The stigma of mental health problems in pregnant women or mothers has an impact on their health and the development of their children
Bias and stigma remain against mothers and pregnant women with mental health needs. Providing judgment-free and respectful, compassionate care will support the open dialogue of mental health and illness – Photo by 🇸🇮 Janko Ferlič on Unsplash
Authors
Alicia Salamanca Fernández
PhD in Gender Studies from the UCM. Social worker, specialised in violence, mental health and substance addiction. Currently, she coordinates services and teams in violence and mental health services, and also teaches at the VIU University. She is a consultant, trainer and advisor for social organizations, universities and public administrations. At the same time, she produces didactic and informative materials and is a member of the Ibero-American Network of Mental Health and Gender.
Berenice Domínguez Gómez
Social Psychologist from the Universidad Autónoma Metropolitana (UAM-X) in Mexico. She has a Master’s Degree in substance addiction from the University of Barcelona. She has been coordinator of the Service of Information and Attention to Women (SIAD) and the Service of Integral Attention LGBTIQ+ (SAI) of the Fundación Salud y Comunidad in Pineda de Mar. She is currently a Feminist Psychologist at Espai Ariadna, a comprehensive care service for cis and trans women, living alone or with their children, who require a safe space to deal with situations of gender violence and addictions.
The intersection of gender, maternity and mental health is a complex, multidisciplinary issue that has been explored in the scientific literature using a variety of approaches. This article focuses on the stigma faced by pregnant women or mothers with mental disorders, a problem that encompasses several dimensions related to social inequalities and structural discrimination.
Structural stigma and gender
The processes of stereotyping, labelling and stigmatisation have been developed as mechanisms of social control, both formally and informally. In the case of women, these processes have been powerful tools for establishing difference and subordination (Hansen, 2019; Rovira-Guardiola, 2022). The misogynistic stereotype, which attributes to women personality traits such as weakness, fickleness and emotionality, perpetuates the normalisation of women’s suffering and constantly calls into question their capacity and credibility, especially when they denounce violence perpetrated by men. For those suffering from mental health problems, this stigmatising imaginary is compounded by the stigma and discourse associated with mental illness. This combination of factors makes women’s rights particularly vulnerable (FMP, 2021).
Structural or institutional stigma refers to a set of norms, policies and procedures emanating from public or private institutions that restrict the rights and opportunities of people with mental illness, legitimise power differentials and reproduce inequalities and social exclusion (Mora-Ríos et al., 2014). This type of stigma is particularly prevalent among pregnant women or mothers with mental disorders, who face a double burden: discrimination related to their mental health condition and gender expectations and stereotypes related to maternity and motherhood.
Maternity and mental health problems
The intersection of maternity and severe mental health problems adds another layer of complexity for these women. In addition to the challenges of parenthood, these women face double discrimination: the pressures of traditional gender roles and the stigma associated with mental illness. Several qualitative studies have shown that these women often face a pervasive judgement about their ability to be adequate mothers, which makes them feel constantly tested (Díaz-Pérez et al., 2017). This judgement comes from both health professionals and family members and is based on stereotypes of ‘bad mothers’, which wrongly associate mental health conditions with an inability to care for children properly.
In the context of maternity and motherhood, some additional barriers make it difficult for women with mental disorders to recognise and report the violence they face.
These barriers may be related to a lack of awareness of the violence they are experiencing or to an internalisation of the stigma prevalent in their environment. In addition, some women may blame themselves for the violence they experience or fail to recognise it as such (FMP, 2021). There is some evidence that these women are more likely to experience gender-based violence. According to a report by FEDEAFES (2017), they are two to four times more likely to experience intimate partner violence than women without these diagnoses.
Mental health stigma in maternity care is a significant concern, particularly for women who experience depression and other mental health issues during pregnancy and postpartum. The stigma surrounding mental health can lead to feelings of shame, guilt, and embarrassment, making it more challenging for women to seek help – image, adapted from Infonova #40, all rights reserved
Impact of stigma on mental health and maternity
The stigma associated with mental illness affects not only the individual but also their family and carers. In the context of maternity, this stigma manifests itself in many ways, from a lack of credibility when women report experiences of violence, abuse or mistreatment, to a sense of intrusion in the face of intervention by social services, which are also perceived as threatening for fear of losing custody of children. Self-stigma can also reduce the likelihood of women seeking help, perpetuating a cycle of deteriorating mental health.
