The PERI Model of Radical Healing as a Framework for Advancing Perinatal Mental Health

Abstract

Perinatal mental health disorders are among the most common complications of pregnancy and childbirth and represent a leading cause of maternal mortality in the United States. Black, Indigenous, and other People of Color (BIPOC) are disproportionately affected, reflecting the impact of structural racism, inequitable care, and broader social determinants of health. While medical and public health frameworks have advanced important strategies to address these inequities, psychological perspectives accounting for sociopolitical and cultural contexts remain underutilized, limiting responsive and effective mental health care for BIPOC individuals. We introduce the PERI Model of Radical Healing to reframe perinatal mental health equity as a liberatory and intergenerational process. This model emphasizes four interconnected domains: Practice, Emancipation, Resistance, and Intergenerational Hope. It positions perinatal mental health not only as the reduction of pathology but as a source of justice, dignity, and collective flourishing.

Perinatal mental health disorders, including postpartum depression, anxiety, post-traumatic stress, and substance use disorders (SUDs), are among the most common complications of pregnancy and childbirth. ¹ They are also the leading underlying cause of maternal mortality in the United States. ² Yet, not all birthing populations experience these challenges equally. Black, Indigenous, and other People of Color (BIPOC) are disproportionately burdened by perinatal mental health disorders and their consequences (e.g., mortality) and face systemic barriers to effective, culturally responsive care.^3–6 In fact, all-cause maternal mortality is highest among Black birthing folks (followed by Native American and Hispanic birthing folks), with a mortality rate of 50.3 deaths per 100,000 live births in 2023 compared to 14.5 deaths for White birthing people.^7,8 These inequities stem not only from differential access to resources but also from structural racism in health care systems,^9–11 discriminatory treatment practices,^4,12–14 and broader social determinants of health such as poverty, housing insecurity, exposure to trauma, and historical trauma.^15–20

Approaches to improving perinatal mental health equity have been proposed by public health and medical professionals such as psychiatrists and obstetrician-gynecologists.^4,21,22 These include education on and screening of perinatal mental health conditions, perinatal mental health campaigns, and the integration of psychological interventions into maternal and primary health care settings. ²³ While these approaches have been essential for advancing awareness and access to care, the broader perinatal mental health landscape has remained largely centered within a medical model, with much of the dominant research, theory, and systems-level intervention development led outside of psychology.

Although psychologists and therapists frequently provide the treatment for perinatal mental health conditions, ²⁴ psychological theory has been less consistently leveraged to shape how equity, healing, and wellbeing are conceptualized in this area. As a result, many existing approaches emphasize diagnosis, screening, and individual symptom reduction without fully accounting for the sociopolitical, cultural, and historical contexts that structure perinatal distress—such as racism in health care, intergenerational trauma, cultural invalidation, and structural barriers to safety and support during pregnancy and postpartum.^25,26 While traditional evidence-based interventions are critical, they may be insufficient on their own to close equity gaps or promote liberation-centered forms of healing for BIPOC in the perinatal period (e.g., up to 1 year postpartum).

This is where the Psychological Framework of Radical Healing, originally developed by French et al. ²⁵ to conceptualize resilience and well-being among BIPOC populations in the face of racial oppression, offers a critical lens. By bridging psychological theory explicitly into perinatal equity efforts, radical healing expands the focus beyond pathology to include cultural affirmation, resistance, dignity, and collective liberation as central processes of perinatal mental health.

The Psychological Framework of Radical Healing

Radical healing is defined by French et al. ²⁵ as the ability to exist in the dialectic of resisting oppression and moving toward freedom. The Psychological Framework of Radical Healing emphasizes that wellness is not simply the absence of distress but the active cultivation of these five interrelated components: critical consciousness, cultural authenticity and self-knowledge, radical hope, emotional and social support, and strength through resistance. ²⁵ This framework and its components are rooted in liberation psychology, Black psychology, Black Feminist principles, ethnopolitical psychology, and intersectionality theory. Applying this framework to perinatal mental health equity allows us to reconceptualize interventions, research, and policies to better support marginalized birthing populations. In what follows, we propose a conceptual model grounded in the Psychological Framework of Radical Healing that is directly applied to the perinatal context and outline a future research agenda with recommendations for clinical implications that leverage these principles to promote mental health equity.

