Shortage of perinatal healthcare workers hurting underrepresented communities

It’s widely accepted that the U.S. is experiencing a mental health crisis. Often overlooked, even in the midst of the crisis, is perinatal mental health. Perinatal refers to the period of time from pregnancy up until one year after birth. Mood and anxiety disorders during that time affect at least 20% of mothers but are often left undiagnosed, forcing new parents to navigate those difficulties alone. People of color and low-income mothers are even more likely to struggle with these issues but less likely to receive the care they need.

But there’s movement on the matter: A new bill called the Moms Matter Act, that aims to expand and diversify the state’s perinatal workforce, is making its way through the Massachusetts Legislature. One of its fiercest advocates is Dr. Rose Molina, an OB-GYN and assistant professor at Harvard Medical School. Dr. Molina joined All Things Considered host Arun Rath to discuss the importance of helping new mothers, especially those from underrepresented communities, get the help they need. What follows is a lightly edited transcript.

Arun Rath: First off, as an OB-GYN, you encounter this population every day. When did you realize that the system, as it stands now, is not doing the job?

Dr. Rose Molina: I encounter this issue every day that I’m in clinic. I think that mental health challenges really have a disproportionate effect—particularly on communities of color, low-income communities, and immigrant communities—and there is so much strength and resilience in people having the courage to speak out about the help that they need and the issues that they’re struggling with.

Yet what’s really challenging for me as an OB-GYN is to get people the mental health support that they need in a timely manner. Waitlists are long, and there are few behavioral health clinicians that come from the same communities as patients who speak their language, who understand life in their shoes, and who can really develop that trusting kind of therapeutic relationship that we know is so important for better mental health outcomes. And so, for that reason, I wholeheartedly support the Moms Matter Act, and I hope that it is moved favorably out of the [Legislative] committee.

Rath: You spoke to the Joint Committee on Mental Health, Substance Use and Recovery, and something that was interesting that you talked about was how, in terms of tackling this problem, it’s not just about expanding the workforce but diversifying it. Could you expand on that?

Dr. Molina: That is a really important part of this bill. And yes, we do have a workforce shortage. We certainly need to expand capacity. We need more behavioral health clinicians across the board—that’s certainly true. But, as I mentioned, particularly for the patients that I see who are often people who identify from marginalized communities, whether they’re Black or Brown or recently-arrived folks, they really want to see people who look like them, who have shared lived experience, who they can communicate with in the same language, especially as they’re sharing some of the most deeply private parts of their lives.

And we know that mental health, sadly, remains very stigmatized in many communities, and so being able to talk about what people are struggling with, whether it’s depression, anxiety, suicidal thought, thoughts about harming their baby, for example—things that are very stigmatized in our society. It’s hard for people to do that when they don’t feel comfortable with the behavioral health clinicians they see. So diversifying the behavioral health clinician workforce is critical.

One of my great privileges is, because I speak Spanish, most of the patients that I see speak Spanish, and I know that many of them sort of breathe a sigh of relief when they see that they can communicate directly with me without an interpreter. I can only imagine how important that sensation is when they’re talking about something as private as their mental health issues.

And oftentimes related to mental health issues are other socially stigmatizing conditions, like struggling with food insecurity, struggling with finding housing, struggling with intimate partner violence, a lot of issues that are deeply private and are hard to talk about with anybody, let alone someone who might not share the same background or be able to communicate directly in the same language.

Rath: Over the last few years, especially since the pandemic, we’ve talked a lot on this program about community health centers and their importance in serving communities that we’re talking about here—that are underserved. Is there a role for community health centers in getting out this perinatal care to these communities that need it?

Dr. Molina: Absolutely. Really, community health centers are the backbone of the health system, and we reach the most marginalized communities in a welcome, inclusive and geographically accessible way. Health centers are super important, and I think are the backbone and need to be at the forefront of expanding mental health for pregnant individuals.

Rath: So, with this moment of attention, then, how would you like to see things expand? What would be ideal for you to see in Massachusetts as we go forward?

Dr. Molina: One of the things that the Moms Matter Act would do is provide more funding to community-based organizations that do a lot of the frontline support in helping birthing people welcome new babies into their lives. So I think that we need to build more connections between community-based organizations and the healthcare system, particularly in this space of mental health. So thinking about who mental health workers are—whether they are social workers, licensed mental health counselors, peer specialists—all of those folks need training and need support in their professional development to be able to continue to reach people where they need.

So I think really thinking broadly about who the behavioral health workforce is—not only thinking about the people who sit within clinics but also the people who live and work in communities and how we can provide the best training for those individuals to also provide mental health support and counseling for the individuals who need it to really meet people where they’re at.

Rath: And finally, you mentioned earlier some of the warning signs to look out for. For anybody who’s listening who is in this part of their life, if you’re not really up on the latest in mental health, what are warning signs to look out for, and what should people do to get help?

Dr. Molina: The most common mental health conditions we see in the pregnancy period are depression and anxiety. These are both mood disorders and any sort of symptoms around feeling down, sad, depressed, lack of energy, having problems with sleep, changes in appetite, feeling more irritable; all of these things can be symptoms of depression, particularly in the postpartum period.

It’s important for new moms to think about their well-being in the context of the first few weeks. That can be challenging because in the first few weeks, we know most people are not sleeping. Their eating might also be a little bit erratic as they’re taking care of a newborn, especially if they start to have thoughts of harming themselves or harming other people, including their babies. So we certainly encourage anyone who thinks those symptoms apply to them to reach out—whether it’s their midwife, OB-GYN, or whoever they see for pregnancy care—to reach out and have a conversation about those symptoms.

And for anyone who is in need of urgent mental health support, they can always call 1-800-981-4357. There’s also a statewide behavioral health helpline for anyone in Massachusetts, and the number for that is 1-833-773-2445.