Culturally-centered healthcare is focused on the patient, addressing the patient's desires, comfort, and trust, with emphasis on cultural indicators of respect. This concept views the dynamics between healthcare providers and the patient as a partnership that is centered on the patient's needs and empowers them at the same time.
Rural communities are becoming more and more diverse. Twenty-one percent (21%) of rural residents were racial and ethnic minorities in 2016, including Hispanic, Black, and American Indian rural residents. Immigrants are largely responsible for the 37% of rural population growth between 2000 and 2018. These numbers must be considered when developing maternal health programs, as they carry economic, geographic, social, and political implications.
Engaging all members of the community is important for increasing understanding of existing barriers and opportunities to improve culturally-centered maternal care. Excellent communication skills, counseling skills, and cultural centeredness are the foundation of respectful maternity care, and care providers must be aware of historical trauma and its impact on birth experiences and outcomes.
It is best practice for clinicians providing care to a pregnant woman and her family to practice culturally-centered care, including acknowledging the role of culture when screening for and treating perinatal mood disorders. Maternity care must also be sensitive to the unique culture of each rural community, which may be unrelated to race and ethnicity. Community-based doula programs, community health workers, and peer counselors can help bridge cultural barriers in healthcare, particularly in underserved communities.
Low-income women of color are at increased risk of perinatal mood disorders due to increased risk factors like stress, racism, and discrimination. They are less likely to be screened for postpartum mood disorders and less likely to seek support than white mothers. Further, in some groups, it is taboo to discuss mental illness. When women recognize symptoms in themselves, they may minimize or disregard them because of shame, perceived stigma, and/or cultural beliefs. In addition, Black women may experience concerns of being deemed a “bad mother” or having children removed from their care.
A literature review of postpartum depression in Latina women found that many women believed their traditional cultural practices from their country of origin protected them from postpartum depression. An example is la cuarentena, which is a 40 day recovery period when family members fully care for the new mother and baby so they can focus on resting and healing. The study unearthed how Latina mothers often felt the culture in the U.S. did not support such traditions and left them feeling isolated.
Care providers must have an understanding of culture and history to provide adequate maternal care to American Indian women. Because of the complexity of Native history, some communities have developed Native-specific services, such as the Changing Woman Initiative in New Mexico, which provides comprehensive women's health with Native culture interwoven throughout. The medicine wheel represents holistic health — including physical, spiritual, emotional, and mental health — and emphasizes that all areas of health be interconnected, reciprocal, balanced, and whole. Consequently, physical ailments and psychological struggles are indistinguishable and American Indians may demonstrate mental distress in a manner that complicates diagnosis of perinatal mood disorders.
Although approximately 20-25% of new mothers experience a perinatal mood disorder, one study found that nearly 50% of women who exhibited symptoms of general or postpartum depression opted not to receive mental health support. The top three reasons pregnant and non-pregnant women gave for not receiving mental health treatment were cost, disapproval of treatment, and stigma concerns. Providers should use discretion and culturally-centered care when administering mood disorder screening and treatment.
Resources to Learn More
The National Birth Equity Collaborative (NBEC)
Offers a variety of resources, research, policy advocacy, racial equity training, and community-centered collaboration to support Black maternal and infant health.
Organization(s): The National Birth Equity Collaborative (NBEC)
with Native American Women with Postpartum Depression
Presentation slides from the 2016 Postpartum Support International Conference providing the findings and recommendations from research involving American Indian mothers and postpartum depression.
Author(s): Barnes-Palty, P.
Organization(s): Postpartum Support International (PSI)