Qualitative Assessment of Access to Perinatal Mental Health Care: A Social-Ecological Framework of Barriers

Abstract

Introduction. Psychological distress affects up to 25% of pregnant women and contributes to poor birth outcomes. This project aimed to triangulate themes from interviews with low-income pregnant or postpartum women, primary care providers and mental health providers regarding knowledge of and barriers to mental health services in the perinatal period.

Methods. Study personnel conducted interviews in Sedgwick County, Kansas until saturation of themes within each group. Thirty-three interviews were transcribed, independently reviewed using grounded theory and themes were stratified using the social-ecological model framework.

Results. Individual level themes including cost/lack of insurance and transportation were consistent across groups, however women only identified barriers at this level. Consistent themes across provider groups included lack of support at the interpersonal level; poor communication between providers at the organizational level; and Medicaid limitations at the public policy level.

Conclusions. Multi-level interventions are needed to improve access to mental health care for low-income women in the perinatal period.