Conceptual Model: The PERI Model for Radical Healing

Building on French et al.’s ²⁵ Radical Healing framework, we propose a perinatal-specific psychological model that reimagines healing during pregnancy and postpartum as a liberatory process rather than solely an individual clinical outcome: the PERI Model for Radical Healing. We conceptualize perinatal radical healing as an interconnected process through which birthing people reclaim cultural identity, resist systemic oppression, engage in collective forms of care and advocacy, and sustain hope for future generations. This model highlights the ways that healing in the perinatal period extends beyond individual symptom reduction to encompass intergenerational and community-level flourishing.

The proposed PERI Model for Radical Healing is organized around four interconnected domains: Practice, Emancipation, Resistance, and Intergenerational Hope (see Fig. 1 and Table 1). Practice refers to grounding within ancestral knowledge, rituals, and community practices that affirm cultural identity and counteract the erasure of such traditions within medicalized systems of care. This includes culturally rooted postpartum care practices such as cuarentena or lying-in periods; zuo yue zi or “sitting the month” in which birthing people focus on rest and recovery post-delivery while receiving integrated Traditional Chinese Medicine dishes, herbs, and practices from caregivers; the support of doulas and community birth workers; spiritual and embodied rituals of transition; intergenerational kinship networks; and collective spaces for storytelling, grief, and meaning making. These practices not only promote emotional and relational well-being during pregnancy and postpartum but also serve as acts of resistance and restoration in the context of reproductive inequity. Mental health providers who lack cultural awareness and responsiveness impede healing and cause harm, whereas providers who express openness to listening to and exploring individuals’ cultural identities and display cultural symbols or artwork in their spaces enhance healing. ²⁷ Data from different groups and cultures demonstrate that cultural grounding, cultural identity, and respect for culture-based knowledge and choices in perinatal health care are associated with positive outcomes, which establishes how key Practice is for perinatal mental health.^28–30

FIG. 1.

The PERI Model of Radical Healing.

Table 1.

Domains of the PERI Model for Radical Healing and Linkages to the Radical Healing Framework

PERI domain	Definition	Perinatal examples	Related radical healing component(s)a
Practice	Cultural and ancestral grounding through rituals and community traditions that affirm identity and counter medicalized erasure.	Postpartum traditions (e.g., cuarentena, zuo yue zi), doulas, storytelling and grief rituals, and kinship-based support.	Cultural authenticity
Emancipation	Liberation from oppressive structures and creation of conditions for dignity, autonomy, and reproductive sovereignty.	Decolonial/community-informed care, bodily autonomy in birth, structural supports (e.g., paid leave, Medicaid expansion).	Critical consciousness
Resistance	Collective solidarity, advocacy, and organizing that transform inequity into empowerment.	Peer support groups, advocacy for respectful maternity care, and community mobilization for birth equity.	Support; resistance
Intergenerational Hope	Future-oriented vision of healing rooted in cultural memory and liberated possibilities for future generations.	Sankofa-informed meaning-making, parenting as legacy, hope as motivation for change.	Radical hope

The PERI Model extends the Radical Healing Framework by specifying how its core processes uniquely manifest in perinatal contexts shaped by reproductive oppression and structural inequities.

a

Radical healing components from French et al. ²⁵ : critical consciousness, cultural authenticity, radical hope, support, and resistance.

PERI, Practice, Emancipation, Resistance, and Intergenerational Hope.

Emancipation, which lies at the center of the model, captures the transformative aim of the PERI Model: the pursuit of liberation from oppressive structures and the creation of conditions where pregnant and postpartum people can not only survive but also thrive with dignity and autonomy. Emancipation reflects an ongoing process and end state of structural and relational freedom, in which care is grounded in justice, safety, and self-determination. However, emancipation can also be practiced through approaches that restore psychological agency such as trauma- and oppression-informed practices that prioritize safety, choice, and empowerment.^31–33 It can also be reflected in culturally responsive interventions that move beyond symptom reduction to support meaning-making, identity affirmation, and liberation from shame and medicalized narratives that locate distress solely within the individual. Liberation has long been a concept central to health and well-being; data show that community-informed care models, which create circumstances where people feel they can thrive, and decolonial practices in perinatal care are associated with improved maternal and infant outcomes.^34–36 In this way, emancipation represents both a psychological and structural process: creating the conditions in which perinatal individuals can heal from trauma, reclaim wholeness, and envision liberated futures for themselves and their families.

