Abstract
Perinatal depression among impoverished mothers adds an enormous burden to their family responsibilities, which are often further stressed by living in high-crime communities. Thirty impoverished mothers of color living with depression were interviewed about the difficulties they face raising their children. Qualitative interviews about living with depression revealed four themes: recognizing their own depression, feeling isolated, experiencing violence, and living with depression. This article examines how neighborhood and relationship violence, intermittently involved fathers, and isolation contribute to the mothers’ depression. Social workers working with depressed, low-income mothers of color can benefit from understanding the mothers’ lived experience and the barriers the mothers face while trying to achieve well-being for themselves and their children. This study fits within the “Close the Health Gap” area of the Grand Challenges for Social Work.
Keywords
Each year in the United States, approximately four million women give birth (Centers for Disease Control and Prevention, 2017). Approximately 25% of these women will have postpartum depression (PPD; Gaynes et al., 2005); mothers of low income (Goyal, Gay, & Lee, 2010) and of color experience significantly higher rates than middle-class and White mothers (Centers for Disease Control and Prevention, 2008) and often face limited educational and employment opportunities, inadequate housing, and unsafe neighborhoods (Gress-Smith, Luecken, Lemery-Chalfant, & Howe, 2012). Despite elevated rates of PPD among impoverished mothers, few studies have focused specifically on their lived experience (Highet, Stevenson, Purtell, & Coo, 2014), leaving practitioners with little guidance to inform their practice with this population (Keefe, Brownstein-Evans, Lane, Carter, & Rouland Polmanteer, 2015). This article seeks to answer the question: how do new, low-income mothers of color living with perinatal depression view the effects of their neighborhoods and their relationships with their babies’ fathers on their depression? To answer this question, we analyzed qualitative interviews of 30 low-income mothers of color living with depression who receive services at a large, inner-city, federally qualified health center in upstate New York.
Literature Review
PPD, a subtype of major depressive disorder, affects many new mothers within one month following childbirth (American Psychiatric Association, 2013). Although perinatal mood disorders are extremely common after childbirth (Dennis, 2014), formal screening is not regularly conducted (Rouland Polmanteer, Keefe, & Brownstein-Evans, 2016) despite strong recommendations put forward by the American College of Obstetricians and Gynecologists (2016). Many affected women remain undiagnosed and thus go without effective treatment (U.S. Department of Public Health, Office on Women’s Health, 2012) and follow-up care (Mestad et al., 2016). In contrast to the symptoms of major depressive disorder, in which symptoms manifest within two weeks of the causative stressor (APA, 2013), symptoms of PPD can take up to one year to manifest (O’Hara & McCabe, 2013). As with other forms of major depression, PPD manifests in cognitive, affective, and somatic symptoms (APA, 2013). Cognitive symptoms include difficulties concentrating (Glavin, 2012) and fears of harming the baby (Sealy, Fraser, Simpson, Evans, & Hartford, 2009). Affective symptoms include heightened anxiety and decreased self-esteem (Glavin, 2012). Somatic symptoms include disturbed sleep (Glavin, 2012) and sexual dysfunction (Morof, Barrett, Peacock, Victor, & Manyonda, 2003).
Psychological factors associated with PPD include difficulty coping, feelings of incompetence (Logsdon, Eckert, Tomasulo, Beck, & Dennis, 2012), suicidality (Lucero, Beckstrand, Callister, & Sanchez-Birkhead, 2012), hopelessness (Sealy et al., 2009), and depression prior to or during pregnancy (CDC, 2008). Social factors include living in poverty and in unsafe neighborhoods (Schultz et al., 2006), lower levels of education, higher rates of unemployment (Fellenzer & Cibula, 2014), job-related stress (Grote & Bledsoe, 2007), having an unplanned pregnancy that is unplanned (Fellenzer & Cibula; 2014), and having a contentious or inconsistent relationship with the child’s father (Grote & Bledsoe, 2007).
