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21 April 2026

12 Pages

Perinatal Mood Disorders Among Low-Income Birthing Persons Living in Urban Areas in the United States

and
1
Department of Social Work, Binghamton University, State University of New York, Binghamton, NY 13902-6000, USA
2
School of Social Work, University at Buffalo, State University of New York, 685 Baldy Hall, Buffalo, NY 14260-1050, USA
*
Author to whom correspondence should be addressed.
Encyclopedia2026, 6(4), 93;https://doi.org/10.3390/encyclopedia6040093
This article belongs to the Collection Encyclopedia of Social Sciences
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Definition

Perinatal mood disorders (PMDs) affect approximately 15% of birthing persons during the pregnancy or postpartum (up to one year after birth) time period. People who recently gave birth and are of diverse backgrounds and identities, especially those who are oppressed, are disproportionately affected by PMDs and may experience these conditions differently. One such group is low-income birthing persons living in urban areas. This article will summarize PMDs, including their prevalence rates and how they are disproportionately experienced among low-income birthing persons living in urban areas. The factors to be reviewed include racism, cultural stigma, community stressors, issues with access to services, lack of resources, socioeconomic concerns, and healthcare system problems. Additionally, how PMDs among low-income birthing persons living in urban areas can be prevented, identified, and treated will be discussed. Strategies include practicing cultural humility and promoting anti-oppressive practice, building positive relationships with birthing persons, utilizing formal and informal social supports, promoting community engagement, sharing resources and tangible supports, following universal screening recommendations, addressing barriers to care, and advocating for effective policies.

1. Perinatal Mood Disorders Among Low-Income Birthing Persons Living in Urban Areas in the United States

Each year in the United States, an estimated 5.4 million people become pregnant [1] and 3.6 million deliver a live birth [2]. Of these individuals, approximately 15% will be diagnosed with a perinatal mood disorder [3,4]. Perinatal mental health conditions have emerged as a primary cause of 23% of maternal deaths in the United States [5].

2. Defining Perinatal Mood Disorders (PMDs)

Perinatal mood disorders (PMDs) are broadly defined as mental health conditions with onset during the pregnancy or post-birth time period [6]. Most commonly, the postpartum period is recognized as being from birth to one year after birth [7]. Common conditions clustered under the umbrella term of PMDs include antenatal or postpartum depression, anxiety, and bipolar disorder [7]. PMDs are all characterized by mental health symptoms that affect functioning [6]. Predominant symptoms include feelings of apathy, sadness, anxiety, or fear [6]. Diagnostically, PMDs include a mood disorder, such as major depressive disorder, generalized anxiety disorder, or bipolar I disorder, with the peripartum onset specifier added [8]. For example, the commonly used phrase of postpartum depression is diagnostically classified as major depressive disorder with peripartum onset [8].
Although there can be some utility in delineating specific diagnoses in perinatal mental health, particularly for medical systems and insurance companies, such language reflects the medicalized and oppressive concepts of American society [9]. Note that mothers of color who meet symptom thresholds for major depressive disorder with peripartum onset often do not identify with terms like postpartum depression [10]. Historically the term postpartum depression has been inappropriately used as a catchall phrase [9,11], clouding the literature on perinatal mental health. Lastly, given the comorbidity of perinatal mental health symptoms, particularly depression and anxiety [7], a more holistic term is appropriate. For these reasons, PMDs will be the term used in this overview.

3. Disparate Experiences of PMDs

Certain groups of birthing individuals, particularly those who are of diverse backgrounds and identities and who may endure oppression due to their race, ethnicity, or other demographic identity factors, disproportionately experience PMDs [12]. One group of people with higher rates of PMDs are low-income birthing persons living in urban areas [13]. Although this group is recognized to be at a significantly higher risk for perinatal mental health symptoms [14], and may experience perinatal mental health differently, including recognition of symptoms and help-seeking behavior [15,16], there is limited synthesis of existing research to best understand the contributing factors of PMDs for this population. This review will summarize recent findings and then use the information to identify how to address disparities and improve perinatal mental health for low-income birthing persons living in urban areas in the United States.

4. Prevalence

Disparities in PMD rates exist by geographic location, race, ethnicity, and socioeconomic status [13,14,17]. Although estimates vary, and are influenced by the research methodology and the measurement of key variables such as how PMDs are operationalized [18], the prevalence of PMDs among people living in urban areas who have given birth approaches 56% [19]. Considering race and ethnicity as one variable alongside geographic location, researchers found that black, urban residents are more likely to receive a diagnosis of PMDs compared to white, urban or rural residents [13]. In fact, non-Hispanic black perinatal individuals are one of the groups most likely to experience PMDs, including depression and anxiety, both during pregnancy and after birth [14,20,21,22].
Recent findings provide evidence that economic stress negatively influences mental health during the perinatal period as well [23]. In fact, racial and ethnic disparities are more pronounced when employment status is considered [24]. Specifically, among employed perinatal persons, those who are black are significantly more likely to experience perinatal depression than their white counterparts, yet there is no difference by race among unemployed birthing persons [24], suggesting that socioeconomic status likely influences the experience of PMDs. Making matters worse, birthing persons of color with public insurance (a proxy measure for low income) are less likely to receive treatment for PMDs [25]. Researchers in countries outside the United States have also found PMD rates to be higher among people from low-income or middle-income countries [26].
Given that individual factors, such as race and ethnicity, and contextual factors, such as socioeconomic segregation and urbanity, are associated with high-risk clusters of PMDs [17], when combined they likely worsen perinatal mental health [27]. Therefore, it is not surprising that low-income birthing individuals residing in urban areas would have a higher prevalence of PMDs than other individuals who have recently given birth. However, little research has considered this population, specifically highlighting their unique experiences of PMDs and how to address their needs while valuing resiliency and joy.

