Objective: to explore the factors that might account for low levels of consultation for perinatal depression among Black Caribbean women and their absence from perinatal research in the UK. Design: qualitative study using in-depth interviews. Setting: antenatal clinics in a large teaching hospital and community health centres in the northwest of England. Participants: a purposive sample of 12 Black Caribbean women was selected from a larger mixed-method study involving both Black Caribbean (n=101) and White British (n=200) women. Findings: thematic analysis of women's narratives suggested that, despite attendance at antenatal classes, Black Caribbean women experienced difficulty conceptualising perinatal depression and expressed reservations about the nature and treatability of the condition. Personal and social imperatives to minimise distress, reluctance to discuss problems, and stoicism in the face of adversity were barriers to help-seeking. Black Caribbean women were willing to counter personal barriers and fears of engaging with mental health services to seek help. When they did so, however, health professionals appeared to be unable/unwilling to diagnose perinatal depression. Key conclusions: the absence of Black Caribbean women with perinatal depression from clinical practice and research may be because social, structural and personal barriers prevent these women from accessing the care and support they need. Implications for practice: in order to address the needs of child bearing women in a multi-cultural context, service providers need to ensure that culturally sensitive practice is a reality and not rhetoric. Education and training (both that given to women via antenatal classes and to health professionals) may need to be reviewed in order to improve cultural sensitivity and efficacy. © 2007 Elsevier Ltd. All rights reserved.