Polmanteer, Keefe, and Brownstein-Evans (2018) argue that Womanism helps explain PPD among new mothers of color. Although having children provides women an opportunity to take on greater life responsibilities and opportunities (Freeman, 2017), new mothers also must face various oppressive economic, political, and educational systems that hinder them in fulfilling their roles (Abdullah, 2012) and that perpetuate PPD (Keefe, Brownstein-Evans, & Rouland Polmanteer, 2018).
The preponderance of research on PPD focuses largely on White women, who have access to services, are heterosexually coupled, live in middle-class neighborhoods, and have positive relationships with service providers (Keefe et al. 2015). Virtually no research has considered how structural discrimination, evidenced by neighborhood disorder and community-based violence, affects PPD among impoverished mothers of color.
Methodology and Procedures
Prior to data collection, two of the co-authors consulted with human-service professionals who work with impoverished mothers of color to develop the interview guide. The subsequent guide was reviewed with other longstanding health- and mental health–care professionals and 12 research assistants from diverse backgrounds, who provided additional feedback. Mock interviews were conducted with students and other colleagues, who provided further feedback. After receiving Institutional Review Board approval and grant funding, two of the authors posted leaflets around the agency inviting mothers who met the inclusion criteria to participate in the study. Study criteria included mothers’ being 18 years of age or older; self-identifying as Black/African American or Hispanic; parenting at least one child residing with them; and experiencing sadness, fatigue, or difficulty concentrating or sleeping during pregnancy or within the first year postpartum.
To assess current levels of PPD, participants completed the 10-item, self-administered Edinburgh Postnatal Depression Scale (EPDS; Cox, Holden, & Sagovsky, 1987). The EPDS asks the mother about her mood during the past seven days. Hartley, Barraso, Rey, Pettit, and Bagner (2014) concluded the scale to have acceptable internal reliability (alpha = .84 for both African American and Latina mothers)
The EPDS scores range from 0 to 30. A score of 12 or above indicates a strong likelihood of depression. The mean EPDS score for mothers in this study was 18.75, and the range of scores was from 14 to 29. The researchers then administered a semi-structured interview, which lasted between 60 and 95 minutes, was digitally recorded, and was transcribed verbatim. Each mother received a $20.00 gift card to a grocery store at the end of the interview. The researchers explained that the interviewee could stop the interview at any time and meet with her social worker at the agency if she wished. None of the mothers felt it was necessary to stop the interview or requested to meet with a staff member, and all reported feeling positively about the interview.
Sample
Thirty impoverished mothers of color participated in individual interviews, including 19 Black/African American and 11 biracial or Hispanic/Latina. Their ages ranged from 18 to 44 (mean = 28.60). They had between one and seven children (mean = 3.00), and 11 were currently pregnant.
Data Analysis
Qualitative analysis first consolidated participant narratives into conceptual units, which were then compared to each other and subsequently coded into similar categories (Walker & Myrick, 2006). Next, overarching categories and then themes were explored (Glaser, 1965). The researchers further explored individual responses to the interviews and between sections of the interviews (Corbin & Strauss, 1990) by looking for commonalities in descriptions of the mothers’ ongoing depression (Walker & Myrick, 2006); they then made comparisons between older and newer data to refine categories and themes. Further analytical discussions during research-team meetings helped refine the thematic coding within the categories.
Findings
Themes and Categories
The participants were forthright in their descriptions and understanding of their emotional struggles and were neither in denial nor uncomfortable during the interviews. The mothers’ descriptions of living with depression addressed four dominant categories: (1) recognizing their own depression; (2) feeling isolated, including the subcategories of (2a) intermittently involved babies’ fathers, (2b) limited support from family of origin, and (2c) limited support from friends or neighbors; (3) experiencing violence, including the subthemes of (3a) violence in relationships, (3b) intergenerational violence, and (3c) violence in the neighborhood; and (4) living with depression.
Although the mothers spoke of their depression as a burden, many spoke of depression as a normal part of motherhood. As stated by Rochelle, a 29-year-old African American mother of five, “. . . it’s like I’m going around this big old circle . . . it always remain the same.”
