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.
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