ADriane Nieves

A'Driane Nieves is a writer and artist best known for her love of Prince. She writes about navigating the nuances of motherhood and bipolar disorder type 2 along with her thoughts on various social justice issues on her blog

How Women of Color Can Manage The Impact of Acculturative Stress and Discrimination During Pregnancy

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dr sumner acculturative stress and discrimination during pregnancyToday I’m thrilled to have Dr. Lekeisha Sumner with us to share insight on two very common types of stress women of color may experience during pregnancy and tips on how we can manage both. Dr. Lekeisha Sumner, PhD, ABPP is a board-certified clinical psychologist with specialization in both clinical psychology and medical psychology. She is currently an Associate Professor in the Department of Psychology at Alliant International University and Assistant Clinical Professor in the Department of Psychiatry & Biobehavioral Sciences at UCLA. A frequent commentator on psychological science, she has written extensively on trauma and the intersection of culture and gender in health and well-being. Dr. Sumner maintains an independent practice in West Los Angeles where she was recently commissioned by the Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment to serve on the Strategies for Improving Outcomes for Peripartum Women committee.

With so many changes in one’s body, daily routine, and responsibilities, it’s typical for many women to feel overwhelmed at times both during pregnancy and after the birth of baby. And yet, for some women, these feelings can be compounded by stressful experiences related to their cultural backgrounds or ethnicities, which increases their vulnerability for emotional distress.

Take for example, Olivia, a bright and compassionate 28-year old woman who was in the second trimester of her first pregnancy when we met. She had moved to the United States several years ago from her native country and was elated to finally have the opportunity to be with the man of her dreams and start a family. Her husband, a US native, was supportive of her adjustment to life in a new country and particularly attentive to her needs during pregnancy. She was especially grateful for the comfort he provided now that she lived without her extended family.

Despite all the wonderful changes that were happening in her life, Olivia felt chronically overwhelmed and was stunned by the recent discovery that she had developed hypertension during her pregnancy. She had already unsuccessfully tried the home remedies her mother suggested which included taking a walk around the block and listening to relaxing music. But, at the urging of her husband who observed her increasingly distressed mood, she decided to enter psychotherapy.

Olivia began experiencing stress on her job long before she became pregnant but things only intensified once she disclosed her pregnancy to her boss. Since that time, she began to experience difficulty sleeping, little appetite, constant worrying, and difficulty concentrating and had even begun to grind her teeth during sleep. Given the severity of the symptoms, Olivia was concerned that they would negatively impact her pregnancy. As she began to delve into the underlying sources of her stressors and the contexts in which they occurred, it became clear that many of the experiences she described are common among women from some ethnic and cultural groups (especially women of color, refugees, immigrants, etc.) yet rarely discussed: acculturative stress and discrimination.

Acculturative stress typically refers to the emotional strain of having to alter one’s cultural attitudes, beliefs or behaviors to adapt to and navigate a distinctly different culture. For Olivia, acculturative stress presented as the strong social pressure she felt to quickly learn English and lose the accent of her native language. She also experienced discrimination on her job as her boss would often humiliate her by making snide comments about immigrants within earshot. He would keep constant tabs on her, would make embarrassing “jokes” about people of color and her accent, and routinely give her lower performance evaluations than her colleagues even though her productivity was equal too or greater than theirs. After disclosing her pregnancy, these incidents worsened. Although working in a hostile climate resulted in her having performance anxiety, ruminative thoughts and nightmares, she was too intimidated to report this behavior to human resources and believed she would have been labeled as being “too sensitive,” “playing the race card” and perhaps worse, risk further alienation and stigmatization.

Over a period of time, intense and chronic stressors like the ones Olivia experienced can wear on a person and leave them feeling emotionally drained and depleted. The stress brought on by discrimination and acculturative strain during pregnancy can quickly erode one of the most sacred and enjoyable periods of a woman’s life and render women at risk for symptoms of depression and anxiety, and poorer lifestyle choices (e.g. eating habits, nicotine use) as they attempt to cope. For some groups, these stressors may alter the release of bodily hormones that may affect the outcomes of pregnancy. For example, African American women across the economic and educational strata have the highest rates of preterm birth in the United States. Studies confirm that these findings are in part due to the high levels of chronic stress and ethnic discrimination they are exposed to throughout the lifespan. While research shows that these stressors do not affect everyone or every group of pregnant women exactly the same, they can certainly diminish mood mood, energy, and confidence in caring for baby.