Resistance, in contrast, emphasizes the power of collective solidarity and everyday practices through which emancipation is pursued and sustained. Resistance emphasizes the power of solidarity, recognizing that social support, advocacy, and community organizing are essential for countering isolation and transforming experiences of inequity into opportunities for collective empowerment. Interventions that include collectivistic components such as peer support groups and community events not only support maternal health outcomes but also provide spaces where individuals can share openly about their perinatal health journeys in a space free from the stress of oppression. ³⁵ Involving doulas, family, and community support systems in care increases positive maternal health outcomes and safety, sometimes, in part, via resistance strategies. These resistance strategies include advocating for birthing preferences and reporting abuses/complaints.^35,37 Together, emancipation and resistance are deeply interconnected: emancipation represents the liberated conditions of healing that the model seeks to cultivate, while resistance represents the mechanisms through which individuals and communities challenge oppression and move toward that liberated future.

Finally, Intergenerational Hope underscores the future-oriented vision of perinatal radical healing, drawing on the principle of Sankofa—turning back to the past to build a better future—as birthing people imagine liberated possibilities for themselves, their children, and their communities. In this context, intergenerational hope refers to a collective and culturally grounded belief that healing, safety, and flourishing are possible not only for oneself but across generations, even in the face of ongoing structural oppression. Unlike individual optimism, intergenerational hope is relational and sustained through ancestral knowledge, cultural continuity, and community-based visions of liberation. During the perinatal period, this form of hope may be especially salient, as pregnancy and parenting often evoke a period of heightened focus on legacy, caregiving, and the desire to disrupt cycles of trauma. Intergenerational hope is transmitted through storytelling, culturally affirming practices, and embodied caregiving relationships that foster emotional safety and belonging for both parent and child. Hope can be a driving force for both individual and collective change, and data suggest that hope is a motivating factor for parents to create stable and safe home lives and relationships for their children. ³⁸ Within the PERI Model, intergenerational hope functions as both a mechanism and outcome of healing, supporting meaning-making, relational repair, and the cultivation of a liberated future for pregnant and birthing people and future generations. Together, these four processes of Practice, Emancipation, Resistance, and Intergenerational Hope reframe perinatal mental health equity as a liberatory and intergenerational project that integrates cultural grounding, liberation, solidarity, and hope.

Importantly, French et al. ²⁵ were clear that individual and collective processes of critical consciousness, cultural authenticity, radical hope, support, and resistance unfold within, and are constrained by, broader systems of oppression. Thus, the PERI Model for Radical Healing also situates its domains within broader systemic and structural conditions. Perinatal radical healing does not occur in isolation but is deeply shaped by the policies, institutions, and practices that determine access to equitable and culturally responsive care.

Reproductive Justice ³⁹ is a framework developed by women of color activists and scholars, most notably SisterSong Women of Color Reproductive Justice Collective. The Reproductive Justice Framework centers three core principles: the right to have children, the right not to have children, and the right to parent children in safe and sustainable communities. ³⁹ Grounded in human rights and intersectional feminist praxis, reproductive justice holds that true reproductive well-being cannot be separated from the social, political, and economic conditions that determine whether those rights can actually be exercised. In this way, the PERI Model aligns closely with the Reproductive Justice Framework, which provides a critical structural lens through which perinatal radical healing can be understood as a liberatory process rooted in rights, dignity, and collective care, rather than solely an individual clinical outcome.

