Bridging the Gap: Why Culturally Responsive Care Matters in Postpartum Recovery

By Yaranil Ferrer, LCSW, PMH-C

Identification rates of perinatal mental health conditions have seen a twofold increase over the past few years. While increased or improved screening may account for the numbers, systemic stressors may also play a role. For BIPOC communities, the data is alarming; although rates of diagnosis have increased, the BIPOC community continues to lack adequate screening, with research suggesting that women of color are often less likely to receive equitable screening and, even when symptoms are present, they are less likely to have those symptoms recognized by providers, and thus receive a diagnosis and care, despite being at increased risk for perinatal mood and anxiety disorders.

Cross-cultural screening presents fundamental issues; assessment tools are often not culturally sensitive, and when they are, clinicians might not have the information available to them. Symptomology, language, and norms all affect how individuals express themselves, and without an understanding of the cultural nuances, symptoms, treatment, and recommendations may fall short. For example, individuals from different backgrounds might describe their symptoms of depression using physical complaints such as fatigue or headaches, rather than openly expressing sadness, which could be misunderstood or overlooked by providers unfamiliar with these cultural expressions. This is why culturally responsive care is essential in postpartum recovery, not optional. We must equip ourselves to competently respond to the unique challenges BIPOC families face during the perinatal period, and we must do so with humility.

Systemic Barriers in Postpartum Care

Systems aren’t built for nuance. Women aren’t always offered services in their preferred language; trauma-informed care is often lacking, and biases go unchecked. Because systems do not take history or context into account, they often apply blanket treatment approaches that can unevenly affect families of color. Lack of trust in systems already exists and statistics on Black maternal mortality rates, for example, can confirm the need for caution. A lack of follow-up care, inadequate referrals for families of color, and implicit biases can amplify distrust. 

System-Level Interventions for Equity

To address these systemic barriers, system-level interventions are needed. Healthcare leaders and providers can advocate for the adoption of comprehensive language access, ensuring qualified interpreters and translated materials are available at every point of care. Implementing routine, required anti-bias and anti-racism training for all staff can help promote equity and awareness across teams and create a work culture that values equity. Regularly reviewing provider outcomes and patient feedback can help identify and address patterns of inequitable care. By advocating for these changes in their organizations, providers help shift the system toward truly responsive and equitable care.

Culturally Responsive Care In Action

Culturally responsive care is defined as care that is adaptable and aware of cultural identity and context, including language, values, and familial and community considerations. It is more than awareness of cultural differences and requires providers to change their approach, communication, and interventions to meet the needs of the person sitting across from them. To begin implementing culturally responsive care, providers can start by taking a few initial steps: first, actively seek out training on cultural humility and cross-cultural care to build foundational understanding; second, prioritize using qualified interpreters and providing written materials in a family’s preferred language; and third, ask open-ended questions during appointments to better understand each family’s beliefs, practices, and needs. These are just a few practical ways in which providers can act now and move toward culturally responsive care. 

Adaptation in practice can mean using qualified interpreters during appointments if a family prefers communicating in a language other than English, providing written materials in their primary language, or adjusting communication style to ensure understanding and build trust. It may also involve collaborating with other providers, inviting family members or support people in the care conversation as appropriate, and modifying appointment schedules to observe cultural or religious traditions. This is especially important in maternity care because provider treatment and sensitivity can directly affect whether symptoms are reported, needs are expressed, and care is trusted and thus utilized. Culturally responsive care is active, requiring healthcare professionals not only to identify needs but also to practice due diligence and take action to meet those needs.

Practicing Curiosity and Cultural Humility

Curiosity and genuine interest are required in order to adequately practice culturally responsive care. To meet families where they are and practice said care, healthcare providers and birth workers will want to understand perceptions of mental health, expectations of self and others, how people seek help and support, and what supports are available to them. It is also important to understand an individual’s expectations and norms around postpartum recovery, such as whether they practice cuarentenas, confinement, or other practices. When such practices are dismissed or pathologized, we run the risk of pathologizing a potential protective factor, one that may bring families together during a sacred time while prioritizing the care of the birthing person. In addition, dismissing traditional practices may lead to distrust, further disengagement from care, and discourage help-seeking behaviors. In all, it may exacerbate risk factors while fostering distrust, leading those same risk factors to be withheld from the very people who can help address them.  

Patient-Centered Care Within Cultural Context

Equally, it is important to mention that just because someone identifies with a given culture or background does not mean they want to take part in these practices. Instead, we look at everyone within their own context and can truly practice patient-centered care by deferring to the individuals and families as the experts. Boundaries should be respected, and beliefs and perspectives on mental health, what it means to seek support from a professional, how much is shared, and historical backgrounds all need to be considered when supporting families.

Addressing Bias and Power Dynamics

BIPOC families face overlapping barriers when trying to access mental health support. Cultural humility necessitates acknowledging our inherent biases and knowledge gaps; it requires self-reflection and curiosity. Additionally, cultural humility calls for accepting and actively addressing power imbalances, which requires deep reflection and careful observation of patient-provider interactions in the room while holding oneself accountable. To do so, providers should ask open-ended questions rather than simply checking boxes; we need to allow for inquiry, nuance, and conversation rather than one-directional communication that further widens power differences. In doing so, we need to validate the experiences of the families we are helping. Listening and turning the volume of our assumptions down will be necessary. You can do this by asking yourself, “How might my own cultural background and experiences influence my perceptions of this family?” “What assumptions am I bringing into this interaction, and how could they affect the care I provide?” and “Have I created space for the family’s voice and preferences to guide care decisions?” Acknowledging our own biases is a required, ongoing practice for building trust and providing equitable and humane care.

Culturally Grounded Screening and Assessment

The need for culturally grounded screening tools and interventions cannot be understated. Blanket treatments or screenings are a disservice to BIPOC individuals and families. When utilizing screening tools, language, traditions, and norms need to be considered, and the tools adapted to capture the full scope of the families’ experience in the office. For example, the Edinburgh Postnatal Depression Scale (EPDS) has been translated and culturally validated in multiple languages, yet its sensitivity and specificity can vary across populations, so providers should select appropriate versions and consider culturally informed interpretation guidelines. Seeking out culturally validated tools and reviewing the latest research when choosing screening instruments helps ensure more accurate and meaningful assessment. To better adapt and interpret these tools for diverse families, providers can consult relevant cultural adaptation research, seek input from cultural experts or community leaders, and, where possible, observe how clients respond to certain questions to identify possible cultural differences in symptom expression. Additionally, using open-ended follow-up questions alongside standard screenings can help clarify responses that may be influenced by cultural factors. 

Take Action

Culturally responsive care is an act of respect, justice, and healing. It is not optional, and it is essential to equitable postpartum care. Ongoing examination of biases and self-reflection are necessary, but it does not stop there; action is required. You can choose to take action by connecting with BIPOC providers, having a diverse pool of referral sources, asking open-ended questions, using culturally validated tools and acknowledging your own discomfort as you self-reflect. These are just a few actions providers can start taking now. Information gathering is not enough, and families suffer when we are not proactive.

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Explore these PSI Resources:   

Resources for BIPOC Families
Postpartum Planning Class
Resources for Professionals
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