By Amy Kennedy
As a mother of five, I’m intimately familiar with the overwhelming flood of emotions that comes with carrying a child, giving birth, and journeying through the postpartum phase. Deep love, nervousness about being a good parent, anticipation of the life ahead – all driven into high gear by our bodies’ hormonal response. While each person’s experience with pregnancy and the postpartum stage varies, up to 80% of women will experience the “baby blues” after giving birth. Anxiety, depression, and intrusive thoughts are all common experiences in the postpartum phase. The U.S. has tragically seen two recent, high-profile cases marked by postpartum psychosis and the worst possible outcomes. Even as a mental health advocate entrenched in the failures of our systems, I am left grappling. How could we have failed these women and their families so gravely? How did we get to a point where one in five maternal postpartum deaths are attributed to suicide?
In the U.S., maternal mental health conditions are the leading cause of pregnancy-related death, while less than 15% of those who suffer from a maternal mental health disorder will receive treatment. Some of those women feel apprehensive to even ask for help for fear their children will be unjustly taken by child protective services. Like so many mental health conditions, the pandemic has exacerbated what was already a growing problem for new and expecting mothers. 2020 Mom highlights a study indicating maternal depression and anxiety rates increased by 64% during the pandemic. Further, maternal mortality disproportionately affects Black mothers – even when adjusted for income. Building a diverse provider workforce is essential to addressing these inequitable health outcomes. To unpack just what that building process needs to look like: It means increasing mental health provider reimbursement rates, introducing new school and community mental health professional pipeline programs and programs, training providers to screen for mental health needs, and maximizing inter-state licensing flexibility.
With one in five maternal postpartum deaths attributed to suicide, and with depression and substance misuse among the most significant risk factors for maternal suicide, improved care for mothers and those who are pregnant is a matter of life and death. These numbers and statistics represent real people, dealing with real crises.
Structural treatment gaps disproportionately impact new and expecting mothers, particularly mothers of color. Studies have shown that women of color experience postpartum depression at a rate of nearly 38% compared with approximately 13% to 19% for all postpartum women. Higher rates of ‘co-occurring adversities’, including racism, poverty, and workplace discrimination, negatively impact the overall well being of mothers and babies of color. In 2020, prior to the pandemic spike, a study revealed that only one in eight women reported being screened for postpartum depression. This is an egregious abdication of duty to our mothers as a society. Mental health screenings are one of the most evidence-based and scalable crisis solutions on the table.
In every state, legislators have the opportunity to make great strides in increasing access and affordability of treatment for maternal mental health and substance use. To stop headline-making tragedies, far-too-common maternal suicides, and better support every new mom, we need to screen for challenges, connect to resources, and deliver quality care without causing a loss of custody. Medicaid expansion is one way in which to make these interventions a reality for the women and families who so desperately need them. A 2020 study revealed that Medicaid expansion was “significantly associated with lower maternal mortality.” 10 states including Texas, Wisconsin, and Georgia have not yet expanded Medicaid. State legislators can and should take this life-saving action to expand.
New Jersey First Lady Tammy Murphy has made maternal health the subject of her National Governors’ Association Spouse Initiative, which I am proud to support. I see many intersections in the policy solutions needed to support youth mental health with that of maternal mental health.
Those policy solutions include adopting the Zero Suicide Framework; integrating mental health and substance use care into primary care; and ensuring commercial reimbursement for medically necessary mental health services through strong coverage requirements and effective regulations.
Postpartum mental health care is a lifeline to those who can access it, but we are a long way from providing the interventions mothers need. The connection between maternal and youth mental health are inextricably linked, and we cannot move forward on one without the other. Concerted collaboration with policymakers, payors, providers, families and community members will save lives, bolster communities, and secure healthy environments for America’s mothers and families. We cannot afford to let more mothers down.