A study carried out in four mental health centres in Mexico City found that family and health workers were the main sources of stigma. Women with mental health problems report feeling disqualified and untrustworthy, especially when they try to talk about their experiences of violence or sexual abuse (Mora-Ríos et al., 2014). Violence by omission is also significant, where violence is perpetrated by simply failing to provide certain necessities, such as medication or food. These women are more vulnerable to all forms of gender-based violence, which leads to greater impunity for perpetrators and increases the vulnerability of women with severe mental health problems.
Intersectionality and mental health
The intersectional approach is essential to understanding the complexity of the experiences of pregnant women or mothers with mental health problems. This approach, originally proposed by Crenshaw (1989) and developed by authors such as Hankivsky et al (2010), analyses the simultaneous interaction of different social factors at different levels. In the context of mental health, this involves examining how gender, poverty, ethnicity and other social determinants interact to create unique experiences of stigma and exclusion.
The work of Mora-Ríos et al (2014) uses this approach to understand how sex and gender interact with other dimensions of social inequality in specific historical and geographical contexts to create unique experiences in health settings. The results show that users’ perceptions of their condition are influenced by factors such as social vulnerability, precarious living conditions, violence, substance use and lack of a support network. Gender also influences these experiences: women are more likely to be victims of gender-based violence, while men are more likely to use substances.
Obstacles in health care and social services
Mental health professionals’ anxieties about myths about mental illness reflect the need for a holistic approach that addresses both mental health and social determinants. A more equitable power relationship between professionals and clients/patients is crucial to promoting their empowerment and autonomy. The compartmentalisation of these issues is also an obstacle to implementing a holistic health perspective that takes into account the social determinants of mental health through comprehensive interventions that target this compartmentalisation.
A study by the Federación de Mujeres Progresistas (FMP – 2021) identifies the barriers related to gender socialisation that are likely to affect the provision of services to women:
- Lack of time to care for their health: in the context of the cultural mandate to care, many women prioritise the needs and well-being of others over their own, limiting the time and resources devoted to their own health.
- Over-psychologisation of conditions: at the diagnostic level, the over-psychologisation of women’s conditions can lead them to express their complaints in ways that are less socially alarming, resulting in inadequate attention from health services.
- High levels of stigma and invalidation: Women are stigmatised and invalidated in their choices and actions, both within the nuclear family and with primary caregivers, which has a negative impact on their emotional and mental well-being.
- The perpetrator as primary caregiver: The situation where the perpetrator is the primary caregiver, combined with the lack of privacy and intimacy and the need for accompanied medical consultations, can create significant barriers to expressing discomfort and disclosing GBV situations, thus limiting access to appropriate care.
Conclusions and recommendations
The stigma associated with mental disorders in women who are mothers or who are pregnant is a significant barrier that affects both the health of mothers and the development of their children. Addressing this stigma through education, support and improved access to mental health care is essential to ensure the well-being of these women and their families. Society and health systems must work together to create a more inclusive and supportive environment in which all women can receive the care and support they need.
Dignified care for pregnant women and mothers with mental health problems requires intervention strategies that address stigma and the intersection of multiple factors of inequality.
It is essential that professionals working with these women receive appropriate training to address prejudice and gender stereotypes, and to provide caring, non-discriminatory support.
The design of care centres for pregnant women or mothers with mental health problems, as well as intervention programmes, must take into account all relevant elements in order to respond to these realities. This means changing the order of priorities, focusing research, intervention models, programme design and the construction of care centres on the specific needs of these women (Domínguez & Salamanca, 2023).
Education and awareness-raising are powerful tools for reducing stigma. Educational programmes for health professionals and the general public can help to correct misconceptions and promote empathy and more informed understanding (Waqas et al., 2020). It is also important to promote a supportive environment where women feel safe to talk openly about their mental health concerns without fear of being judged. Initiatives such as support groups or peer networks provide safe spaces to share experiences and receive emotional support, while empowering women to become informed and conscious agents of change, enabling them to re-signify themselves from a dignified and compassionate perspective.
References
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Díaz-Pérez, I., Gómez-Benito, J., & Saldaña-Dueñas, J. (2017). Maternidad y trastorno mental grave: Experiencias de maternidad. Revista de Salud Mental, 36(1), 57-59. Recuperado de https://dialnet.unirioja.es/descarga/articulo/5836864.pdf
Domínguez Gómez, B., & Salamanca Fernández, A. (2023). Feminizar la atención en drogodependencias y salud mental: Enfrentando la ceguera de género. Infonova, Asociación Dianova España, 40, Adicciones, violencia de género y abordajes centrados en el trauma. Recuperado de https://dianova.es/wp-content/uploads/2023/05/INFONOVA-40-3.pdf
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FEDEAFES. (2017). Investigación sobre violencia contra las mujeres con enfermedad mental. Informe de resultados.
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