Expert Q&A: Mothers in silence: 1 in 5 experience perinatal mental illness, yet most go untreated

Twenty percent of women experience mental health conditions, such as depression or anxiety, during pregnancy and the first year of parenthood.

Kara Zivin, professor of psychiatry and obstetrics and gynecology at the University of Michigan, is part of this statistic. She studies health policy and maternal outcomes, having chronicled her own experience with depression during pregnancy in a memoir.

“When I became pregnant, I wondered how my preexisting depression diagnosis and antidepressant use could affect my baby’s development in utero and after delivery,” Zivin said. “I knew the risks, but didn’t anticipate how sick I would become.”

In the following Q&A, Zivin, also a policy researcher at the U-M Institute for Social Research and U-M Institute for Healthcare Policy and Innovation, discusses the most common complications of childbirth, the pressure of modern motherhood, the importance of a support network, and how open conversation and presence can shift the reality of families facing perinatal mental health challenges.

How common are perinatal depression and anxiety today? What does the data help us understand about what moms are going through?

Perinatal mood and anxiety disorders affect roughly 1 in 5 women during pregnancy through one year postpartum, making them among the most common complications of childbirth. Research shows these conditions are widespread, underdetected and undertreated. The consequences of leaving them unaddressed extend beyond the mother to her baby, her family and her community. Many women never reach the systems that would identify and help them, which means the true scope of the problem is likely larger than what we can measure.

Why do so many mothers still feel pressure to stay silent about their struggles?

Motherhood comes loaded with expectations that may be different from reality. When reality falls short of the ideal, many women blame themselves rather than the expectations. Silence can also feel like self-protection from judgment, from intervention, from having to face what you already suspect is true. The women who pay the highest price are often the ones who had the least support to begin with.

You mentioned motherhood comes with lots of expectations. It can feel harder than expected. What helps moms avoid guilt or a sense of failure?

Guilt may be unavoidable, so it may help to understand where it comes from. Much of what mothers experience as personal failure results from social, cultural and systemic expectations. What helped me was understanding that what I experienced had a name, it was common and it was not a reflection of my love for my son or my capacity as a mother. That context came late for me. I wrote my memoir “Persevered” in part so other women might find the context sooner.

What would you say to a mom who feels pressured to breastfeed even when it’s hurting her well‑being?

A fed baby and a well mother matter more than meeting anyone else’s expectations. The pressure women feel around feeding choices is shaped by cultural ideals that rarely reflect individual circumstances. It takes a real toll. No single parenting choice defines what it means to be a good mother.

What are simple, realistic ways moms can support their own mental health in everyday life?

Perinatal mental illness is a medical condition, not the result of inadequate self-care. I want to be careful not to suggest that the right habits will prevent what many women go through. That said, being honest with a trusted provider about how you are actually feeling matters—and earlier is usually better. Having at least one person in your life who knows the truth of how you are doing is also important, as are sleep, movement and connection when possible.

How can partners, friends and family show up for a mom who might be struggling?

Show up without waiting to be asked, without needing her to name what is wrong. In my experience, the people who helped most were the ones who acted on what they observed rather than waiting for me to ask for help. Asking when you are that unwell can feel impossible. Believe her when she tells you something is hard. Do not minimize it. That goes further than most people realize.

Does postpartum depression also affect fathers? And how can they be supported?

Perinatal mental illness also affects partners and fathers, both directly and indirectly. Research shows that fathers can experience postpartum depression, too. When one parent is struggling, the other often carries an invisible weight that goes unacknowledged. The focus on the mother, although appropriate given the physical realities of pregnancy and birth, can leave partners without language for their experiences or permission to seek help themselves. We should address parental mental health rather than maternal mental health alone.

If you could make parenthood feel safer and more supported, what changes would you start with?

I would start with the gaps that exist long before a woman ever reaches a doctor’s office, the shortage of providers, the lack of insurance coverage and the absence of paid leave. Maternity care deserts are areas where there is no obstetrician within driving distance. These are systemic problems that do not have individual solutions.