States Look to Address the Impact of Postpartum Depression

August 01, 2019|12:51 p.m.| ASTHO Staff

Seven percent of pregnancy-related deaths are associated with underlying mental health conditions. As the United States continues to see increasing rates of maternal mortality and morbidity, it is critical that we focus on improving the mental health of mothers. One of the better known maternal mental health conditions is postpartum depression, a mood disorder that can affect women after childbirth. Mothers with postpartum depression experience feelings of extreme sadness, anxiety, and exhaustion that may make it difficult to care for themselves, their children, and others. Data from the Pregnancy Risk Assessment Monitoring System (PRAMS), a CDC surveillance project that collects state-specific, population-based data on maternal attitudes and experiences before, during, and shortly after pregnancy, show that one in nine U.S. women experience symptoms of postpartum depression.

While there is not a single cause of postpartum depression—it likely results from a combination of physical and emotional factors—some women are at greater risk for developing postpartum depression because they have one or more of the following risk factors:

  • Symptoms of depression during or after a pregnancy.
  • Previous experience with depression or bipolar disorder.
  • A family member who has been diagnosed with depression or other mental illness.
  • A stressful life event during pregnancy or shortly after giving birth.
  • Medical complications during childbirth.
  • Mixed feelings about pregnancy.
  • Lack of strong emotional support from a partner, family, or friends.
  • Alcohol or other drug use problems.

Legislative approaches to address maternal mental health conditions and postpartum depression include increasing awareness of risk factors for and effects of postpartum depression, increasing access to prenatal and postpartum screening for these risk factors, and increasing access to treatment and support services for women at high risk for postpartum depression. Below is an overview of state legislative activity in 2019 to address the screening and treatment for maternal mental health conditions and postpartum depression.

Texas passed two bills addressing postpartum depression. The first, HB 253, requires the health and human services commission to develop and implement a five-year strategic plan to improve access to postpartum depression screening, referral, treatment, and support services. The strategic plan must include: strategies to increase awareness among providers about the effects of postpartum depression on outcomes for women and children; establish a referral network of community-based mental health providers and support services; increase access to formal and informal peer support services; raise public awareness and reduce stigma related to postpartum depression; and leverage sources of funding to support community-based screening, referral, treatment, and support services. The second bill, SB 750, instructs the commission to develop and implement a postpartum depression treatment network for women enrolled in the state’s medical assistance program as well as the Healthy Texas Women program.

In Oklahoma, a new law, SB 419, directs the state licensing boards to work with hospitals and healthcare professionals to develop policies and materials addressing education about and assessment of perinatal mental health disorders in pregnant and postpartum women.

The Illinois legislature passed several bills addressing maternal mental health and postpartum depression. HB 2438 requires that mental health conditions occurring during pregnancy or during the postpartum period, including postpartum depression, be covered by insurers, and that licensed physicians, advanced practice registered nurses, and physician's assistants who provide prenatal and postpartum care for a patient ensure that the mother is offered screening or is appropriately screened for mental health conditions. Additionally, HB 3511 establishes the Maternal Mental Health Conditions, Education, Early Diagnosis, and Treatment Act and requires the department of human services to develop educational materials for health care professionals and patients about maternal mental health conditions and requiring birthing hospitals to supplement the materials with relevant resources to the region or community in which they are located. The bills passed both the house and senate and were sent to the governor in June.

In Virginia, the governor signed HB 2613, adding information about perinatal anxiety to the types of information licensed providers providing maternity care must provide to each patient, which includes postpartum blues and perinatal depression.

The New Jersey legislature considered companion bills (S1759 and A1099) that would direct the commissioner of health, in conjunction with the State Board of Medical Examiners and the New Jersey Board of Nursing, to work with health care facilities and licensed health care professionals to develop policies and procedures to educate patients and families about perinatal anxiety and screen new mothers for perinatal anxiety.

The Massachusetts legislature is considering House Bill 1879, which would require the division of medical assistance to provide coverage of screenings by pediatricians for postpartum depression in mothers of newly born children during any visit to a pediatrician’s office up to one year from the date of the child’s birth.

In Pennsylvania, companion bills (HB1271 and SB370) would establish the Prenatal and Postpartum Counseling and Screening Act and would require a hospital, birthing center, physician, or nurse-midwife to provide pregnant women with a fact sheet that includes common symptoms of prenatal and postpartum depression as well as postpartum psychosis for emotional traumas associated with pregnancy and parenting. Providers would also be required to provide women with a resource list of professional organizations that provide prenatal and postpartum counseling and screen women for postpartum depression symptoms prior to discharge from the birthing facility and during the first few postnatal check-up visits. The Pennsylvania legislature also adopted a pair of resolutions (SR108 and HR306) recognizing the month of May 2019 as Postpartum Depression Awareness Month.

State health agencies have a unique opportunity to improve the mental and physical health of pregnant and postpartum women through the establishment and regulation of maternal mortality and morbidity review committees, the establishment and enforcement of guidelines and policies increasing access to screening and treatment for pregnant and postpartum women who are at high risk of mental health conditions and postpartum depression, and by increasing awareness of screening and treatment options among providers, women, and their families. ASTHO will continue to monitor legislative activity on this important public health issue.