(PS13-A19) Adversity and Postpartum Health Experiences: The Role of Race-related Discrimination

Background: 1 in 8 women will experience postpartum depression (PPD) per year in the U.S. (Bauman et al., 2018). Rates of PPD are influenced by adverse life experiences and sociodemographic factors, such as race, ethnicity and income (Guintivano et al., 2018). Early recognition of PPD is essential to reduce its long-term impact on mothers and their children, but postpartum visits are highly underutilized by new mothers (Danilack et al., 2019). Race-related discrimination may be one important mechanism for this relation as it reduces a women’s comfort when utilizing health care (Tully et al., 2017; Wouk et al., 2021). This study examined how adverse life experiences and race-related discrimination predicted PPD and postpartum visit utilization. 

Methods: Data were drawn from the Pregnancy Risk Assessment System (PRAMS), a population-based survey coordinated by the CDC, utilizing data from the 9 states that included race-related discrimination questions. Mothers endorsed the total number of adverse life experiences prior to birth, whether or not they experienced race-related discrimination prior to birth, if they utilized a postpartum visit, and whether or not they experienced PPD (N = 15,597). Sociodemographic characteristics (e.g., education, urban/rural status, marital status, insurance), prior depression, and birth complications were included in analyses as covariates, and regression analyses with complex sample weighting were completed within each race or ethnicity.  

Results: Women of every race and ethnicity were significantly more likely to experience PPD if they reported a greater number of adverse life experiences (B(SE) range: .12 (.06) to.365 (.12)). Women of most races and ethnicities, except Other-Nonwhite and Hispanic, were significantly more likely to experience PPD if they reported experiencing race-related discrimination (B(SE) range: .69 (.27) to 2.08 (.42)). White Non-Hispanic (B(SE) = -.09 (.02)), Black (B(SE)  = -.09 (.02)), and Hispanic (B(SE) = -.15 (.04)) women were less likely to utilize a postpartum visit if they reported a greater number of stressors. Black women (B(SE) = -.37 (.13)) were significantly less likely to utilize a postpartum visit if they had experienced race-related discrimination.

Conclusions: Our findings align with emerging research highlighting the negative influence race-related discrimination can have on perinatal health outcomes (Alhusen et al., 2016; Crawford et al., 2022; Guintivano et al., 2018), and support recent calls advocating for race-related discrimination to become a standard question in the PRAMs survey (Almeida et al., 2021). Many women reported that discrimination did not deter them from utilizing a postpartum visit - this is important as postpartum visits can be an initial intervention provided to women experiencing PPD (Tully et al., 2017). Black women were the only subsample of women where experiencing both adverse life experiences and race-related discrimination was associated with both increased risk of PPD and reduced utilization of postpartum visits. Overall, the findings suggest multiple barriers to intervention for postpartum women and highlight the importance of equitable, antiracist, trauma-informed healthcare.