Taking aim at the U.S. maternal mental health crisis

Each year, around 4 million babies are born in the United States.¹ And one-eighth (500,000) of the parents who give birth to them spend the prenatal and postnatal period battling a mental health disorder.² Most parents who experience maternal mental health (MMH) disorders suffer from depression or anxiety. They may also have obsessive-compulsive disorder, bipolar disorders, addiction or even psychosis.³

Only 10% of those who experience diminished mental health during this period seek help from a medical provider.⁴ Many parents facing MMH disorders simply suffer in silence, while others are lost to suicide. An estimated 20% of maternal deaths are caused by suicide each year.⁵

This private and painful epidemic also has significant effects on birth outcomes of both parent and newborn. Untreated mental illness during pregnancy can result in lower birth weight, as well as a higher chance of hypertension in the birthing parent. And once the baby is born, if their birth parent suffers from postpartum depression, the infant may experience slowed motor and cognitive development, disrupted sleep patterns and long-term negative effects on their physical growth.⁶ These health deficits have profound ripple effects. It’s estimated that the total cost to the health care system of not treating initial MMH conditions is $32,000 per parent-infant pair, adding up to an annual total of $14 billion in the United States.⁷

Countless organizations, task forces and health care advocacy groups are zeroing in on this multifaceted problem and bringing needed support to those most likely to be affected. Here’s how health plans and employers alike can take action.

The problem:

Mental health struggles are stigmatized, making it daunting for those suffering to self-report their MMH symptoms.

How payers can help:

Health plans are in a unique position to intervene during the prenatal and postnatal periods, given the far greater volume of health care utilization that occurs during that time. The moment an ob/gyn confirms a pregnancy, the health plan should start sharing information with the member. They should cover everything from typical signs of MMH difficulties to an easy, personalized path for seeking support. Reminding members that MMH disorders are both common and treatable doesn’t just raise health literacy and boost the odds that they’ll seek help. It also drives home the message that MMH symptoms are as natural as morning sickness and should carry no more stigma than that condition.

Using comprehensive health information and robust data analytics, health plans may also be able to identify members at elevated risk of MMH conditions. While MMH conditions can affect anyone, research shows that the following can increase risk:⁸

• Certain health conditions, such as a previous history of depression 
• Behaviors such as perinatal smoking 
• Circumstances such as job loss

Researchers at the University of Virginia School of Medicine found that women over age 40 who have twins are at markedly higher risk for postpartum depression.⁹ And a 2023 study found that parents who conceived after IVF treatment also had a higher risk.¹⁰

By understanding who is at heightened risk, plans can trigger timely screenings, ensuring that members get the care they need as early as possible. They may also proactively connect them with a case manager who can guide them to available resources and serve as a 24/7 point of contact.

How employers can help: 

While most employees desire more support with — and more discussions of — mental health at work, less than half feel their mental health is treated as a priority at their current company.¹¹ Employers must make it clear that mental health difficulties are both understood and supported within the working environment.

What might that look like? Managers reiterate to direct reports that taking time off to deal with mental health troubles is not only acceptable but encouraged. They also offer an employee mental health benefit and ensure that benefits across the portfolio take a whole-person approach to health. IVF coverage is great, for instance, but even better are fertility benefits that cover clinically guided support to help reduce stress and anxiety throughout the process.

The problem:

Providers who most often see prenatal and perinatal patients — such as obstetricians, pediatricians and primary care providers — lack specialized training in mental health care and feel ill-equipped to address emergent mental health conditions.

How payers can help:

Health plans can collaborate closely with providers, educating them on best practices for both treating and referring patients with MMH concerns. Offering seminars or webinars on the epidemic of MMH disorders, hosting conferences on the subject and otherwise disseminating information about this epidemic can move the needle on providers’ comfort and competence in addressing these conditions.

Many health plans have sought creative ways to address a nationwide shortage of mental health professionals, from partnering with community-based organizations to encouraging providers to offer more rigorous mental health care. By giving primary care providers thorough training on how to partner and collaborate with mental health professionals, they can serve as a more authoritative source of MMH support in their own practice and ensure a more seamless transition for the patient moving from the care of their general practioner to that of a mental health specialist.

How employers can help:

By continuing the drumbeat of mental health education to which they’ve already committed, employers can help make it clear to employees that they have numerous options for addressing MMH symptoms that extend beyond their ob/gyn practice or primary care provider’s office. An employee assistance program may serve a role here, as well as stronger messaging around its availability to employees.

For employers that offer access to doulas as part of an employee’s fertility benefits, these nonmedical professionals can provide vital emotional and educational support, reducing anxiety and feelings of isolation. Research shows that people who received doula care had 57% lower odds of postpartum depression and postpartum anxiety.¹² Notably, doula support can extend throughout the pregnancy, labor and after the birth, giving the expectant or new parent another consistent touchpoint for care and support.

The problem:

Maternal care in general is too siloed, creating numerous opportunities for struggling new and expecting birth-givers to slip through the cracks.

How employers and payers can help:

When an expectant parent receives advice from a variety of prenatal and postnatal providers, it can hard to reconcile their sometimes differing input. It can also be highly daunting to navigate the multiple appointments that seeing each of these providers requires. And if problems exist with the baby’s ability to gain weight or latch during breastfeeding, seemingly “less important” issues like the birth-giving parent’s mental health can be moved to the back burner.

Both employers and health plans can bring much needed cohesion to this fractured health care landscape by connecting people with a maternity support program that offers continuous assistance from preconception through the postpartum period. With a focus on prenatal care and pregnancy health, and by giving equal weight to the health and well-being of both parent and infant, programs like these both monitor and manage countless aspects of the pregnancy and postpartum periods. This offers birth-giving parents a single trusted point of contact throughout their pregnancy and postpartum journey.

Solutions like these can reduce patients’ uncertainty and fear in a uniquely challenging time of life and answer any questions that arise as they navigate this period. This alone is invaluable to new parents and parents-to-be. But, crucially, having steady access to one-on-one expertise and education can also help patients more readily understand and seek help for any MMH struggles that may arise — before they reach a crisis point.

Learn more about Optum Women's Health Solutions for Health Plans and Employers.