Monika Watat, Makeen Yasar, Abdelkader Awad, Rania Berkane, Sigry Ortiz Flores, Josue Fraga, Harneel Gill, Amina Latif, Daphne Okoro, and Kaylah Wade

The Big Picture – Postpartum Depression (PPD) in South LA

Important Note: In this paper, we primarily use the term “mothers” to align with the language used in most of the research and data cited. However, we acknowledge that the term may not fully encompass the diverse experiences of all birthing people. Birthing people, including those who do not identify as mothers or who represent a variety of gender identities, are an important part of the conversation surrounding postpartum mental health. While our use of “mothers” reflects the scope of the data available, we remain committed to inclusivity and recognize the need for language that reflects the diversity of all individuals who give birth.

The above vignette is a classic case of postpartum depression (PPD), a mental health condition attributable to new mothers often within 4 weeks of delivery. PPD is characterized by persistent symptoms of depression, including sadness, lack of interest, low self-esteem, sleep disturbances, appetite changes, anxiety, self-blame, and difficulty bonding with the baby (Robertson et al., 2004).

Often, when we think of birth, we imagine the delivery itself rather than the care that follows. Medical training typically focuses on pregnancy and labor, leaving a lingering and seldom-answered question: What happens to the one who gives birth after delivery? And what does that look like in a city like Los Angeles’s most diverse, vibrant, and under-resourced community?

This study explores the experiences of mothers in South Central Los Angeles who have experienced postpartum depression. Our goal is to illuminate not only the social barriers driving disparity but also the structural systems that shape care. By gathering perspectives from patients, providers, researchers, and public officials, we identified actionable recommendations to improve direct patient care, healthcare systems, and the broader strategies needed to advance maternal equity.

Community Context – South Central LA and Maternal Health Disparities

The area commonly known as South Central LA is defined by the LA County Department of Public Health as Service Planning Area 6 (SPA 6). South of the 10 Freeway and Downtown LA’s gleaming skyline, SPA 6 includes neighborhoods such as Athens, Baldwin Hills, Crenshaw, Hyde Park, and Watts, with Willowbrook and Compton forming its southernmost edges.

SPA 6 is racially and culturally diverse, home to a predominantly Latine population (68%) and the largest Black/African American community in Los Angeles County (28%). This demographic landscape reflects a rich history of migration, particularly the Great Migration, during which Black Americans fled Jim Crow-era violence in the South in pursuit of safety, opportunity, and stability in cities like Los Angeles.

Despite this cultural wealth, SPA 6 remains heavily impacted by systemic inequities. The region experiences higher rates of poverty and lower access to healthcare compared to other parts of LA. According to the LA County Department of Public Health, 31% of families in SPA 6 live in poverty—nearly double the county average. These social drivers of health deeply impact both maternal and infant outcomes.

The 2023 MLK Community Healthcare Needs Assessment put it plainly:

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“Maternal and infant health disparities are directly related to the underlying social and economic inequities that exist in our community. In 2021, South Los Angeles had 11.2 births per 1,000 (14,938 live births) compared to 9.6 births per 1,000 population in Los Angeles County. [Additionally] our community experienced almost double the rate of infant deaths per 1,000 compared to Los Angeles County during that same year.”

When it comes to postpartum depression, SPA 6 remains underserved and under-researched. The Los Angeles Mommy and Baby (LAMB) Survey conducted in 2016 found that SPA 6 had the highest reported PPD rates in the county, with a 12% disparity between SPA 6 and SPA 5, the most affluent region. Yet no new data has been collected since, leaving a critical gap in understanding how PPD manifests in this community today.

This is where Charles R. Drew University of Medicine and Science (CDU) plays a pivotal role. Founded in 1966 following the Watts Rebellion, CDU is a historically Black graduate institution committed to health equity and social justice. The university trains healthcare professionals to serve underserved communities and actively works to reduce maternal mortality, particularly among Black women, through targeted research and culturally competent care.

In light of SPA 6’s compounded vulnerabilities—racial, economic, and systemic—it is essential to listen directly to the voices of mothers in this community. As one patient shared:

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“Growing up, I didn’t know anyone who would openly say they were depressed… even now, a lot of my family… they are not seeking therapy, even though they’re dealing with grief and loss and just post-traumatic stress of all the things going on.”

Without updated, community-specific data, it’s impossible to develop targeted interventions. Research must be a foundation for action. The LAMB survey once prompted the formation of the LA County Preconception Health Collaborative, which improved mental health screening and support for expecting mothers. Updated data from SPA 6 could catalyze similarly impactful changes today.

