US sees slight improvement in maternal mental health

For the report, PCMMH evaluated all 50 U.S. states and the District of Columbia on 18 different measures across three domains:

• Providers and programs, which includes whether a state has at least one inpatient maternal mental health program and whether it has or had a state-sanctioned task force for maternal mental health.
• Screening and screening requirements, which includes whether a state is a top performer on the HEDIS "prenatal depression screening" measure and the number of obstetric providers who submitted claims for prenatal maternal mental health screening.
• Insurance coverage and treatment payment, which includes whether a state expanded Medicaid and whether it extended Medicaid coverage to one year postpartum.

Overall, the United States earned a grade of D+ for maternal mental health, a slight improvement from the D grade it earned in 2023.

In 2023, 40 states, along with the District of Columbia, earned either a D or F grade. This year, 29 states earned either a D or F grade. There were also fewer states with failing grades. In 2023, 15 states earned an F grade, but only five states did so this year.

However, even with these improvements, many states are still earning C grades or below when it comes to maternal mental health. Only four states, California, Pennsylvania, Utah, and Washington, earned a B grade. California, which received a B+, had the highest grade out of all the states.

"We're seeing incremental improvements in state efforts to address maternal mental health and improvements in the state-level data that is available," said Caitlin Murphy, a research scientist at George Washington University's Milken Institute School of Public Health, who helped create the state report cards.

"Yet, grades are still dismally low. … States should be commended for their hard work to address maternal mental health disparities, and we still have a long way to go," Murphy said.

HHS launches roadmap to improve maternal mental health

According to the American Psychiatric Association, around one in five pregnant or postpartum women in the United States will experience a mental health disorder, including depression, anxiety, or suicidal ideation. However, few of these women will receive treatment.

To address this issue, HHS' Task Force on Maternal Mental Health launched a new roadmap to improve maternal mental healthcare in the United States. The roadmap includes five core recommendations:

• Build a national infrastructure that prioritizes perinatal mental health and well-being.
• Make mental healthcare and services accessible, affordable, and equitable.
• Use data and research to improve health outcomes and increase accountability.
• Encourage prevention and partner, engage, and educate communities on providing care.
• Listen to the experiences of people with maternal mental health problems and respond to their needs.

During interviews with the task force, women shared changes that would have improved their experience during pregnancy. These changes include opportunities to connect with experienced mothers, access to high-quality care, and specialty training for perinatal mental health support for those in under-resourced communities.

The report also called for states to enact paid family leave. The House Bipartisan Paid Family Leave Working Group, which launched in January 2023, calls for every U.S. state, territory, and the District of Columbia to provide at least six months of guaranteed leave.

Maya Mechenbier, a member of the task force, also noted that many mothers who were interviewed said they had to return to work only a few weeks after giving birth. "The mental health impact of having to leave your baby and return to work before you're ready cannot be overstated," she said.

Advisory Board maternal health resources

For more insights on maternal health, check out these Advisory Board resources:

• Our take: Addressing the root causes of maternal health inequity
• Cheat sheet: Postpartum depression care
• Market insights: Health plans' top 3 maternal care priorities
• Ready-to-use slides: Maternal & reproductive health market trends
• Our take: 5 steps to improve women's health and well-being

(O'Connell-Domenech, The Hill, 5/15; Policy Center for Maternal Mental Health State Report Cards, accessed 5/17; Policy Center for Maternal Mental Health State Report Cards news release, 5/14; Policy Center for Maternal Mental Health methodology and measures, accessed 5/17; Firth, MedPage Today, 5/15)