There are some ways to help lessen the impact of acculturative stress and discrimination. For instance, women who use healthy coping strategies (e.g meditation, walking, journaling, asking for help), those with a strong belief in their ability to overcome obstacles and those who have pride in and a connection with their cultural heritage and cultural values all seem to have better emotional responses in the face of these types of stressors than those without. Also, women who feel a sense of belonging and receive support from their partners throughout pregnancy and post-partum also tend to respond better. For Olivia, getting involved in an on-line support group, a local church that appreciated congregants from diverse backgrounds and engaging in psychotherapy were all beneficial in helping to restore her well-being and equipping her to improve her ability to cope.

For all women, the pregnancy experience is shaped not only by biology but also by psychological and cultural influences. While you may be limited in eradicating all stressors during pregnancy, given the suffering that severe culture-specific stress during pregnancy can cause for you and baby, it’s a good idea to discuss with your doctor as soon as possible any concerns in your life.   You will also want to monitor your stress levels not only during pregnancy but also in the many months after your bundle of joy is delivered. Taking a few extra steps can help you better prepare to be the best warrior mom you can be.

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3 Ways We Can Improve Maternal Mental Health Care For Women of Color

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women of color Earlier this week, I shared my growing concern with women of color and their maternal mental health being underserved by professionals and those in the mental health advocacy space. (Note: “Women of color” refers to women who are not considered to be Caucasian: Hispanic/Latina, Black or African-American, Asian/Pacific Islander, Native American, Indian, of biracial heritage, etc) Today, I’d like to offer just a few ways in which I think we can improve our efforts, and make maternal mental health advocacy more inclusive of mothers of color, our experiences, and our needs.

Believe Us

I mentioned in my earlier post that many of the women I’ve spoken with expressed frustration and dismay that they were not taken seriously when they told their doctor, social worker, pastor, or a mental health professional that they were struggling. Their symptoms were minimized, their concerns and lack of awareness about what they were experiencing dismissed, and some even stated they were degraded by the professionals they reached out to. That’s unacceptable, and does more harm to women already suffering. One mother, who is African-American, described her experience to me as this:

“When I FINALLY went to a therapist, after my second child, I was dealing with PPD then. We began talking about my life (two kids under 3, stressful full time job, lack of support from significant other), and her response was to ask me if I was on birth control so I wouldn’t have any more kids.”

Her experience mirrors my own. After the birth of my second child, I knew something was wrong but couldn’t identify what. I was depressed and anxious and my moods were out of control. When I mentioned it to my OB at 8 weeks postpartum, he said I just needed more sleep. When I told him how out of control I felt, he wrote me a prescription for an anti-depressant, said I should discontinue it in a few weeks once I was feeling better, and told me to follow up with my primary care doctor. The medicine didn’t work. I was still a wreck. I went to my primary care doctor and she just told me that again, I was just tired. When I finally realized what I was experiencing was PPD and anxiety (thanks to Postpartum Progress’ Plain Mama English Guides), I called the NJ state PPD hotline. It took two days for a call back, and I was told that because I was on Medicaid, I’d have to see a social worker who was also a therapist from the state’s mental health program. At that appointment, I unloaded everything to him: my swinging moods, rage, intrusive thoughts, depression, fear. He asked me questions about my “living situation” and his next words I remember to this day:

“Well, you know, I mean what you’re experiencing isn’t postpartum depression or anxiety. You’re just experiencing the stress of being an unwed mother to two children who’s in a rocky relationship. Women like you…in your type of situation…in your culture, experience it, you know? Of course you’re stressed. You’re young, with an infant and toddler, going to school and working full-time…there are plenty of other Black women like you who face these kinds of daily challenges, you know what I mean? You just have to shoulder it and keep going the best you can. I think you’re going to be alright once you figure out how to manage it all.” 

Despite taking down my family and personal history where I detailed several things that placed me at risk for PPD (family history of mental illness, personal history of depression and anxiety, single, unexpected pregnancy, early childhood trauma, minimal support from family and friends), this therapist ignored all of it and said what I was experiencing was expected because of my cultural experience. This (White) man was not helpful nor was he culturally competent and a good match for my particular needs. I struggled to find adequate help for two more months.

Tell Us, Talk to Us, Become Culturally Competent

During my first and second pregnancies, I wasn’t screened for PPD or told anything about it, despite being at risk for developing it.  I didn’t even know PPD was A Thing. Other mothers of color have told me they’ve had similar experiences:

“I wish my doctor had told me anything. I had no information whatsoever.”