5. Contributing Factors and Experience

Low-income birthing persons living in urban areas experience PMDs differently than their rural counterparts. Birthing persons living in urban areas are disproportionally single parents and are more susceptible to factors that negatively affect their health and mental health [28]. To improve their well-being, understanding their experiences and the circumstances contributing to PMDs is critical. The factors to be reviewed include racism, cultural stigma, community stressors, barriers to care access, lack of resources, socioeconomic concerns, and healthcare system problems.

6. Racism

Urban communities are oftentimes affected by both geographic and environmental racism [29,30] including racial residential segregation [31]. Various forms of discrimination and oppression, including white privilege, contribute to the experience of racism in urban spaces [30]. The groups most likely to be affected are low-income and, frequently, people of color [29]. Both race and social class matter in assessments of urban communities including neighborhood quality [31] and physical health outcomes [28]. Experiencing racial discrimination is associated with poor mental health among low-income urban residents of color [28]. Lane et al. [32] and Keefe et al. [33] argue that urban areas are ripe for social unrest that often leads to negative birth outcomes and family disruption, including dilapidated housing, food deserts, and disproportionate rates of incarceration. Urban residents are likely to experience oppression due to their socioeconomic status and race, helping to explain why racism, including stereotyping and discrimination, is a significant predictor of PMD among low-income birthing persons living in urban areas [15,27,34,35].

7. Cultural Stigma

Low-income birthing persons living in urban areas are likely to experience cultural stigma. Cultural stigma is the socially constructed experience of “othering” due to deviations from beliefs, values, or roles within the culture of the individual [36]. Evidence supports that experiencing cultural stigma can influence an individual’s health and mental health [36]. In a review of qualitative studies on postpartum depression among persons of color who had given birth, Beck [16] reported cultural stigma as one of five key themes that Latinx and African American individuals who gave birth identified as their primary experience of living postpartum depression.
Specific to birthing persons are the intense cultural beliefs related to parenting, family roles, employment and earnings, or community beliefs about what qualities make up a “good mother”, which can all emerge as concerns [10,37]. A common fear experienced among birthing persons is being perceived as bad or ineffective due to housing, location, or socioeconomic status [18]. Another concern is the inability to acknowledge mental health symptoms for fear of being perceived as incompetent [38]. Cultural stigma can affect a birthing person’s ability to identify or acknowledge mental health symptoms [15,16]. Further, cultural stigma, especially if internalized, can deter help-seeking behavior and treatment [15,16,38] among individuals who have recently given birth.

8. Community Stressors

Communities can be affected by the physical environment (i.e., natural or built), or the social environment, such as lack of concern for social problems by city officials or others with power [39]. Sometimes these stressors can become a polycrisis, which is a series of persistent, compounding, and interconnected community-level crises [39]. In low-income urban communities, there may be an increased risk of traumatic events, such as assault [40], which serves as a risk factor for mental health conditions. Traumatic events [40] and life stressors [41] can negatively affect communities and, especially if multiple stressors occur simultaneously, affect the functioning of the system and overall mental health of all residents [42]. Interestingly, among young birthing persons, perceived neighborhood safety mediates the relationship between life stressors and depression [41] such that the perception of having strong and positive relationships with one’s neighbors appears to enhance emotional well-being.
Among birthing individuals of color, mental health is likely to be influenced by ecological, contextual, and community factors [43], which span system levels [42]. Community factors are even more influential than individual factors in the development of PMDs [44,45]. Commonly experienced stressors among low-income birthing persons living in urban areas include poverty, lack of available and affordable housing, and violence or safety concerns [37,42,43,46]. There is evidence for a cumulative effect of trauma affecting perinatal mental health among low-income women [47,48], including depression [42].

9. Barriers to Care Access

Urban communities are affected by barriers to care access for mental health services [49,50]. Researchers have identified commonly experienced challenges, including increased risk of trauma and other mental health crises, high demand for services, inequalities in obtaining care, decreased continuity of care, and highly medicalized or pathologized treatment options [49,50,51]. These access challenges unfavorably affect the experience of PMDs among urban birthing persons of low income due to racism and discrimination [51]. Birthing persons of color are more likely to report and experience barriers to treatment access and unmet access needs, including lack of services and transportation, lack of childcare, and time constraints [16,18,38,52,53].

10. Lack of Resources

Healthy parenting practices and child development require resources, including quality infant–parental and familial time, access to healthy foods, and financial stability to offset medical and childcare expenses [32,54]. When a parent or family experiences poverty, resources tend to be limited and can cause parenting stress, which negatively influences caregiving and child development [54]. Unsurprisingly, a lack of resources can affect the experience of PMDs among low-income, urban birthing persons [27,37,43,55] and exacerbate symptoms. Common concerns include a lack of accessible and affordable childcare options [15], inadequate medical insurance coverage [15], and food insecurity [42]. Oftentimes these limited resources occur together, which can lead to a cycle of deprivation that can contribute to depression potentially across familial generations [42].

11. Socioeconomic Concerns

Socioeconomic concerns can contribute to racial disparities in health and mental health [28] and affect the prevalence of PMDs, including how they are experienced [46,56]. Poverty, social welfare benefit restrictions, a poor labor market, underemployment and unemployment, limited maternal or family leave, and gender bias in economics and wages can all contribute to PMDs and may disproportionally affect birthing persons of color [15,37]. Various researchers have highlighted the negative role low income has in PMDs. Many of the birthing persons Keefe and colleagues interviewed [10] reported financial troubles leading to a host of concerns including interpersonal violence, inability to provide consistent childcare, suspicion of service providers, social isolation, and community violence. Similarly, Abrams and Curran [57] concluded that many young people who recently gave birth experienced tremendous stress due to their inability to pay household bills.

