Other groups
There are some groups who we know are more likely to experience inequalities in perinatal mental health, yet we do not currently know how many people are impacted in our local population.
Personal or family history of mental health conditions
Prevalence
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- Having previously experienced mental health problems before pregnancy is a strong risk factor for experiencing mental health problems during the perinatal period (74).
- Having a family history of mental health conditions can also be a risk factor. For example, having a family history of bipolar disorder is associated with a greater risk of post-partum psychosis (75).
Experience
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- A review of qualitative literature about the experiences of motherhood in women with severe mental illness found that (76):
- Problems with service provision included: lack of continuity of care; difficulties interacting with healthcare professionals; delayed treatment for postpartum psychosis due to misdiagnosis; not being able to have their baby with them in hospital; drug side effects impacting their parenting; and the need for more practical help during mental health crises (such as childcare).
- Women highlighted an unmet need for peer support groups and information provision.
- Individual healthcare professionals were often named in positive experiences of services.
- A review of qualitative literature about the experiences of motherhood in women with severe mental illness found that (76):
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Disabled parents
Risk factors
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- Disabled mothers are (77):
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- Twice as likely to experience domestic abuse.
- 1.4 times as likely to be a lone parent.
- Twice as likely to have a disabled child (by the age of 7 years).
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- Some physical disabilities are associated with a higher risk of physical health complications during pregnancy and childbirth (78).
- People with a learning disability are more likely to experience risk factors for poor perinatal mental health, including social isolation, poverty and poor housing (79).
- Disabled mothers are (77):
Access
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- Women with physical disabilities often face barriers to accessing maternity care, including around (78):
- Physical accessibility (such as a lack of accessible public transport or suitable equipment)
- Service design (which can make it difficult to obtain relevant health information)
- Relationships with professionals (such as prejudice and lack of knowledge around disability)
- Women with physical disabilities often face barriers to accessing maternity care, including around (78):
Experience
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- Small national surveys have found that disabled parents report walking a ‘tightrope’ of demonstrating they deserve and are eligible for assistance, but not to the extent that professionals deem them to be a risk to their children (80).
- These surveys found that disabled parents:
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- Tended to acknowledge they would benefit from support but were cautious about having contact with children’s services (80).
- Rarely had their voices heard, including people not recognising their knowledge of their own disability (80).
- Over a quarter felt their rights were poorly respected by maternity care providers because of their disability (81).
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- A review of the experiences of women with physical disabilities found many had mixed or negative experiences of maternity care (82).
- A review of the experiences of women with learning disabilities during pregnancy highlighted that many struggled to understand information that was presented to them (79). Some women endured negative responses towards their pregnancy from professionals (79). Fewer women with learning disabilities are involved in decisions about their perinatal care than women without learning disability (79).
Young people in care and care leavers
Prevalence
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- Care leavers are twice as likely to have postnatal depression than their counterparts (83).
Risk factors
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- Pregnancy and the transition to parenthood can compound the difficulties faced by young care leavers (84).
- Around 22% of female care leavers become young mothers, which is around 3 times the national average (85).
- 1 in 10 young care leavers (aged 16 to 21) who are parents have had a child taken into care in the last year (85).
- Many young care leavers report a lack of support when becoming parents (84).
- Pregnancy and the transition to parenthood can compound the difficulties faced by young care leavers (84).
Access
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- Many care experienced parents struggle to access mental health services, due to a lack of suitable services and fears around being viewed negatively by social care professionals (86).
Experience
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- Care leavers report facing increased scrutiny from social care services; and in particular, many young fathers report feeling judged and stereotyped by professionals (84).
LGBTQ+ parents
Prevalence
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- There is evidence to suggest that LGBTQ+ parents are at higher risk for poor mental health during the perinatal period, including low mood, stress and depression (87).
- Some perinatal experiences can be distressing for trans and non-binary parents, such as having to discontinue gender-affirming healthcare (87)
Experience
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- A large national survey of trans and non-binary birth parents found that (88):
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- 30% had given birth without accessing support from midwives.
- For those who did access maternity care, 28% felt they were not treated with dignity and respect during labour and birth.
- Less than half felt their decisions around infant feeding were always respected by midwives (compared to 85% of the general population).
- A review of the experiences of LGBTQ+ parents found examples of exclusion within perinatal mental healthcare (87).
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- A large national survey of trans and non-binary birth parents found that (88):
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Military families
Prevalence
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- There is a higher prevalence of mental health conditions amongst veterans, including anxiety, depression and PTSD; the symptoms of which are likely to persist during the perinatal period (89).
- People whose partner is deployed in the military are at higher risk of depressive symptoms and psychological stress during the perinatal period (90).
Adverse life events
Prevalence
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- Mothers who have experienced childhood maltreatment (such as emotional and sexual abuse) are more likely to experience (91):
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- Suicidal ideation during the perinatal period.
- Difficulties in maternal and infant emotional regulation.
- Disrupted mother-infant relationships.
