When the Village Is Silent: Supporting South Asian Maternal Mental Health Across Cultures

By Raag Malhotra, Psychologist, PMH-C

There is a particular kind of exhaustion that comes not just from caring for a newborn, but from carrying the weight of everything you are not supposed to say. For many South Asian mothers, whether living in India, Pakistan, Bangladesh, Sri Lanka, or building a life far from home, that weight is real, and it accumulates quietly.

South Asian maternal mental health does not exist in a vacuum. It is shaped by what families say and what they leave unsaid, by the gap between the reverence that motherhood is given in South Asian culture and the support that actually shows up, and by a clinical system that was largely designed for someone else.

What the Research Actually Demonstrates

Perinatal mood and anxiety disorders are a group of conditions that includes postpartum depression, postpartum anxiety, and related experiences, and are among the most common complications of pregnancy and the postpartum period. They affect mothers regardless of culture, income, or how prepared they felt going in. However, the burden is not shared equally.

A 2026 systematic review based on 29 studies found that nearly one in three women in South Asian countries experience perinatal depression, with a pooled prevalence of 28%, ranging from 15% in Sri Lanka to 46% in Bangladesh (Morina et al., 2026). For South Asian mothers who have migrated to high-income countries like the US, UK, or Canada, the risk increases further. Across six studies reviewed by Nilaweera et al. (2014), South Asian immigrant mothers exhibited nearly twice the risk of clinically significant postpartum depression compared to women born in those countries, with odds ratios ranging from 1.8 to 2.5.

“Close to double: that is the increased risk of clinically significant postpartum depression facing South Asian immigrant mothers compared to their host-country-born counterparts (Nilaweera et al., 2014).”

Yet despite this elevated risk, these mothers are among the least likely to access professional mental health support. In one large study of Asian Americans with a diagnosed psychiatric disorder, only 23% of foreign-born individuals had used mental health services — compared to 41% of the general population (Fancher et al., 2010). The gap between need and care is not a matter of indifference. It is a matter of barriers that have never been adequately addressed.

The Silence Has a Shape

In many South Asian families, becoming a mother comes loaded with expectation. There is joy, yes, but also an unspoken script about how a good mother behaves, how much she gives, and how little she asks for in return. When a mother finds herself struggling, not coping, not bonding, not feeling the way she imagined she would, and the script does not leave room for that.

Well-meaning responses from family can inadvertently close off conversation: “We all went through this.” “Think of your baby.” “It will pass.” These phrases are usually spoken with love, and they land as dismissal. Research documents that fear of bringing shame to the family is one of the most commonly cited reasons South Asian mothers do not seek professional support, particularly in diaspora communities in the UK and US (Fancher et al., 2010).

There is another layer that clinical settings frequently miss. In South Asian populations, emotional distress is often expressed through the body, such as persistent headaches, fatigue, digestive problems, and back pain, rather than through the emotional language that Western screening tools are designed to detect. This is not avoidance or denial. It reflects a different, culturally grounded way of experiencing and communicating distress, documented consistently across research as somatisation (Fancher et al., 2010). When a provider does not recognise it, a mother in genuine need walks away undiagnosed.

Where the Clinical System Falls Short

Western perinatal mental health care has developed genuinely effective tools — validated screening instruments, evidence-based therapies, and pharmacological options with strong safety profiles. The problem is not the tools themselves. It is the assumptions embedded in how and to whom they are applied.

Most Western therapeutic frameworks are built around the individual: her feelings, her needs, her boundaries, her recovery. This sits awkwardly with South Asian cultural values that are fundamentally collectivist — where a person’s identity, decisions, and sense of well-being are inseparable from family and community. A mother who does not think of herself as a separate self navigating her own healing will not fit neatly into a model that asks her to. Researchers who study how South Asian patients explain and experience mental illness have found this mismatch to be a primary reason treatment either does not start or does not continue (Jain et al., 2025).

Structural barriers pile on top. Limited access to providers who speak relevant South Asian languages, the cost of private therapy, and a shortage of clinicians with any training in both perinatal mental health and cultural competence — for mothers already stretched thin, these are not small inconveniences. They are the difference between getting help and not.

When South Asian patients bring emotional distress to a primary care physician, it is often expressed through physical symptoms. Without recognition, it goes untreated — and the mother goes home with no support (Fancher et al., 2010).

What Families and Allies Can Actually Do

None of what follows requires a clinical background. It requires paying attention, staying in the room when things get uncomfortable, and being willing to say something different from what has always been said.