12. Healthcare System Problems

There is a shortage of trained and accessible perinatal mental health professionals in the United States. Britt et al. [58] found that 96% of women live in an area without trained perinatal mental health professionals, with 70% of all counties lacking perinatal mental health resources. Estimates indicate that nearly 14,000 providers are needed to address the nationwide gaps in perinatal mental health care [58]. Of the providers that do exist, few understand racial, ethnic, and cultural differences [15,16]. Even fewer are from similar backgrounds to their clients. For example, the Bureau of Labor Statistics [59] reports that approximately 70% of healthcare social workers and mental health therapists are white. This state is unfortunate because birthing individuals, particularly those who are black, prefer providers of similar racial and ethnic backgrounds to themselves [52]. Not surprisingly, birthing persons commonly mistrust healthcare providers [16,18,27,46,52], which is rooted in systemic oppression and bias.
Based on specialty, training, or competency, providers may engage in different practices related to screening, assessment, and referral to services [25,53]. Although screening for PMDs is a universal recommendation by the American College of Obstetricians and Gynecologists [60], nearly 25% of black birthing persons are not screened for PMDs [25], yet positive screen rates are high among urban, low-income individuals [20]. Worse still, of the mothers who screen positive for PMDs, few are referred for mental health care [44,61]. All of these factors contribute to birthing persons of color being less likely to identify symptoms, be screened for perinatal mental health conditions, and seek symptom management and treatment.

13. Addressing Disparities

Given the difficulties that many low-income birthing persons experience in accessing care, a shift to the prevention, identification, and treatment of PMDs is needed. Concepts and strategies include practicing cultural humility and promoting anti-oppressive practice, building positive relationships with birthing persons, utilizing social supports, promoting community engagement, sharing resources and tangible supports, following universal screening recommendations, addressing access barriers, and advocating for effective policies.

14. Practicing Cultural Humility

Cultural humility is an approach to practice that can be advantageous when working with individuals from diverse identity backgrounds [62], particularly those who are oppressed. Cultural humility is recognized as the lifelong process of self-reflection and learning from others by being open to cultural information, exploring cultural ideas, addressing biases and power imbalances, and promoting respect [62,63]. In a therapeutic context, practicing cultural humility includes developing trusting alliances with clients, navigating differences in world views, addressing cultural biases or missteps, engaging in self-reflection, and recognizing implicit bias [63]. Disrupting and deconstructing oppressive systems, and addressing disparities in working with people, involves an approach focused on intersectionality, cultural humility, and anti-oppressive practices [64,65].
Providers working with birthing persons of color should approach practice and care in a culturally humble manner [66]. This can be done by employing a cultural humility framework that acknowledges culture, dismantles power dynamics and hierarchies, minimizes assumptions, advocates for mothers needing services, acknowledges the feelings and experiences of mothers, communicates transparently, and establishes trust [64,66]. Providers should acknowledge the role of power dynamics [64], with expertise and training simultaneously serving as both a resource and a hinderance [65].
Part of this approach is being informed of stereotyping, oppression, and stigmatization that people with perinatal depression are likely to experience [15]. Providers are encouraged to continue developing self-awareness and being cognizant of dynamics related to race and ethnicity, including white supremacy [52], and working to address these biases [51], including implicit bias. Continuing education and specialized curricula on perinatal mental health, such as the PMH-C certification [67], can promote cultural awareness and competency in working with those experiencing PMDs [44].
Employing a culturally humble approach can address racial discrimination and systemic oppression and reduce perinatal depression [35]. Supporting organizations that practice cultural humility or operate from a culturally centered perspective and value the community, financially (with grants and donations) and through referrals and marketing, should be encouraged [27,42,53]. Likewise, organizations should utilize evidence-based, culturally informed interventions. For example, CenteringPregnancy is an empirically supported, group-based model that uses risk assessment, psychoeducation, and social support to improve perinatal outcomes [68,69,70] including mental health. This approach is empirically supported for use with mothers of color [70] who are of low income [68].

15. Building Positive Relationships with Birthing Persons

Fisher et al. [71] stress that perinatal competencies and the way they are relayed matters to new birthing persons. People of color experiencing perinatal depression report valuing providers who are caring, compassionate, supportive, and accommodating in their approach to services [71], ideally offering a long-term connection [43] and establishing healthy attachment, trust, and support [18,27,51]. Clear communication [15], validation, reassurance, and consistency are important skills for providers and caregivers to offer [43,71]. Nijagal and colleagues [51] encourage providers to view each interaction with perinatal individuals as an opportunity to build trust and communicate empathy. Additionally, community services must recognize the birthing person as the expert and prioritize their preferences, needs, and values [27]. Beyond cultural humility, providers must pursue ongoing training if they wish to provide high-quality care to new parents who are of low income [44].

16. Building and Utilizing Social Supports

Social support can benefit birthing individuals and parents by decreasing isolation, loneliness, and depression [42] and offer a range of assistance such as educational, emotional, or tangible [43]. Social supports can be informal, such as partners, family members, or friends, or formal, such as obstetrical and gynecological medical professionals, pediatric medical professionals, mental health clinicians, or doulas.
Related to informal supports, black birthing persons often want their partners involved in their care [52] if the relationship is available and supportive [72]. Relying on trusted others, such as partners, family members, and friends, is important to urban mothers experiencing perinatal depression [72]. Therefore, offering and promoting opportunities to connect with family members and friends in meaningful and substantive ways can help address PMDs [42]. Birthing persons who desire building social support connections can find peers or support groups online through reputable organizations like Postpartum Support International [67].
Other key individuals include peers, birth or postpartum doulas, community leaders, faith communities, and online groups, all of which can be strong sources of support for mothers of color experiencing PMDs [15,16,37,43,46,56,58]. Peers and doulas, who can be credentialed and reimbursed for perinatal services, are helpful in building social support especially within healthcare systems [51,58]. Community and other faith-based organizations that may offer tangible social and mental health support in an integrated manner have also been shown to be very helpful supporting new birthing persons, as well as reducing racial and socioeconomic disparities in PMDs [53]. Knowing about and referring to a range of services based on the birthing person’s needs can address PMDs among individuals of color [18,27].

