Disability, Pregnancy, and Maternal Mental Health Fact Sheet
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Key Facts: Maternal Mental Health (MMH) Conditions
1 in 5 Mothers Are Impacted by Mental Health Conditions
Maternal mental health (MMH) conditions are the MOST COMMON complication of pregnancy and birth, affecting 800,000 families each year in the U.S. [1,2]
Mental Health Conditions Are the Leading Cause of Maternal Deaths
Suicide and overdose are the LEADING CAUSE of death for women in the first year following pregnancy. [3]
Most Women Are Untreated, Increasing Risk of Negative Impacts
75% of women impacted by maternal mental health conditions REMAIN UNTREATED, increasing the risk of long-term negative impacts on mothers, babies, and families. [4]
$14 Billion: The Cost of Untreated Maternal Mental Health Conditions
The cost of not treating MMH conditions is $32,000 per mother-infant pair, or $14 BILLION each year in the U.S. [20]
Certain Individuals are at Increased Risk for Experiencing MMH Conditions
High-risk groups include people of color, those impacted by poverty, people with disabilities, military service members, and military spouses. [22,23,24]
It's Not Just Postpartum Depression: There are a Range of MMH Conditions
MMH conditions can occur during pregnancy and up to one year following pregnancy and include depression, anxiety disorders, obsessive-compulsive disorder, post-traumatic stress disorder, bipolar illness, psychosis, and substance use disorders. [21]
Learn More about Maternal Mental Health Conditions
Learn more about maternal mental health conditions with our Maternal Mental Health Fact Sheet.
Key Facts: Disability, Pregnancy, and Maternal Mental Health
Approximately 20% of individuals who give birth in the United States identify as having a disability [5], and approximately 1 in 8 births are to women with disabilities. [6]
Women with disabilities are twice as likely to experience MMH conditions as compared to women without a disability. [7]
Women with disabilities face challenges accessing health care before, during, and following pregnancy, potentially exacerbating risk of pregnancy complications and maternal morbidity, including MMH conditions. [8]
Women with disabilities are more likely to be individuals of color and more likely to live in poverty, increasing their risk for experiencing MMH conditions and increasing challenges in accessing appropriate mental health care. [9]
One of the most frequent concerns raised by women with disabilities is a lack of health care professional knowledge and awareness about how their disability could affect their pregnancy and how pregnancy might affect disability-related symptoms, progression, and other concerns. Likewise, health care professionals report a lack of training and insufficient resources related to disability. [6]
Types of Disabilities
Approximately 60 million Americans, or 25% of the U.S. population, have a disability. This chart shows how individuals with disabilities self-identify. Individuals can have more than one disability. [8]
Sensory Disabilities
Affect hearing and vision.
Intellectual and Developmental Disabilities
Affect cognitive and adaptive functioning (e.g. Down syndrome, autism spectrum disorder).
Physical Disabilities
Affect mobility, flexibility, dexterity (e.g. cerebral palsy, spinal cord injuries).
Factors Impacting Perinatal Healthcare for Women with Disabilities
Lack of Knowledge Among Clinicians
Many women with disabilities report that their clinicians were less knowledgeable about their specific disability than they would have preferred, offered inaccurate information, and expressed negative stereotypes about people with disabilities. This negativity may be stressful and exacerbate MMH conditions. [10]
Non-Medically Necessary C-Sections
When caring for women with disabilities, providers are more likely to elect a cesarean procedure when not medically necessary. Provider assumptions and lack of knowledge contribute to barriers that disrupt and delay maternity care for disabled persons. [10]
Inaccurate and Negative Perceptions
The perception that disabled persons are not sexually active, do not desire creating a family, or are not capable of parenting has led to limited access to sexual and reproductive health services for persons with disabilities. [10]
Medical and Social Challenges
Women with disabilities face both medical factors (such as a higher incidence of chronic disease) as well as social factors (including barriers to employment, education, stable housing, and access to health care), which can increase risk of negative pregnancy outcomes, including MMH conditions. [8]
Inaccessible Screening Tools
Validated screening tools for MMH conditions (e.g. Edinburgh Postnatal Depression Scale, Patient Health Questionnaire) may not be accessible to women with disabilities due to disparities in English literacy, health literacy, or cognitive limitations. [11]
Lack of Information on What to Expect
Lack of information about the effects of different disabilities on pregnancy and postpartum adds to the challenges women with disabilities face. [18]
Fear of Child Protective Services
Parents with disabilities and their families are frequently and often unnecessarily forced into the child welfare system, and once involved, they lose their children at disproportionately high rates. [19]
Challenges Women with Disabilities Experience
Women with Physical Disabilities
Encounter medical offices with inaccessible equipment, including exam tables, weight scales, bathrooms, and hospital beds. [12]
Face challenges in breastfeeding, such as difficulties with milk supply, latching, limited information, lack of support, and disability-related health conditions, which can impact a new mother’s mental health. [13]
Visually Impaired Women
Can experience more difficult mother–infant interactions due to the lack of eye contact, gestures, postures, and facial expressions. [14]
Lack of positive feedback from the baby can impact a new mother’s mental health. [14]
Women with Intellectual and Developmental Disabilities (IDD)
Receive less emotional or social support during their pregnancies and are less likely to have the robust friend networks that can facilitate good pregnancy outcomes. [15]
Face barriers which include lack of educational materials and resources geared toward the learning and cognitive needs of women with IDD. [15]
Deaf and Hard of Hearing (DHH) Women
Often experience communication breakdowns, lack of accommodations (e.g. communication supports such as interpreters), and inadequate provider training. [16]
Strategies for Improving Perinatal Healthcare for Women with Disabilities
Educate health care professionals to recognize inherent biases in the delivery of care for disabled people and educate on culturally responsive health care.
Create services informed by cultural humility and responsive care.
Provide disability and empathy training to clinical and office staff.
Address environmental needs to ensure spaces, equipment, educational materials, and resources are accessible for people with disabilities.
Create and implement a screening follow-up system including referral to an appropriate local behavioral health provider and initiation of medical therapy. [17]
Ensure that appropriate disability related services and social services are in place to provide support throughout transitions after delivery and after the final postpartum visit.
Screen routinely for MMH conditions with screening tools tailored for persons with disabilities.
Conduct additional research on perinatal mental illness amongst women with disabilities.
Learn More about Disability and Pregnancy
The National Center for Disability and Pregnancy at Brandeis University is devoted to understanding pregnancy experiences, perinatal risks, complications, and outcomes in people with disabilities through population base research.
What to Expect includes tips for women with physical disabilities about how to navigate pregnancy and the postpartum period, including practical ideas for preparing for life with a baby.
The Accessible Care Pregnancy Clinic at Sunnybrook Health Sciences Centre in Toronto, Canada is a specialized clinic that provides prenatal care for women, trans, and non-binary people with physical disabilities.
Through The Looking Glass provides home-based services to families when a child or parent has a disability, medical, or developmental issue.
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Editorial Team
This Fact Sheet was prepared by MMHLA's Graduate School Intern, Niaja J.E. Nolan, MPH, with input and assistance from Hilary Brown, PhD, University of Toronto, and Joanne Nicholson, PhD, Brandeis University. It was funded by grants from the California Health Care Foundation and the W.K. Kellogg Foundation.
Citations
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Mitra, M., Long-Bellil, L. M., Iezzoni, L. I., Smeltzer, S. C., & Smith, L. D. (2016, July). Pregnancy among women with physical disabilities: Unmet needs and recommendations on navigating pregnancy. Disability and health journal. Retrieved April 18, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4903955/.
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