- One study found that women who had two or more stressful life events (including divorce, unemployment, serious illness of a close relative) within the past year were 3 times more likely to have consistently high depressive symptoms throughout the perinatal period (92).
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- Mothers who have experienced childhood maltreatment (such as emotional and sexual abuse) are more likely to experience (91):
Additional resources
- Trans + Non-binary Experiences of Maternity Services
- Gender Inclusive Language in Perinatal Services: Mission Statement and Rationale
- An online resource for patients on Pregnancy, Birth and Parenthood after Childhood Sexual Abuse
References
74. Public Health England. Mental health in pregnancy, the postnatal period and babies and toddlers Report for NHS Cambridgeshire and Peterborough CCG [Internet]. 2020 [cited 2023 Jan 31]. Available from: https://fingertips.phe.org.uk/profile-group/mental-health/profile/perinatal-mental-health/data#page/13
75. Jones I, Craddock N. Familiality of the puerperal trigger in bipolar disorder: Results of a family study. American Journal of Psychiatry. 2001;158(6).
76. Dolman C, Jones I, Howard LM. Pre-conception to parenting: A systematic review and meta-synthesis of the qualitative literature on motherhood for women with severe mental illness. Arch Womens Ment Health. 2013;16(3).
77. Šumilo D, Kurinczuk JJ, Redshaw ME, Gray R. Prevalence and impact of disability in women who had recently given birth in the UK. BMC Pregnancy Childbirth. 2012;12.
78. Lawler D, Lalor J, Begley C. Access to Maternity Services for Women With a Physical Disability: A Systematic Review of the Literature. Int J Childbirth. 2013;3(4).
79. Homeyard C, Montgomery E, Chinn D, Patelarou E. Current evidence on antenatal care provision for women with intellectual disabilities: A systematic review. Midwifery. 2016;32.
80. Munro ER, Zonouzi M, Fountain R, Harris J, Vale D. Re-imagining social care services in co-production with disabled parents [Internet]. 2018 [cited 2023 Feb 1]. Available from: https://www.drilluk.org.uk/wp-content/uploads/2019/06/Research-Findings-Munro-et-al.-2018-Re-imagining-social-care-services-in-co-production.pdf
81. Hall J, Hundley V, Collins B, Ireland J. Dignity and respect during pregnancy and childbirth: A survey of the experience of disabled women. BMC Pregnancy Childbirth. 2018;18(1).
82. Blair A, Cao J, Wilson A, Homer C. Access to, and experiences of, maternity care for women with physical disabilities: A scoping review. Vol. 107, Midwifery. 2022.
83. Botchway SK, Quigley MA, Gray R. Pregnancy-associated outcomes in women who spent some of their childhood looked after by local authorities: Findings from the UK Millennium Cohort Study. BMJ Open. 2014;4(12).
84. Fallon D, Broadhurst K, Ross E. Preventing unplanned pregnancy and improving preparation for parenthood for care-experienced young people. Coram. 2015;(October).
85. Winterburn M. Finding their feet: equipping care leavers to reach their potential [Internet]. 2015 [cited 2023 Mar 7]. Available from: https://www.centreforsocialjustice.org.uk/wp-content/uploads/2018/03/Finding.pdf
86. Care Journeys. Care-experienced Parents Unite for Change [Internet]. 2022 [cited 2023 Mar 28]. Available from: https://www.barnardos.org.uk/sites/default/files/uploads/Care%20Experienced%20Parenthood%20Report.pdf
87. Kirubarajan A, Barker LC, Leung S, Ross LE, Zaheer J, Park B, et al. LGBTQ2S+ childbearing individuals and perinatal mental health: A systematic review. Vol. 129, BJOG: An International Journal of Obstetrics and Gynaecology. 2022.
88. LGBT Foundation. Trans + Non-binary Experiences of Maternity Services [Internet]. 2022 [cited 2023 Feb 14]. Available from: https://dxfy8lrzbpywr.cloudfront.net/Files/97ecdaea-833d-4ea5-a891-c59f0ea429fb/ITEMS%2520report%2520final.pdf
89. Anderson EH, Morrow C, Mattocks KM, Shivakumar G. Perinatal Symptoms and Treatment Engagement in Female Veterans. Mil Med. 2021;
90. Godier-Mcbard LR, Ibbitson L, Hooks C, Fossey M. Military spouses with deployed partners are at greater risk of poor perinatal mental health: A scoping review. Vol. 165, Journal of the Royal Army Medical Corps. 2019.
91. Souch AJ, Jones IR, Shelton KHM, Waters CS. Maternal childhood maltreatment and perinatal outcomes: A systematic review. Vol. 302, Journal of Affective Disorders. 2022.
92. Rubertsson C, Wickberg B, Gustavsson P, Rådestad I. Depressive symptoms in early pregnancy, two months and one year postpartum-prevalence and psychosocial risk factors in a national Swedish sample. Arch Womens Ment Health. 2005;8(2).