17. Following Universal Screening Practices

Screening for PMDs is recommended [16,18,19,73], with commonly used screening instruments being psychometrically suitable for low-income, urban parents [19]. Validated screening tools for PMDs, like the Edinburgh Postnatal Depression Scale (EPDS), are free and readily available online [74,75] and can effectively detect depression [75] and anxiety [74] symptoms. Screening can be integrated into obstetric and gynecologic, pediatric, or mental health care. Professionals interested in learning more about screening and perinatal mental health in general can use resources like the perinatal mental health certification (PMH-C) through Postpartum Support International [67]. To minimize concern over stereotyping or mistrust of providers [38], universal screening as a best practice should be explained to birthing persons, the majority of whom report being willing to be screened [76].

18. Promoting Community Engagement

Having a positive perception of the community, including its safety, can mitigate the effect of life stressors on mental health [41]. Therefore, building community and social environment through engagement with key people in the birthing person’s life, building trust with them, and providing comfort is helpful. People who have given birth and live in urban areas view community outreach as one strategy to address PMDs [72]. To promote community engagement, providers can work with community leaders, including faith groups, to raise awareness and support for PMDs [53,56]. Mutually hosted and supported events for PMD awareness, screening, and referral have been found to be effective [16]. Uchechukwu et al. [77] found that helping new birthing persons with PMDs to become involved using strategies focused on reducing barriers such as childcare, fostering connections among peers, and accessing local gathering places helped to normalize the PMD experience.

19. Sharing of Resources

Low-income birthing persons living in urban areas benefit from tangible resources and information. A key insight from the analysis by Nijagal et al. [51] was, “It’s hard to focus on pregnancy when you’re focused on survival” (p. 723). All appointments, including medical, can start by exploring what a mother and her family would benefit from that day to ensure needs are being met and resources are shared [51]. Keefe et al. [43] found that many of the mothers of color they interviewed reported resources that distributed diapers, baby care items, information on referral sources, and job and educational opportunities to be very helpful.
In addition to assessing needs and providing tangible resources, advocating and providing information can be beneficial. In particular, information about childcare and medical insurance can be valuable for people experiencing PMDs [15]. Where to find information and support should be communicated to new parents [16] and community referrals provided if appropriate [15]. Online offerings can be an option especially if access barriers are high [16].

20. Addressing Access Barriers

Mental health services are recognized by birthing persons of color as a component of perinatal care [52]. However, services should be mother-centered [53] and accessible [51]. For example, the distances a new parent must travel should be considered [52] when planning where and how services are offered. Perinatal urban mothers share that home visiting, if available, would be helpful to support their mental health [72]. As another example, recognizing that perinatal people are oftentimes balancing erratic and inconsistent schedules [43] is important when service providers consider the times and lengths of appointments. Mothers of color experiencing PMDs report that having services that are accessible, flexible, and mother–infant supportive is helpful [43]. Many people who have recently given birth note that the overreliance on the medical model and medications is detrimental to their overall wellbeing [43], whereas care that is integrated and leverages interdisciplinary teams can best address PMDs [27,51].

21. Policy Advocacy and Change

Addressing stressors within communities, including urban areas, requires incremental changes to policy [39]. Policy advocacy and modification requires input from stakeholders representing diverse perspectives and expertise [39]. To address PMDs, involving birthing persons directly alongside community leaders and policymakers is needed.
These stakeholders can collaboratively join to build policy specific to PMDs. For example, despite there being a universal practice recommendation, only 10 states have policies related to screening for PMDs [78]. In addition to screening and awareness, state- and federal-level policy changes are needed to address factors that contribute to or exacerbate the experience of PMDs for low-income birthing persons living in urban areas. For example, improved maternal and family leave, adequate medical insurance, and affordable childcare are areas in need of modification to best support birthing persons and their mental health [15,23,55]. Developing and funding policies to support educational and employment opportunities, including those of a livable wage, can benefit birthing individuals, especially in urban communities [42].

22. Conclusions

PMDs are very common among new birthing persons in the United States. Certain groups, including low-income birthing persons living in urban areas, disparately experience PMDs. This article summarized the contributing factors specific to this experience, including racism, cultural stigma, community stressors, barriers to care access, lack of resources, socioeconomic concerns, and healthcare system problems. Informed by this discussion, specific recommendations to address these factors are provided. Action steps include practicing cultural humility, building positive relationships with birthing persons, utilizing social supports, promoting community engagement, sharing resources and tangible supports, following universal screening recommendations, addressing access barriers, and advocating for policy change. With ongoing attention and work, PMDs and their untreated impact can be addressed to improve the well-being of birthing persons, infants and children, partners, families, communities, and society.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Data Availability Statement

No new data were created or analyzed in this study. Data sharing is not applicable to this article.

Conflicts of Interest

The authors declare no conflicts of interest.

