Maternal Depression and Medicaid Policy Solutions Highlighted in Special Issue of Health Affairs

About one in five pregnant and postpartum people are diagnosed with mental health conditions each year, and a new research finding adds to the growing body of evidence that sustained Medicaid coverage before, during, and after pregnancy can help.

Medicaid expansion was associated with a 16 percent decline in self-reported pre-pregnancy depression and the improvements increased over time from when states expanded Medicaid, a new article published in the October issue of the journal Health Affairs found.

The October issue is dedicated to perinatal mental health and features several important new Medicaid-related studies and policy recommendations to help improve the lives of thousands of mothers and babies across the country. In particular, the issue includes important considerations for supporting mental health needs and lowering barriers to care for pregnant and postpartum people of color and reimagining a system of care that is equitable and antiracist.

State and federal leaders have many policy opportunities to improve perinatal mental health, and several recommendations included in the issue–one year of postpartum Medicaid coverage, closing the Medicaid coverage gap and investing in data, research, and accountability for maternal health outcomes–are currently being considered in the Build Back Better bill moving through Congress.

In the Medicaid expansion study, researchers used state-level survey data from low-income people giving birth between 2012 and 2018 and found that Medicaid expansion,  “was significantly associated with a 9.6-percentage-point (22 percent) increase in pre-pregnancy Medicaid coverage, a 2.5-percentage-point (16 percent) decrease in self-reported pre-pregnancy depression, and a nonsignificant increase of 2.3 percentage points (9 percent) in pre-pregnancy screening for depression.”

The findings associating Medicaid expansion with lower rates of pre-pregnancy depression are critically important because the consequences of untreated perinatal depression affect not only the mother, but impact the relationship with the child and the stability of the family. Children cared for by parents experiencing depression are more likely to have developmental delays and miss out on critical bonding experiences that support their brain development, which reinforces the need for dyadic care, such as the approach taken in England and several other countries that offer joint mother-baby inpatient admission to psychiatric treatment. There are no mother-baby units available in the U.S., according to an additional article in the issue.

Pregnant people with depression are more likely to give birth to a low birthweight baby or deliver preterm, and people giving birth who have at least one mental health disorder have a rate of severe maternal morbidity that is more than 50 percent greater, and incur hospitalization costs associated with delivery that are 9 percent higher, than people without mental health disorders, two additional articles in the issue point out.

In a powerful personal essay, researcher Kara Zivin describes her own experience with perinatal depression that nearly ended her life and makes a strong case for extending Medicaid postpartum coverage to one year after deliver. She also calls for creating a safer climate for pregnant people to disclose their mental health challenges and better tracking to examine how mental health conditions contribute to maternal mortality and morbidity.

Mental health conditions are the underlying cause of nearly one in nine pregnancy-related deaths, an additional article finds, and state maternal mortality review committees deem 100 percent of these deaths preventable. Untreated perinatal mental health conditions, encompassing pregnancy and the first five years of a child’s life, carry a societal burden of $14 billion per year in the US, and this is likely an underestimate.

Explore the full issue here.

Maggie Clark is a Program Director at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.