Barriers to services faced by minorities
Barriers to seeking help have particularly been recognised among people with immigrant backgrounds (e.g., Firth et al., 2022), as well as among LGTBQ minorities (Kirubarajan et al., 2022). Immigrants face various challenges related to the quality and availability of services in a new country (e.g., Dela Cruz et al., 2023). Asylum seekers and refugee women are likely to face more barriers to seeking help than the general population, exacerbating inequality in healthcare (Firth et al., 2022).
Despite the identified risk factors, women with immigrant backgrounds often receive perinatal care later than recommended and they also have poorer access to health services (Almeida et al., 2013; Saunders et al., 2023). An unfamiliar and fragmented healthcare system, negative interaction experiences and communication difficulties with healthcare professionals, and culturally unsensitive services weaken the possibility for sufficient support and successful interaction (Fair et al., 2020; Kasper et al., 2022; Pangas et al., 2019; Watson et al., 2019). Language barriers can affect women’s health literacy and prevent potentially informed choice and consent for healthcare (Fair et al., 2020). Aiyar et al. (2023) identified regional differences in obstetric outcomes, and refugee and asylum‑seeking women have reported both a lack of interpreter support and cultural incompatibility in perinatal care. Immigrant fathers have similarly described cultural challenges and mismatches in services (Vo et al., 2024), which can reduce the overall quality of care (da Conceição et al., 2015). Some men also reported feelings of shame related to attending appointments, being present during childbirth and participating in infant care when these roles were not considered culturally normative (Aiyar et al., 2023).
Attitudes and stigma related to mental health, together with limited information on mental health, may prevent individuals with immigrant backgrounds from seeking help and reduce their possibilities of receiving sufficient support (Almeida et al., 2024; Firth et al., 2022; Heer et al., 2024; Watson et al., 2019). According to Firth et al. (2022), in addition to a limited understanding of the concept of depression, parents’ belief in self‑care and the contradictory advice received from healthcare providers and family members can hinder help‑seeking for perinatal depression. Mental health problems such as depression may also be culturally unacceptable, as they can be perceived as a sign of weakness or as something that prevents women from fulfilling their expected roles in society. These perceptions can contribute to emotional isolation, feelings of being misunderstood and even separation from family and a lack of social support (Watson et al., 2019). The cultural background also shapes parents’ preferences and beliefs, including their expectations regarding the need for medical care during the perinatal period (Fair et al., 2020).
Disabilities and parenthood
Women with intellectual disabilities report limited decision-making power in perinatal services, a lack of information about pregnancy, difficulties understanding information, feelings of unsuitability for motherhood and fears of child removal. These challenges may contribute to disengagement from care (Homeyard et al., 2016). There is also a need to explore interventions that best support parenting skills for parents with intellectual disabilities (Coren et al., 2018). Mothers with physical disabilities or functional limitations report more severe depressive symptoms than persons without disabilities. The association between physical disability and postpartum depression is robust (Pingeton & Goodman, 2025).
Maternal disability is a risk factor for underutilisation of perinatal services, especially when additional challenges such as intimate partner violence exist. Physical barriers such as mobility challenges and inadequate accessibility, along with financial constraints, create external obstacles. Insufficient staff training on recognising domestic abuse and ensuring accessibility limits comprehensive support for parents with disabilities. Psychological factors, including stigma and the perception of pregnancy as ‘high-risk’, further reduce women’s perceived need to seek care (Breckenridge et al., 2014).
Professional expertise and shortcomings in the service structure
Professionals’ limited knowledge, skills and confidence in addressing paternal perinatal mental health reduce the acceptability of assessments and create concerns about causing offense, managing safety and balancing both parents’ needs. Professionals highlighted gaps in training, a lack of clear guidelines and the absence of standardised tools or referral pathways as major barriers. Introducing routine screening and structured approaches was seen as essential to normalise paternal mental health support and improve inclusion (Darwin et al., 2021).
Mothers with depression value individualised, culturally sensitive care and emotional validation, which is frequently lacking in current services. Peer support and accessible treatment models are essential to reduce isolation and meet women’s specific needs. They emphasised the importance of having their role as a mother validated and understood, as this helped normalise their experiences. Breastfeeding was identified as a significant source of stress, leading to a clear need for targeted support in this area (Westgate et al., 2023).
Fathers often respond positively when included in screening, reporting little distress and expressing appreciation for being acknowledged. Organisational culture and service remit strongly influenced attitudes toward fathers’ mental health. Services were largely mother-focused, with routines and communication directed at mothers, and some professionals not viewing fathers as equal caregivers. Limited contact opportunities, time pressures and workload constraints further hindered engagement and screening. Fathers often perceived maternity and child health services as primarily for women, preferring to discuss mental health with general practitioners (Darwin et al., 2021).
Due to cultural differences, expectations and practices related to maternal health care may not match between women and professionals. It is essential to recognise that the needs of immigrant women extend well beyond pregnancy. Increasing trauma awareness, cultural sensitivity and stronger interpretation services have been identified as an important area for development in perinatal services for parents with immigrant backgrounds (Fair et al., 2020). Pangas et al. (2019) studied experiences of maternity care among refugee women and observed that continuity, culturally appropriate care and healthcare relationships played an important role in the positive experiences of women. The attitudes of healthcare providers impact on women’s access to perinatal mental health support (Watson et al., 2019).