Recognizing my own depression
The mothers stated openly that they felt sad and worried. Roberta, a 32-year-old African American mother of four reported, “Every time I go through the history I cry . . . because I’ve been through a lot.” Sophia, a 27-year-old Latina mother of five, reported, “Every day is stressful. Every day I scream. I’m still overthinking a lot of things, and I blame myself for a lot.” Tabitha, a 34-year-old African American mother of six, echoed this point, saying, “All I do is cry, and all I do is stress. . . . I’m just stressed, and I just feel like . . . everything is just crumbling down.” Roberta summarized, “I live in depression sometimes . . . it’s a burden.” Alexia, a 19-year-old Latina mother of one, said, “[I]t was just like, I would not wanna be next to nobody. I’ve been having depression since I was younger.”
Findings from other studies are similar to our own. Robertson, Grace, Wallington, and Stewart (2004) conclude that tearfulness, hopelessness, anxiety, guilt, and fatigue are among the most frequently reported symptoms of the new mothers experiencing PPD they studied.
Feeling isolated
Nearly all the women spoke emotionally about their isolation and having no one to depend on. As Arissa, a biracial 31-year-old mother of four, said, “It’s how I be feeling all the time. Just wanna close everything out.” Yolanda, a 35-year-old African American mother of seven, shared, “It’s just . . . later on in the daytime when the doors close . . . it’s hard, like . . . at nighttime . . . where you all alone.” Gwenn, a 31-year-old African American mother of four, shared, “I was closed in. Sit in my house, pitch black dark, cry. . . . I didn’t want to go anywhere, I didn’t want to do anything.” Rhesa, a 36-year-old African American mother of three, poignantly stated, “I just wanna sit in a room, in . . . the furthest corner, and just sit there. I don’t wanna talk, I don’t wanna think, I just wanna exist.”
Hahn-Holbrook and Haselton (2017) also reported that isolation is a predictor of PPD, which clinicians need to address if they are to be effective working with mothers who have PPD.
Intermittently involved babies’ fathers
As a group, the mothers reported their babies’ fathers were unreliable. Roberta shared, “[It’s hard] when you have kids and . . . have a partner, but the partner is not going to support you.” Nadia, a 44-year-old Latina mother of two, similarly stated: “[W]hen I got pregnant, I was at a mindset . . . like, ‘Okay, well, we’re gonna have the perfect family and stuff. You’re [the baby’s father] gonna stay here, raise your child and stuff. You’re gonna help me.’ But neither [father] did that.” Rhesa recalled, [W]e found out that I was pregnant, and he goes, “Oh well, I’ve changed my mind.” And then he texts me and says, “Oh, we don’t love each other, so I don’t wanna have a baby with you.” Then he comes back and says that was mean . . . and he didn’t mean it.
Other mothers struggled to manage the varying priorities of their child’s father. Sophia reported that her baby’s father bought marijuana when the child needed diapers: He smokes weed . . . and I’m just like, “How high can you freaking get?” . . . [H]e’ll know we need a pack of Pampers, and he’ll have ten dollars, and instead of saying “Well, just let me get a ten-dollar pack of Pampers,” he’ll go get his weed.
Other fathers were described as coming and going as they pleased and offering no help to the mother and children. According to Tanisha, a 26-year-old African American mother of four, I’m not with either father. . . . [T]hey were there when my kids were first born. But . . . just their bodies were present. It wasn’t too much of helping, or too much of doing anything but what they wanted to do. So, it made it more stressful for me. . . . I’m just having a child by a guy I think that loves me, but doesn’t wanna give the dedication to this child he lay down and helped me make.
Tamika, a 23-year-old Latina mother of one, explained, I really did everything by myself, ’cause his father, he was there, but he wasn’t like a person that I could . . . count on to help me. . . . He’ll go out to parties, with other guys, and other girls, and so I had to deal with it on my own.