References

  1. Guttmacher Institute. Pregnancy Trends in the United States. 2025. Available online: https://www.guttmacher.org/fact-sheet/pregnancy-trends-united-states#:~:text=Some%205%2C359%2C550%20pregnancies%20occurred%20in,in%20the%20South%20and%20Southwest (accessed on 13 April 2026).
  2. Centers for Disease Control and Prevention. Births and Natality. 2025. Available online: https://www.cdc.gov/nchs/fastats/births.htm (accessed on 13 April 2026).
  3. Fawcett, E.J.; Fairbrother, N.; Cox, M.L.; White, I.R.; Fawcett, J.M. The prevalence of anxiety disorders during pregnancy and the postpartum period: A multivariate Bayesian meta-analysis. J. Clin. Psychiatry 2019, 80, 18r12527. [Google Scholar] [CrossRef] [Scilit]
  4. O’Hara, M.W.; Wisner, K.L. Perinatal mental illness: Definition, description, and aetiology. Best Pract. Res. Clin. Obstet. Gynaecol. 2014, 28, 3–12. [Google Scholar] [CrossRef] [Scilit] [PubMed]
  5. Barfield, W.D.; Ghenet, B.; Cox, S.; Warner, L.; Azeez, O.; Riggs, J.; Russell, R.; Bowron, S.; Churchill, R.E. From Data to Action: CDC’s Public Health Surveillance for Women, Infants, and Children, 2nd ed.; Centers for Disease Control and Prevention: Atlanta, GA, USA, 2020. Available online: https://stacks.cdc.gov/view/cdc/100800 (accessed on 13 April 2026).
  6. Byrnes, L. Perinatal mood and anxiety disorders. J. Nurse Pract. 2018, 14, 507–513. [Google Scholar] [CrossRef] [Scilit]
  7. Weingarten, S.J.; Osborne, L.M. Review of the assessment and management of perinatal mood and anxiety disorders. Focus 2024, 22, 16–24. [Google Scholar] [CrossRef] [Scilit] [PubMed]
  8. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed.; Text Rev.; American Psychiatric Association: Washington, DC, USA, 2022. [Google Scholar] [CrossRef] [Scilit]
  9. Moran, R.L. Blue: A History of Postpartum Depression in America; The University of Chicago Press: Chicago, IL, USA, 2024. [Google Scholar]
  10. Keefe, R.H.; Brownstein-Evans, C.; Rouland Polmanteer, R.S. Perspectives on good mothering from low-income mothers of color with maternal depression. J. Hum. Behav. Soc. Environ. 2018, 28, 271–285. [Google Scholar] [CrossRef] [Scilit]
  11. Wisner, K.L.; Moses-Kolko, E.L.; Sit, D.K. Postpartum depression: A disorder in search of a definition. Arch. Women’s Ment. Health 2010, 13, 37–40. [Google Scholar] [CrossRef] [Scilit]
  12. Hoyert, D.L. Maternal Mortality Rates in the US: 2022 NCHS Health E-Stats, 2024. Available online: https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2022/maternal-mortality-rates-2022.pdf (accessed on 13 April 2026).
  13. Nacev, E.C.; Martinez Acevedo, A.C.; Kaufman, M.; Fuerst, M.F.; Knapp, J.M.; Rodriguez, M.I. Differences between rural and urban residence in the detection and treatment of perinatal mood and anxiety disorders. AJOG Glob. Rep. 2024, 4, 100351. [Google Scholar] [CrossRef] [Scilit]
  14. Sujan, A.C.; Nance, N.; Quesenberry, C.; Ridout, K.; Bhala, M.; Avalos, L.A. Racial and ethnic differences in perinatal depression and anxiety. J. Affect. Disord. 2023, 334, 297–301. [Google Scholar] [CrossRef] [Scilit]
  15. Barnett, K.S.; Banks, A.R.; Morton, T.; Sander, C.; Stapleton, M.; Chisolm, D.J. “I just want us to be heard”: A qualitative study of perinatal experiences among women of color. Women’s Health 2022, 18, 17455057221123439. [Google Scholar] [CrossRef] [Scilit]
  16. Beck, C.T. Experiences of postpartum depression in women of color. Matern. Child Nurs. 2023, 48, 88–95. [Google Scholar] [CrossRef] [Scilit]
  17. Ulrich, S.E.; Sugg, M.M.; Ryan, S.C.; Runkle, J.D. Mapping high-risk clusters and identifying place-based risk factors of mental health burden in pregnancy. Ment. Health 2023, 4, 100270. [Google Scholar] [CrossRef] [Scilit] [PubMed]
  18. Price, S.K.; Masho, S.W. What does it mean when we screen? A closer examination of perinatal depression and psychosocial risk screening within one MCH home visiting program. Matern. Child Health J. 2014, 18, 765–771. [Google Scholar] [CrossRef] [Scilit]
  19. Chaudron, L.H.; Szilagyi, P.G.; Tang, W.; Anson, E.; Talbot, N.L.; Wadkins, H.I.; Tu, X.; Wisner, K.L. Accuracy of depression screening tools for identifying postpartum depression among urban mothers. Pediatrics 2010, 125, e609–e617. [Google Scholar] [CrossRef] [Scilit]
  20. Edwards, M.V.; Campbell, H.K.; Miller, C.R.; Vazirabadi, G.; Fisher, E.K.; Mathews, K.J. Positive depression screening at the first prenatal visit in a low-income primarily black population. J. Health Care Poor Underserved 2022, 33, 20–32. [Google Scholar] [CrossRef] [Scilit] [PubMed]
  21. Hernandez, N.D.; Francis, S.; Allen, M.; Bellamy, E.; Sims, O.T.; Oh, H.; Guillame, D.; Parker, A.; Chandler, R. Prevalence and predictors of symptoms of perinatal mood and anxiety disorders among a sample of urban black women in the south. Matern. Child Health J. 2022, 26, 770–777. [Google Scholar] [CrossRef] [Scilit]