“When I had my daughter I was 20 and unwed (but my boyfriend was present). I got lectured from a social worker about my elevated risk for shaken baby syndrome. But no one asked about my mental health, either at discharge or at my follow up appointments.”

” I was upfront about my bipolar disorder with staff at the birth center. In the office, they even said, “You know you’re at increased risk for postpartum depression, right?” Then after the birth, the midwife attending just went about her business doing paperwork and asked me to sign to accept financial responsibility. Another midwife came in to check on me and asked me how I was feeling in front of family and friends. I was NOT about to say that I was having intrusive thoughts (I didn’t even know what to call it then). A lady who wasn’t a midwife (I think she was in billing) called to ask how I was doing. I broke down in tears on the phone. She called me weekly for several weeks. She gave me more care and concern postpartum than any of the midwives did.”

“She (my doctor) mentioned it, I just wish maybe she talked about it more in depth with me- signs/symptoms, etc.”

We need those in charge of our pregnancy and postpartum care to do a better job of informing us about what the signs and symptoms of postpartum mood disorders are. We need to be made aware of how they can manifest in our lives, and what places us at particular risk for occurrence. Providers need to become more culturally competent on how issues such as racial and gender discrimination, racial profiling and harassment, the high rate of domestic violence in our communities, our high rates for chronic illness, violence, poverty, and other sociopolitical aspects of our lives impact our mental health. Treatment plans then need to stem from an understanding that takes all of these factors into consideration.

Advocate for Better Access, Better Quality of Care, More Awareness

Reports have shown that there are disparities in mental health treatment, quality of care, and access to services when it comes to minority mental health, especially for women of color. Aside from cultural stigma, barriers to treatment include lack of insurance coverage post pregnancy, the costs of mental health services, and very little community resources in neighborhoods with significant minority populations. Educational literature and books on maternal mental health are hardly written with our experiences and needs in mind. Research on women of color and maternal mental health does exist but it is not extensive. Many awareness campaigns lack a multi-cultural focus, despite pregnant mothers of color facing significant and unique physical and mental health risks .

How can we do better? I’d like to see more literature featuring women of color distributed in doctors offices and where social services are located. It would alleviate a huge burden if mental health offices had childcare so we could safely leave our children in the care of others while we are seeing a therapist. We should create more spaces for mothers of color to gather and discuss their struggles and experiences with each other to gain support. More mental health professionals should offer reduced rates or at least accept Medicaid. There should be collaboration between cultural institutions our neighborhoods trust and national mental health organizations to raise awareness and eradicate cultural stigma on an ongoing basis. I’d like to see the expansion of Medicaid so more mothers can have comprehensive and longer coverage that enables them to access mental health services.

I think while some strides have been made, we still have much further to go to help women like myself. I’d like to see a more concentrated effort made in advocating for better care, easier access, and more awareness that empowers mothers of color. Doing so will help us give our families and ourselves the strong starts we deserve.

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Suffering in Silence With Intrusive Thoughts: What I Couldn’t Say

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african american, intrusive thoughts, postpartum depression, postpartum anxiety, treatmentToday I’m bringing you a story from my (beautiful) friend Arnebya (pronounced Arnebya). She is a DC-based writer and editor (by day). A three-time BlogHer Voice of the Year, Arnebya’s work has appeared on multiple lifestyle and parenting blogs. She was also a member of the 2013 Listen to Your Mother DC cast. Most recently, she was published in the HerStories anthology “My Other Ex: Women’s True Stories of Leaving and Losing Friends”. She blogs at You can find her on Twitter and Facebook. She can be persuaded to do illegal things if you pay her in steamed Brussels sprouts. She is one of the wittiest women I know and I’m honored she’s bravely chosen to share her very serious experience with you. Also, I’m putting a trigger warning here for detailed descriptions of the intrusive thoughts she experienced. Please read with care.

The reel in my head flashes. Flashes of thoughts, ideas, memories flit through my mind in snatches of scenes. I see breakfast. Flash. My mind is a View Master but I don’t know who’s in control of the little orange switch. I wish whoever is making the picture change so quickly would depress the lever slowly, more softly. That damn boing slap noise is starting to irritate me.

Flash. Me. Dancing.

Flash. Lunch.

Flash. The baby, so sweet. Me. Hanging. It would be such a relief, hanging. It would hurt, though, that’s why it’s a no-go. Wait, no, it’s a no-go because I don’t necessarily want to die. I just kind of – ok, wait, yes, I do want to die BUT I’m fine; it’ll pass. It’s time to feed the baby.


