Fertility brings an increased risk of receiving a mental health diagnosis, from pre-menstrual dysphoric disorder (PMDD) to depression following miscarriage, post-natal psychosis and ante- and post-natal depression. Suicide is a leading cause of death in new mothers. Across the world, women’s reproductive systems remain a political battleground and subject to external controls from access to contraception and abortion in the USA to getting better mental health care for perinatal mental illness. Women can feel disempowered and unheard by the professions as recent maternity scandals in the UK have revealed. There is also pressure for women to have ‘natural’ births without intervention. What part do misogyny, patriarchal attitudes and aspects of feminism itself play here? We can all advocate and support fellow women who are struggling with any of the complications of fertility and not getting the care they need. There are ‘red flags’ we can all remember for getting mental health care involved in the perinatal period: Providing pregnant women with the information to make truly informed decisions about their health care is crucial. Perinatal mental illness is real and can kill.