As we recognize National Suicide Prevention Week, it’s important to shine a light on an often-overlooked reality: Mental health deaths, which includes both suicide and unintentional overdoses, have been identified as the leading preventable cause of pregnancy-related death [1].
From the challenges of infertility, to the vulnerable postpartum period, to the hormonal shifts of perimenopause, mental health struggles can intensify throughout the reproductive lifespan in ways that are both deeply personal and profoundly connected to systemic gaps in care.
Maternal suicide rates have remained high, even as other causes of maternal death such as sepsis and hemorrhage, have declined. The perinatal period is a time of increased access to healthcare for many, which theoretically should offer increased opportunity to screen for and address the risk of suicide, and yet death by suicide still accounts for 20% of postpartum deaths [2]. Mothers who experienced perinatal depression had a three times greater risk of suicidal behavior when compaired to peers who did not experience perinatal depression, and this increased risk did not immediately resolve, it remained increased for decades [3]. One study found that most postpartum suicides occurred in the 9 to 12 month postpartum range, with the highest rates occurring in remote and rural areas [4].
Sadly, self-inflicted violence is not the only concern during the perinatal period. Homicide rates during the perinatal period are also alarming. In the US, more pregnant people die from homicide and suicide than any individual medical cause [5]. Research has also shown that Black birthing people between the ages of 18 to 24 experience death due to homicide at a rate of nearly four times the national average [5]. In 2020, perinatal women in the US experienced a 35% higher risk for homicide compared to non-pregnant/postpartum peers [6].
The weeks and months following birth are often painted as joyful, but research shows that the postpartum period carries a heightened risk of suicide. For some new parents, feelings of isolation, intrusive thoughts, or overwhelming despair can eclipse the expected “happiness” of welcoming a child. When left untreated, postpartum depression and anxiety can escalate to suicidal thoughts or actions. Recognizing these warning signs early, being vigilant for risk factors, and ensuring rapid access to compassionate mental health care can save lives.
For individuals and couples facing infertility, the emotional toll can be devastating. The longing to build a family is often accompanied by a sense of loss, extensive (and expensive!) medical interventions, financial strain, and a sense of stigma or failure. Studies show that people experiencing infertility are at increased risk for not only depression and anxiety, but also suicidal ideation [7]. These thoughts are rarely spoken about openly, yet they are more common than most realize. Support from mental health professionals, peer networks, and fertility-informed counselors is essential to validate and protect the well-being of those navigating this difficult journey.
Suicide risk does not fade after the reproductive years. During perimenopause—the years leading up to menopause—shifting hormones can trigger significant mood changes, sleep disruption, anxiety, and even the return of past trauma. Research shows that suicide rates among women often peak during midlife, a pattern linked not only to biological changes but also to social factors such as caregiving stress, relationship transitions, and cultural silence around menopause. Despite the complex psychosocial stressors of midlife, there is an established correlation between perimenopause and increased risk for suicidal thoughts [8]. Perimenopause is a critical time for screening, support, and normalizing conversations about mental health.
When we look at suicide risk across the reproductive lifespan, a clear message emerges: mental health is inseparable from reproductive health. Whether someone is struggling to conceive, adjusting to life after birth, or navigating midlife transitions, the need for comprehensive, stigma-free mental health care remains constant.
But there is hope. While research has identified dozens of risk factors for suicide, it has also unveiled countless protective factors, many of which we can capitalize on! Social support and connection to care are profoundly impactful, regardless of life stage.