As time has shown, this community needs—and deserves—advocates who are willing to ask the right questions, listen with intention, and work collectively toward a future where maternal mental health is prioritized and protected.

Methodology

This study utilized a Community-Engaged Research Project (CERP) approach—a participatory research model involving collaboration with community stakeholders at every phase. The goal was to ensure that the study was deeply informed by the lived realities of those directly impacted by postpartum depression in SPA 6.

Our approach began with an internal group assessment involving student researchers and long-standing community faculty members. This assessment helped identify a research topic that was both urgent and resonant. To establish a foundation for the study, we conducted an in-depth literature review examining factors that contribute to or exacerbate PPD. This informed the structure and scope of our own exploratory work.

Over the following two months, we conducted outreach to identify and recruit stakeholders with either lived or professional experience related to postpartum depression. This effort was carried out in partnership with the Black Maternal Health Center of Excellence (BMHCE), a trusted organization committed to reproductive justice and culturally responsive maternity care. BMHCE not only helped us connect with mothers in the community but also emphasized the importance of compensating participants for their time and emotional labor.

With participants identified, we conducted in-depth interviews using open-ended questions. These conversations took place in settings chosen by the participants, such as homes, clinics, or community spaces, helping ensure safety and comfort. The interview process emphasized storytelling and vulnerability, encouraging participants to express their experiences in their own words.

After interviews were completed, our team analyzed the data by coding responses and identifying central themes. These included barriers to care, cultural and structural contributors to PPD, and gaps in support systems. These insights informed our final recommendations to improve care, strengthen advocacy, and apply reproductive justice principles to maternal health.

As one participant noted:

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“I feel like if I knew that I had that mental support beforehand…I could have reached out sooner.”

That insight, among many others, reinforced the need for a proactive, inclusive, and community-centered research model that listens first—and acts second.

Theoretical Framework: Why Reproductive Justice Matters

To understand the root causes of postpartum depression (PPD) in South LA and how to address them equitably, this study was grounded in a reproductive justice framework. Reproductive justice, as defined by the SisterSong Women of Color Reproductive Health Collective, is:

“the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.”

This framework was developed in the 1990s by Black women leaders such as Loretta Ross as a response to the limitations of the mainstream reproductive rights movement, which primarily emphasized legal access to abortion and contraception. Ross and others argued that true reproductive freedom cannot be achieved without addressing the social conditions that shape a person’s ability to make reproductive choices—conditions like poverty, racism, immigration status, and access to healthcare.

As one BMHCE research expert we interviewed noted:

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“We’re not just talking about access. We’re talking about systems that weren’t built for us. Reproductive justice asks what it means to be able to give birth—and live well after giving birth—as a Black woman in America.”

Applying this lens allowed us to look beyond individual mental health histories and examine how broader social and structural forces, such as systemic racism, housing instability, food insecurity, and provider bias, contribute to PPD in SPA 6.

Through this framework, we explored not only whether care was available but also whether it was respectful, culturally affirming, continuous, and safe. Reproductive justice calls on us to ask:

• Who is most vulnerable?
• Who is not being heard?
• What do they need to thrive?

In our study, the reproductive justice framework functioned as both a guide and a goal—helping us design a study rooted in dignity, equity, and collective liberation, and pointing us toward the kind of structural transformation needed to truly support mothers in SPA 6.

Participant Demographics

Patient Participants

Healthcare Providers

Community Stakeholders

Ethical Considerations

Ethical integrity was central to the design and execution of this study. Given the sensitive nature of postpartum depression (PPD) and the vulnerability of the population involved, multiple safeguards were implemented to ensure the research was conducted responsibly and respectfully.

Informed consent was obtained from all participants, who were fully informed about the study’s purpose, their rights, and the voluntary nature of their involvement. They were reminded that they could withdraw at any time without penalty. To protect privacy, all personal information was anonymized, and data were de-identified.

Patient participants received compensation to acknowledge their time and emotional labor and to reduce financial barriers to participation. Interviewers were prepared to offer referrals to mental health resources if needed, and participants could skip any questions they were uncomfortable answering.

The research team also maintained close communication with community partners to ensure the study remained aligned with community priorities.

Outcomes and Findings

This section presents findings from both the literature review and the qualitative interviews conducted with birthing people, mothers, healthcare providers, and public health stakeholders. We organize the findings into three key components:

  I. Themes from the literature

 II. Themes from patients

III. Themes from provider perspectives

This layered analysis offers a picture of how systemic barriers, cultural factors, and interpersonal dynamics shape postpartum mental health in SPA 6, and what opportunities exist for change.