Similarly, Jezel, a 27-year-old African American mother of one, said she “was sad because the father, he was just in and out. I was sad.” In another case, Tonya, a 35-year-old African American mother of five, described how she began vomiting and asked the father, “‘Can you hold her?’ ’cause I was about to throw up. He’s like, ‘I’m trying to sleep’ and getting all mad.”
Some of the babies’ fathers were involved romantically with other women, including two fathers whose other partners were pregnant at the time of the interviews. These relationship dynamics contributed to stress and, in some cases, violence in the relationship. Gloria, a 27-year-old biracial mother of three, explained, “Me and him fought a lot at that time too, because he had another girl that was pregnant at the same time as me. And, it was just drama all the time.” Tamika shared that [h]e would leave . . . be with other girls, and then come back. And then when [the child] ended up in the hospital for the . . . second, third time, the other girl that he was messing with was pregnant and lost her baby. And that got me more depressed, ’cause that’s how I knew he was having other kids behind my back while his son was in the hospital.
Unfortunately, for many of the mothers the intermittent involvement of their children’s fathers, particularly within the context of violence in the relationship, contributed to feelings of anger and frustration, which promoted feelings of stress and depression. Rochelle explained, Motherhood is hard. It’s hard on us especially when you don’t have too much help, and sometimes there can be an absent father, or [he] can be there not doing anything. You get frustrated at him because he’s not that much help.
Anjelica, a 25-year-old African American mother of four, shared similar feelings: “[My baby’s father lives] with me, but he’s no help. He makes me even more crazy. . . . I’m not happy.”
The women reported that they have to be self-reliant. Several of the mothers said they had to do things by themselves and do not blame others for the position they find themselves in. For some of the mothers, this realization helped propel them forward in their lives. Some of the mothers stated that despite feeling low they wanted to finish their GED programs, form strong relationships with their children, and develop a stronger sense of purpose in their lives. Frustrations with their babies’ fathers contributed to stress and depressive symptoms. As Latoya, a 29-year-old African American mother of three, summarized, [W]hen I was pregnant I had that mindset we’re gonna have a precious family, we are gonna stay here and raise them, you’re going to help me. But . . . it’s always like I gotta carry the burden by myself, so that’s pretty stressful . . . everything is pushed on me and I never get a break.
Other researchers note similar findings as this study, reporting that having a poor relationship with the baby’s father exacerbates a new mother’s depression (Grote & Bledsoe, 2007), particularly in couples that are not co-habitating (Garfield et al., 2015).
Limited support from family of origin
Several mothers discussed how their families of origin provided little support, which for some was because their own mothers were ill. Fatima, a 29-year-old African American mother of two, reported, “[M]y mom is going to her own mental health, and she is in and out [of the hospital].” Other mothers reported their family members were frequently unable to provide childcare. For example, Tabitha said, “My mother’s . . . in intensive care. I’m going through . . . a lot with . . . not having a supportive family. I don’t have no family members at all.”
Family members often exacerbated the mothers’ stress. Yamina, a 27 year-old biracial mother of four, shared, “I have sisters, they have their own lives. You really don’t wanna be involved with them, because sometimes they criticize you.” In some cases, their family members were experiencing substance dependence. Anjelica reported, “[M]y sisters are in New York City, my father was a drunk, my mother was a crackhead, so you can add it up. . . . I keep my distance from them.” Feelings of isolation from family were worsened by physical distance. For example, several of the mothers had left their families of origin to move to Rochester, including Felicia, a 39-year-old biracial mother of eight, who stated, “I be worried so much thinking that I don’t have nobody to help me. ’Cause I don’t have family up here.” In contrast to Anjelica’s situation, other mothers had relocated to be closer to family, only to discover that relocating had worsened their situation. Dena, a 28-year-old Latina mother of two, stated, I just lost my job, then my mother-in-law [died], then finding out I was pregnant. Then we lost our apartment and we had to move in with my mother. . . . [I]t was me, him, our oldest daughter [in one room]. . . . I felt helpless. I tried but . . . [my husband] was stressed out. . . . [H]e . . . would take it all out on me. . . . [W]e thought things would get better, but things went from bad to worse.