When Mother's Day HurtsWhen Mother’s Day Hurts“There is, I am convinced, no picture that conveys in all itsdreadfulness, a vision of sorrow, despairing, remediless, supreme.If I could paint such a picture, the canvas would show onlya woman looking down at her empty arms.”-Charlotte BronteAs Mother’s Day approaches, I’ve been speaking with several of my clients who’ve struggled to become mothers and/or have lost a child in utero about what this day means to them and how they feel. I’d like to share some of the themes that have emerged through our discussions. Unfair. For many women, the veneration of mothers on this day is deeply painful. Feelings of anger, irritation, envy, and confusion arise. Why me? Why haven’t I become a mother after so much effort? Why did I lose this much sought-after pregnancy? The women I see in my practice have typically spent months, sometimes years, trying to birth a healthy baby. They may have sacrificed tremendous time, energy, and spent the reserves of their emotional and financial resources to try to conceive. They may have given birth and held a dead baby in their arms. The legacy of their losses becomes their new reality, and they must learn to navigate the world with the constant presence of someone’s absence. This, my friends, is unfair. Isolation. Infertility and/or pregnancy loss is often a silent struggle. Research reports that women who are struggling to become mothers experience increased feelings of anxiety, depression, isolation, shame, guilt, and loss of control. Depression levels in people with infertility have even been compared with patients who have been diagnosed with cancer, and couples tend to report that infertility or pregnancy loss have been the “most difficult” events in their lives thus far. This silent sorority of women is estimated to affect 1 in 8 couples (or 12% of married) who struggle to get pregnant or sustain a pregnancy (Rooney & Domar, 2018). That’s roughly the size California, folks! And yet, we don’t talk about it enough, and that’s especially true for men. Sadly, when these discussions do come up, well intended yet uninformed family, friends, or coworkers can say thoughtless, hurtful comments. This can further the cycle of silence. Grief/Loss. If you wonder what that constant tension is in your body, that heavy feeling that sits on your chest – it’s grief. Feelings of anger, depression, anxiety, fear – all different colors of grief expressed. Loss is ever present in the stories of those struggling to create their families, and it doesn’t just disappear when a baby arrives. For some of my clients, the losses can be layered, so let’s take a look at some of them:What’s been lost?Loss of the experience of pregnancy and birth – you feel you are missing out on one of the most miraculous events of lifeLoss of sense of belonging – you don’t quite fit amongst your friends, family, or society at largeLoss of being in control – of your body – of your life. This wasn’t how it was supposed to beLoss of feeling healthy and normal – your identity shifts from “healthy person” to “infertility patient”Loss of feeling competent – you feel you can no longer achieve what you set out to doLoss of sexual intimacy, identity, and privacy – what had been the most private and intimate acts is now publicThe Eagles band has a song titled “Hole in the World” and I think it certainly applies here - -There's a hole in the world tonightThere's a cloud of fear and sorrowThere's a hole in the world tonightDon't let there be a hole in the world tomorrowIdentity Disruption. Talking with a client who had experienced three recurrent pregnancy losses in the recent past, she noted how her relationship to mother’s day had not transitioned the way she expected, from honoring your mother figure to honoring yourself as a mother. She further described feeling excluded from parenthood and being relegated to still sit at the “kid’s table.” For so many women, they had constructed (whether conscious or unconscious) a reproductive narrative, a story of the family they would have one day and the role they would play in that family. And this story can be largely influenced by the dominant cultural narrative regarding becoming an adult – separating from your parents, establishing your own residence, taking responsibility for your life, and creating your own family. Being denied these important rites of passage and roles can be experienced as an existential crisis. Who am I? Where do I belong?Heroism. The people that I’ve had the privilege to work with during their parenting journey are nothing short of courageous as they attempt to create life against the odds. Some of those people came home with a baby, while others made the heartbreaking decision to be childless due to financial constraints and/or unwillingness to undergo fertility treatments. Some of them only have pictures of the child that never breathed air. As Dr. Ilona Laszlo Higgins expressed in her book “Creating Life Against the Odds,”The struggle of these individuals to create and nurture children goes well beyond the desire to produce a new generation in one’s own image, or to have a living repository for one’s inheritance. It is about the sense of completion that comes from the conscious commitment to be responsible for the well being of another. It is the wisdom that comes from the ashes of loss, translated into new life. (Intended) parents such as these set an example for all of us about the hard work of love. I couldn’t agree more. Society often pathologizes and judges the lengths these folks go to in order to become parents. I’ve had several clients exclaim, “I would never do that,” and then when faced with no other alternative, start down the path they said they would never go. To me, these individuals aren’t crazy, they’re heroes. They are willing to recreate their story and consider what could be versus what should have been. They grieve their losses and nurture their wounds, then carry on. On this day, it is my hope you can do the following for yourself:Practice being with grief, in whatever form it takes, unconditionally and nonjudgmentally. Be with your deeply wounded self.Acknowledge that there’s a missing piece to your life puzzle. A hole in your world.Take good care of yourself. Far from being selfish, self-care in grief is courageous.Forgive yourself. You did nothing wrong. Create a ritual to acknowledge what or who is missing. Write a letter, bury an object, say a prayer, light a candle, carry flowers, whatever honors the void. Ritual acts, whether private or public, are ways in which we give way to the feelings of love, pain, and connection. References/Recommended further readings:Cacciatore, J. (2017). Bearing the unbearable: love, loss, and the heartbreaking path of grief. Wisdom Publications, Somerville, MA. Fast Facts About Infertility. Available at: http://www.resolve.org/about/fast-facts-about-fertility.html. Resolve: The National Fertility Association. Higgins, I. L. (2006). Creating life against the odds: the journey from infertility to parenthood. Xlibris Corporation. Jaffe, J., Diamond, M., & Diamond, D. (2005). Unsung lullabies: understanding and coping with infertility. St. Martin’s Press, New York, NY. Rooney, K. & Domar, A. (2018). Dialogues Clin Neurosci. Mar; 20(1): 41–47.
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