Reimagining Perinatal Mental Health: An Expansive Vision For Structural Change

Abstract

Diagnoses of depression, anxiety, or other mental illness capture just one aspect of the psychosocial elements of the perinatal period. Perinatal loss; trauma; unstable, unsafe, or inhumane work environments; structural racism and gendered oppression in health care and society; and the lack of a social safety net threaten the overall wellbeing of birthing people, their families, and communities. Developing relevant policies for perinatal mental health thus requires attending to the intersecting effects of racism, poverty, lack of child care, inadequate postpartum support, and other structural violence on health. To fully understand and address this issue, we use a human rights framework to articulate how and why policy makers must take progressive action toward this goal. This commentary, written by an interdisciplinary and intergenerational team, employs personal and professional expertise to disrupt underlying assumptions about psychosocial aspects of the perinatal experience and reimagines a new way forward to facilitate wellbeing in the perinatal period.

Adapting Mindfulness‐Based Cognitive Therapy for Perinatal Depression to Improve Access and Appeal of Preventive Care

“…Developers of the EC PRISM model refer to the ecosystem of early childhood prevention and intervention research to illustrate the complexity and dynamic nature of the forces relevant to effecting population‐level impacts 26 . Similarly, efforts to advance prevention of PD exist within a complex ecosystem that includes prenatal care systems; larger health systems; local, state, and national policy initiatives; the attitudes, biases, and priorities of policy makers and the public; and historical and current treatment of women and people of color and other underserved populations 6 . Framework developers also signal that the greatest potential for ecosystem change occurs through harnessing and enhancing existing elements.…”

“…26 Similarly, efforts to advance prevention of PD exist within a complex ecosystem that includes prenatal care systems; larger health systems; local, state, and national policy initiatives; the attitudes, biases, and priorities of policy makers and the public; and historical and current treatment of women and people of color and other underserved populations. 6 Framework developers also signal that the greatest potential for ecosystem change occurs through harnessing and enhancing existing elements. Consistent with this idea, Center M aims to work synergistically with existing prenatal care structures.…”

“…Our interprofessional team of mental health, health equity, social workers, perinatal care clinician‐scientists, community partners, and biomedical innovators adapted MBCT‐PD for delivery in standard prenatal care settings. This work was informed by barriers and opportunities identified in the literature and several emerging initiatives to envision and enact perinatal care systems improvements 6 . Center M is informed by the Early Childhood Precision, Innovation, and Shared Measurement (EC PRISM) Model, 26 which aims to address the paradoxical phenomenon of significant advances in the establishment of evidence‐based interventions without accompanying improvements in these outcomes at the population level.…”

“…5 Traditional systems of prenatal care are not designed to routinely center perinatal mental health, and any care offered focuses predominantly on treatment rather than prevention. 6 Treatment relies heavily on antidepressant medications, which may be ineffective, as many individuals have concerns about the impact of medication on their fetus or breastfeeding newborn. Treatment also commonly includes referral for therapy outside of the prenatal care setting.…”

The transition to parenthood in obstetrics: enhancing prenatal care for 2-generation impact

“…However, there is a need to move beyond deficit models to address more holistically the totality of the TtP experience, including the social, cultural, and financial contexts in which this transition occurs. 16 Using a lens of 2-generation development and neuroplasticity, enhanced obstetrical care could help interrupt the intergenerational transmission of disparities and trauma and promote optimal beginnings for the whole family. 17,18 Pediatric care programs can serve as models of change for the systematic development, testing, and incorporation of new content into prenatal care as universal, first-tier treatment and evidenced-based, triaged interventions according to the level of need.…”