and additional factors—in large part because of systemic racism. Additionally, Asian women consistently exhibit higher rates of depression, compared with non-Hispanic white women. Rates of depression also differ among mothers from different Asian countries. This could be caused by providers misinterpreting symptoms among immigrants and social stigma related to seeking services. Unfortunately, these nuances are still not being taken into account in the current design of many tech-based solutions.
Tech-based solutions provide hope for the personalization needed to prevent and treat perinatal depression and other mood disorders in communities of color. It is the responsibility of researchers and tech-based designers to counteract the intergenerational consequences of postpartum mood disorders for women of color by innovating and recentering their solutions during this pandemic and beyond.