Person-environment interactions during pregnancy and postpartum and their influence on perinatal mental health: A qualitative analysis

Background: Perinatal mental health conditions are the leading underlying cause of maternal mortality, with 80% of deaths considered preventable. However, factors contributing to or protecting against the development of perinatal mental health conditions remain poorly understood. This study aimed to explore the perspectives of pregnant and postpartum individuals to understand how they experience pregnancy and postpartum, and how such experiences influence their mental health during both perinatal periods (i.e., pregnancy, postpartum). Methods: Data were obtained from a subset of participants (n = 17) enrolled in a larger prospective cohort study. Semi-structured interviews during pregnancy (n = 10) and postpartum (n = 15) were conducted remotely (i.e., Zoom, phone). Interviews were independently analyzed using inductive thematic analysis, respective to each perinatal period. Results: Resource accessibility emerged as an overarching theme, with five resources (themes) acting as barriers or facilitators to mental well-being depending on their accessibility. Three resourcessocial support, logistics, and physical healthwere considered influential across both perinatal periods, to varying degrees. When resources were inaccessible during pregnancy, they became barriers to mental well-being, contributing to experiences of loneliness, frustration, worry, an increased mental load, and ultimately, increased stress. These experiences were often intensified postpartum due to unmet expectations of having increased support to manage increases in logistical demands (e.g., domestic labor, caregiving) amid postpartum recovery and workforce participation. Conversely, when resources were accessible, this facilitated mother’s perceived ability to cope with the stress induced by the demands of this life-stage, the COVID-19 pandemic, and other logistical responsibilities.Conclusions: Findings indicate perinatal individuals view their mental health as being shaped by interactions within their socioenvironmental contexts, highlighting societal norms and institutional practices that are perceived to impose unrealistic expectations on perinatal individuals to independently manage caregiving, domestic labor, and workforce participation amid resource inequities. Further research is needed, particularly among groups disproportionately impacted by maternal mortality and social determinants of health (SDoH), to guide policy reforms and public health interventions that create more inclusive, supportive environments to promote perinatal mental health and, in turn, the health of children, families, and the broader population.