I. Literature Review Themes

Our literature review highlighted four broad and interrelated risk domains for postpartum depression (PPD), particularly among Black and Latina mothers:

While these studies identify significant predictors of PPD, they often lack qualitative nuance and cultural specificity. To address this gap, our project intentionally centers on the lived experiences and community voices.

II. Patient Perspectives: Themes from Interviews with Mothers

Our interviews with mothers in SPA 6 revealed three key themes:

1. Cultural and Emotional Barriers to Seeking Help
2. Gaps in Postpartum Care and Provider Awareness
3. Healing through Culturally Rooted and Peer-Based Support

Theme 1: Cultural and Emotional Barriers to Seeking Help

Many participants struggled to name what they were going through and described intense guilt, shame, and emotional suppression. In Black and immigrant communities, they said, mental illness is often downplayed or interpreted as weakness. Several mothers shared that they didn’t feel permission to express their distress because of internalized and external expectations to “be strong.”

“Growing up, I didn’t know anyone who would openly say they were depressed… Even now, a lot of my family, they are not seeking therapy, even though they’re dealing with grief and loss and just post-traumatic stress of all the things going on.”

A Filipina mother described feeling numb and disconnected:

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“I feel like the minute that I took the baby home, I was just more withdrawn. I didn’t care about him, honestly… It was to the point I didn’t care when my baby was crying.”

Even when mothers recognized that something was wrong, they often didn’t know where to go or whom to trust. The fear of being judged—or worse, having their child taken away—further discouraged them from seeking help.

Theme 2: Gaps in Postpartum Care and Provider Awareness

Mothers repeatedly described postpartum checkups as rushed and transactional, with the focus almost entirely on the baby’s physical health. Many said that no one screened them for depression, asked about their emotions, or followed up about their well-being—even when they raised concerns themselves.

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“She was just trying to make sure that because I’m 35 that my health didn’t take a turn…I would go, we’d do an ultrasound, she’d look at my baby, and that was it.”

Others said they were referred to therapists who lacked expertise in maternal mental health or who weren’t culturally sensitive. One participant shared:

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“[The psychologist] wasn’t trained in postpartum depression… I had to get reassigned.”

This aligns with literature identifying the underdiagnosis and mistreatment of PPD due to provider inexperience and health system fragmentation.

Theme 3: Healing through Culturally Rooted and Peer-Based Support

For many mothers, the turning point came when they found peer-led support groups, especially those designed for Black women or facilitated by doulas and community-based organizations. These spaces allowed them to speak freely, cry without shame, and understand that what they were experiencing was not a personal failure.

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“I found out about the resources after, and I felt like I had already started to spiral…I think that making sure people know that postpartum depression can manifest in different ways [is crucial].”

Participants emphasized that education and emotional preparation should start during pregnancy, not after the crisis begins. They expressed strong interest in programs that combine prenatal education, postpartum check-ins, and peer mentorship.

III. Provider Perspectives: Themes from Stakeholder Interviews

Healthcare providers, mental health clinicians, and public health leaders echoed many of the same concerns. Their insights fell into four thematic categories:

1. Cultural Stigma and Trust Barriers
2. Disjointed Healthcare Systems and Siloed Care
3. Provider Shortages and Gaps in Training
4. Value of Culturally Grounded, Community-Based Models

Theme 1: Cultural Stigma and Trust Barriers

Providers reported that many patients delay seeking care out of fear and shame. A psychiatrist reflected:

“There’s a lot of shame and embarrassment… And if the provider doesn’t look like them or doesn’t understand where they’re coming from, they’re even less likely to open up.”

Clinicians emphasized the importance of cultural humility and relational trust as foundational to effective care.

Theme 2: Disjointed Healthcare Systems and Siloed Care

Providers described how postpartum mothers often stop seeing their OB/GYN but continue attending pediatric visits—yet pediatricians are not trained to assess maternal mental health.

“Mothers will stop coming to follow-up appointments, but they’ll be […] seeing the child’s pediatrician.”

Another psychiatrist offered a stark breakdown:

“33% of my patients are only seeing a psychiatrist regularly, 33% are only seeing their primary care physician regularly, and 33% are seeing both.”

This fragmentation leads to missed opportunities for screening, follow-up, and holistic support.

Theme 3: Provider Shortages and Gaps in Training

One doula explained that mental health referrals are often ineffective because there are so few providers trained in perinatal mood and anxiety disorders (PMADs). Insurance navigation was also cited as a significant barrier.

“People are getting referred to therapists who don’t even know what PMADs are.”

