Mental Health the Leading Driver of Maternal Mortality

It’s the 21st century and despite decades of medical and technological advancements, the U.S. maternal mortality rate remains stubbornly high.

Depending on which study you believe, the nation’s maternal mortality rate is as high as 32.9 deaths for every 100,00 births or as low as 10.4. By even the most optimistic metrics, the United States trails at least three dozen other countries, including Belarus, Poland, and the United Kingdom, to name just a few.

The U.S. Centers for Disease Control and Prevention (CDC) published a report in 2022 that showed that mental health issues – particularly suicide and overdose — are the leading cause of pregnancy-related deaths. Maddeningly, the authors insist that more than 80 percent of those deaths are preventable.

The news is far worse for non-white women. Black mothers, in one tragic example, are three times more likely to die in childbirth than their white counterparts.

“We have to prevent these deaths,” K.S. Joseph, a physician and epidemiologist in the OB-GYN department of the University of British Columbia and the study’s lead author told NPR. “Even if we say that the rate is 10 per 100,000 and not 30 per 100,000, it does not mean that we have to stop trying.”

A Call to Arms

The situation is dire enough that it moved a cross-section of researchers to sound the alarm, penning a letter to the journal Health Affairs.

The authors, in a push for major reforms, argue that perinatal mental health is just as crucial as the physical for maternal and child welfare.

The researchers point to recent policy initiatives, such as the TRIUMPH for New Moms Act and Medicaid expansion, that policymakers drafted to tackle these challenges. They also concede that the nation’s healthcare system still struggles to meet the mental health needs of perinatal individuals and their families, especially among minority populations. But they add that a reproductive justice framework, emphasizing bodily autonomy and safe environments, remains essential for understanding and addressing perinatal mental health disparities.

The current maternal health landscape reflects systemic disparities, where marginalized groups experience poorer outcomes and distrust healthcare providers. Reproductive justice, developed by Black feminist activists, underscores the need to address structural root causes of health disparities. Trauma, both personal and historical, contributes to perinatal mental health challenges, affecting maternal and child outcomes across generations.

Policy Proposals

The commentary piece suggests multiple  policy proposals, such as:

• Broadening the understanding of perinatal mental health challenges.
• Standardizing certifications for perinatal mental health providers.
• Facilitating community-based care payments.
• Expanding for perinatal psychiatry access program funding.
• Reinstating the 2021 Child Tax Credit.
• Implementing universal basic income programs.
• Promoting workplace policies supporting families.

These policies, the authors insist, would address systemic barriers to perinatal mental health care, such as limited access to qualified providers and intense financial pressure.

“Broadening the understanding of what constitutes perinatal mental illness and wellness and grounding this understanding in reproductive justice would lead to policies that close some of these gaps and serve as an example to other healthcare sectors,” the authors conclude. “None of these policies is unattainable. The challenges lie in who the nation values and how US society chooses to demonstrate that.”

Further Reading

Preventive Health Care in Children and Maternal Schizophrenia

Parental Mental Illness and Child Injury Risk

Maternal Postnatal Depression and Infant Immunizations