Megan Markle made the difficult confession that she experienced suicidal thoughts while pregnant with her son. As a reproductive and perinatal psychiatrist and a Black mother as well, I am heartbroken by the revelation. In her interview with Oprah about her break from the British royal family, Markle highlighted many of the risk factors for perinatal depression and its devastating consequences that many of my patients face every day. Racism is one of them.
While Markle discussed feelings of hopelessness, social isolation, and the lack of support as some of the factors that contributed to a decline in her mental health, it was her understanding of racism as a toxic stressor that spoke to me on both a personal and professional level. I spent the first six years of my life in England and very clearly remember the racism I experienced as a child across the pond. The royal family’s concern about the darkness of her future son’s skin, for example, speaks to the stress my complexion invited into my life.
Now, as an American doctor specializing in the treatment of pregnant and postpartum patients, I know all too well that racism is a significant factor that can influence the development of depression during pregnancy and the postpartum period. While women of color are up to three times more vulnerable to mental health conditions during this time, medical literature suggests that they are less likely to receive psychiatric help than white women. According to Markle, her identity as a mixed-race woman in the royal family contributed to her stress. When she reached out for help, she was denied the support she needed.
Even when care is available and accessible, some women of color are very reluctant to accept it. Several months ago, I evaluated a pregnant Black patient referred to me by her OB-GYN. She did not believe she needed psychiatric care, and refused my help because she felt stigmatized by the referral. When she told me her story, she explained that she was not sick, only struggling with the circumstances of her life. Like Markle and many women of color, she felt the pressure to be strong and solution-oriented. Because she said she didn’t feel sick, I asked her to consider a different question: Do you feel like yourself? I wish more women of color would embrace this threshold for seeking care.
Pregnant with my second child, I spent most of 2020 thinking about race-based trauma and its impact on Black mothers and children. To be more accurate, I spent most of the year trying not to think about it. Despite my passion for social justice, it was too stressful for me to engage in painful conversations that reminded me of belonging to a reviled race. I felt sickened by the white people around me in both personal and professional circles either arguing that all lives mattered or using me as a sounding board to assuage their guilt about Black lives not mattering.
It was all too much. From the police murder of George Floyd to the pregnancy-related death of one of Indiana University’s Black pediatric residents, I strenuously avoided any media coverage of these events for my own health and the well-being of my pregnancy. Being such a high-profile figure and the subject of racist reporting and rumors, Markle had less of a choice.
While I’m saddened by Markle’s struggle, I am also heartened by her courage to share her story. As one of the most famous women in the world, she has highlighted many of the risk factors for perinatal depression that are further exacerbated by the complexities of race-based trauma.
It is my hope that her transparency about her mental health will not only encourage other women of color to identify and eliminate toxic stressors from their lives as they are able, but also raise awareness about the heightened vulnerability of the pregnancy and postpartum period.