Postpartum Depression in Black Women Remains Overlooked – Dallas Weekly

Report on Postpartum Depression, Racial Disparities, and Sustainable Development Goals

Introduction: A Public Health Crisis Viewed Through the SDG Lens

The rising prevalence of postpartum depression (PPD), particularly among Black women in the United States, presents a significant challenge to the achievement of several key Sustainable Development Goals (SDGs). This issue directly intersects with SDG 3 (Good Health and Well-being), SDG 5 (Gender Equality), and SDG 10 (Reduced Inequalities). The failure to provide adequate, equitable maternal mental healthcare undermines progress towards universal health coverage and perpetuates systemic disparities.

SDG 10: The Challenge of Reduced Inequalities in Maternal Healthcare

Data reveals a stark disparity in maternal mental health outcomes, highlighting a failure to meet the targets of SDG 10. Black mothers face a disproportionately high burden of PPD, compounded by systemic inequities within the healthcare system.

Key Statistics on Racial Disparities

• The rate of PPD among Black women nearly tripled between 2010 and 2021, rising from just over 9% to almost 25%.
• Black mothers are 46% less likely to be screened for PPD compared to their white counterparts.
• According to a Columbia University survey, only 37% of Black women receive treatment for maternal mental health conditions, compared to 67% of white women.

Case Study: Systemic Failures and Institutional Gaps

The experience of Kay Matthews in 2013 exemplifies the institutional failures that contribute to this crisis. Following a stillbirth, she experienced inadequate and racially insensitive care, receiving no informational resources or follow-up support for her trauma and grief. This lack of care is a direct contravention of the principles of SDG 3.8 (Universal Health Coverage). In response to this gap, Matthews founded the Shades of Blue Project, a non-profit organization that provides community-based support, contributing to the grassroots achievement of SDG 3 by serving women abandoned by the formal healthcare system.

SDG 3: The Link Between Mental Health and Maternal Mortality

The connection between mental health and maternal mortality is a critical focus area for achieving SDG Target 3.1, which aims to reduce the global maternal mortality ratio. Unaddressed mental health conditions are a leading driver of maternal deaths.

Clinical Findings and Health Impacts

Medical experts emphasize that mental health cannot be separated from physical health during the perinatal period.

1. Leading Cause of Death: Mental health conditions, including depression and anxiety, account for 23% of all maternal deaths, according to the Centers for Disease Control and Prevention.
2. Physiological Stress: Chronic stress during pregnancy releases cortisol, creating a traumatic in-utero environment that can lead to adverse outcomes.
3. Associated Health Risks: Poor maternal mental health is linked to an increased risk of preterm birth, low infant birth weight, hypertension, and diabetes during pregnancy.
4. Developmental Impacts: PPD can negatively affect infant development, leading to poor maternal-infant attachment, challenges with breastfeeding, and delays in a child’s cognitive and language development.

Barriers to Universal Health Coverage (SDG 3.8) and Poverty Reduction (SDG 1)

Socioeconomic factors are significant barriers to accessing necessary maternal mental healthcare, directly impacting SDG 3.8 (access to quality and affordable healthcare) and exacerbating conditions related to SDG 1 (No Poverty).

Socioeconomic Stressors and Cost of Care

• Poverty as a Stressor: Low socioeconomic status is identified as a primary stressor that can lead to depression and anxiety in pregnant and postpartum individuals.
• Dependence on Public Insurance: A substantial portion of births in the nation (approximately 40-50%) are covered by Medicaid, highlighting the vulnerability of low-income mothers.
• Prohibitive Treatment Costs: The cost of specialized PPD medication, such as a two-week course of Zurzuvae, can be approximately $8,700 without insurance, placing effective treatment out of reach for many and failing the SDG 3.8 target of affordable essential medicines.

Future Outlook: Threats to Sustained Progress

Healthcare professionals and community leaders express significant concern that potential changes in public policy and funding could reverse the progress made in maternal health. These threats jeopardize the long-term sustainability of efforts aimed at achieving SDGs 3, 5, and 10.

Vulnerability of Healthcare and Social Support Systems

Potential reductions in funding for programs like Medicaid and for non-profit organizations pose a direct threat to the health and well-being of vulnerable mothers. Experts warn that such changes could lead to a regression in maternal health outcomes and have an “astronomical impact” on the social support services that are critical for communities. Maintaining, rather than dismantling, these systems is essential for continued progress toward global health and equality targets.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being

  This is the primary SDG addressed. The article focuses extensively on maternal health, specifically postpartum depression (PPD), its prevalence, consequences, and the barriers to treatment. It discusses maternal mortality, mental health disorders, and access to healthcare services, all of which are central to SDG 3.

