Recall the last time you told a child “no” and how it made you feel. If you are a parent, you say “no” a lot: No, we cannot stay at the park for four hours. No, you cannot color the walls. These are the types of “no’s” we expect as parents and caregivers. Now imagine you are a parent telling your child they cannot have a second serving because you need to save money to pay rent instead of putting food on the table. How would this experience feel different? This scenario is the reality for far too many parents, particularly mothers, and is one of the driving factors contributing to mothers’ reports of depression and anxiety. Faced with limited financial resources, they must determine which necessities are more urgent, and each decision is a compromise on another aspect of the families’ well-being. In this blog, we explore how maternal depression and anxiety are linked to material hardships and children’s health and development as well as how discrimination and marginalization have resulted in high rates of mental health disparities for Black mothers in particular. We also consider potential solutions for advancing maternal mental health equity rooted in the experiences and leadership of Black women.

There is a cyclical connection between maternal depression and anxiety and an inability to afford basic needs – also known as economic hardships. Depression and anxiety resulting from or exacerbated by economic hardships can impact daily tasks such as eating, working, or sleeping. If untreated, it may make it more challenging for a person to obtain and retain employment. This is particularly concerning for mothers because it may lead to her family facing even further risk of financial instability and inability to afford basic needs. For example, one study surveyed low-income families with young children at two time-points, 15 months between encounters. The results showed, compared to mothers without depression at baseline, families of mothers experiencing depression were 1.5 time more likely to report food insecurity during the follow-up interview. We know from decades of research that food insecurity – a key marker for economic straing – adversely affects parent and children’s health and early cognitive development, rippling across two generations.

Black mothers experience alarmingly high rates of anxiety and depression due to longstanding systemic racism, marginalization, intergenerational poverty, and violence against women of color. Without the necessary mental health treatment, these conditions can worsen, negatively affecting other facets of their lives. According to a study of women with postpartum depression (depression after giving birth), only 4% of Black women started mental health treatment compared to 9% of white women. Of these women, Black women were twice as likely to be lost to follow-up treatment. Research indicates this disparity is, at least in part, linked to several systemic injustices that result in significant barriers to mental health care that Black mothers, and more broadly, Black adults face. These include socioeconomic disparities that prevent Black adults from accessing care, such as lack of health insurance, stigma around mental health diagnoses and treatment, mistrust of healthcare providers due to the long history of discrimination in healthcare, and lack of culturally competent providers who recognize that complaints of physical symptoms may also be related to poor mental health. The increased prevalence of depression and anxiety coupled with inadequate access to care may further worsen a cycle of poor mental health and material hardships for Black mothers, which in turn affects their children.

While numerous studies examine the relationship between maternal depression and material hardships, there is no conclusion regarding which comes first in this chicken-and-egg situation. Given this complexity, tackling disparities in maternal mental health will require multipronged approaches and solutions that recognize the complexities, interconnectedness, and bidirectionality of these adverse conditions. First, providing mothers with high-quality, culturally appropriate mental health resources is key for mitigating long-term mental health. For Black mothers, organizations such as Shades of Blue Project offer support throughout pregnancy and even after birth. In addition to providing mental health care, mitigating material hardships for families is also essential for reducing maternal depression and anxiety. Research consistently shows federal assistance programs reduce economic difficulties among low-income families, which in turn may reduce depression and anxiety. Further, policies that financially support parents, including monthly Child Tax Credit payments and other direct cash programs, have been shown to alleviate maternal stress and anxiety among Black mothers specifically and help children thrive.

Among the many inequities facing Black mothers with low incomes, alarmingly high rates of maternal depression and anxiety are among the most concerning. Future policies should focus on preventive care to improve mothers’ mental health as well as policies that address longstanding systemic race-based inequities. In June 2022, The Biden Administration released the White House Blueprint for Addressing the Maternal Health Crisis, which contains 50 actions that over a dozen agencies can undertake to help improve maternal care, including addressing mental health and racial health disparities. These policies include increasing access and affordability to maternal health care, allowing the voices of women giving birth to be heard regarding their experiences, improving research practices, diversifying providers, and supporting women economically and socially throughout pregnancy and after. As a country, we cannot continue to ignore maternal mental health disparities. We must take urgent collective action to address the root causes of maternal depression and anxiety so that all mothers can be parent they desire to be.