(The Hill) – Pregnant women and new mothers are facing a deadly mental health crisis across the United States.
Mental health conditions, the leading underlying cause of pregnancy-related deaths in the country, are driving an alarming rise in maternal mortality rates, which climbed roughly 60 percent between 2019 and 2021, according to the Centers for Disease Control and Prevention (CDC).
Suicides and overdoses account for nearly a quarter of those deaths, according to the CDC.
Rates of substance use, depression, anxiety and other serious mental health conditions — like suicidal ideation and postpartum psychosis — appear to be rising among pregnant women and new moms.
“I am very concerned,” said Ludmila De Faria, chair of the American Psychological Association’s committee on women’s mental health.
The CDC recently released data showing maternal deaths dipped in 2022 and reported that 817 women died from maternal causes that year. While the decrease in deaths is a step in the right direction, physicians warn more data is needed to see if maternal mortality really is on the decline.
The agency has not released detailed data on the causes of those deaths, so it remains unclear how many maternal deaths in 2022 stemmed from mental health conditions.
It is difficult to gauge just how much maternal mental health is worsening in the U.S. given the limited data available.
While suicide rates appear to be climbing among pregnant and postpartum women, for instance, Christine Yu Moutier, chief medical officer at the American Foundation for Suicide Prevention, cautions this may in part be due to better data collection on maternal mortality rather than a true increase.
She points in particular to the Preventing Maternal Deaths Act, which Congress passed in 2018, as a reason for the data improving.
But even considering the still-limited data on the subject, some research suggests maternal mental health is deteriorating.
One 2020 study found that suicidality, meaning either thoughts of suicide or suicide attempts, increased in the decade before the onset of the COVID-19 pandemic.
Researchers at the University of Michigan, examining suicide rates among pregnant people with private health insurance between 2006 and 2017, found the number of women who thought about suicide or self-harm tripled during those years.
Health experts also believe rates of mental health conditions such as anxiety and depression have gone up among pregnant women because they’ve become more widespread in the population as a whole, according to De Faria.
Since 2020, global rates of depression and anxiety have increased by 25 percent, according to the World Health Organization.
In the U.S., depression rates reached an all-time high last year, according to a Gallup survey; 29 percent of American adults admitted in the survey that they had been diagnosed with the illness at some point in their lives — 10 percentage points higher than in 2015.
The same survey found many more women have experienced depression than men: About 36 percent of women reported being diagnosed with depression at some point in their lives, compared with about 20 percent of men.
And that disparity is growing as women see a particularly sharp spike in depression. The rates have risen almost twice as much among women as they have among men since 2017, the survey shows.
Suicide rates among young women in the U.S. are also on the rise. Deaths by suicide increased by 4 percent from 2021 to 2022 among women ages 25 to 34, according to the most recent CDC data.
Some experts, like Moutier, worry that maternal mental health may have worsened due to decreased access to mental health care.
The U.S. is experiencing a mental health provider shortage, with about 47 percent of Americans, or 158 million people, living in a mental health workforce shortage area as of this year, according to health policy research group KFF.
On top of this, many physicians who treat pregnant or postpartum women, such as primary care physicians or obstetrician-gynecologists, do not check in on mental health despite professional organizations recommending that they do so.
Angelina Spicer told The Hill that when she visited her OB-GYN for a six-week postpartum checkup after her daughter was born eight years ago, the physician just made sure “she was clear to have sex again” and never asked how she was handling life with the new baby.
Spicer, a stand-up comedian, experienced severe anxiety and depression following her daughter’s birth.
But she said the conversation with her physician during the checkup centered on Spicer’s weight. The doctor commented on how she “looked amazing” and “just like she did before the baby,” Spicer remembers.
“I was like, why are we talking about what I look like? And why is nobody asking me why I feel like I’m drowning?” she said.
Less than 20 percent of pregnant and postpartum women with 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. Just 9 percent of pregnant women and 11 percent of postpartum women with private insurance undergo a mental health screening.
In part due to this lack of screening, while about 1 in 8 women will experience postpartum depression in the year after they give birth, roughly half of these cases will go undiagnosed, a 2019 study found.
Even when cases of depression are caught, many women do not receive care. A study published in 2015 found only 22 percent of perinatal women who screened positive for depression received treatment.
“The impact this has on women who don’t receive treatment and the impact on families is huge,” said Elizabeth Cherot, president and chief executive officer of March of Dimes.
“Think about how if left untreated how [poor maternal mental health] impacts parents, babies, families and our whole society.”
Mood disorders either during or right after a pregnancy can harm a mother’s relationship with her baby and partner.
“Emotional distress can hinder a mother’s ability to form a strong, nurturing bond with her baby, impairing her capacity to provide the responsive care crucial for the infant’s healthy development,” according to one 2023 study.
“Strained emotional states can reverberate into the mother’s partnership causing communication breakdowns and emotional distance.”
Beyond the realm of treatment, or the lack thereof, health experts also worry the shifting landscape of reproductive laws after the Supreme Court’s 2022 decision overturning Roe v. Wade could have a negative impact on maternal mental health.
Following that decision, “what you have is potentially a significant increase in the number of unplanned pregnancies,” De Faria told The Hill.
In the year after the Dobbs vs. Jackson Women’s Health Organization decision, states with abortion bans had an average fertility rate 2.3 percent higher than states without them, according to a 2023 analysis.
That increased fertility rate led to roughly 32,000 more births than expected, according to the analysis. It is not clear how many of those pregnancies were planned.
Having an unplanned pregnancy can be “a huge stressor” for someone with or without a preexisting psychiatric illness, De Faria said.
Numerous studies show a connection between unplanned pregnancies and higher rates of perinatal depression.
One conducted in Brazil in 2017 found that women with unplanned pregnancies were 2 1/2 times more likely to suffer from depression during their pregnancy and postpartum months compared to women with planned pregnancies.
Although experts have concerns about the future of maternal mental health, they also agree that there may be some light in the darkness.
“What makes me have hope is the attention that has been turned towards it,” Caitlin Murphy, a research scientist at the Milken Institute School of Public Health, said about the nation’s poor maternal mental health and screening rates.
“Once information gets out people start to do something about it.”
