In your work, you talk about systems of oppression and how they impact access to resources, power, and opportunities. How do/would you see this issue relating to perinatal mental health in particular?
In the area of perinatal mental health, systemic racism, for example, results in 1) disproportionately more information and support being available that centers the experiences and needs of white families coping with perinatal mental health challenges, 2) disproportionately more white mental health care providers being accessible, and 3) disproportionately more perinatal mental health training centered on the experience and needs of white families being provided by white educators. While more information and support for perinatal mental health challenges are absolutely needed for white families, there is a comparative dearth of culturally appropriate information, support, and mental health care available to meet the needs of families of color. In addition to this dearth of resources, parents of color are parenting while their family and community are targeted by systemic racism. The measurably greater stress of this experience is chronic, significant, and inescapable. Parenting can be very hard. Parenting while coping with perinatal mental health challenges is even more difficult. And, parenting while coping with perinatal mental health challenges and while being targeted by systemic racism is exponentially more difficult still. These patterns are also true for families targeted by systemic heterosexism, cisgenderism, classism, ableism, and so on.
What misconceptions do you see non-POC perinatal providers having when it comes to relating to and working with families of color?
First, white perinatal care providers, like me, hold a great deal of unearned privilege. Not only do we tend not to recognize the privilege our white skin affords us, we also tend to fail to see how our unearned privilege negatively impacts the care we provide and the families we seek to serve. So, white perinatal providers must learn to see the elephant in the room: our unearned privilege and its negative repercussions in our work. If we do not do this, we will be unable to openly address power dynamics that can make therapy with us unsafe for our clients of color.
Second, we white perinatal care providers tend to think that our good character and/or good intentions will protect us from holding biases that negatively impact the care we provide families of color. Unfortunately, this is just not true. Anyone who lives in a society with systemic racism, such as the United States, will unavoidably soak up pervasive, false, and profoundly damaging messages about the supposed superiority of white people and the supposed inferiority of people of color. The situation is similar to breathing polluted air. No matter how much we do not want that pollution to enter our bodies, no amount of willpower can stop it. We are left with ingrained racial bias that we did not choose to develop and of which we may be largely or entirely unaware. Regardless of our intention or awareness, a wealth of research shows that automatic and unconscious cognitive processes routinely result in our biases affecting our judgments, decisions, assumptions, and behaviors. Being a good person with good intentions does not make us immune to bias and its negative impact on the families we seek to serve. Lessening the negative impact of racial bias in the provision of perinatal care requires the intentional and ongoing development of specialized knowledge and skill.
A third misconception white perinatal providers often have is that the perspectives, experiences, and life contexts of families of color are homogeneous. The truth is that there is incredibly diversity within communities of color. People who are only offered the racial or ethnic categories of “Black or African American,” “Hispanic,” “American Indian or Alaska Native,” “Asian,” and “Native Hawaiian or Other Pacific Islander” to describe themselves actually trace their roots to a vast number of countries, cultures, languages, and histories. Because of this immense diversity, there is no such thing as a “typical” person of color from any of these racial/ethnic categories. While it can be helpful to be aware of common patterns (e.g., how systemic racism affects a particular community), people of color need to be seen as individuals whose lived experiences will vary greatly even within a particular racial or ethnic group and whose lives are affected by many factors, only one of which is their racial/ethnic identity.
How would you explain the difference between a provider’s cultural competence and their cultural humility?
There are many models of cultural competence. The brief definition I tend to use for cultural competence is the ability of providers and organizations to understand and respond effectively to the cultural needs of clients. In one model, Campinha-Bacote describes cultural competence as the ongoing, dynamic, and multidimensional process of developing, experiencing, and applying cultural awareness, knowledge, skills, encounters, and desire. While Campinha-Bacote’s model mentions cultural humility briefly, it is not fully incorporated into the model.
Tervalon and Murray-Garcia conceptualize cultural humility as “a commitment and active engagement in a lifelong process that individuals enter into on an ongoing basis with patients, communities, colleagues, and with themselves.” Cultural humility goes beyond cultural competence by recognizing that we can never be fully culturally competent in any culture but our own. (And our own culture really is best understood as our particular subculture reflecting the intersection of our racial/ethnic/cultural heritage, immigration status, socioeconomic status, sexual orientation, gender identity/expression, and so on.) Cultural competence is not enough when a society is grounded in one or more systems of privilege/oppression. Cultural humility requires that we learn to recognize and counter bias and oppression as a fundamental part of individually and collectively providing effective care to families in our increasingly diverse world. This means that the ranks of perinatal care providers must not remain disproportionately white and that white perinatal care providers must actively help change that oppressive status quo.
How can a provider start on the road to cultural humility?
Because the development of cultural humility is a lifelong process, it cannot be “attained.” It is better understood as a non-linear journey or a developmental process, rather than a destination. This means that one–or even many–readings, webinars, classes, or trainings will necessarily be insufficient to develop cultural humility. There will always be something more to learn and another step to take. A good place for white perinatal care providers, like me, to start is by looking within: learning about hidden cognitive processes within ourselves, understanding our own white racial identity development, exploring our unearned white privilege, and evaluating race-based power differences between ourselves and our clients and colleagues of color. Many cultural competence trainings ignore or only insufficiently touch on this kind of inward examination, focusing instead on facts and figures (cultural knowledge) related to communities of color that are viewed as “other” relative to the assumed norm of whiteness. But, there is nothing inherent in whiteness that justifies it being the reference against which communities of color are measured and described.
How important is it for a family of color to see a therapist of color for their perinatal mood or anxiety disorder?
It is critical that families of color have equitable access to therapists of color for their perinatal mood or anxiety disorder. Some families of color may still choose to see a white therapist for any number of reasons. But the current state of affairs is that families of color are often unable to find a therapist of color while white families can easily see any number of white therapists if they desire. Families of color deserve an equal opportunity to receive perinatal mental health care from therapists who are truly culturally competent because they have lived experience with a similar cultural, historical, and social context.
Cynthia Good Mojab, MS Clinical Psychology, is a Clinical Counselor, International Board Certified Lactation Consultant, author, and internationally recognized speaker. She is the Director of LifeCircle Counseling and Consulting, LLC where she specializes in providing perinatal mental health care, including breastfeeding-compatible treatment for perinatal mental health challenges. Cynthia is Certified in Acute Traumatic Stress Management and is a member of the American Academy of Experts in Traumatic Stress and the National Center for Crisis Management. Her areas of focus include perinatal loss, grief, depression, anxiety, and trauma; lactational psychology; cultural humility; and social justice. She has authored, contributed to, and provided editorial review of numerous publications.