This lack of expertise directly contributes to delayed or inappropriate care, particularly for Medicaid patients.

Theme 4: Value of Culturally Grounded, Community-Based Models

Stakeholders overwhelmingly endorsed programs like the AAIMM Doula Initiative, which embeds care in culturally relevant practices. A lactation consultant highlighted how breastfeeding difficulties are often intertwined with postpartum depression—yet rarely addressed in prenatal education.

A BMHCE leader put it bluntly:

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“We need to acknowledge how white supremacy and racism impact maternal health. This isn’t just about clinics or hospitals—it’s about systems that weren’t built for Black women.”

The Director of the Maternal and Child Health Department praised county-level programs but noted that they remain too small and underfunded to meet the scale of the crisis. She called for policy changes that invest in workforce diversity, expand Medicaid coverage for mental health, and ensure early, continuous, and culturally respectful care.

Together, these provider perspectives reinforce the idea that postpartum depression cannot be treated in isolation. It must be approached as a public health concern that intersects with racism, poverty, fragmentation in care delivery, and cultural exclusion. Integrating community wisdom, shared responsibility, and trauma-informed practices is essential for systemic change.

Recommendations

The insights shared by mothers and providers across SPA 6 make one thing clear: postpartum depression cannot be treated in isolation. It is not just a clinical diagnosis—it is a symptom of deeper systemic failures, including fragmented care, cultural disconnection, and the lack of sustained emotional support during the postpartum period.

And yet, the solutions are within reach. The stories we heard point to what works: culturally rooted care, peer-led spaces, and systems that listen. Based on these findings, we offer the following recommendations:

1. Normalize Mental Health as Part of Maternal Health

Mental health screenings should begin during pregnancy and continue beyond the standard 6-week postpartum visit. Pediatricians, OB/GYNs, primary care providers, and doulas should all be equipped to screen, respond to, and refer mothers experiencing postpartum depression. Integrating mental health into every stage of perinatal care ensures that no concern is dismissed, and no mother falls through the cracks.

2. Invest in Peer Support and Culturally Grounded Models

Mothers in this study consistently emphasized the transformative power of being seen and heard by someone who understands. Peer support groups, culturally matched doulas, and community-rooted education programs create safe spaces where mothers can speak openly without shame. Initiatives like the AAIMM Doula Program and BMHCE’s group sessions must be expanded and sustainably funded to reach more families.

3. Improve Collaboration Across Systems of Care

Too often, providers work in silos—missing opportunities to share information and coordinate care. A mother may see her child’s pediatrician regularly but have no continued contact with her OB/GYN or mental health provider. Strengthening communication between all touchpoints in the maternal care journey is critical. Shared records, collaborative protocols, and interdisciplinary training can create a seamless support network for new parents.

4. Train Providers in Cultural Humility and Perinatal Mental Health

Training should go beyond screening tools—it must include culturally responsive communication, trauma-informed practices, and awareness of the unique challenges facing Black and Brown birthing people. At the same time, we must invest in building a more diverse workforce that reflects the communities being served. Representation builds trust, and trust improves outcomes.

5. Center Community Voice in Program and Policy Design

The people most affected by postpartum depression must have a central role in shaping the systems intended to support them. This includes actively involving mothers, doulas, peer leaders, and trusted community stakeholders in program development, public health messaging, and outcome evaluation. Their lived experiences are not only valid—they are vital to creating care that is responsive, respectful, and effective.

These recommendations are not just a summary of what we heard; they are an affirmation of what communities have long known. The path to equitable maternal mental health does not begin in a boardroom or clinical office—it begins by listening deeply to those who live the reality every day. Meaningful change will only come when their voices are not only heard but also lead.

Conclusion

Postpartum depression does not occur in a vacuum. It is shaped by the systems, relationships, and conditions that surround a mother—and too often, those systems fall short. In SPA 6, the mothers and providers we spoke to revealed a shared truth: while the clinical language of depression may be universal, the experience of it is deeply contextual, and the pathways to healing must be equally nuanced.

This study offers both a mirror and a roadmap. It reflects the barriers faced by so many—dismissed symptoms, siloed care, cultural disconnection—but it also highlights what’s possible when care is community-informed, peer-supported, and culturally grounded.

We began this chapter with the story of a mother who left her appointment feeling unseen and unheard. While she is a composite of many voices, her journey represents something very real. What if she finally connected with a doula program that centered her story, validated her feelings, and gave her tools to heal? Everything changed. She would no longer be alone—and that could make all the difference.

Her story reminds us that healing is not only possible, but within reach—when we choose to build systems that listen.

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