Reproductive justice–driven pregnancy interventions can improve mental health

(Press-News.org) March 10, 2025 — Perinatal interventions guided by reproductive justice principles can have positive effects on the perinatal mental health of Black birthing patients and, perhaps, the mental health development of their infants, states a systematic review published in a special issue of Harvard Review of Psychiatry, part of the Lippincott portfolio from Wolters Kluwer.

Mental health interventions incorporating reproductive justice principles "utilize a trauma-informed approach to address the psychosocial stress and trauma of racism and their negative effects on pregnant parents and offspring," Cristiane S. Duarte, PhD, MPH, of Columbia University Irving Medical Center (CUIMC) and New York State Psychiatric Institute in New York City, and colleagues explain. "They link the health of pregnant parents to the upstream structural determinant of racism and attempt to combat its negative effects on both physical and mental health by giving agency back to Black birthing communities."

High-level evidence-quantified intervention outcomes in multiple settings

Dr. Duarte’s team identified 12 randomized controlled trials of interventions explicitly designed to address reproductive justice or increase autonomy, community input, racial equity, and/or the cultural relevance of perinatal care for Black birthing people and their infants. The interventions were initiated during pregnancy or delivery and occurred in hospitals, prenatal clinics, and birthing centers, as well as during home visits. The trials measured maternal and/or infant mental health outcomes or developmental processes relevant to mental health.

Five studies employed interpersonal psychotherapy (IPT) or culturally tailored cognitive-behavioral therapy (CBT), two focused on group prenatal care, and four investigated culturally tailored home visiting programs with local community health workers or doulas. Ten studies measured maternal mental health, one included both infant mental development and maternal mental health outcomes, and one focused on infant mental development.

Positive mental health effects observed in a variety of outcomes

Seven studies had statistically significant positive results. Six found improvement in maternal mental health outcomes: reduction in ante/postpartum depressive symptoms (five studies), antepartum anxiety, and antepartum stress, and increase in postpartum adjustment. The other study identified a significant effect on infant mental health with REACH-Futures (Resources, Education, and Care in the Home by Black community health workers). One of the studies without significant findings was a pilot trial that did not evaluate for statistical significance.

"Effective intervention types included psychologically oriented modalities (IPT, culturally tailored/culturally sensitive CBT, CBT integrated into home visits), group prenatal care integrated with skill-building sessions (CenteringPregnancy Plus), and an educational intervention based on an interactive online platform (Birthly)," reports Simone Dreux, a CUIMC medical student and one of the article’s lead authors. "Of note, most effective interventions were specifically geared toward birthing people deemed at risk for developing mental health conditions—including antepartum and postpartum depression, and antepartum anxiety—as well as those with a previous history of mental health conditions."

Eight studies recruited predominantly low-income participants. Four of them found significant benefits for maternal mental health, and one study (REACH-Futures) found a significant benefit for infant mental development. "This finding is notable because low-income Black birthing people are at even higher risk of developing perinatal mental health conditions than low-income people of other races," the authors point out.

In their discussion, Dr. Duarte’s team suggests potential mechanisms related to their results: Engaging racially concordant community health workers “may increase social belonging, reduce isolation, and improve the emotional experience of pregnancy.” Culturally relevant, psychologically oriented interventions may improve mental health by focusing on “communication skills, goal setting, and problem-solving.” Additionally, group care affirms and respects the autonomy of birthing patients by allowing them to “take ownership of their prenatal care.”

Read Article: Reproductive Justice Interventions in Pregnancy: Moving Toward Improving Black Maternal Perinatal and Intergenerational Mental Health Outcomes

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