Pregnancy, childbirth and caring for an infant can be stressful. One in five women experience mental health problems, such as anxiety or depression, during their pregnancy or after giving birth. This can have very serious consequences for women, their infants and their families. It is critical that we identify women who are struggling with their mental health so that we can offer help and support.

The guidelines set out by the National Institute for Health and Care Excellence (NICE) in England recommend that all women should be asked about their mental health when they attend their first appointment in pregnancy and again soon after they give birth. In our new paper, we used responses to three national maternity surveys in England to find out whether women are being asked in accordance with the guidelines.

Over 13,000 women who gave birth between 2014 and 2020 took part in our surveys. Across the three surveys, we found that between 17% and 20% of these women were not asked about their mental health during pregnancy and between 12% and 26% were not asked after they gave birth. We also found that women from ethnic minority backgrounds were less likely to be asked about their mental health, when compared to white women. This is important because if certain groups of women are less likely to be asked, then these same groups of women are less likely to be identified as needing support and less likely to receive treatment.

If we don’t ask, then we risk missing vulnerable women who can be helped.

So why are some women not asked about their mental health? Studies have shown that there are barriers for healthcare professionals when it comes to talking to women about mental health. These include time constraints during maternity appointments, lack of training and confidence to talk to women about their mental health, not knowing how to support women with symptoms or how to get help for women who need further input. There may be additional barriers for healthcare professionals when it comes to talking about mental health with women from ethnic minority backgrounds. These include difficulties with language and communication and concerns over how cultural beliefs might affect perceptions and conversations about mental health.

And why is it so important? If we don’t ask, then we don’t know how many women are suffering from mental health problems around the time of pregnancy or who these women are. We therefore don’t know the scope of the problem, how the problem affects different groups of women, or whether we have adequate services and resources to meet the needs of all women needing support. We know that maternal suicide remains the leading direct cause of death over the first year following pregnancy. This is a startling reminder of the importance of recognizing women who need help, and this may start with a simple question. If we don’t ask, then we risk missing vulnerable women who can be helped.