Pregnant women and new mothers face a deadly mental health crisis in the United States.
Mental health issues, the leading underlying cause of pregnancy-related deaths in the country, are leading to an alarming increase in maternal mortality rates, which climbed about 60% between 2019 and 2021, according to the Centers for Disease Control and Prevention. of Disease Prevention (CDC).
Suicides and overdoses account for nearly a quarter of these deaths, according to the CDC.
Rates of substance use, depression, anxiety and other serious mental health issues – like suicidal ideation and postpartum psychosis – appear to be increasing among pregnant women and new mothers.
“I’m very concerned,” said Ludmila De Faria, chair of the American Psychiatric Association’s council on women’s mental health.
The CDC recently released data showing that maternal deaths declined in 2022 and reported that 817 women died of maternal causes that year. Although the decline in deaths is a step in the right direction, doctors caution that more data is needed to determine whether maternal mortality is truly declining.
The agency has not released detailed data on the causes of these deaths, so it is unclear how many maternal deaths in 2022 were due to mental health issues.
It is difficult to assess how much maternal mental health is deteriorating in the United States, given the limited amount of data available.
While suicide rates appear to be increasing among pregnant and postpartum women, for example, Christine Yu Moutier, chief medical officer of the American Foundation for Suicide Prevention, warns that this may be due in part to better collection data on maternal mortality rather than a real increase. .
She specifically cites the Maternal Death Prevention Act, passed by Congress in 2018, as a reason for the improved data.
But even considering the still limited data on the subject, some research suggests that mothers’ mental health is deteriorating.
A 2020 study found that suicidal tendencies, meaning suicidal thoughts or suicide attempts, increased in the decade before the COVID-19 pandemic began.
Researchers at the University of Michigan, examining suicide rates among pregnant women with private health insurance between 2006 and 2017, found that the number of women who thought about suicide or self-harm tripled over the of these years.
Health experts also believe that rates of mental health problems such as anxiety and depression have increased among pregnant women because they have become more prevalent in the general population, according to De Faria.
Since 2020, global rates of depression and anxiety have increased by 25%, according to the World Health Organization.
Depression rates in the United States hit a record high last year, according to a Gallup survey; 29 percent of U.S. adults admitted in the survey that they had been diagnosed with an illness at some point in their lives, up 10 percentage points from 2015.
The same survey found that far more women than men have experienced depression: About 36 percent of women reported being diagnosed with depression at some point in their lives, compared to about 20 percent of men.
And this disparity is growing as women see a particularly sharp increase in depression. Rates have increased almost twice as much among women as among men since 2017, according to the survey.
In the United States, suicide rates among young women are also increasing. Suicide deaths increased 4% between 2021 and 2022 among women ages 25 to 34, according to the most recent CDC data.
Some experts, like Moutier, worry that mothers’ mental health has deteriorated due to decreased access to mental health care.
The United States is experiencing a shortage of mental health providers, with about 47 percent of Americans, or 158 million people, living in a mental health staffing shortage area this year, according to the research group on KFF health policies.
Additionally, many doctors who treat pregnant or postpartum women, such as primary care physicians or obstetrician-gynecologists, do not check on their mental health, despite recommendations from professional organizations.
Angelina Spicer told The Hill that when she visited her obstetrician-gynecologist for a six-week postpartum exam after the birth of her daughter eight years ago, the doctor simply made sure “that she was ready to have sex again” and never asked her how she was behaving. life with the new baby.
Spicer, a stand-up comedian, suffered from severe anxiety and depression after the birth of her daughter.
But she said the conversation with her doctor during the exam centered on Spicer’s weight. The doctor commented on how she “looked amazing” and “just like she did before the baby,” Spicer recalled.
“I was wondering: why are we talking about my appearance? And why doesn’t anyone ask me why I feel like I’m drowning? she says.
Fewer than 20 percent of pregnant and postpartum women on Medicaid receive a mental health screening, according to the Policy Center for Maternal Mental Health.
Screening rates are even lower for women with private insurance, the organization found. Only 9 percent of pregnant women and 11 percent of postpartum women with private insurance receive mental health screening.
Partly because of this lack of screening, while about 1 in 8 women will experience postpartum depression in the year after giving birth, about half of these cases go undiagnosed, according to a 2019 study.
Even when cases of depression are detected, many women do not receive care. A study published in 2015 found that only 22% of perinatal women who tested positive for depression received treatment.
“The impact this has on women who are not receiving treatment and on families is enormous,” said Elizabeth Cherot, president and CEO of March of Dimes.
“Think about the impact that, if left untreated, (poor maternal mental health) has on parents, babies, families and our entire society. »
Mood disorders during or just after pregnancy can harm a mother’s relationship with her baby and her partner.
“Emotional distress can hinder a mother’s ability to form a strong, nurturing bond with her baby, thereby impairing her ability to provide the responsive care essential for healthy infant development,” according to a 2023 study.
“Tense emotional states can spill over into the mother’s partnership, causing breakdowns in communication and emotional distance. »
Beyond the realm of treatment, or lack thereof, health experts are also concerned about the changing landscape of reproductive laws after the Supreme Court’s 2022 decision overturning Roe v. Wade, which could have a negative impact on maternal mental health.
As a result of the ruling, “what is potentially happening is a significant increase in the number of unplanned pregnancies,” De Faria told The Hill.
In the year following the Dobbs v. Jackson Women’s Health Organization decision, states with abortion bans had an average fertility rate 2.3% higher than states without a ban, according to a 2023 analysis.
This increase in the fertility rate resulted in about 32,000 more births than expected, according to the analysis. It is not clear how many of these pregnancies were planned.
Having an unplanned pregnancy can be “a huge stressor” for someone with or without a pre-existing psychiatric illness, De Faria said.
Many studies show a link between unplanned pregnancies and higher rates of perinatal depression.
A study conducted in Brazil in 2017 found that women with unplanned pregnancies were 2.5 times more likely to experience depression during their pregnancy and postpartum months than women with planned pregnancies.
Although experts worry about the future of maternal mental health, they also agree that there might be some light in the darkness.
“What gives me hope is the attention that has been paid to it,” Caitlin Murphy, a research scientist at the Milken Institute School of Public Health, said of poor maternal mental health and rates of screening in the country.
“Once the information gets out, people start to do something.”
— Updated at 10:11 a.m.
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