Racism is embedded in the systems and institutions that shape our health and mental wellbeing – from housing to education and employment to access to clean air and green space. As a South Asian woman, I’ve been failed by these structures throughout my life – none more so than during my journey from trying to conceive through to pregnancy, childbirth and postpartum.
Having experienced perinatal mental illness (PMI), I’m all too aware of how systemic racism intersects with complex cultural issues of stigma, shame and guilt. In my case, this was compounded by years of fertility struggles and debilitating physical ill health during pregnancy. Yet nowhere along my siloed care pathways were the dots joined up, and this took a significant toll on my mental health.
South Asian women face greater risk of PMI and stark disparities in support and outcomes (Black and South Asian women views of perinatal mental health services). During an already vulnerable time, we find ourselves navigating harmful stereotypes and exclusionary practices that erode the quality, safety and dignity of our care.
Motivated by these disparities and my own experiences, I carried out research with South Asian mothers with experiences of PMI. Centring lived experience as the primary source of expertise, my aim was to focus on solutions shaped by those they’re intended to support.
Methods
Mothers could take part in a creative focus group or an informal semi-structured interview. Rather than directing conversations, I used a loose topic guide to allow experiences to emerge organically. I intentionally avoided asking directly about racism, creating space for mothers to raise it in their own terms. As a researcher with lived experience, I was able to build trust and foster a culturally sensitive, safe and open environment.
Given the deep complexity of PMI in South Asian communities, emotional wellbeing was prioritised over output throughout. The research took place in a trusted community setting and incorporated creative activities such as photovoice, I-poetry and mapping. Sitting beyond the boundaries of language, these accessible creative outlets enabled complex, nuanced, reflexive and candid expressions of experiences, hopes and dreams. Sharing food was an intentional element, reflecting cultural practices of connection and storytelling. Mothers were given a care package (including creative pens, journalling notebooks and postcards, scented candles, hand cream, tea, and hot chocolate) to take home to support continued creative practice and wellbeing.
This strengths-based approach supported meaningful insight while avoiding the extractive, draining, and exposing nature of traditional research. It created a validating space for collective healing and collaborative reflection, reimagination and solution building. This was important for countering experiences of trauma, dismissal and misrepresentation.
Findings
This research exposes how systemic racism, clinical dismissal, cultural incompetence and fragmented care combine to create a perfect storm of neglect, mistreatment, and dangerously delayed care. PMI in South Asian women is not just a clinical issue – it’s a profound crisis of trust and equity, where institutional harm intersects with cultural stigma leaving mothers unheard and unsupported.
Mothers described being invisible and isolated – with their agonising pain routinely invalidated and mental health needs ignored:
- ‘It’s the Mrs Begum Syndrome…institutional racism – when people look at you, we’re fobbed off as whining women.”
- “The trauma of being dismissed, that your pain is invalidated because you’re Brown.”
Fear of discriminatory treatment and poor outcomes forced some to make defensive decisions:
- “I requested a caesarean – not out of preference – but out of fear of worse outcomes for Brown mothers.”
Racist stereotyping led to delayed interventions and serious complications:
- “They left me in stirrups bleeding. If my mum hadn’t walked in, I don’t know what would’ve happened.”
- “I was screaming in pain, I said it was hurting, but she wasn’t listening. She had no intention of easing up. She said ‘oh, it’s just normal’.”
Constantly explaining cultural context to uninformed clinicians left women feeling emotionally exhausted, judged and withdrawing from services.
- “Mainstream therapists aren’t equipped to understand the nuances of Asian communities.”
- “If somebody doesn’t have understanding of your background, they mislabel it and mislabel you.”
These experiences – compounded by cultural stigma and expectations and wider structural barriers – exacerbated PMI and access to support.
Despite this, mothers found strength and support through informal networks – family, community spaces, and even strangers. A unanimous need emerged for culturally-informed, community-based and holistic peer support.
Recommendations
Recommendations are directed at key stakeholders who have the power to enact systemic change including healthcare, public sector, and faith organisations, VCSEs, professional bodies, housing providers and transport operators.
They include:
- Mandating anti-racist, co-produced clinical training
- Ensuring continuity of carer and proactive culturally literate PMI screening
- Investing in community-based, culturally grounded and holistic support hubs
- Delivering faith-based anti-stigma and public education initiatives
- Addressing structural barriers such as housing and transport
What next?
Since publication in February, this research has informed an upcoming perinatal mental health tender with the NHS Race and Health Observatory, as well as a formal evidence submission to Baroness Amos’s national maternity and neonatal investigation, the interim findings of which highlight what many already know: a pattern of longstanding systemic failures in safety, quality of care, and organisational culture including racism, discrimination, and lack of accountability.
But this is not new. Repeated inquiries have exposed the same disparities impacting Black, Asian and other racialised communities. So why has nothing changed? We can only tackle the impact of racism on mental health by addressing the underlying root drivers – particularly wider social determinants – of health and wellbeing. Without building this into perinatal care systems, we’ll never achieve the reform that is necessary. Instead, we risk continually perpetuating the same cycles of avoidable harm that come from blaming individuals rather than holding our statutory systems to account.
Call to action
This is a call to action for the UK Government. If Wes Streeting is serious about his renewed commitment to perinatal health, this must be reflected in how he drives forward the National Maternity and Neonatal Taskforce – with urgency, accountability and measurable reform. Ensuring pregnancy and birth is safe for every person of every skin colour requires a shift away from fragmented approaches towards prevention and whole-systems change. Without this, the harm and injustice outlined here is not accidental – it is inevitable.