  22. Vance, A.J.; Shuman, C.J.; Bell, S.; Tilea, A.; Courant, A.; Tabb, K.M.; Zivin, K. Evaluating birthing individual and infant healthcare utilization and costs among individuals experiencing perinatal mood and anxiety disorders. Matern. Health Neonatol. Perinatol. 2025, 11, 21. [Google Scholar] [CrossRef] [Scilit] [PubMed]
  23. Zahid, N.; Blebu, B.; Felder, J.; McCulloch, C.E.; Chambers, B.D.; Curry, V.C.; Carraway, K.; León-Martínez, D.; Coleman-Phox, K.; Kuppermann, M.; et al. Economic insecurities and mental health among low-income pregnant people in the central valley region of California. Women’s Health Issues 2025, 35, 105–115. [Google Scholar] [CrossRef] [Scilit]
  24. Mukherjee, S.; Trepka, M.J.; Pierre-Victor, D.; Bahelah, R.; Avent, T. Racial/ethnic disparities in antenatal depression in the United States: A systematic review. Matern. Child Health J. 2016, 20, 1780–1797. [Google Scholar] [CrossRef] [Scilit]
  25. James, K.F.; Klomhaus, A.M.; Elliott, T.; Mensah, M.; Jeffers, K.S.; Choi, K.R. Structural factors in health care associated with the mental health needs of black women in California during the perinatal period. J. Obstet. Gynecol. Neonatal Nurs. 2023, 52, 481–490. [Google Scholar] [CrossRef] [Scilit]
  26. Mitchell, R.A.; Gordon, H.; Lindquist, A.; Walker, S.P.; Homer, C.S.E.; Middleton, A.; Cluver, C.A.; Tong, S.; Hastie, R. Prevalence of perinatal depression in low- and middle-income countries: A systematic review and meta-analysis. JAMA Psychiatry 2023, 80, 425–431. [Google Scholar] [CrossRef] [Scilit]
  27. Estriplet, T.; Morgan, I.; Davis, K.; Crear Perry, J.; Matthews, K. Black perinatal mental health: Prioritizing maternal mental health to optimize infant health and wellness. Front. Psychiatry 2022, 13, 807235. [Google Scholar] [CrossRef] [Scilit] [PubMed]
  28. Stuber, J.; Galea, S.; Ahern, J.; Blaney, S.; Fuller, C. The association between multiple domains of discrimination and self-assessed health: A multilevel analysis of latinos and blacks in four low-income New York City neighborhoods. Health Serv. Res. 2003, 38, 1735–1760. [Google Scholar] [CrossRef] [Scilit]
  29. Patel, Z. Racial disparities in urban planning: “Environmental racism”. Brown Undergrad. J. Public Health 2024, 3. [Google Scholar]
  30. Pulido, L. Rethinking environmental racism: White privilege and urban development in southern California. Ann. Assoc. Am. Geogr. 2000, 90, 12–40. [Google Scholar] [CrossRef] [Scilit]
  31. Krysan, M.; Couper, M.P.; Farley, R.; Forman, T.A. Does race matter in neighborhood preferences? Results from a video experiment. Am. J. Sociol. 2009, 115, 527–559. [Google Scholar] [CrossRef] [Scilit]
  32. Lane, S.D.; Webster, N.; Levandowski, B.A.; Rubinstein, R.A.; Keefe, R.H.; Wojtowycz, M.A.; Cibula, D.A.; Kingson, J.; Aubry, R. Environmental injustice: Childhood lead poisoning, teen pregnancy, and tobacco. J. Adolesc. Health 2008, 42, 43–49. [Google Scholar] [CrossRef] [Scilit] [PubMed]
  33. Keefe, R.H.; Lane, S.D.; Rubinstein, R.A.; Carter, D.; Bryant, T.; Thomas, M.D. African American fathers: Disproportionate incarceration and the meaning of involvement. Fam. Soc. 2017, 98, 89–96. [Google Scholar] [CrossRef] [Scilit]
  34. Bossick, A.S.; Bossick, N.R.; Callegari, L.S.; Carey, C.M.; Johnson, H.; Katon, J.G. Experiences of racism and postpartum depression symptoms, care-seeking, and diagnosis. Arch. Women’s Ment. Health 2022, 25, 717–727. [Google Scholar] [CrossRef] [Scilit] [PubMed]
  35. Weeks, F.; Zapata, J.; Rohan, A.; Green, T. Are experiences of racial discrimination associated with postpartum depressive symptoms? A multistate analysis of Pregnancy Risk Assessment Monitoring System data. J. Women’s Health 2022, 31, 158–166. [Google Scholar] [CrossRef] [Scilit] [PubMed]
  36. Quinn, D.M.; Chaudoir, S.R. Living with a concealable stigmatized identity: The impact of anticipated stigma, centrality, salience, and cultural stigma on psychological distress and health. J. Personal. Soc. Psychol. 2009, 97, 634–651. [Google Scholar] [CrossRef] [Scilit]
  37. Rouland, R.S.; Keefe, R.H.; Brownstein-Evans, C. Postpartum depression among low-income mothers of color: A Womanist perspective. J. Sociol. Soc. Welf. 2018, 45, 3–16. [Google Scholar] [CrossRef] [Scilit]
  38. Iturralde, E.; Hsiao, C.A.; Nkemere, L.; Kubo, A.; Sterling, S.A.; Flanagan, T.; Avalos, L.A. Engagement in perinatal depression treatment: A qualitative study of barriers across and within racial/ethnic groups. BMC Pregnancy Childbirth 2021, 21, 512. [Google Scholar] [CrossRef] [Scilit]
  39. Okada, N.; Renn, O. Coping with persistent disruptive stressors and polycrisis: Community-based policy making and local empowerment. Int. J. Disaster Risk Sci. 2025, 16, 560–574. [Google Scholar] [CrossRef] [Scilit]
  40. Goldmann, E.; Aiello, A.; Uddin, M.; Delva, J.; Koenen, K.; Gant, L.M.; Galea, S. Pervasive exposure to violence and posttraumatic stress disorder in a predominantly African American Urban Community: The Detroit neighborhood health study. J. Trauma. Stress 2011, 24, 747–751. [Google Scholar] [CrossRef] [Scilit]
