Black mothers bear heaviest burden of postpartum depression

Carmen Knight Myles did not recognize herself after her son was born. The Houston social innovator and digital creator, already adjusting to new motherhood alone in a new city during the height of the COVID-19 pandemic, found herself staring at a closet full of clothes that no longer fit a body, or a self she no longer recognized.

“I was really struggling with figuring out who this new person was. I felt like I didn’t know myself,” said Myles, founder of Mama Khronicles and a certified postpartum doula. “But I did not know how to explain that to anyone.”

Her silence was not weakness. For Black mothers in Houston and across the country, that silence is a symptom of cultural stigma, systemic neglect, and a health care system that has long failed to see them fully.

Postpartum depression is the most common complication of childbirth, affecting approximately one in eight women in the United States, according to the Centers for Disease Control and Prevention. Yet close to 60% never receive treatment. Research from the Maternal Mental Health Leadership Alliance and the Icahn School of Medicine at Mount Sinai states that Black women are twice as likely as white women to experience postpartum mental health conditions, and half as likely to receive care.

In Harris County, the crisis is not a statistical abstraction. Public health data show the county’s Black maternal mortality rate reached 83.4 pregnancy-related deaths per 100,000 live births between 2016 and 2020, a figure that has drawn national attention and placed Houston at the center of an urgent and long-overdue conversation.

What is postpartum depression? 

Postpartum depression is a moderate-to-severe mood disorder that can occur immediately following delivery or up to a year after giving birth. Its symptoms extend far beyond sadness and can include persistent irritability, withdrawal from family, obsessive anxiety, difficulty bonding with a newborn, and in serious cases, suicidal ideation.

Dawnestel Fodeibou, an international board-certified lactation consultant and a certified public health professional with the Harris County Public Health Maternal and Child Health Program, has spent 12 and a half years working at the intersection of infant feeding and maternal well-being. She knows that postpartum depression does not always announce itself clearly, and that for Black mothers, it rarely looks the way popular culture suggests.

“It can show up in a lot of different ways. Sometimes it’s detachment. Sometimes it’s obsessive behaviors,” Fodeibou said. “We’re looking at body language, the willingness to participate in the care of oneself and in the care of the baby. It’s not so much the presence of stress. It’s how it’s being managed.”

Fodeibou personally experienced a late pregnancy loss and a premature delivery during her first year in the field. She described how her own grief deepened her resolve and her clinical sensitivity. She recalls preparing to return to work after losing her son and wrestling with whether she could face new mothers while managing her own grief. Her faith, her family, and a determination to prevent other mothers from suffering alone carried her forward.

The weight of the cape 

Carleigh Joseph-Olivas entered this space almost by accident. A licensed clinical social worker, doula, and mental health therapist specializing in mothers in recovery, she describes herself as having been called to perinatal work since childhood. The recovery space, however, found her.

What she sees in her practice confirms that the “strong Black woman” trope is a clinical obstacle.

“We are strong, we are Black women, we can overcome anything. We handle the hard things,” Joseph-Olivas said. “And we often handle them alone. It’s almost like a badge of honor to wear the superhero cape all the time. And then postpartum, I am like, take it off. Take it off.”

She teaches her clients about postpartum care traditions from other cultures, in particular the first 40 days observed in several countries across Africa and Asia, during which a new mother’s feet are not expected to touch the ground. Meals are prepared, the baby is held, and the mother is restored in body and spirit. 

“It blows their minds,” Joseph-Olivas said. “They’re like, well, that is not what it is here. I got six weeks to get it together, and I have to go back to work. Because if I don’t pay these bills, who else is going to pay them?”

A 2024 Health Affairs study found that even after controlling for clinical factors, Black women consistently faced disparities in diagnosis and treatment access for perinatal mood disorders. 

Joseph-Olivas urged families and community members to recognize the red flags that do not look like sadness. Neglected hygiene. A mother consumed by guilt for taking an hour to get her hair done. A woman who sits among loved ones and still feels nothing. 

“Sometimes we ignore the void,” she said. “She’s not crying, so there’s no postpartum depression there. But sometimes it’s just like I don’t feel anything. So let’s pay attention to the wide range of signs that come.”

When there is no village

Myles, now nine months postpartum with her second child, launched a maternity support group called Mama Khronicles. She had begun sharing her struggles on Instagram stories, the breast engorgement from a long commute back to work, the tears she could not explain to friends who did not yet have children. 

She organized a meetup. Four mothers at a park, no agenda, just conversation. From that gathering grew a community of meetups, virtual events, and play dates. She became a certified postpartum doula because her community kept asking questions she did not yet have the answers to.

Today, Mama Khronicles fills a gap the health care system leaves wide open.

“Community is important because motherhood is very isolating,” Myles said. “And just by having other women to talk to who live in the same timeline as you, it makes so much of a difference.”

Houston-based resources 

On the clinical and policy side, Fodeibou is doing the same work in a different way. As part of the Harris County Public Health Maternal and Child Health Program, which includes the Healthy Start and ACCESS Harris County initiatives, she provides free lactation consultations, conducts home visits, and trains colleagues across disciplines to recognize the signs of postpartum mental health challenges.

“When we do notice the signs, we can support that mother, but also get her connected to the appropriate services,” Fodeibou said. “We actually connect them and walk them through those connections and resources.”

The program maintains partnerships with the American Heart Association for blood pressure monitoring, counselors and therapists who serve entire families, and community health educators embedded in the neighborhoods where Houston’s Black mothers live, all at no charge to enrolled families.

Joseph-Olivas leads a nonprofit doula organization, Delighted to Doula, that provides free postpartum follow-up care for up to eight weeks to families who cannot afford private services. She also serves as a contracted therapist through the organization. She frequently informs mothers about Postpartum Support International, a resource she says many physicians have never heard of.

Postpartum Support International operates free virtual support groups that meet multiple times per week, organized by identity, circumstance, and lived experience, including groups specifically for Black mothers, as well as a 24/7 hotline and text line, where someone answers within 30 seconds.

“So much of life is done alone,” Joseph-Olivas said. “And we don’t have to.”

BY THE NUMBERS

1 in 8 women experience postpartum depression

 ~60% of women with PPD never receive treatment 

2x more likely Black women vs. white women to experience postpartum mental health conditions 

50% less likely Black women to receive treatment compared to white women