The numbers are higher than most people realise

Perinatal depression affects around 10 to 15 percent of mothers in high-income countries. But for South Asian women, the rates are considerably higher. A 2025 systematic review and meta-analysis of 29 studies found a pooled prevalence of perinatal depression of 28 percent across South Asian countries, with rates in Bangladesh reaching 46 percent. Studies in Pakistan put antenatal depression as high as 40 percent. Even within diaspora communities in the UK and Canada, South Asian women show elevated rates compared to the white majority population.

These aren’t just numbers. They represent women who are struggling through pregnancy and the postpartum period without adequate support, in many cases without ever being asked the right questions by the people around them or by their healthcare providers.

Why South Asian women don’t seek help, and why it’s not simply about stigma

Stigma is real. But reducing the barriers to help-seeking to ‘stigma’ alone misses the structural specificity of what South Asian women are navigating.

A 2024 qualitative study published in BJPsych Bulletin interviewed 23 Black and South Asian women who hadn’t accessed perinatal mental health services. The barriers identified weren’t just individual. They were societal, cultural, organisational, and individual, often operating simultaneously. Women feared being seen as inadequate mothers. Some living in intergenerational households lacked the basic privacy to receive a call or a letter from a mental health service. Many had never been referred at all.

A 2026 reflective paper in BJPsych Bulletin put it plainly: for South Asian women, family networks can be both a source of support and a barrier to help-seeking. Duty, silence, and culturally rooted expectations can mask distress, often for years.

Postpartum Support International describes this well: fear of bringing shame to the family is one of the most commonly cited reasons South Asian mothers in diaspora communities don’t seek professional help. Well-meaning phrases from family members, ‘We all went through this,’ ‘Think of your baby,’ ‘It will pass,’ are often spoken with love. They land as dismissal.

The message a mother internalises is clear: her needs are secondary. Asking for help means failing.

What ‘good mother’ expectations actually cost

There’s a particular emotional weight South Asian mothers carry into the perinatal period. The unspoken script about how a good mother behaves, how much she gives, and how little she asks for in return. Caring for herself, whether that’s attending therapy, setting limits on visitors, or admitting she’s struggling, can feel like a contradiction of the role she’s supposed to fill.

This isn’t a cultural failing. It’s a consequence of real structural pressures that have measurable health effects. Research consistently links lack of social support, interpersonal relationship stress, and son preference to elevated perinatal depression risk in South Asian contexts. For diaspora women, pregnancy can be deeply isolating. They’re often far from the family support they would have had back home, and navigating a healthcare system that may not understand their cultural context. 

The cost of staying silent is not just maternal. Untreated depression in pregnancy is associated with disrupted infant bonding, impaired early cognitive development, and increased risk of postnatal depression. The window of pregnancy and early postpartum is genuinely critical, not just for the mother, but for the child.

What culturally adapted support actually looks like, and why it works

The evidence base for culturally adapted therapy in South Asian perinatal populations has grown substantially in recent years. This isn’t theoretical. It’s clinical trial data.

The ROSHNI-2 trial, a multicentre randomised controlled trial published in The Lancet in October 2024, tested a culturally adapted group CBT-based programme for British South Asian women with postnatal depression. Women who received the adapted therapy recovered faster than those receiving standard care. The intervention was delivered in participants’ preferred languages, incorporated cultural context into how distress was understood and addressed, and created group spaces where women felt heard without having to explain their lives from the beginning.

Closer to home: a 2025 randomised controlled trial from the University of Toronto, including our own Sukoon Cares advisor Dr. Farooq Naeem and Dr. Ishrat Husain, tested online culturally adapted CBT for Canadian South Asians with depression and anxiety. Participants in the adapted intervention reported significantly higher satisfaction and therapeutic engagement. The trial, funded by Health Canada, represents the first published report of culturally adapted CBT for this population in a Canadian context.

What makes cultural adaptation effective isn’t decoration. It’s not a matter of using a few Urdu or Hindi words, or hanging a South Asian painting in a therapy room. It’s about a clinician who understands that a patient might not be able to ‘set limits’ with her mother-in-law in the way a standard CBT worksheet suggests. It’s about holding the complexity of a woman who loves her family and is also drowning within its expectations, without pathologising either side of that.

It’s about not making her explain herself from scratch every session.

Why this matters for prenatal care specifically

Most of the clinical attention in perinatal mental health is still directed at the postnatal period. But two-thirds of postnatal depression cases are thought to present antenatally, during pregnancy itself. The prenatal period is, in many ways, the intervention point we keep missing.

For South Asian women, pregnancy is also a period of intensified family scrutiny, shifting roles, and heightened pressure to conform to expectations around how a mother-to-be should behave, eat, rest, and feel. Asking for mental health support during this time takes a specific kind of courage. And it becomes considerably harder when the support available doesn’t understand the world a woman is actually living in.

Maternal mental health screening tools can also miss South Asian women. Research notes that South Asian women often present with somatic symptoms of distress, headaches, fatigue, bodily pain, rather than the affective language most standard tools are calibrated to catch. Culturally informed screening, and culturally informed therapy, are different from each other and both are necessary.

If you’re reading this during pregnancy or early postpartum

The script that says asking for help makes you a bad mother is wrong. Clinically, evidentially, wrong. Caring for your mental health during pregnancy is one of the most protective things you can do, for yourself and for your baby.

South Asian women in diaspora communities are not less resilient. They’re navigating more, often with fewer of the right supports around them. What changes outcomes isn’t pushing through alone. It’s having access to care that actually fits.