• SDG 5: Gender Equality

  The article centers on a health issue that exclusively affects women. It highlights how gender intersects with race, leading to specific forms of discrimination and neglect within the healthcare system. The story of Kay Matthews and the statistical disparities in care for Black mothers underscore the need to address gender-based inequalities in health.

• SDG 10: Reduced Inequalities

  A core theme of the article is the racial and socioeconomic inequality in healthcare. It explicitly details how Black women are disproportionately affected by PPD and are less likely to be screened or receive treatment compared to white women. The article also points to socioeconomic status and reliance on Medicaid as significant factors, linking poverty and race to unequal health outcomes.

• SDG 11: Sustainable Cities and Communities

  This goal is connected in a secondary capacity. The article mentions that “long-term exposure to air pollution” is a factor believed to contribute to the increased rate of PPD. This links environmental conditions within communities to public health outcomes.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. SDG 3: Good Health and Well-being

   • Target 3.1: By 2030, reduce the global maternal mortality ratio. The article directly addresses this by stating that mental health conditions like depression “account for 23% of maternal deaths” and that “Georgia has the second-highest rate of maternal mortality in the nation.”
   • Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being. The article’s entire focus is on PPD, a significant mental health issue. It highlights a patient who “died by suicide” due to an undiagnosed mental health disorder and discusses the lack of screening and treatment, which are essential for prevention and promoting well-being.
   • Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines. The article discusses the reliance on Medicaid for health coverage (“roughly 40% of the nation’s births are covered by Medicaid”) and the prohibitive cost of PPD medication (“Zurzuvae… can cost roughly $8,700”), which directly relates to financial risk and access to affordable care.

2. SDG 5: Gender Equality

   • Target 5.1: End all forms of discrimination against all women and girls everywhere. The article provides a clear example of discrimination through Kay Matthews’ experience, where she felt racism was “prevalent… within the healthcare system.” The statistical evidence that Black mothers are “46% less likely to be screened for PPD” also points to systemic discriminatory practices.
   • Target 5.c: Adopt and strengthen sound policies and enforceable legislation for the promotion of gender equality and the empowerment of all women and girls at all levels. The article mentions that Georgia is “working with national health organizations to create a set of directives hospitals can use to handle patients specifically at risk for postpartum depression,” which represents a policy-level action to improve health outcomes for women.

3. SDG 10: Reduced Inequalities

   • Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of… race, ethnicity… or economic or other status. The article highlights the exclusion of Black women from adequate maternal mental healthcare. The work of the “Shades of Blue Project” is a direct effort to empower and support a community that has been marginalized by the healthcare system.
   • Target 10.3: Ensure equal opportunity and reduce inequalities of outcome… by eliminating discriminatory… practices. The article details the unequal outcomes, such as the PPD rate for Black women nearly tripling and the disparity in treatment rates (37% for Black women vs. 67% for white women). This demonstrates a clear inequality of outcome that needs to be addressed by eliminating discriminatory practices in healthcare.

4. SDG 11: Sustainable Cities and Communities

   • Target 11.6: By 2030, reduce the adverse per capita environmental impact of cities, including by paying special attention to air quality. The article makes a direct, though brief, link by stating that “long-term exposure to air pollution” is a contributing factor to PPD, connecting urban environmental quality to maternal health.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article provides several quantitative and qualitative indicators:

• Maternal Mortality Rate: The article explicitly mentions that mental health conditions “account for 23% of maternal deaths” and refers to Georgia having the “second-highest rate of maternal mortality in the nation.” This is a direct indicator for Target 3.1.
• Prevalence of Postpartum Depression (PPD): The article provides specific data on the prevalence of PPD, noting an increase “from 9.4% in 2010 to roughly 19% in 2021” and a near tripling for Black women to “almost 25%.” This measures the burden of a key mental health condition (Target 3.4).
• Rates of Health Service Coverage and Utilization:
  • Screening Rate: The statistic that “Black mothers are 46% less likely to be screened for PPD” serves as an indicator of unequal access to preventative services (Targets 3.4, 10.3).
  • Treatment Rate: The comparison that “Fewer than 37% of Black women received treatment… compared to 67% of white women” is a direct indicator of inequality in access to care (Targets 3.8, 10.3).
• Proportion of Population with Access to Affordable Medicines: The article highlights the cost of the PPD drug Zurzuvae at “$8,700” as a barrier, implying that the affordability and accessibility of essential medicines is a key metric (Target 3.8).
• Proportion of Births Covered by Health Insurance: The mention that “roughly 40% of the nation’s births are covered by Medicaid” and “closer to 50%” in Georgia is an indicator for financial risk protection and access to health services (Target 3.8).
• Infant Health Outcomes: The article links PPD and maternal stress to adverse outcomes like “stunted infant growth,” “preterm birth and low infant birth weight,” which can serve as indirect indicators of the effectiveness of maternal mental health support.

4. SDGs, Targets and Indicators Table

Source: dallasweekly.com