By Alisha Saxena
Mental health conditions are the most frequent underlying cause of maternal death in the United States. They are also the most common complications of pregnancy and childbirth. Maternal mortality is on the rise in the United States, increasing by 38 percent between 2020 and 2021, and the U.S. has the highest maternal mortality rate of any high-income country. October is Global Mental Health Month, which offers an opportunity to raise awareness and take action to address the maternal mental health crisis in the United States. To address this crisis, Congress must meaningfully invest in maternal mental health supports and services to better address the well-being of birthing people at this critical time in their lives.
Maternal mental health conditions, the most common of which are depression and anxiety, are most likely to occur in the perinatal period, which includes the prenatal and postpartum periods. The maternal mental health crisis is tied to cultural barriers, systemic racism, and income inequality. Due to social stigmas associated with mental illness, 75 percent of birthing people impacted by mental health conditions remain untreated. These untreated mental health conditions are more prevalent across communities of color—for instance, Black women are twice as likely as white women to experience mental health conditions during the perinatal period but are half as likely to receive care.
Black and Hispanic women experience higher rates of maternal mental health conditions due to the combination of racial discrimination in health care and income inequality. Income inequality and systemic racism are associated with adverse mental health conditions for expecting and new parents and result in disparate health outcomes. For instance, single Black mothers are six times more likely to experience depressive symptoms than other pregnant people. However, the full degree of racial disparities in maternal mental health has not been captured. The many challenges to gathering this information include limited access to care; cultural stigmas that may prevent disclosure of mental health needs; and systems of white supremacy that influence mental health research and interventions. State and federal policymakers must do more to understand and address these disparities. They can implement proven policy changes that make a difference, including paid family leave, Early Head Start, and comprehensive screening programs, but these policies are often underfunded or funded at the discretion of states, meaning many families don’t benefit from them.
Access to care also impacts mental health outcomes. The maternal mental health crisis in the United States is worsened by maternity care deserts, defined as a county with no hospitals, birth centers, or midwives to provide obstetric care. Concerningly, these deserts constitute 36 percent of all U.S. counties, and the populations of these counties are disproportionately rural, low-income, and non-white. For instance, in 2020, more than a quarter of Native American babies were born in areas with limited or no maternity care. This lack of available care exacerbates pre-existing racial disparities in health outcomes, such as higher rates of postpartum depression for Black women that increase their risk of pre-term births. Thus, women in these deserts are more likely to experience chronic conditions before and throughout pregnancy.
Congress and the Biden Administration are acting and stating their priorities in addressing the maternal mental health crisis. For example:
- In May 2023, Congress reintroduced the Black Maternal Health Momnibus Act, a legislative package that includes a focus on maternal mental health. The Moms Matter Act, a part of the package, would establish a Maternal Mental Health Equity Grant Program to invest in local initiatives supporting people with mental health conditions during or after pregnancy. Many of these programs target underserved communities, and the funding would also be allocated to grow and diversify the maternal mental and behavioral health care workforce to expand access to high-quality maternal mental health care. Though the Momnibus Act was reintroduced in May 2023, Congress has not yet been passed it.
- The White House released its inaugural Blueprint for Addressing the Maternal Health Crisis in June 2022, making a commitment to be the “model employer” for maternal mental health coverage and to launch a media campaign aimed at reducing the stigma for postpartum depression and other mental health disorders. Furthermore, the blueprint called on Congress to invest $7 million to support the nationwide 24-hour maternal mental health hotline. Congress included this funding in the FY23 budget, and as of May 2023, the hotline, which is run by the Health Resources and Services Administration (HRSA), had supported almost 12,000 pregnant and postpartum individuals who were largely reaching out due to “feeling overwhelmed, depression, and anxiety.” The success of the hotline affirmed that the blueprint strategies can lead to tangible change in maternal mental health trends in the United States.
- In September 2023, HRSA took an important step forward when it announced an investment of $90 million in awards to support maternal health, which included funding for efforts to address the successful delivery of maternal mental health programs.
These efforts are important, but they are not enough. Congress must simultaneously address other parts of a system that perpetuate community-based disparities in health outcomes, including racial bias and discrimination in health care and data collection for vulnerable populations. Furthermore, a combination of robust policies and strategies is needed to effectively improve parental health outcomes, from paid family leave to Early Head Start and comprehensive screening programs. Addressing the maternal mental health crisis will require significant action, investment, and intentionality from Congress to bolster support for families and promote health equity.
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