Need Outpaces Maternal Mental Healthcare Access in 150 Counties

Seven in 10 counties in the United States have insufficient maternal mental healthcare access, a problem that exacerbates maternal health outcomes, according to a new assessment from the Policy Center for Maternal Mental Health.

This comes as nearly 700 counties are at high risk for maternal mental health disorders, the researchers said.

Maternal mental health is a key facet of overall maternal health. According to the National Alliance on Mental Illness (NAMI), maternal mental health disorders occur in around a fifth of people while pregnant. Having a maternal mental health disorder can have clear adverse impacts on the pregnant or recently post-partum person as well as the baby, NAMI says.

This latest report from the Policy Center for Maternal Mental Health showed that the risk for maternal mental health disorders is widespread.

Using a 36-point Risk Factor Score (RFS) assessing risk factors like the prevalence of domestic violence, poverty, unintended pregnancy, and social isolation, the researchers found that nearly 700 counties in the US are at high risk for maternal mental health disorders. Additionally, more than half of the perinatal population lives in a country with an RSF level of 15 or more.

The places with the highest RFS levels, and therefore the highest risk for maternal mental health disorders, include the Mississippi Delta area, the Gulf Coast, greater Appalachia, New Mexico, and Arizona. Rural counties were more likely to have a high RFS level, likely because individuals living there face greater socioeconomic challenges.

Places with higher risk for maternal mental health disorders were also more likely to have high rates of domestic violence, violent crime, unintended pregnancy, and child poverty. These regions are also more racially and ethnically diverse, with places with higher RFS levels being home to more non-White individuals.

Counties with higher RFS levels do have higher rates of people who say they have available emotional support, plus better self-reported coping ability.

But still, professional resources to prevent, identify, or treat maternal mental health disorders are left wanting.

The researchers assessed the provider shortage gap in the nation’s counties by estimating that a county would need five providers per 1,000 births. Overall, 70 percent of counties fall below that maternal mental healthcare provider threshold, meaning they don’t have enough resources to meet the needs of pregnant and postpartum people.

The gap in maternal mental health providers is biggest in Los Angeles County in California, where the area needs 384 more maternal mental health providers to meet the need. Other metro areas likewise have large gaps in maternal mental health providers, likely because these regions have a high rate of births that exceeds the number of mental health providers practicing there, the researchers said.

Finally, the researchers identified what they termed maternal mental health “Dark Zones,” defined as areas with high risk for maternal mental health disorders but limited resources.

There are 157 counties that have an RFS level of greater than 25 and a provider shortage of three or more, representing the most at-risk and under-resourced regions, the researchers found. Maternal mental health Dark Zones were more common in the South and Midwest regions of the US, with Texas, Michigan, Indiana, Tennessee, Louisiana, New Mexico, and Oklahoma having particularly low rates of care access.

Places with lower risk for maternal mental health disorders plus greater resources tend to be places with higher educational attainment and a greater population of White people. This accentuates a racial and educational health disparity in mental healthcare, the researchers said, but some evidence showed that other socioeconomic factors may attenuate those disparities.

For example, in the Atlanta Metro area and the “Research Triangle” of North Carolina, there’s both a high population of non-White people with lower educational attainment. But still, between better resource allocation plus lower rates of risk factors like rates of domestic violence, violent crime, children in poverty, and teen pregnancy, these regions see similar RFS levels as Whiter areas with higher educational attainment.

Such findings could help steer regions looking to improve maternal mental health, the researchers said, but it will be essential for counties and states to identify the challenges specific to their populations.

States may also look at their Medicaid programs, community-based care partnerships, and insurer requirements for maternal health coverage to tailor solutions to their unique barriers, the researchers recommended.