From our founders
Our mission at Needed is to champion nutrition for women, and to support women’s health throughout the perinatal stage. We know that optimal health extends beyond nutrition to include physical, mental, and emotional health.
The purpose of this survey is to better understand how mental health is impacted along the journey to and through motherhood. Understanding the scope and extent of the issues we collectively face is the first step in advocating for systemic change so that women can access the mental health support they need during the perinatal stages and beyond.
It is our hope that this report helps to shine a light on women’s real lived experiences and unmet mental health needs, as well as provide resources for women in the perinatal stage.
Founders, Julie and Ryan
What we found
Research of women’s health issues is chronically underfunded – in both research dollars and venture capital investment. From underrepresentation of women in health studies, trivialization of women's physical complaints, and discrimination in awarding research grants, gender bias has been an ongoing issue in healthcare.
Maternal mental health is no exception and women and their families are suffering as a result. Alarmingly, mental health issues are the most common complication of pregnancy and childbirth, but support is severely lacking.
Mental health issues are the most common complication of pregnancy and childbirth.
The report below summarizes what we learned.
The unique demands of the perinatal stage
The perinatal stage is a uniquely demanding time in a woman’s life. While maternal mental health struggles are often reduced to postpartum depression, the reality is a much bigger picture that impacts women in a number of different ways at all stages of motherhood.
Dr. Phabillia Afflack, MD
“Nutrient deficiencies and physiological changes can impact how moms feel in the fourth trimester and throughout motherhood.”
“There is an abrupt drop in estrogen and progesterone and an increased incidence of abnormal thyroid function following childbirth. These hormonal factors can result in postpartum mood changes. Deficiencies in omega-3, vitamin B6, Vitamin D, Zinc, and Selenium are also implicated in postpartum mood disorders. Providers should consistently check labs during and after pregnancy. I recommend moms continue on their prenatal vitamin and omega-3 postpartum to replenish nutrient levels.” Dr. Phabillia Afflack, MD
“63% of women reported they’ve struggled with mental health in the perinatal stage.”
While existing data reports that 20% of women experience some type of perinatal mood and anxiety disorder (PMAD), our data suggests that this number is significantly understated.
63% of women reported they’ve struggled with mental health in the perinatal stage.
Maternal mental health is so much more than postpartum depression
The source of the discrepancy may be that mental health struggles extend beyond diagnosed PMADs, which typically include conditions focused around the postpartum phase - postpartum depression, postpartum anxiety, postpartum obsessive compulsive disorder, postpartum bipolar, and postpartum psychosis.
Instead, mental health struggles can show up in a number of ways and throughout all stages, from preconception through postpartum and beyond.
Here are the many varied ways that mental health struggles affected our survey respondents:
Contributing factors: Hormonal changes and more
The perinatal stages - before, during, and after pregnancy are marked by significant hormonal shifts. These physiological and hormonal changes contribute to various aspects of a woman’s mental health.
Hormonal changes before pregnancy can be influenced by a woman discontinuing birth control or taking hormone supplements in preparation for fertility treatments.
A woman produces more estrogen during a single pregnancy than she does throughout the entire rest of her life when not pregnant. Estrogen is active throughout the body, including in the region of the brain that regulates mood. Progesterone can cause fatigue, sluggishness, and even sadness.
Just after delivery, levels of estrogen and progesterone plummet. Levels of various hormones fluctuate throughout postpartum in response to stress, sleep, breastfeeding demands, and the return of menstrual cycles. Hormones impacted during the postpartum phase that affect mental health include estradiol, progesterone, oxytocin, cortisol, and thyroid hormones.
Lauren Hays, Psychiatric Mental Health NP
“It is crucial to recognize when these emotions may signal a more serious issue, such as if they are interfering with daily life”
"In the midst of the joy and chaos of motherhood, moms may feel a wide range of emotions. It is crucial to recognize when these emotions may signal a more serious issue, such as if they are interfering with daily life. This includes more than prolonged sadness or depression. It includes the loneliness and isolation, the loss of interest in activities once enjoyed, loss of appetite and/or sleep disturbances, hopelessness, persistent anxiety and catastrophic thoughts. There are various presentations of mood and anxiety disorders that so easily evade the standard perinatal screenings currently in place to catch us.” - Lauren Hays, Psychiatric Mental Health Nurse Practitioner
Data shows that “reproductive hormones are known to modulate behavioral, emotional and cognitive response, therefore rapid changes during pregnancy and labor create a vulnerable terrain leading towards postpartum disorders.”
Here are the factors that negatively impacted the mental health of respondents. The percentages reflect the percent of total respondents who identified with each of these factors. Our survey prompted respondents to select all that apply:
These factors all impact the internal dialogue of women. Fifty-five percent of women reported experiencing more negative self talk or self criticism than they did prior to the perinatal stage.
78% of women reported weight gain during pregnancy negatively impacted their mental health in the perinatal stage and beyond.
The physical changes that come with the perinatal stages are normal and natural as the body changes to accommodate and support a growing child. But for many women, these changes come with unique mental health challenges.
“Pregnancy-induced weight gain and body changes often lead to mental health challenges, including negative self-talk, self-criticism, and feelings of inadequacy. The societal pressure for a 'perfect' pregnancy body, amplified by unrealistic social media depictions, can exacerbate these emotional struggles. These pressures continue postpartum, with societal and media expectations for a swift return to pre-pregnancy bodies, intensifying body image issues. These unrealistic expectations can increase stress around food and negative emotions related to weight gain. However, it's crucial to remember that these feelings are normal and valid, and seeking support from healthcare providers, therapists, or support groups is vital for managing these challenges and maintaining a positive self-image. Prioritizing self-care, positive body image messages, and connection with others experiencing similar challenges can also aid in navigating this transformative stage.” - Dr. Alyssa Berlin, PsyD
Maternal mental health challenges can start before conception
Maternal mental health challenges can happen at all stages of the journey, including during prior to conception. In fact fertility issues are a major source of stress and anxiety for many women
of women experiencing infertility have a psychiatric diagnosis, most often depression or anxiety, but very few individuals seek psychiatric help—one study found less than 7% sought care.
