Social Inequity in Maternal Mental Health: The Case of the COVID-19 Pandemic in Israel

Background and Purpose: Social inequity has long been associated with poor mental health outcomes. The Arab population in Israel, which is an ethno-national minority and comprises 20% of Israel’s population, has lower socioeconomic status, education, and employment rates compared to the Jewish population. These disparities place Arab women at greater risk for maternal mental health difficulties. Indeed, prevalence of maternal depression in Israel ranges between 20%-30% among Arab women and 10%-15% among Jewish women. Maternal mental health has long lasting negative consequences on mothers, babies and entire families, and the COVID-19 pandemic has added strain to already existing maternal mental health difficulties. Yet, it is unknown whether COVID-19 has exacerbated existing social inequalities. Hence, this is the first study to examine the association between social and medical support, economic and COVID-19-related factors, and maternal depressive symptoms (MDS), and whether these associations perform differently among Jewish and Arab women.

Methods: In this cross-sectional study, 970 pregnant or up to six-months postpartum women (750 Jewish and 149 Arab), aged 18 and above, filled out an online self-report questionnaire regarding whether they currently have an income (no/yes), their level of distress from future economic situation due to COVID-19, level of distress from possible COVID-19 contamination, perceived social support, changes in support from perinatal medical providers and level of MDS (measured using the EPDS). A link to the questionnaire was posted on social media networks or distributed through OB/GYN offices. Data were analyzed using linear regression and PROCESS moderation analyses.

Results: Prevalence of MDS (EPDS>=10) was significantly higher among Arab women (58%) than among Jewish women (35%). Higher MDS were associated with higher levels of distress from future economic situation (b=.510, p<.0001) and from possible COVID-19 contamination (b=.730, P<.0001), lower perceived social support (b=-.398, p<.01), and negative change in support from perinatal medical providers (b=-.980, p=.001). Moreover, moderation analyses showed that, for Jewish women, higher levels of distress from future economic situation and from possible COVID-19 contamination were associated with higher levels of MDS (b=.67, SE=.12, p<.001; b=.85, SE=.13, p<.001; respectively), and those who did not have an income had higher levels of depression compared to those who had an income (b=-1.004, SE=.47, p<.05). For Arab women, higher levels of social support were associated with lower levels of MDS (b=-.91, SE=.29, p=.002).

Conclusions and Implications: MDS have elevated more than twofold during the COVID-19 pandemic in Israel, and various factors seem to contribute differently to MDS for Jewish and Arab women. Since Arab women are economically disadvantaged, it may be that COVID-19 exacerbated only Jewish women’s economic concerns. On the other hand, social distancing and lockdowns restricted traditional face-to-face social support practices. However, since the Arab population lives with their extended family they were most likely able to continue receiving face-to-face social support, ultimately contributing to reduction in MDS. Social workers should help promote social justice policy and practice in the field of maternal mental health in order to reduce maternal mental health inequalities, while helping promote positive resources which can buffer maternal depression.