Preventable Maternal Deaths Skyrocketed During the Pandemic; Philanthropy Needs to Intervene

Maddie Taylor
May 2022

Suicide and overdose are the leading causes of death in the first year postpartum, with 100% of these deaths deemed preventable. Perinatal mood and anxiety disorders (PMADs) are the most common complication of pregnancy and are increasingly recognized as a major contributor to severe maternal morbidity and mortality (1). PMADs include depression, anxiety, psychosis, post-traumatic stress disorder, and substance use disorder (2).PMADs impact 1 in 5 people or approximately 800,000 people every year in the United States (3). More clinically serious than the “baby blues,” (4–7). Recent data from 14 states showed that nearly 1 in 9 pregnancy-related deaths had PMADs as the underlying cause, and nearly all were preventable (7). Among pregnancy-related deaths determined to have mental health causes, 63% were suicides and 24% were unintentional poisonings or overdoses (7). Current substance use or a history of substance use was present in 67% of the suicides and unintentional deaths (7). Pregnant people experiencing PMADs are suffering from higher rates of premature death by way of suicide or overdose, compared to pregnant people without PMADs (7).

If it’s preventable, why is this national crisis happening? There are two driving factors:  1). a lack of access to health care to address PMADs; and2.) acute environmental stressors, including the COVID-19 pandemic. Underinsurance and lapses in insurance during the perinatal period are barriers to accessing health care and culturally appropriate mental health care, which can cause delays in seeking care and exacerbate PMADs (8,9). Pregnant people have significantly higher rates of mood disorders than the general population during times of national crisis, and there has been a three-fold increase in PMADs during COVID-19 (10,11).

There are effective solutions to address maternal mental health and substance misuse, improve early relational health, and increase positive health outcomes in the long run. A key source for addressing pregnancy-related deaths by way of suicide or overdose is a resourced and trained community-based workforce (12). A community-based workforce lives in and shares the culture, language, and life experiences of the community members they serve, providing trust, relational expertise, and a deep knowledge of community resources (13). This workforce includes trained professionals such as perinatal community health workers, peer recovery specialists, and doulas. These professionals serve as the first line of defense for pregnant people with PMADs, providing racially and culturally competent care, linkages to resources, and referrals to other healthcare providers (14). Peer recovery specialists, in particular, have been shown to help people in the perinatal period recover from substance use disorders (15) and develop resilience.

At CHAP, we believe that philanthropy is uniquely poised to work with other funders, government agencies, the private sector, and community-based organizations to encourage innovation around addressing PMADs. Philanthropic funding can be used to ensure that community-centered models of care for PMADs—including training members of the community-based workforce in perinatal mental health and substance misuse—are championed and widespread. Philanthropy can also fund technical assistance opportunities for states, community-based organizations, and national associations around topics, such as Medicaid reimbursement for doulas, peer recovery specialists, and community health workers to provide interventions proven to be effective in addressing mental health and substance misuse. Finally, philanthropic organizations can support intermediaries who braid funding to promote sustainable financing of the community-based workforce.

When PMADs are successfully addressed, overall health outcomes for moms and babies also improve. We encourage other foundations to invest in maternal mental health and support partners to help build a diverse and robust maternal mental health ecosystem to address an issue impacting 1 in 5 American families during pregnancy and early parenting.

References

1.    Brown CC, Adams CE, George KE, Moore JE. Mental Health Conditions Increase Severe Maternal Morbidity By 50 Percent And Cost $102 Million Yearly In The United States. Health Aff. 2021;40(10):1575–84.

2.         Kendig S, Keats JP, Camille Hoffman M, Kay LB, Miller ES, Simas TAM, et al. Consensus Bundle on Maternal Mental Health: Perinatal Depression and Anxiety. Obstet Gynecol [Internet]. 2017 [cited 2021 Nov 9];129(3):422–30. Available from: https://pubmed.ncbi.nlm.nih.gov/28178041/

3.   Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol [Internet]. 2005 [cited 2021 Nov 9];106(5 Pt 1):1071–83. Available from: https://pubmed.ncbi.nlm.nih.gov/16260528/

4.    Davis NL, Smoots AN, Goodman DA. Pregnancy-Related Deaths : Data from 14 U.S. Maternal Mortality Review Committees, 2008-2017. 2017;13:3–6.

5.    Admon LK, Dalton VK, Kolenic GE, Ettner SL, Tilea A, Haffajee RL, et al. Trends in Suicidality 1 Year Before and After Birth Among Commercially Insured Childbearing Individuals in the United States, 2006-2017. JAMA psychiatry [Internet]. 2021 Feb 1 [cited 2021 Nov 9];78(2):171–6. Available from: https://pubmed.ncbi.nlm.nih.gov/33206140/

6.    Mangla K, Hoffman MC, Trumpff C, O’Grady S, Monk C. Maternal self-harm deaths: an unrecognized and preventable outcome. Am J Obstet Gynecol [Internet]. 2019 Oct 1 [cited 2021 Nov 9];221(4):295–303. Available from: https://pubmed.ncbi.nlm.nih.gov/30849358/

7.    Trost SL, Beauregard JL, Smoots AN, Ko JY, Haight SC, Moore Simas TA, et al. Preventing Pregnancy-Related Mental Health Deaths: Insights From 14 US Maternal Mortality Review Committees, 2008–17. Health Aff. 2021;40(10):1551–9.

8.    Margerison CE, Hettinger K, Kaestner R, Goldman-Mellor S, Gartner D. Medicaid Expansion Associated With Some Improvements In Perinatal Mental Health. Health Aff. 2021;40(10):1605–11.

9.    Daw JR, Hatfield LA, Swartz K, Sommers BD. Women In The United States Experience High Rates Of Coverage “Churn” In Months Before And After Childbirth. Health Aff (Millwood) [Internet]. 2017 Apr 1 [cited 2021 Nov 9];36(4):598–606. Available from: https://pubmed.ncbi.nlm.nih.gov/28373324/

10.  Davenport MH, Meyer S, Meah VL, Strynadka MC, Khurana R. Moms Are Not OK: COVID-19 and Maternal Mental Health. Front Glob Women’s Heal. 2020 Jun 19;0:1.

11.  Doyle FL, Klein L. Postnatal Depression Risk Factors: An Overview of Reviews to Inform COVID-19 Research, Clinical, and Policy Priorities. Front Glob Women’s Heal. 2020 Oct 22;0:14.

12.  Matthews K, Morgan I, Davis K, Estriplet T, Perez S, Crear-Perry JA. Pathways To Equitable And Antiracist Maternal Mental Health Care: Insights From Black Women Stakeholders. Health Aff. 2021;40(10):1597–604.

13.  Community-Based Workforce Alliance. What is a Community-Based Workforce? [Internet]. [cited 2021 Nov 10]. Available from: http://communitybasedworkforce.org/

14.  Selix N, Henshaw E, Barrera A, Botcheva L, Huie E, Kaufman G. Interdisciplinary Collaboration in Maternal Mental Health. MCN Am J Matern Child Nurs [Internet]. 2017 Jul 1 [cited 2021 Nov 10];42(4):226–31. Available from: https://pubmed.ncbi.nlm.nih.gov/28301335/

15.  Fallin-Bennett A, Elswick A, Ashford K. Peer support specialists and perinatal opioid use disorder: Someone that’s been there, lived it, seen it. Addict Behav. 2020 Mar 1;102:106204.

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