Queer birthing parents who faced postpartum mental health challenges often avoided seeking help because of fears of being declared unfit, the involvement of child welfare services, the stigma of mental illness, and concerns about racism, homophobia, and transphobia, according to a new study.
The Participants
“I was greatly worried that I would not be given the same care due to race, and that my struggles would make it more likely that the state would intervene,” said Gwen, a Black queer woman who was married and lived in Florida.
KK, a White nonbinary asexual married person in North Carolina, said “I felt like I would be judged for having mental health issues or that they wouldn’t believe me about them. I tried to get help before and it seemed like they just brushed me off.”
And Mika, an American Indian cis pansexual married woman in Oklahoma, said, “Doctors here don’t take women seriously. If you go in wanting to talk about anxiety or depression, you’re treated like you are just on your period. If you push further, you’re considered hysterical.”
These are just a few of the many experiences explored in a new study by Dr. Abbie Goldberg, one of the leading social scientists studying LGBTQ families, and Dr. Reihonna Frost.
The study explored postpartum mental health challenges among queer parents, particularly those who have often been invisible, including bisexual, trans, nonbinary, low-income, and young parents, and parents of color. It surveyed 99 queer parents who had given birth between 2018 and 2023: 81 were cisgender women, 17 were nonbinary, and one was a trans man; 64 identified as bisexual, 17 pansexual, five lesbian, two queer, and 11 something else. More than half reported a household income of under $50K, and over a quarter were below the federal poverty level. In terms of race and ethnicity, 77 identified as White only; 5 as Black; 6 as Hispanic/Latinx; 1 as American Indian/Alaska native, and 10 as multiracial or a combination of identities. Additionally, 23 were ages 19 to 25, and 36 were ages 26 to 30; the remaining ones were 31 to 45. (See the full paper for more demographics and information on how they were recruited.)
Mental Health Issues
Among all of the participants, 88 said they had at least one mental health issue in their first year postpartum, including major depressive disorder (64); anxiety disorder (64); obsessive-compulsive disorder (13); bipolar disorder (13); and other diagnoses (19), including posttraumatic stress disorder. Factors that participants said contributed to their distress included “isolation, lack of partner support, financial issues, difficult birth experiences, and gender dysphoria.”
While others may face some of these challenges, too, the researchers suggest that queer birthing parents may experience them at higher levels because of “structural stigma and heterosexism,” particularly because queer people experience higher rates of poverty than non-queer ones and may also experience social isolation from rejecting communities and families.
Additionally, the gender dysphoria experienced by some trans and nonbinary participants “underscores the particular vulnerability” of non-cisgender individuals who give birth. Most studies in this area have focused on trans men, the authors note, but nonbinary people “may be especially vulnerable to invisibility and erasure in the perinatal health context, in that nonbinary identities are less familiar to health providers.”
Facing Fears and Seeking Help
Of the 88 who experienced postpartum mental health problems, 56 endorsed having sought help. Those who didn’t, and even some who did, expressed various fears about doing so: almost half feared judgment by providers; more than half feared that their mental health issues would lead to them being deemed “unfit,” possibly leading to their children being taken away; and more than one-third expressed distrust of child welfare services. Participants with incomes below the poverty line and those age 25 and younger were especially likely to fear the child welfare system, sometimes because of prior personal experiences with it as children or adults. Others spoke of how their racial identity, gender identity/expression, or single-parent status might invite greater scrutiny or bias by health providers.
Many participants were reluctant to seek help because of the stigma of mental illness, a stigma that could be either internalized (feeling that they should simply improve on their own or that needing help made them bad parents) or externalized (disapproval from others). Four participants worried about homophobia or transphobia in the medical system; three of these were nonbinary and all were pansexual. Three worried about racism; two of these were Black and one was Hispanic.
Participants also described experiences and fears of being invalidated by providers who didn’t take their feelings seriously. Some, especially in more conservative states in the South and Midwest, felt this was because of how women and those assigned female at birth are often treated by health providers. A few felt their invalidation was or might be because of their LGBTQ identities, too.
“These fears are intersecting and overlapping,” the researchers assert.
Nevertheless, more than two-thirds of participants sought help, largely motivated by a desire to be good parents, but sometimes because they felt they were reaching a “breaking point” or because of a partner’s pressure to seek help. The authors say this shows ”the potentially critical role of partner support in mental health treatment for new parents.”
Some participants shared, however, that they had found it difficult to get postpartum mental health support, or received resources that “were not helpful or meaningful” or not combined with follow up by the health care provider.
Limitations
The study is notable for including a large number of bisexual cis women partnered with men—women who are often left out of research on LGBTQ parents, explain the authors. Few female-partnered cis women participated in the study, however, which limited conclusions about that group. There were also “too few participants in various racial/ethnic groups to meaningfully describe racialized intersections with other marginalized statuses.” The researchers also say that they did not dig into financial challenges as much as they could have, and they did not explore how family frictions may have changed over time, “and/or in the current sociopolitical climate”—all areas worthy of further research.
Takeaways
The researchers say their findings stress the need for healthcare providers “to exhibit an open, nonjudgmental, and reassuring stance,” and to be proactive in attending to parents’ mental health. Practitioners may also compassionately leverage people’s motivations for seeking mental health assistance, such as partner pressure and the desire to be good parents, as ways of encouraging mental health treatment.
And practitioners can better support postpartum queer birthing parents by understanding how intersections among income, race, gender identity, and sexual orientation may cause patients to avoid seeking help.
Participants’ fears about child welfare services underscore, too, that “this system is not an effective substitute for investing in communities.” The authors therefore recommend advocating for the development of better services, support, and opportunities for all families, building trust with vulnerable communities, and connecting families with community resources that can decrease the likelihood of child welfare system involvement.
And their findings highlight the need for increased training of providers on working with queer, trans, and nonbinary birthing people in the postpartum period and beyond, being “alert to their unique needs and concerns, and the reality that they may carry with them past experiences with biased, insensitive providers.”
Future work, they say, should look even more closely at queer parents’ experiences with postpartum mental health, “seeking to understand how their experiences of identity, risk, resilience, parenting, and well-being intersect and unfold over time, particularly in the current sociopolitical climate, where LGBTQ+ rights are debated and LGBTQ+ lives are under threat.”
The paper is “Saying ‘I’m not okay’ is extremely risky: Postpartum mental health, delayed help-seeking, and fears of the child welfare system among queer parents,” in Family Process, June 23, 2024.
For more on postpartum care, see the recent queer-inclusive (but not exclusive) book Your Postpartum Body, by Ruth Macy and Courtney Naliboff. While this book is somewhat more focused on physical health, it touches on issues of mental health as well, such as finding support, advocating for oneself, and validating people’s experiences.