It is 2001, January. At the baby’s two month checkup, the pediatrician asks questions about how the infant with the weird name is faring. How many wet diapers? Is her stool runny? Are you exclusively nursing still? Oh, this baby is thriving. She’s a joy, so easy, except when she’s crying and I don’t know what she wants and I wish she’d just stop it already because I am so tired and he’s playing chess online again like he doesn’t hear her and…FLASH. I see the baby in a casket. Poor baby. Who did that to you?

 Flash. Come back. Pay attention.

And you? How are you, Mom? Fill out this form for us, OK, and let us know how you’re doing.

The form reads: I feel sad sometimes, all the time, never. I feel anxious sometimes, all the time, never. Uh huh. Lie. Lie about these questions because if they knew about the flashes they would take this baby and your man would hook up with that busty woman from the club. Take the middle child. Give them back sometimes because that seems normal. Is it normal? It wouldn’t be on the paper if it wasn’t normal to feel this way sometimes, right? I wish I could ask. I can’t.


It’s 2003. The second baby is two months old. The same pediatrician asks questions about the infant, nursing, wet diapers. Fill out this form. I lie. Again. At home, my mind races. The baby is in the microwave or the dryer or the tub filling slowly with warm water that I’ve neglected to add bubbles to. I never see myself doing these things, never see myself as the culprit, the one who hurts the babies. I just see the babies . . . there. In perilous positions. I don’t tell anyone. I’d hoped it wouldn’t happen this time.

In the middle of the night with my first infant, I cried. I couldn’t sleep. The baby would die if I slept. Either I would hurt the baby and the baby would die, or the baby would die peacefully while I selfishly slept and didn’t know. Elaborate scenes of investigations and tiny, white funeral gowns, flooded my mind. I knew what songs would be played at my daughter’s funeral because I made the program in my mind.

When my second daughter was a few months old, I refused to leave the house for a week. My hair wasn’t right. Nothing fit. I needed a shower. I couldn’t find my shoes. Leave the house? With a toddler and an infant? On purpose? I would agree, then bail, standing in the kitchen at the sink, crying, holding onto the counter, whirling around, away from my husband’s inquiring (I saw accusing) eyes. Another day, I’d say. And then I’d sit in the bathroom with sweaty palms and itchy underarms and shake my head to clear it of the scenes that wouldn’t stop on the reel: an accident, mangled bodies, an airborne baby. Best to stay at home. Something bad will befall us if we leave. Maybe I should kill us all, beat fate to the gate.

I’d hoped it wouldn’t happen again.


It’s 2009. The third baby is nestled in my arms, still breathing after a frightening birth. The same pediatrician smiles, says, “This’ll be quick; you’re old pros.” Flash. Throw the baby. Run. Convince them it’s for the best. I look up at her, glance at my husband, smile.

Not again, I think.


I never did tell the truth about the intrusive thoughts I was having. I suffered quietly, afraid that my children would be taken because I was off in the head; afraid that speaking my fears of hurting the children or myself would only make the desire stronger. Even as I knew the facts, even as I knew the statistics, even as I knew the doctors only wanted to help, that my husband was trying his best to understand and help, I never once got close to actually admitting how I truly felt, what the flashes felt like.

I both love and respect our pediatrician. Even that wasn’t enough to beat the stigma associated with asking for help with postpartum depression. And I knew what was going on, every time. And still I remained quiet. I’m five years postpartum from my youngest now. The flashes still happen, sometimes. I got medication once, but it was just last year which is funny because I was much less embarrassed when it wasn’t associated with post pregnancy depression. This is something we have to change, socially, personally, medically.

While there may be similarities in each woman’s postpartum depression experience, none are identical. My struggles with undiagnosed and untreated postpartum depression are my own, my story. If you are suffering, tell someone. If I were to get pregnant again, I would immediately tell my doctor about my difficulties after each child. It is unfortunate that it took three postpartum experiences to know that this is what’s best, it doesn’t have to. There is no shame in what happens to our brains chemically after birth, and there is no shame in seeking help.

You deserve it. Your baby deserves it.

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Women of Color and Maternal Mental Health: Why Are We So Underserved?