Impact of positive experiences with care
Positively experienced care during the perinatal period has been identified as a significant protective factor leading to better psychosocial well-being among mothers. Ways to remove barriers to seeking help and strengthen support in perinatal services were identified in the literature.
The importance of positive care experiences
Strong systems and positive environments foster positive interactions between women and healthcare providers (Miyauchi et al., 2022). Person- and family-centred services that take into account the needs of all family members were associated with increased trust, commitment and continuity of care (Billings et al., 2024; Van den Ber, 2020). Such approaches support help-seeking and promote resilience, and they may reduce delays in care and social isolation when parents are experiencing mental illness (Burton et al., 2022; Harries et al., 2023; Ramsauer & Achtergar, 2018). Psychoeducation and community-based support further increase awareness and facilitate access to help, especially when a lack of information may prevent adequate support (Firth et al., 2022). It is essential that professionals can respond to women’s needs in an open, non-judgmental and genuinely motivated manner. Care should be grounded in a trusting relationship between women and healthcare professionals, delivered flexibly and continuously, and organised in a patient-centred way. In addition, women should have genuine opportunities to choose between different treatment options offered to them (Webb et al., 2021).
Positive treatment experiences protect mental health
Positive treatment experiences strengthen trust and protect mental health (Bell et al., 2016). Good communication and the opportunity to participate in care decisions in childbirth increase parental well-being and protect against depression (Bell & Andersson, 2016; Silva-Fernandez et al., 2023). Empathetic communication and postpartum support reduce the risk of PTSD and support both parents (Shorey & Chan, 2020). In addition, fathers' involvement and positive experiences of care have been shown to reinforce the beneficial psychological effects of parenthood (Arnold et al., 2025; Palioura et al., 2023).
Literature addressing the capacity of healthcare services to support patients in challenging situations consistently highlights the importance of patient-centred and sensitive care. Van den Berg and colleagues (2018) reported that following miscarriage, parents have reported that they valued patient-centred health care highly. They hoped to be recognised as individuals undergoing a significant life event, rather than being treated solely as a medical case. Sensitive, empathetic and emotionally validating care has been shown to support parents after stillbirth and the loss of a child (Peters et al., 2015). Empathetic grief support and opportunities for creating memories in the context of loss can prevent long-term trauma and facilitate recovery (Westby et al., 2021), while emotionally validating care similarly helps parents following miscarriage and child loss (Peters et al., 2015).
Trauma-informed care has been associated with prevention of PTSD and negative birth experiences (Ayers et al., 2016; Givrad et al., 2025, Watson et al., 2019). It also supports continuity of care and prevents fragmentation (Newman et al., 2019). A high-quality therapeutic relationship and continuity supports parents with a history of trauma, ACEs and PTSD (Atzl et al., 2019; Chamberlain et al., 2019). A trusting relationship with healthcare staff increases feelings of security and helps parents with prior adverse experiences to cope with challenging situations (Chamberlain et al., 2019).
Considering the diversity of families
Accessible services and appropriate staff training ensure that parents with mobility limitations or other special needs receive the support they need (Breckenridge et al., 2014). In addition, father-friendly services and peer support reduce feelings of exclusion and support the well-being of the whole family (Baldwin et al., 2018; Shorey & Chan, 2020). Equitable and sensitive perinatal services for sexual and gender minorities reduce stress and marginalisation (Kirubarajan et al., 2022).
The literature on perinatal care among refugee and immigrant families further underscores the importance of continuity, cultural sensitivity and relational aspects of care. In a study on refugee women’s experiences of maternity care, continuity, culturally appropriate care and supportive relationships with healthcare professionals were central to positive care experiences (Pangas et al., 2019). The accessibility and sensitivity of perinatal services are thus key to ensuring equality and inclusion. Culturally sensitive care and adequate access to information help prevent inequities and strengthen inclusion, particularly among families with an immigrant background (Fair et al., 2020; Kasper et al., 2022). Such approaches also prevent treatment discontinuation and strengthen trust in services (Pangas et al., 2020).
Culturally sensitive practices and increased knowledge of mental health can reduce stigma-related barriers to care (Almeida et al., 2024; Firth et al., 2022). Empathetic and non-judgmental care protects dignity and reduces stigma-related barriers to help-seeking, including fears related to child removal or detention (Almeida et al., 2024; Bina et al., 2024; Watson et al., 2019). Improving accessibility, providing interpreter services and ensuring cultural compatibility have been shown to facilitate access to care for immigrant families and refugees (Almeida et al., 2013; Saunders et al., 2023). Interpretation services and the use of plain-language materials support informed decision-making and reduce misunderstandings (Fair et al., 2020; Homeyard et al., 2016). Clear communication and confidential, trustworthy services are particularly important in contexts of legal uncertainty, such as the asylum process (Balaam et al., 2022).