By Dr Miriam Donaghy Founder & CEO of MumsAid
When I first began working in perinatal mental health over 25 years ago, the landscape looked very different. Many mothers who were struggling emotionally kept silent, held back by a lack of awareness but also by stigma and shame — afraid that speaking up meant signalling failure, or something worse. And for those that did reach out, they found almost nothing there to meet them. The idea that pregnancy and the postnatal period could be a time of profound psychological vulnerability — not just joy — was rarely acknowledged openly, and specialist support was virtually non-existent.
Whilst there is still more to do, a lot has changed since then, and as we celebrate the 10th year of Maternal Mental Health Week, it feels important to reflect on the progress I’ve witnessed — and been privileged to be part of.
Here are five changes that give me real hope.
Ten years ago, talking about postnatal depression still carried a heavy stigma. Many mothers felt afraid to admit they weren’t coping, fearing judgement or — worst of all — that their baby might be taken away. Today, that conversation has opened up enormously. Celebrities, journalists, and public figures have shared their own experiences. Social media, for all its complexity, has created communities where mothers find each other and say: me too.
This cultural shift matters deeply. When a mother no longer feels alone or ashamed, she is far more likely to reach out for help early. Stigma costs lives. Reducing it saves them.
The introduction and revision of NICE guidelines on antenatal and postnatal mental health, along with the NHS Long Term Plan’s commitment to expanding specialist perinatal mental health services, has been genuinely transformative. A decade ago, specialist community perinatal mental health teams were patchy at best and non-existent in many areas. Today, while gaps remain — particularly in access and equity — there is at least a recognised infrastructure and a national commitment to build on.
For those of us advocating from the ground up, having policy on our side changes everything. It gives services like MumsAid a stronger foundation to operate from, and it sends a clear message: maternal mental health is not a luxury. It is a clinical and social priority.
When I began this work, the focus was almost exclusively on the postnatal period, and even then, largely limited to the first few weeks after birth. Today, there is a broader understanding that the perinatal period spans from conception through to two years postpartum — and that mental health struggles can emerge and evolve throughout that entire window.
We have also seen growing recognition that fathers, partners, and co-parents are affected too. And critically, we are getting better — though still not good enough — at understanding how trauma, loss, and previous mental health history shape a woman’s perinatal experience. This more holistic view means we can meet families where they actually are, rather than where we assumed they’d be.
This is perhaps the change closest to my heart, and one I have been passionate about throughout my career. For too long, perinatal mental health services were designed with a narrow picture of who a “typical” mother looked like. The lived reality — that some mothers face vastly greater risks and vastly less support — was not reflected in how services were built or funded.
That is beginning to change. I have spent much of my career advocating for young mothers — a group who are too often seen through a lens of risk or deficit, rather than as a community with distinct strengths and real needs. Seeing greater awareness of their specific experiences within perinatal mental health feels long overdue — and having our YoungMumsAid service recognised nationally as an example of what good looks like has been deeply meaningful.
There is also now far greater recognition of the disproportionate impact on Black and Global Majority mothers. The work of the Motherhood group as well as the 5x More campaign have been powerful in shifting that conversation, highlighting the stark inequalities in perinatal mental health outcomes and making clear that structural racism, cultural mistrust of services, and a lack of representation in the workforce are not peripheral issues — they sit at the heart of why so many mothers are failed.
And increasingly, conversations around neurodiversity and intersectionality are also beginning to shape how services are designed, acknowledging that a mother’s experience cannot be separated from the full complexity of who she is.
Awareness without action is not enough. But the fact that these conversations are now happening loudly, in policy rooms as well as community spaces, represents a genuine shift.
Fourteen years ago when I founded MumsAid, there was an enormous gap between what mothers needed and what was available. Specialist talking therapies for perinatal mental health were scarce, waiting lists were long, and there was very little that acknowledged the specific emotional and relational challenges of new motherhood.
The voluntary and community sector has long been at the forefront of developing this field — pioneering innovative, accessible, and community-rooted approaches long before statutory services caught up, and often leading the way in understanding what mothers actually need. That contribution is perhaps better understood now than it once was. There is growing acknowledgement that organisations like MumsAid have got something right: that a relentless focus on what makes services genuinely accessible — including practical provision like childcare, and approaches designed with the most marginalised mothers in mind — can make a profound difference.
But acknowledgement is not the same as investment. The relationship between the voluntary sector and statutory services remains underdeveloped, and funding has not followed the recognition. Greater integration — and the commissioning to support it — is still very much a work in progress.
There is still an enormous unmet need. But the landscape is richer, more diverse, and more honest about its gaps than it has ever been.
A final word
Progress is not linear, and it is not guaranteed. Funding pressures, health inequalities, and the ongoing impact of the cost-of-living crisis mean that many mothers — especially those from marginalised communities — still cannot access the support they deserve. The work continues.
But this Maternal Mental Health Week, I want to hold space for what has changed — because it did not happen by accident. It happened because of advocates, clinicians, researchers, commissioners, and most importantly, the mothers who spoke up. You changed things. We are just getting started.
Miriam Donaghy is a psychotherapist and the Founder and CEO of MumsAid, a charity providing specialist mental health support for mothers. She has worked in perinatal mental health for over 25 years.
To stay up to date with our work and how we are continuing to support developments in maternal mental health care, subscribe to our newsletter.