Blog by Laura Seebohm, CEO of the Maternal Mental Health Alliance (MMHA)
“Health equity is determined by the conditions in which people live, grow, play, age. There’s a powerful social gradient associated with perinatal mental health which cannot be attributed to hormonal, biological differences. This is about health inequalities which reflect social circumstances and gender norms. The impact of structural factors is often neglected.”
– Jane Fisher, Marce Society Conference September 2022
Equity is absolutely the right theme for International Women’s Day 2023. We are facing unprecedented poverty, growing health inequalities and increasing rates of gendered violence and abuse, and it is women who are disproportionately affected.
What does this mean for new and expectant mothers? How are they experiencing this extraordinary time of life within the political, social and economic landscape of 2023? International Women’s Day gives us a great opportunity to reflect on the realities for women during the perinatal period.
In autumn 2022, the MMHA commissioned a poll of 500 new mothers from across the UK. The findings were illuminating:
Every single new mother who responded to our poll reported experiencing health challenges during the perinatal period – that is 100% confirming they had at least one of the common physical or mental health conditions listed.
Four of the top five relate to mental health problems, including 51% self-reporting symptoms of postnatal depression.
It is no great surprise to learn that these statistics vary significantly by demographic. Younger mothers, women who are less socio-economically well off and mothers in rural areas all experience higher rates of postnatal depression.
The poll revealed how crucial the challenges of stigma, trauma and economic deprivation are for maternal mental health and wellbeing. Had the findings provided data on race and ethnicity, there is no doubt that racial discrimination and prejudice would also have featured heavily.
The majority of women (72%) reported that cost of living concerns were negatively impacting their mental health, and again, this was most severely experienced by younger respondents.
It is stark to think about this in the context of the recent MBRRACE-UK report on maternal deaths (2018-20), which highlighted the correlation between the likelihood of a woman dying in the weeks before and after childbirth and high levels of deprivation.
The rising cost of living and its impact on maternal mental health is a clear and serious concern. It is imperative that we give full consideration to how we offer support for women and the additional help which may be needed for the most basic of essentials at this crucial time.
A quarter (25%) of respondents linked their poor mental health during the perinatal period to their own experience of trauma in childhood. This is significant given that we know 70% of women accessing specialist perinatal mental health services also report a history of trauma.
It leads us to question whether our services are delivered with a trauma-informed approach. This is not just important for our specialist services. Our poll shows us that it is midwives, health visitors and GPs who women talk to about how they are feeling, especially young mums who are less likely to tell their partner, family or friends.
These two factors of deprivation and trauma impacting the lives of so many new and expectant mothers are at the heart of inequity for women.
I have 25 years of experience supporting women whose childhood experiences continue to cause adversity into adulthood. Trauma manifested in experiences such as homelessness, addiction, domestic abuse and exploitation. What I have learned in all this time is that women are amazing; the strength, humour, and capacity to support each other create a space for the most inspirational recovery to take place.
But the greatest harm that continues to push women down, to keep us in a place of disempowerment, is stigma. We internalise stigma so it becomes what Hal Khanom describes as a form of “collective coercive control“.
I have seen no greater stigma and shame than the judgements imposed on new and expectant mums. The fear of being viewed, labelled and treated as a ‘bad mother’ is pervasive from the very moment we expect our first child. This is most acutely experienced by those women who are going through additional adversities – trauma, deprivation, and racial discrimination. These challenges on top of poor mental health, lead to women being ever more exposed and scrutinised, yet poorly understood and unsupported.
Laura is Chief Executive of Maternal Mental Health Alliance.
As she explains, stigma is a significant barrier to timely perinatal mental health support. She’ll discuss this on a panel on maternal health at our #IWD webinar.
Book your free place: https://t.co/SEW0uk8QeV pic.twitter.com/Ig6SNXZXW7
— RoyalCollegeObsGyn (@RCObsGyn) March 5, 2023
A story of hope and an opportunity to get it right
When I read through the raw data sent following our recent poll, the impact of stigma was so visible, so blatant. One-sixth of new mothers surveyed didn’t feel comfortable speaking to anybody about their mental health challenges. Almost half of them said that fear of being judged was the reason. The majority felt, in hindsight, that speaking to somebody would have helped them.
Research carried out 10 years ago by the Boots Family Partnership found that 70% of women either underplay or hide the severity of how they are feeling. It is devastating to know that this is still the case, especially because treatment for perinatal mental health problems is so effective. This can be such a story of hope. But too many women are suffering and too many women are taking their lives.
The perinatal period is a time when women will have regular contact with health services. This gives us an amazing opportunity to take away the shame and meet women with compassion. Our attitudes and words have the power to either open somebody up or put them down. Our actions and responses are so important at this extraordinary time of life.
Removing stigma for new and expectant mothers struggling with their mental health isn’t a cure, but it will allow space for amazing recovery to happen.
Kindness and compassion can literally save women’s lives.