Mental Health Conditions: U.S. Policies and Practice to Address the Most Common Complication of Pregnancy and Childbirth (2024)

This is the second article in a three-part article series on perinatal mental health.

Maternal mental health (MMH) conditions are the most common complication of pregnancy and childbirth, affecting 1 in 5 women or childbearing individuals (800,000 U.S. families each year). Recent studies show that suicide and overdose combined are the leading cause of death for mothers in the first year postpartum, contributing to the distressingly high maternal mortality rate in the United States. Sadly, 75 percent of those experiencing MMH conditions go untreated, increasing the risk of multigenerational, long-term negative impacts on the physical, emotional, and developmental health of both the mother and child. The COVID-19 pandemic has fueled a three-fold increase in the number of pregnant women and new mothers experiencing MMH conditions. Women of color are disproportionately impacted by both the pandemic and MMH conditions, experiencing both at rates 2-3 times higher than white women.

The MMH crisis comes at an immense cost. In 2017, not treating MMH conditions cost the United States an estimated $14.2 billion–$32,000 per mother-infant pair–when accounting for lost wages and productivity and poor health outcomes. In response, U.S. government and civil society have taken several steps to support pregnant and postpartum people through screening, education, and treatment. Nevertheless, further action is needed to ensure that individuals struggling with MMH conditions are able to access the care they need and deserve.

Federal Legislation Addressing Maternal Mental Health Conditions

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

More recently, Congress passed legislation to address MMH in the military calling for a study on MMH among military members 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 support for pregnant and postpartum people. Congress is also currently considering 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 legislation giving states the ability to extend pregnancy-related Medicaid coverage from 60 days to a full year postpartum. Medicaid covers almost 50 percent of births in the United States. Ending coverage at 60 days postpartum potentially leaves new mothers uninsured at a medically-vulnerable time 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 past the mandatory 60-day coverage period. While the move was a major win for MMH advocates, the legislation is temporary, optional, and is not supported by additional federal funding. Many are calling for further action to address these insufficiencies.

State Legislation and Actions Addressing Maternal Mental Health Conditions

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 education, support, and real-time psychiatric consultation to assist frontline providers in diagnosing and treating MMH conditions. Both approaches have become models for other states, and leaders of these programs have created learning communities and are undertaking a multiyear study to assess the comparative effectiveness of their efforts.

Many other states have also taken action to address MMH conditions, including convening commissions 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 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.

Remaining Barriers to Care and Next Steps

Despite this progress, the majority of pregnant and postpartum people are still neither screened nor treated for MMH conditions, despite interacting with a healthcare provider an average of 25 times during period from conception to the first year postpartum. Healthcare providers often cite lack of education about MMH conditions, lack of appropriate resources, and lack of reimbursem*nt for screening or treatment. Individuals experiencing MMH conditions face significant barriers, including lack of access to specialized mental health care, particularly racially- 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 address these barriers. The first is to create universal screening recommendations to ensure that all pregnant and postpartum people are educated about and regularly screened for MMH conditions. All medical providers who work with parents during pregnancy and postpartum must be educated about mental health conditions, including how to discuss and screen for these illnesses.

Second, treatment must be readily available and easy to access. Help is currently available from national organizations such as Postpartum Support International; statewide nonprofit organizations such as those in New York, Virginia, and Washington; and community-based organizations such as the Shades of Blue Project in Texas and Cherished Mom in Tennessee. Psychiatry access programs, which help frontline providers assess and treat MMH conditions, have been established in almost 20 states, and over two dozen intensive treatment programs, including in-patient psychiatry units, are available to help those in severe distress. These resources must be supported and strengthened. Finally, insurance must provide adequate reimbursem*nt for MMH care at all levels, from screening through 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 families. By continuing and expanding efforts to support MMH services, policymakers can help create a healthier, more equitable society–for now and generations to come.