Reproductive Justice Interventions in Pregnancy: Moving Toward Improving Black Maternal Perinatal and Intergenerational Mental Health Outcomes.

Learning objective: After participating in this CME activity, the psychiatrist should be better able to:• Discuss the effects of structural racism on pregnancy and obstetric care and their contributions to maternal mental health challenges and inequitable outcomes.• Outline the current understanding of interventions initiated during pregnancy or childbirth that use reproductive justice principles to improve Black maternal perinatal and intergenerational mental health outcomes.

Background: There are significant racial disparities in maternal outcomes for Black compared to White birthing people in the United States (US). Maternal mental health problems negatively affect mothers and their infants. Effects of structural racism during pregnancy and obstetric care may contribute to inequitable maternal mental health challenges and negative offspring outcomes. A reproductive justice framework provides a path for addressing these inequities. This systematic review examines whether pregnancy care interventions driven by reproductive justice principles have successfully improved Black maternal perinatal and intergenerational mental health outcomes.

Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for studies identified in November 2024 in PubMed, PsycInfo, and CINAHL. The studies included randomized clinical trials of Black birthing parents in the US and their offspring. Interventions incorporating reproductive justice principles were defined as those explicitly designed to increase autonomy, community input, racial equity, and/or cultural relevance.

Results: The search revealed 619 unique records. After screening and full-text review, 12 studies were included. Of these, 7 studies reported statistically significant effects on mental health outcomes. The interventions included interpersonal therapy, culturally tailored cognitive behavioral therapy, group prenatal care, community health worker home visits, and an educational online platform. Six studies reported positive effects on maternal mental health outcomes (e.g., depressive symptoms or anxiety). One study reported positive infant mental health or developmental effects.

Conclusions: The effects of reproductive justice-driven interventions on Black maternal and offspring mental health outcomes are promising, but studies are limited. Future studies should further identify active intervention components and assess mental health-related outcomes in both generations to improve the mental health of Black mothers and prevent negative intergenerational effects.