A cross-sectional study of 300 married women diagnosed with primary infertility found that the prevalence of stress among women
Here’s how women reported their lives were impacted by fertility issues:
Women reported that fertility issues impacted their:
“The road to pregnancy, pregnancy itself, and the postpartum period can be a roller-coaster ride of emotions for so many women. Around 13% of all fertile-aged women end up seeking a fertility evaluation and treatment in order to get pregnant in the first place, which can be a very stressful experience.”
Dr. Soyona Rafatjah
More support is needed
It’s clear that mental health issues are commonplace throughout the perinatal stage, with a number of factors contributing, from hormonal changes to lifestyle shifts and the unrealistic perceptions that come with social media use. Some support exists, but it’s not enough.
The American College of Obstetricians and Gynecologists (ACOG) recommends screening for PPD and anxiety at least once during the perinatal period, and once during the comprehensive postpartum visit, but it isn’t a requirement.
Only 68% of women reported that their practitioner screened for perinatal depression or anxiety during and after pregnancy. Even if women are screened, 54% of women reported that they needed more mental health support than they received during the perinatal stage, which indicates that screening alone isn’t cutting it.
My health practitioner screens for perinatal depression or anxiety during and after pregnancy
A mother’s struggles are disregarded not supported
It doesn’t help that society has taken to trivializing some of these feelings, from lack of sleep to “mommy brain”. The reality is that these factors take a serious toll on a mother’s mental health. When a woman is made to feel like all women struggle, or that struggle is just part of the journey, they may downplay the seriousness of their mental health and put off seeking support. In fact, over half (56%) of respondents who reported that they did not seek out support shared that they abstained from doing so because they believed that their symptoms were not serious enough.
Estimates are that 7 in 10 women hide or downplay their symptoms. Without understanding, support, and treatment these mental illnesses have a devastating impact on the women affected and on their partners and families.
“I knew that brains go through a massive transformation in pregnancy and postpartum, and that not feeling like yourself was normal. And yet, I still wanted and needed help to feel okay.”
Ryan Woodbury, Needed cofounder
Women will talk about mental health more than they will seek support
Mental health often comes with a stigma, and sometimes people aren’t willing to share their struggles, even with those closest to them. Our survey found that 74% of respondents felt comfortable discussing their perinatal mental health with those closest to them.
But even though 63% of women said they struggled with mental health, only 52% actively sought support.
Women who struggled with mental health and did not seek support reported they refrained because:
But even though 63% of women said they struggled with mental health, only 52% actively sought support. Those who did not seek out mental health support cited the following:
Women reported that the following supported their mental health during the perinatal stage:
“I found exercise to be really helpful for my mental health, especially if I could get outside. But trying to find time and energy to move while I was still recovering and then adjusting to be a working mom often felt impossible. That feeling of defeat made my mental health struggles even worse.”
Anne, mom of 2
It’s clear that there is work to do to better support maternal mental health. Systemic change takes time, but one of the first steps we can take is to empower women to seek support by providing meaningful education around mental health resources. We can also continue this conversation. Increasing awareness will drive social change with a goal toward improving the quality of care for women experiencing all types of PMADs, and reducing the stigma of maternal mental illness.
We believe it's our responsibility to amplify the voices of every woman and to champion the support we all need on our journeys to motherhood and beyond.
This report is based on proprietary data gathered and analyzed by Needed. For the purpose of this report, Needed surveyed more than 2,000 people in April 2023 to inform our understanding of perinatal mental health and women’s lived experiences.
of respondents are age 25-39
of respondents currently have children
Respondents' life stages
Needed is setting a new standard for perinatal nutrition. The brand offers clinically effective supplements backed by an interdisciplinary collective of thousands of healthcare practitioners. While most perinatal supplements contain the bare minimum of nutrients mamas and little ones need, Needed products are designed to provide mom and baby with the best, most supportive vitamins and minerals. This means each ingredient is thoughtfully added with purpose. Needed's expertly-formulated, third-party batch-tested, ingredients support immune function, healthy skin and vaginal tissues, thyroid function, pregnancy viability (embryo implantation), placenta development, adequate milk supply, and much more. The brand empowers real nourishment for women on their journey to motherhood and beyond and takes the guesswork out of what’s needed at every stage. Needed is the first B-Corp perinatal nutrition company to be Climate Neutral Certified and is also a member of 1% For The Planet.
Julie Sawaya and Ryan Woodbury are both mothers and trained nutritionists who discovered they had serious nutrient deficiencies, despite making conscious decisions to eat a well-balanced diet. They dug into the research and realized we were far from alone. 97% of women in the US take a prenatal supplement, yet 95% of us are still deficient in key nutrients. Conception, pregnancy, and postpartum are nutritionally demanding – yet most prenatals contain the bare minimum of nutrients mamas need. Julie and Ryan realized they needed to raise the bar on perinatal nutrition. They built a collective of more than 3,000 health experts to help define a new perinatal standard and create the products, education, and experiences to make sure women had access to it. Needed was born to meet our needs and those of every mama and mama-to-be. The brand is proud to be the leading perinatal nutrition brand recommended and used by more than 3,000 women’s health experts.