Reducing maternal mortality means investing in mental health

You don’t have to be a public health professional to know that the US has highest maternal mortality rate level of any high-income country. This is frightening, sobering and unacceptable. The situation is especially dire for black women who four times more would rather die than white women.

Conditions are worse in the southern states. In particular, Louisiana ranks 47th out of 48 states on maternal mortality. (California and Texas not included in the ratings as they were analyzed separately.)

However, Louisiana may also be where some of the most important work to reduce maternal mortality is taking shape. That’s because community leaders in the Pelican State understand that the maternal mortality crisis is as much, if not more, a mental health issue than a physical one.

We study politics, medicine, business, and law at Harvard, and we spent much of the first half of 2024 talking to health care providers, doulas, policymakers, community organizers, and activists who are deeply committed to improving maternal outcomes in Louisiana. We came away convinced that reducing maternal mortality nationwide means addressing the lack of investment in mental health—and while it’s too early to tell what the final impact will be, Louisiana is taking this issue seriously.

Most Americans might think of maternal mortality as the death of a pregnant woman during childbirth or due to health complications such as bleeding. But the term covers any death of a person during pregnancy or within a year of giving birth, including mental health-related deaths. This is no small matter. Centers for Disease Control and Prevention reports that mental health conditions, including deaths by suicide and overdose, are the largest contributors to maternal mortality nationwide.

In Louisiana accidental overdose was the leading cause of pregnancy-related deaths in the state in 2020, and the infrastructure to address the problem is lacking. Near 79% of Louisiana citizens live in areas without adequate mental health care, compared with just under 50% of people living in the United States. In Louisiana shortage of mental health professionalsyet only 26% of mental health care needs are currently met statewide.

Short-term solutions include OB/GYNs, who primarily provide prenatal care. Although some obstetrician-gynecologists have severe discomfort Along with providing mental health services, efforts are being made to provide one-stop services. Louisiana Mental Health Perinatal Partnership (LAMHPP)for example, offers training, consultation, and resources to clinicians to improve their ability to support prenatal mental health issues. They do this by setting up a hotline that health care providers can call when they encounter patients with complex mental health problems. At this stage, LAMHES has provided up to nine consultations per week, in the process of expansion.

Louisiana is also deploying Doula Registration Commissionwhich helps register doulas for insurance reimbursement. In fact, Louisiana is just second state Cover doula care through private insurance. Doulas provide fundamental support to a pregnant woman, be it social, cultural or educational, promoting her comfort and empowerment during the critical stages of labor. Although they are not mental health professionals, the support of doulas may be essential for pregnant women to not only survive, but thrive during pregnancy and in the year after giving birth.

Creative care models have also emerged in Louisiana to help support moms. Following her tenure as Secretary of the Louisiana Department, Rebecca Gee, an obstetrician-gynecologist, created Nest Health Integrate compassion into prenatal care through home and virtual visits. Nest, a Medicaid-covered company, offers mental health care to pregnant women who face traveling more than an hour for prenatal care. Nest is guided by terrifying CDC statistics that “more than 80% maternal mortality preventable.”

These programs are currently benefiting pregnant women, and within a few years their collective impact may begin to show in lower mortality statistics.

But until it is widely accepted that mental health is an indisputable part of maternal health, these initiatives will struggle to gain the widespread support they need.

Without support from politicians and policymakers, these programs will face challenges of speed, scale, and bureaucratic red tape. Current LMHPP coverage is slowed by a shortage of mental health professionals and limited grant funding. The creation of the Doula Registration Council took longer than planned due to difficulties in bringing community stakeholders together. Nest Health is still in its early stages and is actively fighting to expand its services, hire staff and make insurance claims easier. Promising and effective local initiatives like these deserve federal and state support, and we can achieve this when state and federal policymakers recognize mental health care as a critical part of prenatal and postpartum care.

When pregnant women die, the consequences are devastating: families become more vulnerable to poverty and babies die more often before his second birthday. Healthy mothers have healthy families whose children grow into adulthood with improved physical and mental health. This is why it is our duty as a society to make room for mental health as it impacts all maternal health outcomes. The health of our mothers – and, as a consequence, our entire society – depends on this.

Nupur Jain is a student at the Brody School of Medicine at East Carolina University and the Harvard T.H. School of Public Health. She is an aspiring obstetrician-gynecologist. Nancy Hinojos is a dual MBA/MPA student at the Harvard Kennedy School and the MIT Sloan School of Management. Shawn Izadi, MD, MPH, is a general surgery resident at Oregon Health & Science University and a graduate of the Harvard T.H. School of Public Health. Chana. He is an aspiring pediatric surgeon.