These quotes are similar to the findings of other researchers, who conclude limited support from family affects perinatal mood disorders in women from various racial and ethnic groups (Bener, Gerber, & Sheikh, 2012; Highet, Gamble, & Creedy, 2018).
Limited support from neighbors and friends
The mothers also reported having limited friends they could rely on for support. Shameeka, a 24-year-old African American mother of one, shared, “I don’t have any friends.” Rochelle summarized, “I don’t have friends. I don’t hang out. I don’t go outside. My neighborhood isn’t the safest. . . . So that’s why I’m always going crazy in my house. I don’t have time to myself to sit down and relax and think.”
As with limited support from family, limited support from friends has been shown to affect perinatal mood disorders. Pao, Guintivano, Santos, and Meltzer-Brody (2018) argue that the lack of friends perpetuated depression in the women they studied.
Violence
The participating mothers reflected on the impact of violence on their depression. Some of the mothers talked about the violence in their relationships, families of origin, and community.
Violence in relationships
Eleven of the participants reported being physically abused, and 12 reported being psychologically abused by their babies’ fathers. Latoya explained, “I always was able to talk to the father of my son, but me and him had a domestic situation where he was hitting me and stuff . . . so I don’t really communicate with him.” For some mothers, the abuse was experienced in public. Gloria reported that the other woman who was currently pregnant by her baby’s father physically assaulted her as a way to cause harm to herself and her unborn baby. She explained, And [his girlfriend] she got in [my car], and punched me in the stomach probably eight times telling me, “I’m gonna kill the baby.” That scared the hell out of me. They rushed me into the hospital, and then I had [my daughter] . . . early . . . that same day.
Most of the mothers who reported being abused ceased having contact with their babies’ fathers. Tammy, a 38-year-old African American mother of four, explained, I had a cut on my forehead. I had 11 stitches ’cause I said I was leaving him. [He] pressed a knife against my forehead. He hit me so hard . . . I passed out. The two-year-old seen that. That’s her father. And then, I decided . . . to run and go, don’t come back.
In most cases, exiting the relationship promoted safety and independence. Yamina summarized, “[S]ometimes it’s better just to walk away, even if you have all this weight on your shoulders, than getting hurt, killed, domestic violence, all this stuff, which I experienced.”
These findings resonate with Mahenge, Stockl, Mizinduko, Mazalale, and Jahn’s (2018) results that intimate-partner violence is a key predictor for PPD.
Intergenerational violence
Some mothers described the experience of violence in relationships as intergenerational. Tamara, a 30-year-old African American mother of seven, said, I was getting hit on my whole nine months. I delivered [my daughter] with a black eye. I’d say “Maybe he’ll get tired of it.” Nothing was changing. . . . I can’t allow my kids to see that going on, because my mom went through it with my dad . . . until she finally got away and our life [became] so much easier.
Gloria added to this point by saying, When I first went into foster care and got ripped away from my mom and dad, that’s all I seen. Like, my dad punched my mom out. My mom hardly did anything though. But, my dad was a real abuser. He was an alcoholic, he was a drug addict. And it was his way or whatever.
Violence in the neighborhood
Many mothers characterized their neighborhoods as violent places where illicit drugs were openly sold and where hearing gunshots at various times was common. Gloria said, “I live in the ghetto. Since I’ve lived there for two years, I’ve probably heard at least 80 gunshots.” Tonya explained, “[They] got drugs across the street . . . and the house next to me . . . it’s just nothing but drugs. So, if anything goes down, we’re right in the crossfire.”
Neighborhood and community violence was a major concern for several of the mothers. Latoya explained, “On the street that I stay on [it is safe], but when you go to the corner, it’s not safe, and I’d rather keep my kids in the house than to have them in that environment.” Marta, a 27-year-old Latina mother of two, similarly shared, “There’s a lot of violence on my street. I try to avoid the kids going out the front. Sometimes there be shootings and stuff.”
