Understanding the Perinatal Mental Health Needs of Rural Communities in the United States: Experiences, Barriers, and Paths Forward

Background and Purpose: Rural communities across the United States often face disproportionately high levels of health disparities, and maternal mental health is no exception. Individuals living in rural areas are more than twice as likely to experience perinatal mood and anxiety disorders (PMADs) compared to their urban counterparts. Despite this heightened vulnerability, there remains a significant gap in the literature examining the specific experiences, challenges, and strengths of rural populations as they navigate mental health during the perinatal period. This study addresses this gap by exploring both the lived experiences of those affected by PMADs and the perspectives of providers serving rural communities.

Methods: Utilizing a qualitative descriptive methodology, this study draws on in-depth, semi-structured interviews conducted with 32 participants between May and June of 2023. Participants included individuals with lived experience of PMADs as well as mental health and maternal healthcare professionals working in rural settings. Interviews were conducted remotely via Zoom, averaging 41 minutes in length. All interviews were transcribed verbatim and analyzed using MAXQDA software to identify recurring themes and patterns.

Results: Analysis of the data revealed four central themes. First, participants described the multifaceted barriers to care faced by rural perinatal individuals, including geographic isolation, lack of anonymity, limited availability of specialized providers, and deeply ingrained stigma around mental health. These barriers often delayed or prevented access to necessary care.

Second, the consequences of untreated PMADs were far-reaching, affecting not only the health of the birthing person but also family dynamics, infant well-being, and community resilience. Participants emphasized how untreated mental health concerns led to feelings of hopelessness, relationship strain, and decreased engagement with community life.

The third theme focused on structural and social risk factors that contribute to poor maternal mental health outcomes in rural areas. These included socioeconomic challenges, underfunded healthcare infrastructure, and the scarcity of culturally competent providers. Importantly, participants also spoke to systemic issues such as the criminalization of mental illness and the ongoing erosion of reproductive health services in rural communities.

Despite these challenges, the fourth theme highlighted the resilience and resourcefulness of rural perinatal individuals. Participants shared personal strategies for self-support, such as peer-based emotional support, faith-based coping mechanisms, and online communities. Informal networks—often composed of friends, neighbors, or extended family—emerged as a crucial source of emotional and logistical support in the absence of formal care.

Conclusion and Implications: This study illuminates the complex and layered experiences of rural populations as they experience mental health challenges and seek mental health care throughout the perinatal period. While barriers such as provider shortages, social stigma, and geographic isolation persist, rural communities also demonstrate strong capacities for resilience and mutual aid. These findings are now informing the development of targeted interventions designed to support maternal mental health in rural areas. By building on existing strengths and addressing systemic gaps, this work aims to create more equitable and responsive care models for rural families.