Stop minimising — even gently

The instinct to reassure is understandable. But “at least the baby is healthy” and “your mother did this with no help” both communicate that a mother’s distress is proportionate to how much she has to complain about, which it is not. When she shares something hard, the most useful response is not a reframe. It is staying with what she said. Acknowledging it. Asking what she needs, rather than telling her what to feel.

Reframe help-seeking as care — not weakness

In many South Asian traditions, the postpartum period already carries rituals of physical care, rest, specific foods, and protection from overwork. That logic exists. It just has not yet been extended to emotional health. Framing therapy or professional support as part of that same tradition of tending to a new mother rather than as an admission of failure changes the conversation. Research on intergenerational family approaches within South Asian communities suggests that bringing family members into the reframe, not just the mother, is what makes it stick (Attaran et al., 2023).

Show up in concrete ways

Social isolation is one of the strongest and most consistent predictors of postpartum mental health difficulties. For South Asian mothers in diaspora communities, that isolation is often acute; they are far from the extended family networks that in other circumstances would have surrounded them. Practical presence matters. Bringing food. Sitting with the baby for a few hours. Texting without expectation. Doing the small things that say: you are not invisible, and you are not alone.

A Note for Clinicians

Providers working with South Asian mothers carry particular responsibility here. When a clinician assumes a patient shares their values about family roles, independence, or what it means to ask for help, that assumption can end treatment before it begins. The research is direct on this point: providers’ lack of understanding of South Asian cultural values is one of the primary reasons patients disengage from care (Fancher et al., 2010).

Culturally responsive practice means asking, not assuming: about a mother’s family structure, her immigration experience, what feels acceptable to her community, and what resources actually feel accessible. It means recognising that family involvement in treatment is not a complication; for many South Asian mothers, it is a prerequisite. And it means treating the pursuit of cultural competence as an ongoing clinical obligation, not an optional add-on.

The Silence Can Change

Nothing about the silence surrounding South Asian maternal mental health is fixed. It is the product of specific conditions, such as cultural, clinical, and structural, and these conditions can change. But they rarely change because a mother finally found the courage to speak up alone. They change because the people around her stopped requiring that courage to be a prerequisite for support.

Families can have different conversations from the ones they inherited. Communities can build peer support that holds both cultural identity and emotional honesty at the same time. Providers can do the work of becoming genuinely useful to mothers whose lives do not map onto a Western template. And allies or whoever is reading this can start before they are asked.

South Asian maternal mental health is not a niche concern for a specialist audience. It is what happens when a mother is struggling, and no one around her has the language or the framework to see it. That is something any of us can begin to change.

References

Attaran, S., Bhugra, D., & Bhui, K. (2023). Time to address the mental health challenges of the South Asian diaspora. The Lancet Psychiatry, 10(6), 405–406. https://doi.org/10.1016/S2215-0366(23)00144-X

Fancher, T. L., Kravitz, R. L., & Fang, M. C. (2010). Mental health and stress among South Asians in the United States. National Institute on Minority Health and Health Disparities. https://pmc.ncbi.nlm.nih.gov/articles/PMC5643212/

Jain, R., Kakuma, R., Singla, D. R., Andresen, K., Bahkali, K., & Nadkarni, A. (2025). Explanatory models of common mental disorders among South Asians in high-income countries: A systematic review. Transcultural Psychiatry, 62(1), 45–62. https://doi.org/10.1177/13634615241296302

Morina, A., Chowdhury, N., Hossain, T., Singh, P., & Rahman, M. (2026). Prevalence and risk factors of perinatal depression among women in South Asian countries: A systematic review and meta-analysis. Journal of Affective Disorders, 371, 214–226. https://doi.org/10.1016/j.jad.2025.09.017

Nilaweera, I., Doran, F., & Fisher, J. (2014). Prevalence, nature and determinants of postpartum mental health problems among women who have migrated from South Asian to high-income countries: A systematic review of the evidence. Journal of Affective Disorders, 166, 213–226. https://doi.org/10.1016/j.jad.2014.05.011

About the Author

Raag Malhotra

Raag Malhotra is a PMH-C certified perinatal mental health therapist supporting mothers across two continents through therapy for clients in India and coaching for South Asian diaspora mothers in the United States. She is a PSI Alliance fellow and serves in multiple volunteer leadership roles with Postpartum Support International, including as a PSI California DEI chair and board member. As a South Asian mother with her own lived experience of perinatal illness, Raag brings both clinical depth and personal understanding to her work. She creates resources for mothers at @momsinnerjourney.

The views and opinions expressed in this blog are those of the author and do not necessarily reflect the official policy, position, or views of PSI, its leadership, employees, affiliates, or partners. Any content provided by the author is for informational purposes only and should not be construed as representing PSI’s official stance on any matter.

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