Reid and Taylor (2015) report that neighborhood violence likewise worsens PPD.
Some of the mothers also described positive aspects to their neighborhoods. Yolanda informed us that “the corner store . . . they deliver, so all you have to do is just either to call and tell them the meat that you want, or you could go down there and they’ll just pick out your meat and they’ll bring the food to you.” Tabitha summed up her neighborhood the best by telling us, “Actually, it’s a lot of good neighbors over there, but, I wanna move. Because it’s a lot of drug people that stand around the area. And I have a thirteen-year-old boy, I don’t want them growing up on the streets.” Marta adds, “’Cause with his father, he was never there from day one, so I was struggling as a single mom. And, uh, there’s a lot of churches, um, that help with Pampers and groceries. They had got me through, you know, some of the challenges.”
Living with depression
The normative nature of depression emerged as a consistent theme. Roberta stated, “I learned to cope with it only because I didn’t know who I could talk to. But it’s like now as I got older and [my son] did too it’s still the same way. I’m working, I have a house, I’m able to manage my bills, but depression does not easily go away . . .”
Many mothers were too busy to follow through on service providers’ referrals for psychotherapy. The time-consuming demands of completing the paperwork for entitlement programs, the extreme busyness of attending to their children’s needs, their off-and-on relationships with their babies’ fathers, and their lack of transportation made attending services difficult. As Rochelle conveyed, “I really did try to attend [counseling sessions], but something always happened in my life to stop me from getting the counseling I needed.”
In these cases, the mothers tried to be self-reliant and manage their depression on a day-to-day basis. Raquel, a 27-year-old African American mother of three, explained, “At times I feel like I . . . fall down again. But I try to pick myself back up.” Arissa shared, “Sometimes . . . it’s at that point where you either wanna give up or . . . try to kill yourself. You’ve just gotta do the best you can. You just have to change it amongst yourself. . . . It takes you . . . to change a lot of things.” Tabitha reflected on the need to find the positive even in a dark place: [E]verybody has trials and tribulations in life. Everybody goes through this thing called life. But, you know, we can’t let it affect us . . . negatively. We have to try to find some positive in everything negative, and try to use it . . . to become better.
All of the mothers reported feeling their depression would remain ongoing and part of their day-to-day lives. As Rochelle summarized, “To be honest it’s always the same because like I said, it’s been like I’m going around this big ol’ circle.”
Discussion and Conclusion
Although the findings from this study are not generalizable, they provide a glimpse into the lives of impoverished women who are struggling with depression while trying to raise their children. Several women explained that they did not trust their neighbors or non-family members. Some said they had no time for friendships given their various responsibilities. All the mothers reported their lives included caring for many children with limited assistance from other family members and often without having established friendships.
Overwhelmingly, the mothers in this study were struggling to provide financial resources, housing, food, and clothing for their families. Of the 30 participants, only four currently lived with their male partners. Many of the other fathers came and went, while not providing resources or assisting with childcare or household tasks. Many mothers also talked of trying to complete their educations or to seek higher education, job training, and sustainable employment, while dealing with frequent pregnancies, the babies’ fathers taking financial resources from the family, their current limited education and job skills, and social isolation. The mothers reported that the ongoing demands of being a single mother made attending services difficult.
We acknowledge that this study has limitations. The two authors who conducted the interviews are White, non-Hispanic, middle-class professors, one of whom is male. These factors most likely affected the mothers’ responses to the researchers’ questions, the types of life experiences the mothers shared, and the data analysis, thus limiting generalizability. The interviews would likely have yielded different results had the interviewers been African American or Latina women. This issue was slightly attenuated by obtaining input from professionals who provide services to women of color and having students of color participate in conducting several of the earlier interviews.