  41. Gao, Y.; Fu, L.; Shen, Y. The impact of urban migration on the mental well-being of young women: Analyzing the roles of neighborhood safety and subjective socioeconomic status in shaping resilience against life stressors. Sustainability 2024, 16, 4772. [Google Scholar] [CrossRef] [Scilit]
  42. Keefe, R.H.; Rubinstein, R.A.; Kiara, V.B.; Music, S.; Nnam, Z.; Lane, S.D. Addressing the triple trauma of factors leading to perinatal health and mental health consequences in two upstate New York communities. Behav. Sci. 2025, 15, 20. [Google Scholar] [CrossRef] [Scilit] [PubMed]
  43. Keefe, R.H.; Brownstein-Evans, C.; Rouland, R.S. Having our say: African-American and Latina mothers provide recommendations to health and mental health providers working with new mothers living with postpartum depression. Soc. Work Ment. Health 2016, 14, 497–508. [Google Scholar] [CrossRef] [Scilit]
  44. Ahmed, M.K.; Keefe, R.H.; Kmush, B.L.; Shuman, E.; Walker, K.; Rubinstein, R.A.; Silverman, R.; Shaw, A.V.; Lane, S.D. A gap analysis in therapeutic services for birthing individuals with perinatal mental health disorders. Soc. Work Public Health 2026, 41, 300–313. [Google Scholar] [CrossRef] [Scilit] [PubMed]
  45. Keefe, R.H.; Rouland, R.S.; Lane, S.D.; Brownstein-Evans, C.; Larrison, C.R.; Delmerico, A.M. The normative nature of depression among impoverished mothers of color: “…going around this big old circle…it always remain the same”. Fam. Soc. 2019, 100, 188–199. [Google Scholar] [CrossRef] [Scilit]
  46. Keefe, R.H.; Rouland, R.S.; Lane, S.D.; Howard, A.; Brownstein-Evans, C.; Wen, X.; Parks, L. “I gotta carry the burden myself”: Experiences of peripartum depression among low-income mothers of color. Adv. Soc. Work 2021, 21, 176–198. [Google Scholar] [CrossRef] [Scilit]
  47. Geronimus, A.T. The weathering hypothesis and the health of African-American women and infants: Evidence and speculations. Ethn. Dis. 1992, 2, 207–221. [Google Scholar]
  48. Kastello, J.C.; Jacobsen, K.H.; Gaffney, K.F.; Kodadek, M.P.; Bullock, L.C.; Sharps, P.W. Posttraumatic stress disorder among low-income women exposed to perinatal intimate partner violence: Posttraumatic stress disorder among women exposed to partner violence. Arch. Women’s Ment. Health 2016, 19, 521–528. [Google Scholar] [CrossRef] [Scilit]
  49. Hung, P.; Negaro, S.N.D.; Hantman, R.M.; Boswell, E.K.; Andrews, C.M.; Odahowski, C.L.; Crouch, E.L. Access and Quality of Mental Health Services in Rural and Urban America. 2025. Available online: https://www.ruralhealthresearch.org/mirror/17/1722/access-quality-mental-health-services.pdf (accessed on 13 April 2026).
  50. Meng, X. Access to mental health services in urban areas: Examine the availability, affordability, and accessibility of mental health services in urban settings, particularly for individuals with intersecting marginalized identities. Curr. Opin. Psychiatry 2024, 37, 185–190. [Google Scholar] [CrossRef] [Scilit] [PubMed]
  51. Nijagal, M.A.; Patel, D.; Lyles, C.; Liao, J.; Chehab, L.; Williams, S.; Sammann, A. Using human-centered design to identify opportunities for reducing inequities in perinatal care. BMC Health Serv. Res. 2021, 21, 714–729. [Google Scholar] [CrossRef] [Scilit] [PubMed]
  52. Kemet, S.; Yang, Y.; Nseyo, O.; Bell, F.; Gordon, A.Y.; Mays, M.; Fowler, M.; Jackson, A. “When I think of mental healthcare, I think of no care.” Mental health services as a vital component of prenatal care for black women. Matern. Child Health J. 2022, 26, 778–787. [Google Scholar] [CrossRef] [Scilit]
  53. Taiwo, T.K.; Goode, K.; Niles, P.M.; Stoll, K.; Malhotra, N.; Vedam, S. Perinatal mood and anxiety disorder and reproductive justice: Examining unmet needs for mental health and social services in a national cohort. Health Equity 2024, 8, 3–13. [Google Scholar] [CrossRef] [Scilit]
  54. Sobowale, K.; Ross, D.A. Poverty, parenting, and psychiatry. Biol. Psychiatry 2018, 84, e29–e31. [Google Scholar] [CrossRef] [Scilit]
  55. Schafer, K.; Daurio, A.M.; Joiner, T.E. Maternity leave, race, and postpartum depression: The impact of public policy on mothers living in poverty. Fam. Commun. Health 2025, 48, 319–327. [Google Scholar] [CrossRef] [Scilit]
  56. Keefe, R.H.; Brownstein-Evans, C.; Rouland, R.S. “I find peace there”: How faith, church, and spirituality help mothers of colour cope with postpartum depression. Ment. Health Relig. Cult. 2016, 19, 722–733. [Google Scholar] [CrossRef] [Scilit]
  57. Abrams, L.S.; Curran, L. “And you’re telling me not to stress?” A grounded theory study of postpartum depression symptoms among low-income mothers. Psychol. Women Q. 2009, 33, 351–362. [Google Scholar] [CrossRef] [Scilit]
