A Qualitative Ecological Exploration of Black Perinatal Mental Health and Wellbeing

In the United States, Black women are three to four times more likely to die from pregnancy-related complications than White women and experience disproportionately higher rates of maternal mental health issues across pregnancy, childbirth, and the postpartum period. Structural racism, healthcare bias, and inequitable access to culturally responsive care position Black women among the most underserved and undertreated populations in the nation and contribute to intergenerational impacts on Black families and communities.

This study aimed to understand how Black communities conceptualize perinatal mental health and wellbeing and identify barriers and facilitators to care, with the goal of informing culturally responsive, community-centered, and family-focused interventions that promote safety, confidence, and agency.

Semi-structured virtual interviews were conducted with Black pregnant and postpartum mothers, fathers, and community members (N = 17) using a qualitative, descriptive approach while noting recurring themes. Participants were English-speaking, residents of the United States, aged 18 years or older, and recruited through purposive sampling via community networks and social media. We analyzed data using reflexive thematic analysis to examine multilevel influences on perinatal mental health. The Social-Ecological Model (SEM) was used as a guiding framework to understand how individual, interpersonal, community, and structural factors shape perinatal mental health and wellbeing as well as access to care.

Among the four levels of the Socioecological model, including individual, interpersonal, organizational, and community/policy, ten subthemes emerged, including perinatal health literacy, supportive networks, collective resilience, healthcare harm and advocacy, medical institutional environments, parenting while Black, and perinatal health climate.

Findings highlight the need for multilevel, culturally responsive, and community-centered strategies to advance Black perinatal mental health and wellbeing.