What Are the Barriers to Accessing Perinatal Mental Health Services?

Multiple studies have documented that, despite our efforts to increase public awareness of and to promote routine screening for perinatal mood and anxiety disorders, accessing perinatal mental health care remains a significant challenge for many women. A recent meta-review from Webb and colleagues examines the complex and multifaceted barriers that impede women from seeking help, accessing care, and engaging in treatment for mental health issues during pregnancy and the postpartum period.

The review synthesizes the findings of 32 systematic reviews and reveals a wide range of barriers across multiple levels–individual, healthcare professional, interpersonal, organizational, political, and societal. At the individual level, stigma surrounding mental illness, poor awareness of symptoms, and fear of consequences like having their child removed by protective services were major deterrents for women. Many women felt ashamed or embarrassed to disclose their mental health issues, perpetuating a cycle of silence and inadequate support.

Healthcare professionals’ attitudes, knowledge gaps, and cultural insensitivity emerged as significant barriers. Some providers dismissed or minimized women’s concerns, lacked training in identifying and managing perinatal mental health issues, or held stigmatizing beliefs themselves. This lack of competency and empathy from providers tasked with the identification of women in need of treatment further discouraged women from seeking help.

Interpersonal factors, such as strained relationships with partners or family members and lack of social support networks, exacerbated the isolation and distress experienced by women with perinatal mental illness. Without a strong support system, navigating the challenges of pregnancy, childbirth, and early parenthood, while at the same time managing mental health issues, became even more difficult.

At the organizational level, fragmented healthcare systems, resource constraints, and inadequate referral pathways compromised access to appropriate care. Women often faced long waiting lists, remote service locations, and a lack of specialized perinatal mental health services, particularly in rural or underserved communities.

Broader societal and cultural factors, such as language barriers, discrimination, and deeply rooted gender norms, also played a role in shaping women’s experiences and access to care. In some communities, mental health issues were heavily stigmatized or viewed as a personal weakness, deterring women from seeking help.

The authors emphasize the need for a comprehensive, multi-pronged approach to address these barriers and improve access to perinatal mental health care globally.[1] Recommendations include increasing awareness and reducing stigma through public education campaigns, providing culturally sensitive training for healthcare professionals, integrating mental health services into routine obstetric and pediatric care, and implementing policies that prioritize and fund perinatal mental health initiatives.

Ultimately, ensuring timely access to perinatal mental health services is crucial for safeguarding the well-being of women, their children, and families. By addressing the many barriers identified in this meta-review, healthcare systems and communities can take steps towards providing the support and resources that women deserve during this vulnerable time.

Ruta Nonacs, MD PhD

References

Webb R, Uddin N, Constantinou G, Ford E, Easter A, Shakespeare J, Hann A, Roberts N, Alderdice F, Sinesi A, Coates R, Hogg S, Ayers S; MATRIx Study Team. Meta-review of the barriers and facilitators to women accessing perinatal mental healthcare. BMJ Open. 2023 Jul 20;13(7):e066703.