  58. Britt, R.; Burkhard, J.; Murphy, C.; Childers, A. Maternal Mental Health Provider Shortages & Population Risk Report. Policy Center for Maternal Mental Health. November 2023. Available online: https://policycentermmh.org/maternal-mental-health-provider-shortages-population-risk-report/ (accessed on 13 April 2026).
  59. Bureau of Labor Statistics. Labor Force Statistics from the Current Population Survey. 2025. Available online: https://www.bls.gov/cps/cpsaat11.htm (accessed on 13 April 2026).
  60. American College of Obstetricians and Gynecologists. Implementing Perinatal Mental Health Screening. 2026. Available online: https://www.acog.org/programs/perinatal-mental-health/implementing-perinatal-mental-health-screening (accessed on 13 April 2026).
  61. Mestad, R.; Lane, S.D.; Hall, M.; Smith, C.J.; Carter, D.B.; Rubinstein, R.A.; Keefe, R.H.; Jones-Moore, C. Prenatal depression: Screening and referral for low-income women during antenatal care. Soc. Work Public Health 2016, 31, 557–564. [Google Scholar] [CrossRef] [Scilit]
  62. Foronda, C.; Baptiste, D.-L.; Reinholdt, M.M.; Ousman, K. Cultural humility: A concept analysis. J. Transcult. Nurs. 2016, 27, 210–217. [Google Scholar] [CrossRef] [Scilit]
  63. Mosher, D.K.; Hook, J.N.; Captari, L.E.; Davis, D.E.; DeBlaere, C.; Owen, J. Cultural humility: A therapeutic framework for engaging diverse clients. Pract. Innov. 2017, 2, 221–233. [Google Scholar] [CrossRef] [Scilit]
  64. Gottlieb, M. The case for a cultural humility framework in social work practice. J. Ethn. Cult. Divers. Soc. Work 2021, 30, 463–481. [Google Scholar] [CrossRef] [Scilit]
  65. Scott, R.D.; Harsma, E.A. Anti-oppressive pedagogy & cultural humility: An intersectional faculty development. Fem. Pedagog. 2024, 5, 9. [Google Scholar]
  66. Buie, D.; Langston, D. Cultural humility within black maternal health: A qualitative action research study. Res. Sq. 2025. [Google Scholar] [CrossRef] [Scilit]
  67. Postpartum Support International. Get Help. 2026. Available online: https://postpartum.net/get-help/help-for-moms/ (accessed on 13 April 2026).
  68. Park, C.H.; Driver, N.; Richards, R.C.; Ward, P. The effects of CenteringPregnancy on maternal and infant health outcomes: A moderation analysis. J. Public Health 2023, 45, e746–e754. [Google Scholar] [CrossRef] [Scilit]
  69. Park, C.H.; Driver, N.; Richards, R.C.; Ward, P. The effects of CenteringPregnancy: A quasi-experimental evaluation. Healthcare 2025, 13, 1052. [Google Scholar] [CrossRef] [Scilit]
  70. Smith, A.M.; Zainab, M.; Lian, B. Effects of CenteringPregnancy on pregnancy outcomes and health disparities in racial groups versus traditional prenatal care. J. Ga. Public Health Assoc. 2020, 8, 080108. [Google Scholar] [CrossRef] [Scilit]
  71. Fisher, L.; Davey, A.; Wong, G.; Morgan-Trimmer, S.; Howard, L.M.; Sharp, H.; Atmore, K.H.; Brook, J.; Collins, G.; Domoney, J.; et al. Women’s engagement with community perinatal mental health services: A realist evaluation. BMC Psychiatry 2024, 24, 492. [Google Scholar] [CrossRef] [Scilit]
  72. Raymond, N.C.; Pratt, R.J.; Godecker, A.; Harrison, P.A.; Kim, H.; Kuendig, J.; O’Brien, J.M. Addressing perinatal depression in a group of underserved urban women: A focus group study. BMC Pregnancy Childbirth 2014, 14, 336. [Google Scholar] [CrossRef] [Scilit]
  73. Price, S.K.; Cohen-Filipic, K. Daily life or diagnosis? Dual perspectives on perinatal depression within maternal and child health home visiting. Soc. Work Public Health 2013, 28, 554–565. [Google Scholar] [CrossRef] [Scilit]
  74. Camacho, E.M.; Shields, G.E.; Eisner, E.; Littlewood, L.; Watson, K.; Chew-Graham, C.A.; McMillan, D.; Gilbody, S. Case-finding with the anxiety sub-scale of the Edinburgh Postnatal Depression Scale in an observational cohort: Sensitivity, specificity, and cost-effectiveness. J. Affect. Disord. 2025, 381, 84–91. [Google Scholar] [CrossRef] [Scilit]
  75. Kendall-Tackett, K.A. Screening for perinatal depression: Barriers, guidelines, and measurement scales. J. Clin. Med. 2024, 13, 6511. [Google Scholar] [CrossRef] [Scilit] [PubMed]
  76. El-Den, S.; O’Reilly, C.L.; Chen, T.F. A systematic review on the acceptability of perinatal depression screening. J. Affect. Disord. 2015, 188, 284–303. [Google Scholar] [CrossRef] [Scilit] [PubMed]
  77. Uchechukwu, L.; Hardman, M.P.; Hadley, I.; Gornik, M.E.; Petty, S.K.; Pryor, T.A.; Alcolado, G.M.; Furer, P.; Reynolds, K.A. “I’m not alone”: Perinatal women’s experiences in an online self-directed program for perinatal anxiety. BMC Pregnancy Childbirth 2025, 25, 190. [Google Scholar] [CrossRef] [Scilit] [PubMed]
  78. Burkhead, J.; Mendoza, M. A Comprehensive Look at State Maternal Health Screening and Reimbursement Legislation. Policy Center for Maternal Mental Health. 2024. Available online: https://policycentermmh.org/a-comprehensive-look-at-state-maternal-mental-health-screening-and-reimbursement-legislation/ (accessed on 13 April 2026).
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