Structural reforms, such as paid parental leave, increased employment and representation of BIPOC providers, Medicaid expansion for postpartum care, and investment in culturally humble providers, create the conditions under which radical healing can flourish. In the context of perinatal mental health, this means that interventions aimed solely at the individual level will remain insufficient unless paired with reforms that dismantle inequities in health care access, quality, and outcomes. Without such reforms, the protective potential of radical healing is limited, as individuals remain embedded in systems that reproduce oppression.

Structural reform is particularly urgent in perinatal care, where systemic racism manifests in higher rates of maternal mortality,^19,40 lack of culturally humble providers,^12,41 and inequitable distribution of mental health resources.^42,43 In the United States, policies that expand Medicaid coverage for perinatal mental health services, extend postpartum insurance eligibility, and reimburse doula or community health worker support represent critical steps toward equity.^44–47 Equally important are reforms in medical education and training that promote cultural humility and address implicit bias among perinatal health care providers. ¹² Grassroots reproductive justice movements have long advocated for additional structural changes, such as paid parental leave, bodily autonomy, universal childcare, and protections for birthing people in the workplace, that extend beyond health care to address the broader determinants of perinatal mental health. Recent legislation in New Mexico implements these efforts through a universal child care program beginning in November 2025, acknowledging child care as a “public good.” ⁴⁸ Ultimately, structural reform is not peripheral but central to the Radical Healing framework. For perinatal mental health equity, this requires a multilevel approach: interventions that empower individuals and communities must be paired with policy, institutional, and systemic changes that create conditions where liberation, equity, and flourishing are possible. Without such systemic changes, the protective potential of radical healing processes will be limited, as individuals remain embedded in environments that reproduce oppression.

Overall, the PERI Model for Radical Healing reframes perinatal mental health equity as more than the prevention or treatment of distress among all individuals and redefines it as the opportunity for all pregnant and birthing people to obtain, in full, the resources, knowledge, practices, and care needed to realize their mental health and well-being. It is a collective and liberatory process that affirms culture, transforms resistance into empowerment, builds solidarity, and nurtures hope. By embedding these interconnected processes into perinatal mental health research and practice, scholars and practitioners can move toward interventions and policies that honor the lived experiences of marginalized communities and advance intergenerational well-being.

Research, Clinical, and Structural Implications of the PERI Model for Radical Healing

The PERI Model for Radical Healing highlights Practice, Emancipation, Resistance, and Intergenerational Hope as interconnected processes through which we can transform systemic oppression into opportunities for resilience and flourishing and aim for transformational change and perinatal mental health equity. Future scholarship and clinical practice can extend this model in several ways.

First, qualitative inquiry is needed to capture how pregnant and postpartum persons describe these radical healing processes in their daily lives. Narrative and participatory methods could explore how birthing people articulate experiences of the Practice of cultural grounding in ancestral practices, the sustaining role of Intergenerational Hope in envisioning children’s futures, and the ways Resistance and collective solidarity are enacted in perinatal support networks or advocacy efforts. Such work would provide rich insights into how the processes of radical healing unfold in the developmental context of matrescence or the process of being a mother.

Second, there is a need for quantitative research that measures these processes in perinatal contexts. New or adapted scales could assess whether Practice buffers against perinatal depression, whether Intergenerational Hope predicts resilience postpartum, or whether active Resistance enhances engagement in care. Critical consciousness, as emphasized in the original Radical Healing framework, ²⁵ could be examined as both a mediator and a moderator, shaping how birthing people interpret discriminatory encounters and empowering them to advocate for themselves and their children. Scales such as the Short Critical Consciousness Scale ⁴⁹ could be adapted to consider critical consciousness development related to reproductive justice and the perinatal experience.

Third, mental health intervention research could explicitly integrate the model’s principles. Evidence-based perinatal treatments can be adapted to emphasize the PERI domains as a therapeutic aim, ensuring that care centers’ cultural knowledge and practices, the pursuit of liberation, the power of collective solidarity and community support, and building intergenerational hope. For example, interventions could incorporate Practice by affirming ancestral rituals and practices and integrating them into a birthing plan. They can foster Intergenerational Hope through future-oriented meaning-making and guiding an individual in a discussion about the visions they have for their children, allowing this to drive their motivation for individual and collective change. Additionally, interventions can strengthen Resistance by connecting patients to peer networks and reproductive justice movements that include discussions around cultural identity, transitions, and advocacy. Finally, with Emancipation, interventions can focus on including opportunities to explore liberation-focused knowledge and connecting individuals with people and places where they feel they thrive. Community-based participatory approaches offer especially powerful opportunities to cocreate psychological interventions with birthing people and communities most affected by inequities. A number of perinatal health and mental health interventions have been created using community-based participatory research (CBPR) methods,^50–52 and these could be expanded upon in the future using the PERI domains as a guide to further integrate radical healing principles for BIPOC communities.

