US 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, touching 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 for mothers in the first postpartum year, contributing to maternal mortality rate in the United States. Unfortunately, 75 percent of people with MMH go untreated, increasing the risk of long-term multigenerational negative impacts on the physical, emotional and developmental health of mother and child. The COVID-19 pandemic has fueled a triply the number of pregnant women and new mothers with MMH disorders. 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, do not treat MMH conditions cost the United States about $ 14.2 billion – $ 32,000 per mother-child pair – when you factor in lost wages and productivity and poor health outcomes. 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 adopted the Postpartum Depression Coming 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 adopted The law on the prevention of maternal deaths, which provided funding to state maternal mortality review committees to examine the cause of death of women during pregnancy and the first year of postpartum.

More recently, Congress passed a law to combat MMH in the military calling for a study on MMH among the military and the launch of 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 support 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 give states the option to expand Medicaid coverage related to pregnancy from 60 days to a full year after childbirth. Medicaid covers nearly 50% 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 maximum incidence of postpartum depression is 3 to 6 months after childbirth, and the maximum incidence of postpartum suicide is 6 to 9 months postpartum, well beyond the mandatory 60-day coverage period. 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 Access to Child Psychiatry Program for Moms in 2013 to provide education, support and real-time psychiatric consultations to help frontline providers diagnose and treat MMH disorders. Both approaches have become models for other states, and the leaders of these programs have created learning communities and are undertaking a multi-year study assess the comparative effectiveness of their efforts.

Many others states have also taken steps to address MMH conditions, including convening committees or task forces to raise awareness, call for screening, and educate providers. Utah, for example, has passed legislation requiring education for providers, screening for parents and a public awareness campaign. Illinois has passed historical legislation recognize that MMH disorders can be a factor in criminal cases and require insurers to cover all mental health care, including for MMH disorders.

Barriers to Remaining Care and Next Steps

Despite these advances, the majority of pregnant and postpartum women are still not screened for or treated for MMH conditions, despite interacting with a health care provider an average of 25 times between conception and the first year. 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 health care 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. Support is currently available from national organizations such as International postpartum support; statewide nonprofit organizations such as those of new York, Virginia, and Washington; and community organizations such as Shades of Blue Project in Texas and Dear Mum in Tennessee. Psychiatry access programs, which help frontline providers assess and treat MMH conditions, have been established in nearly 20 states and more than two dozen intensive treatment programs, including inpatient psychiatry units, are available to help people in great 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.