Perinatal Mental Health in Alabama: The Struggle You Can’t See

By: L.B. Brown, LICSW, CFSW, PMH-C

When someone says “healthy pregnancy”, they’re usually referring to the things we can measure: blood pressure, weight, the baby’s heartbeat. A mother’s mental health is much harder to see. She can look fine, say she’s fine, and still be holding something too heavy for her pregnant self to be carrying. Therein lies the heart of Alabama’s maternal mental health challenge: Maternal mental health is invisible, rarely announcing itself. Many moms don’t bring things related to mood, worry, and substance use up for fear of being judged or about what might happen if they’re honest. Many believe that feeling anxious, low, or overwhelmed is just part of being a mother, and that everyone else is just handling it better. Many may not realize what they’re feeling has a name, or that help exists.

Others simply can’t get to help. Across Alabama, many mothers live in rural communities where the nearest care is a long drive away, and where mental health or substance use providers may be even further out. Add to that the dynamics of work responsibilities, transportation accessibility, other children, and the cost of care. Now think about that mom—she wants support, but she’s struggling to find it, let alone access it.

Timing plays a part too. So much attention goes to the pregnancy and the birth, but the months afterward matter just as much. Postpartum depression and anxiety are the most common maternal mental health disorders after childbirth, affecting roughly 1 in 5 birthing individuals. And they don’t always appear right away! According to the CDC, nearly 3 in 5 women who reported postpartum depressive symptoms at 9 to 10 months had not reported them at months 2 through 6. A mom who seems fine early on may be struggling later: hence why consistently screening for depression and other behavioral health disorders throughout the first postpartum year matters. It can identify women who weren’t symptomatic in the early weeks but go on to develop symptoms.

The data in Alabama backs this up:

• In 2022, the state’s Maternal Mortality Review Committee found that substance use disorders were a key contributor in almost half of all maternal deaths; and
• In a published review of 2020–2021 deaths, 78% of pregnancy-related deaths were determined to be preventable. 

What helps is a simple, human thing: someone asks, the mom feels safe enough to answer honestly, and she’s connected to real support. That moment can happen in an exam room, a community center, or a church hallway—anywhere a trusted person knows how to have the conversation.

That’s the idea behind Every Step, a statewide maternal behavioral health initiative through a collaboration with the Alabama Department of Public Health, Alabama Department of Mental Health, and VitAL. We work with OB/GYNs, community health networks, maternal health providers, and community organizations to make sure the people who see Alabama’s mothers every day are prepared to notice, ask, and connect them to help.

Understanding the problem is the first step. Once we see it, we can do something about it.