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women of color maternal mental healthOver the past year, I’ve made it a point in my advocacy efforts to focus more on women of color, talking with them about their mental health experiences during pregnancy and the postpartum period. Based on those conversations and my own personal experience, I’ve become especially interested in how perinatal mood disorders and their symptoms impact and manifest in our lives, what culturally specific barriers to support and treatment we encounter, and what mental health advocacy efforts are being made to remove those barriers for us. Here’s what I’ve learned from research, Postpartum Progress’ current survey on mothers of color and their experience with perinatal mental health, conversations I’ve had with fellow mothers of color, and from what I’ve seen in the mental health advocacy space.


  • We are woefully underserved by mental health professionals and social services that reside in our communities-for a variety of reasons. Many of the women I spoke to were dismissed, rebuffed, or had their mental health concerns during pregnancy and the postpartum period downplayed by their doctor, pediatrician, pastor, and/or social worker.
  • Women of color are either without health insurance, or have insurance plans that do not cover mental health services, especially during pregnancy. Medicaid, for example, often lapses in many states six weeks after pregnancy, leaving many without continued coverage and access to mental health care.
  • We are not informed or aware of what places us at a particular risk for developing one of these illnesses compared to Whites.
  • We simply aren’t aware of the symptoms of perinatal mood disorders.
  • Stigma around mental illness is prevalent in our cultures but this is especially true when it comes to motherhood. Our cultures place a significant emphasis on us being silent about our struggles, taking care of everyone else before ourselves, turning to religion in an effort to overcome, and on being strong in the face of adversity-particularly in the face of oppression, racism and other socioeconomic stressors. Seeking the help of a professional, and disclosing our symptoms is seen as a sign of weakness so much so that we ignore the need to make our mental health a priority. Health advocacy efforts focus solely on physical illnesses such as diabetes, heart disease, stroke, infant mortality, and cultural disparities in breastfeeding rates. The latest statistics show that women of color and those living at or below the poverty line have a higher rate of occurrence, yet none of the national organizations dedicated to empowering and serving minorities discuss maternal mental health and the disparities that exist in regards to diagnosis, support, and treatment. This is preposterous and negligent considering our rate of occurrence is 1 in 4.
  • Our reasons for not discussing it publicly are a significant barrier to raising awareness and seeking treatment. We face racial and gender discrimination in our places of employment so as you can imagine, disclosure of a postpartum mood disorder can increase the risk of losing our jobs significantly. Many of the women I’ve spoken with have expressed this fear, with several stating it was the sole reason they didn’t seek treatment either during pregnancy or when their symptoms peaked during their child’s first year. Support from family and friends is often minimal due to culture specific stigma and ignorance surrounding mental illness. Many of us living at the poverty line or who are in the lower-income bracket utilize the help of social services such as SNAP, WIC, and TANF; speaking from personal experience, I can say being under scrutiny from social workers and the state triggers fears of losing your children for being seen as unfit to care for them.
  • Lack of research. I’ve grown incredibly frustrated in my efforts to find consistent research on this issue because, quite frankly, it’s pretty scant. Most of the research that focuses solely on women of color and perinatal mental health is also out of date, with data from the late 90’s and early 2000’s.
  • Lack of targeted advocacy. We do not see women who look like us in literature doctor’s offices, or on websites that talk about perinatal mental health. There are very few if any advocacy campaigns or outreach targeted specifically towards us, like there are for other health issues and breastfeeding. Advocacy organizations often focus on minority mental health only during designated months once or twice a year, instead of on a consistent basis. Many organizations simply focus on all pregnant and new mothers, which is fine, but such a general scope ignores our unique experiences with mental health. Our disparities in support and treatment due to socioeconomic stressors, our particular needs, the risk factors we face, as well as the role culturally specific stigma plays as a barrier are not taken into consideration when calls to action are given. They are mentioned as an afterthought, a sentence or two in a post or article. The results of such inattentiveness are programs and initiatives that are not inclusive of our unique needs. Finally, we lack support groups in our own communities as well as safe spaces online to talk with other women like us who understand our unique struggles as mothers, which for many of us creates a very isolated existence.

This has to change. It’s unacceptable and as a woman of color and survivor of postpartum depression and anxiety, it hurts my heart to know our maternal mental health isn’t being actively prioritized, much less thought of.  While I fully understand that postpartum mood disorders don’t discriminate in terms of who they impact, and that the need to help pregnant and new moms is great all across the board, I also know that efforts are seriously lagging behind when it comes to the maternal mental health of women of color. We MUST do better. Later this week, I will talk about how we can but for now, I’m interested to hear your thoughts. Mothers of color, what has your experience been, and what kinds of supports and programs do you think would serve us better? What kind of improvements would YOU like to see?

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