Pregnancy-related mortality and morbidity rates are on the rise in this country. Each year, 700 to 900 women die from pregnancy or childbirth-related causes in the U.S., and approximately 65,000 experience serious complications. For Black women, the statistics are even worse. Regardless of socioeconomic status and education, Black women are three to four times more likely to die from childbirth than non-Hispanic White women. Many factors play a role in these dynamics—which may negatively affect the physical and mental health of Black women throughout the perinatal period.

Addressing racial disparities in pregnancy

Pregnancy-related risk factors such as hypertension, anemia, and gestational diabetes are conditions that affect many expectant mothers. However, distinct racial disparities exist in these conditions, with Black women experiencing them more severely. The Center for American Progress cites “stress related to racial inequality and often inadequate health care,” as factors that exacerbate these conditions. Consider the following study results that demonstrate how these dynamics may play a role:

• Mothers who perceived they had been discriminated against were twice as likely to skip postpartum visits with clinicians.   
• An examination of maternal and infant mortality identified access to health insurance, providers, hospitals and maternity wards, and reproductive health care as significant challenges for women of color. When access is available, quality care and equitable treatment can still be concerns.
• Although Black and White women had similar rates of complications in pregnancy, Black women were two to three times more likely to die from them.
• Findings suggest no apparent link between severe maternal morbidity (SMM) and socioeconomic status or level of education, with Black women experiencing higher rates of SMM than other racial and ethnic groups of women regardless of these factors.

The effect on physical and mental health

Counseling@Northwestern, the online Master of Arts in Counseling program from The Family Institute at Northwestern University, examines these dynamics in the context of physical and mental health. For Black women, stressors such as racism, discrimination, familial and environmental matters, and fiscal responsibilities can add to the toll of pregnancy and have an influence on overall health. Making matters worse, their expressed health concerns are often dismissed, minimized, or invalidated by health care professionals.

Since perinatal depression affects one in seven women, and dynamics such as these can contribute to mental health challenges, more support may be needed. One of the first steps toward finding the right help is identifying if an issue exists. Here are common signs that mental health care may be needed:

• Sadness
• Anxiousness
• Irritability
• Frequent crying
• Trouble sleeping (even when tired) or sleeping too much
• Indecisiveness
• Loss of interest in self-care (e.g., dressing, bathing, fixing hair)
• Loss of appetite or overeating
• Trouble concentrating or remembering things
• Lack of interest in everyday tasks
• Showing too much (or not enough) concern for the baby
• Loss of pleasure or interest in things you used to enjoy

More severe symptoms that require urgent attention:

• Extreme confusion
• Hopelessness
• Seeing things or hearing voices that are not there
• Cannot sleep (even when exhausted)

How counselors can help

Dr. Tonya Davis, a clinical training director at Counseling@Northwestern,  says counselors have a lot to offer new and expectant mothers. For example, moms may need to establish a baseline for what is considered “good mental health” in order to identify potential concerns that fall outside of their norms during and after pregnancy. Knowing the difference between typical and worrisome sadness or anxiety can be helpful when determining when to take additional steps or seek professional help.

Here are six specific ways Dr. Davis suggests counselors can help new and expectant mothers:

• Help women understand the changes going on in their bodies and in their minds as they relate to emotions.
• Normalize experiences that may be new to women in the postpartum period, allowing them to adjust to changes.
• Find a sense of normalcy in what their family looks like now and what it will look like.
• Conceptualize what their new role of mother will be and operationalize the concept of being a mom.
• Work through their expectations of pregnancy and motherhood versus the realities.   

With a better understanding of the specific challenges that new and expectant Black mothers face and a commitment to eliminating barriers to care, we can begin to address racial disparities in perinatal care to ensure that all women get the care that they deserve.