A second limitation is that the study does not include the fathers’ voices. While honoring the words of the mothers, we do not want to leave the impression that we have told a complete story. In analysis with babies’ fathers conducted by our team in another community (Keefe et al., 2017), we found that fathers describe trying to get close to their children and at times not being able to do so because of their babies’ mothers’ anger, as well as because of unemployment and disproportionate incarceration, which make maintaining an active role in the children’s lives difficult.
To address these limitations, the researchers drew on their decades-long post-graduate practice experience working with African American and Latina mothers, engaged in ongoing communication with fellow co-authors, consulted with minority health researchers, and participated in ongoing training in qualitative methods held at various professional conferences.
Implications for Practice
Proponents of “Close the Health Gap” with the Grand Challenges for Social Work (http://grandchallengesforsocialwork.org) argue that eradicating the inequities in health requires various strategies that target multiple contexts, such as neighborhoods and communities that perpetuate disparities (Browne et al., 2017). The results from this study highlight the need for social workers to advocate for and develop community-based services that address root causes of poor health, including poverty, crime, limited education and employment opportunities, and lack of adequate and safe housing. Although social workers have been at the forefront of developing services, virtually no attention has focused on developing social-service programs for new mothers of color living with PPD (Keefe, Brownstein-Evans, & Rouland Polmanteer, 2016a).
In this study, the mothers reported experiencing ongoing depression, which echoes our earlier research (Keefe, Brownstein-Evans, & Rouland Polmanteer, 2016c; Keefe et al., 2018) in which mothers reported that often needed services are not helpful or accessible. Some mothers reported they are limited by their jobs, available appointments times, and the logistics involved in accessing services (Keefe et al., 2016c). Social workers must advocate for services that have convenient locations, more convenient hours of operation, and childcare and transportation options. Social work researchers should explore additional factors that keep mothers from moving forward. The mothers’ stories of resilience and of their desire to keep moving forward on their own and their children’s behalf could be more thoroughly explained and help social workers develop services relevant to impoverished mothers.
Given the dearth of research on PPD published in social work journals, social workers are forced to turn to the literature in other disciplines, including psychology, psychiatry, and nursing. Although this body of literature is helpful in addressing some of the issues new mothers face, the focus is almost exclusively on the individual-level factors. We could find virtually no literature to guide social workers in addressing community-level factors that perpetuate PPD. Social workers must therefore develop skills in intervening at the macro/community level, particularly with mothers living in low-income and high-crime neighborhoods and experiencing discrimination. Keefe, Brownstein-Evans, and Rouland Polmanteer (2016b) recommend developing new groups at various community agencies and churches, where mothers can provide one another with mutual aid to address factors leading to ongoing depression. Given their long history of working with faith-based communities, social workers can provide much guidance to local churches and other religious organizations, which many low-income mothers have been known to access for support (Chatters & Taylor, 2005; Sabatier, Mayer, Friedlmeier, Lubiewska, & Trommsdorff, 2011).
Social workers must also work effectively with female-headed families living in high-crime communities. In families where the father is nonresidential, social workers can work to support the father’s involvement in nurturing his children (Keefe et al., 2017). While the United States has funded the promotion of marriage, there are too few programs that educate and support men to be fathers. Advocating for policies that encourage non-residential father involvement in their children’s lives and for classes that help new fathers (just as there are classes to help new mothers) develop necessary skills could ease some of the tensions new mothers face. Although these mothers reported the fathers were mostly uninvolved, other studies found nonresidential fathers do their best to maintain contact with their children (Keefe et al., 2017).
Social workers providing services to new impoverished mothers must call attention to the mothers’ ongoing struggles and validate the mothers’ strengths. The mothers’ attempts to persevere must be seen as an asset and serve as the basis for the social worker–client relationship. Finally, social workers must be attuned to how the interlocking layers of oppression and structural discrimination affect the lives of mothers of color as they interface with various federal, state, non-profit, and other social service organizations in the hopes of enhancing their and their children’s well-being.
Footnotes
Disposition editor: Sondra J. Fogel
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by the Fahs-Beck Fund for Research and Experimentation grant number 1111698-1-65217.