Black Maternal Health

May is Mental Health Awareness Month and for this newsletter, we would like to highlight the importance of promoting maternal mental health for nicotine cessation. According to recent data from the Pregnancy Risk Assessment Monitoring System, about 50% of women who smoked cigarettes prior to pregnancy continued to smoke during pregnancy.¹ Additionally, an estimated 1 in 10 pregnant women smoke during the last trimester of pregnancy.² An important context to consider is that many people who are pregnant or new parents experience stressors and mental health complications, including depression, anxiety, and trauma that may contribute to unhealthy coping, including nicotine use.³ Parents with lower economic resources, and who were also depressed, are at increased risk for smoking during pregnancy and have a lower likelihood of quitting.¹ For mothers and parents who experience emotional and psychological challenges and are trying to quit nicotine without adequate support and resources, the consequences can potentially impact the entire family.

Those of us who work in nicotine treatment understand that the desire to quit does not always translate into immediate behavioral modification. As a psychologist who works in maternal mental health, I advocate that all moms and birthing people have access to individual or group therapy, medication as needed, peer support, and other mental health resources. There are so many life circumstances that make pregnancy and early parenting challenging and there is a need for adequate emotional support. However, mental health resources are not adequate for changing the landscape of maternal mental health, especially as it relates to nicotine treatment.

Support for new parents who have mental health complications or diagnoses and who are also trying to stop using nicotine products requires the use of a systemic approach. In addition to offering nicotine education and mental health resources, it is important for us to understand the unique basic needs of each person we treat. Where there is a lack of basic necessities (e.g., food, housing, finances), an effort must be made to meet these needs. Where there are challenges with life stressors, we must work to help parents find solutions that work for them. These considerations are essential to sustain nicotine cessation initiatives. So, our charge this month is to expand our conceptualization of effective, long-term nicotine treatment interventions, to include, but not be limited to mental health resources and support when needed.

References:

1. Allen, A. M., Jung, A. M., Lemieux, A., Alexander, A. C., Allen, S. S., Ward, K. D., & Al’Absi, M. (2019). Stressful life events are associated with perinatal cigarette smoking. Preventive Medicine, 118, 264–271. https://doi.org/10.1016/j.ypmed.2018.11.012
2. Tong, V. T., Farr, S. L., Bombard, J. M., DʼAngelo, D., Ko, J. Y., & England, L. J. (2016). Smoking Before and During Pregnancy Among Women Reporting Depression or Anxiety. Obstetrics & Gynecology, 128(3), 562–570. https://doi.org/10.1097/aog.0000000000001595
3. Jones, A. R., Carter-Harris, L., Stiffler, D., Macy, J. T., Staten, L. K., & Shieh, C. (2020b). Smoking Status and Symptoms of Depression During and After Pregnancy Among Low-Income Women. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 49(4), 361–372. https://doi.org/10.1016/j.jogn.2020.05.006

Black Maternal Health Week is April 11-17, 2023, and this this year’s theme is “Our Bodies Belong to Us: Restoring Black Autonomy and Joy.” The ability of Black moms and birthing people to make decisions about our bodies and our health is essential to how we manage all health behaviors and achieve overall wellness. With rising rates of maternal and infant mortality in the Black community, including in Ohio, there is a need to create systems of care that center Mamas’ autonomy and the right to choose care options that align with their cultural beliefs and practices.

The Black Mamas Matter Alliance highlights culturally congruent practices, including access to Black midwifery and Black-led doula care as primary needs for Black mamas and birthing people. Black midwifery and Black-led doulas center Black mothers and babies. By design, they have an inherent understanding of Black bodies and our cultural contexts, they focus on non-medicalized births when possible, and they create environments of active listening and attending to mothers’ needs during pregnancy, birth, and early parenting.

The latter tenet of care translates to other forms health promotion, including nicotine cessation. It suggests the use of comprehensive, culturally congruent models of care that consider a person’s whole life experience.  If for example, a person’s basic needs are unmet, quitting smoking or vaping will be difficult especially if stress is a trigger for use. For Black mamas and parents who are also managing racism- or other trauma-related stressors, but do not have adequate support or resources, quitting will be challenging. Whatever the factors that impact a parent’s ability to quit nicotine must be addressed if they are going to be successful at quitting. As such, we must listen to Black moms and birthing people and respond accordingly.

As providers, we have a wealth of knowledge in regard to our respective disciplines. Many of us have licenses, certifications, and advanced training in our fields. Despite the knowledge we have about health behavior, risks, benefits, and the most effective treatment options, Black women and birthing people are the experts on our bodies and lived experience. As care providers we need to honor that, understand that, and prioritize care that is centered on that. Our bodies belong to us, and we will care for them based on our values, beliefs, and the knowledge we acquire from our providers in making informed decisions.

As you ponder changes you will make in your practice to re-empower Black moms and birthing people to practice autonomy with their health decisions, consider supporting and uplifting Black-owned and led organizations in our community that support birth equity, reproductive justice, and maternal mental health awareness for Black moms and birthing people. The organizations listed below are both local and national organizations that focus on Black maternal health. Support them.

Resources:

https://www.roottrj.org/

https://mhaohio.org/poem-rise/

https://blackmamasmatter.org/2023-black-maternal-health-week/

https://www.shadesofblueproject.org/