For example, community-engaged perinatal mental health interventions such as Listening to Women, ⁴⁶ a text-based Screening, Brief Intervention, and Referral to Treatment program, developed by Guille et al., integrated stakeholder input to address the lived realities of pregnant and postpartum individuals and to improve access to supportive, relationship-centered care. These CBPR-informed approaches demonstrate the value of centering community expertise, trust, and cultural context in intervention development. Importantly, the PERI Model is not proposed as an alternative to CBPR but rather as a complementary framework that can strengthen community-partnered intervention design by explicitly integrating domains of radical healing. Whereas CBPR provides the methodological foundation for equitable cocreation, PERI offers conceptual guidance to ensure that interventions attend not only to symptom reduction but also to liberation, cultural affirmation, resistance, and intergenerational well-being for BIPOC birthing communities. In this way, future CBPR-based perinatal mental health interventions could be further enhanced by using the PERI domains as a guide for embedding radical healing principles throughout development, implementation, and evaluation.

Fourth, the model provides a roadmap for clinical practice. Clinicians can apply a radical healing lens by validating patients’ lived experiences of oppression, affirming cultural knowledge as legitimate sources of healing, and positioning community connection and advocacy as therapeutic resources. This framing builds upon existing recommendations for incorporating cultural humility in clinical work^12,53 and moves psychological interventions from a deficit-based focus on symptom reduction to a liberation-oriented practice that centers dignity, agency, and intergenerational flourishing.

Last, policy-oriented research is essential for examining how structural reforms create conditions where radical healing can thrive. Data to date show that increases in expenditures for peripartum individuals and maternal care reduce maternal mortality, especially for Black individuals, improve maternal mental health and well-being, and reduce rates of preterm birth and low birthweight among infants.^54–56 Policies such as Medicaid reimbursement for doulas, expanded postpartum coverage, paid parental leave, childcare supports, and culturally responsive workforce development represent foundational elements of perinatal radical healing. Many organizations (e.g., Chicago Birthworks, BEE Collective, SisterSong Women of Color Reproductive Justice Collective, Black Mamas Matter Alliance, National Black Women’s Reproductive Justice Agenda, and National Latina Institute for Reproductive Justice) are currently leading the way in improving access to culturally responsive care and pushing for policy reforms for birthing People of Color. Future studies can investigate whether and how these reforms enable greater opportunities for cultural grounding, amplify intergenerational hope, and foster solidarity and resistance across communities. Taken together, these research, clinical, and structural directions underscore that the PERI Model for Radical Healing is not only a psychological framework for research but also a practical guide for mental health, healing, and systemic transformation.

Conclusion

The PERI Model for Radical Healing offers a transformative model for advancing perinatal mental health equity. Most of the focus on perinatal mental health equity has been through a public health or medical model lens. Although these frameworks of understanding and addressing are important, we are missing critical insights from the field of psychology that can be helpful to advance perinatal mental health equity. By incorporating psychological frameworks, especially those rooted in liberation, we can approach perinatal mental health equity in a way that embraces the inherent resilience of birthing People of Color and enhances the evidence-based treatment models with decolonial methods of healing. Furthermore, by using the PERI Model for Radical Healing to guide research, clinical work, and structural reform, perinatal mental health can be reimagined not as the mitigation of pathology but as a site of liberation, cultural continuity, and collective thriving that provides individuals with what they need to realize their full mental health and well-being potential. Future scholarship grounded in this model can help dismantle inequities while envisioning perinatal mental health as a domain where justice and healing are inseparable.