United States Policies and Practices for Addressing the Most Common Complications of Pregnancy and Childbirth

Maternal mental health disorders (MMS) are the most common complication of pregnancy and childbirth, affecting 1 in 5 women or people of childbearing age (800,000 American families each year). Recent studies show that suicide and overdose combined are the leading cause of death among mothers in the first year postpartum, contributing to the desperately high maternal mortality rate in the United States. Unfortunately, 75 percent of people with MMH disease go untreated, increasing the risk of long-term, multigenerational negative impacts on the physical, emotional, and developmental health of both mother and child. The COVID-19 pandemic has tripled the number of pregnant women and new mothers with MMH. Women of color are disproportionately affected by both pandemic and MMH conditions, experiencing both at rates 2-3 times higher than white women.

The MMH crisis comes at a huge cost. In 2017, failure to treat MMH conditions cost the United States between $ 14.2 billion and $ 32,000 per mother-child pair, including lost wages and productivity and poor outcomes. for health. In response, the US government and civil society have taken several steps to support pregnant and postpartum women through testing, education, and treatment. Nonetheless, additional measures are needed to ensure that people with MMH problems can access the care they need and deserve.

Federal Legislation on Maternal Mental Health Problems

In 2015, Congress passed the Bringing Postpartum Depression Out of the Shadows act. The law provided funding to treat MMH conditions for the first time in the country’s history and awarded grants to seven states to create programs to educate providers to treat MMH conditions. In 2018, Congress passed the Prevention of Maternal Deaths Act, which provided funding to state maternal mortality review committees to examine the cause of death of women during pregnancy and the first year of post-pregnancy. partum.

More recently, Congress passed a law to combat MMH in the military calling for a study on MMH among the military and launching a pilot project to assess the impact of doulas in maternity care. In September 2021, Congress funded a 24/7 maternal mental health hotline to provide specialized voice and text assistance to pregnant and postpartum people. Congress is also currently reviewing several pieces of legislation that address maternal mortality and MMH, including the Black Maternal Health Momnibus and the TRIUMPH for New Moms Act.

In April 2021, Congress passed a law giving states the ability to extend Medicaid coverage related to pregnancy from 60 days to a full year after childbirth. Medicaid covers nearly 50 percent of births in the United States. Ending coverage 60 days postpartum potentially leaves new mothers uninsured at a medically vulnerable point in their lives. Notably, the peak incidence of postpartum depression is 3-6 months postpartum and the peak incidence of postpartum suicide is 6-9 months postpartum, both well beyond the mandatory coverage period. 60 days. While the move was a major victory for MMH advocates, the legislation is temporary, optional, and not backed by additional federal funding. Many are calling for new measures to remedy these shortcomings.

Legislation and State Actions Regarding Maternal Mental Health Problems

New Jersey was the first state to require screening for postpartum depression in 2006 and has since created a statewide resource and referral system for providers and parents. Massachusetts launched the Massachusetts Child Psychiatry Access Program for Moms in 2013 to provide real-time psychiatric education, support, and counseling to help frontline providers diagnose and treat MMH conditions. The two approaches have become models for other states, and the leaders of these programs have created learning communities and are undertaking a multi-year study to assess the comparative effectiveness of their efforts.

Many other states have also taken steps to address MMH issues, including convening commissions or task forces to raise awareness, call for testing, and educate providers. Utah, for example, passed a law requiring provider education, parent testing, and a public education campaign. Illinois passed landmark legislation recognizing that MMH conditions can be a factor in criminal cases and requiring insurers to cover all mental health care, including for MMH conditions.

Barriers to Remaining Care and Next Steps

Despite these advances, the majority of pregnant and postpartum women are still not screened for and treated for MMH conditions, despite interacting with a health care provider an average of 25 times during the period from conception. in the first year of postpartum. Health care providers often cite lack of education about MMH conditions, lack of appropriate resources, and lack of reimbursement for screening or treatment. People with MMH disorders face significant barriers, including lack of access to specialized mental health care, especially race and culturally appropriate care, and logistical barriers such as lack of transportation. and childcare.

There are several steps government, civil society, providers and community members can take to overcome these barriers. The first is to create universal screening recommendations to ensure that all pregnant and postpartum people are informed and regularly screened for MMH conditions. All medical providers who work with parents during pregnancy and postpartum should be informed about mental health issues, including how to discuss and screen for these illnesses.

Second, the treatment must be readily available and easy to access. Help is currently available from national organizations such as Postpartum Support International; statewide nonprofits such as New York, Virginia, and Washington; and community organizations such as the Shades of Blue Project in Texas and Cherished Mom in Tennessee. Access to Psychiatry programs, which help frontline providers assess and treat MMH disorders, have been implemented in nearly 20 states, and more than two dozen intensive treatment programs, including including inpatient psychiatry units, are available to help people in severe distress. These resources must be supported and strengthened. Finally, insurance must ensure adequate reimbursement of MMH care at all levels, from screening to treatment.

Robust and comprehensive MMH care can help new mothers thrive during the important perinatal period, leading to optimal health outcomes for themselves, their babies and their families. By continuing and expanding efforts to support MMH’s services, policy makers can help create a healthier and more equitable society, for the present and for generations to come.