When We Talk about Maternal Mortality, We Must Talk about Mental Health
By Ruth Cosse
Last month, Congress passed the Preventing Maternal Deaths Act, which provides a grant program for states to address maternal mortality, which is the death of a woman during pregnancy, during birth, or shortly after birth. This program will allow us to better understand the issue, which is particularly important since from 2000-2014, the maternal mortality rate increased in nearly all U.S. states and Washington D.C. Additionally, approximately 700 women die each year from pregnancy or delivery complications with significant disparities across race and ethnicity.
As a young Black woman, these racial disparities have real life implications for myself, my family, and my community. According to the CDC, for every 100,000 live births in the United States, roughly 47 Black women, 39 American Indian and Alaskan Native women, 18 White women, 12 Hispanic women, and 12 Asian/Pacific Islander women die from pregnancy-related causes. These racial disparities persist even across socioeconomic status levels, with Black women experiencing three times higher maternal mortality risk than white women.
Much of the focus in the maternal mortality crisis is on the physical causes of death, but mental health deserves a more prominent place in this conversation. Seven percent of pregnancy-related deaths were associated with underlying mental health conditions, according to findings from nine maternal mortality review committees published in 2018. Of those deaths, approximately 42 percent had patient related mental health contributing factors such as the absence of social support systems and lack of adherence to medications or treatment plans. Another 27 percent had provider-related mental health contributing factors , such as using ineffective treatments or failing to screen. Of all pregnancy-related deaths, roughly 63 percent were preventable. If these women had access to mental health supports and treatment, they may still be alive.
Given the role of mental illness on maternal mortality, ignoring conditions such as maternal depression can be deadly. Indeed, more than half of poor infants live with a mother who has some level of depressive symptoms. Once again, women of color are disproportionately affected, as 1 in 4 white mothers, 1 in 3 Hispanic mothers, and 1 in 2 Black mothers who have ever experienced a major depressive episode are living in poverty. One study showed that 9 percent of mothers with low incomes with children under age 6 had at least one major depressive episode within the previous year. Untreated depression among mothers living with low incomes effects the health outcomes of the mother and the development of their young child(ren). Fortunately, maternal depression is highly treatable.
All women deserve effective and culturally relevant prevention, screening, and treatment services that meet the needs of them and their young children. As a young Black woman, a daughter of a Black woman, a descendent of countless Black women, and most importantly a being in this world-- I simply can’t ignore this crisis that continues to perpetuate racial inequities and affect many of my sisters. Creating policies that address and prevent maternal mental health problems is an important start to addressing the maternal mortality crisis. The Preventing Maternal Deaths Act is a good step forward in learning more about the cause of maternal deaths so we can determine how to prevent them in the first place.
For more information on CLASP’s maternal mental health work please view our Maternal Depression and Young Adult Mental Health: Agenda for Systems that Support Mental Health and Wellness report and the Moving on Maternal Depression (MOMD) project overview.