When the Wisconsin Maternal Mortality Investigation Team investigates pregnancy-related deaths in the state, they almost always find that the cause is a behavioral health condition. In these cases, all deaths are preventable.
This is an ongoing crisis that often goes unspoken: From 2016 to 2017, more than half of pregnancy-related deaths in Wisconsin were due to mental illness, including suicide, substance use disorder, and overdose.
Related:Pregnant and postpartum women in Wisconsin are lacking access to adequate mental health care. Here’s what’s happening to change that.
Related:Why is the black infant mortality rate in Wisconsin still three times higher than whites?
This isn’t just a Wisconsin issue: Each year, 38 states across the nation, including Wisconsin, submit maternal mortality data to the Centers for Disease Control and Prevention. And every year, mental illness is by far the most common cause.
But that doesn’t have to be the case, say Sen. Tammy Baldwin of Wisconsin and Rep. Gwen Moore of Milwaukee.
“Right now we’re really falling short in terms of supporting the mental health needs of newborns and pregnant women, and we’re seeing the impact of that,” Baldwin said.
That’s why they, along with other federal Democrats, have introduced a federal bill called the Mental Health and Affordable Access (MAMA) Act, which aims to expand access to mental health and substance use disorder services during pregnancy and the postpartum period.
Cost is the biggest barrier to getting mental health help, and Democrats say the new bill will help.
The Mental Health and MAMA bill would eliminate co-payments, coinsurance and deductibles for pregnant and postpartum patients seeking mental health and substance use disorder services within one year of giving birth.
The bill only applies to certain types of insurance — private and government plans, including the Federal Employees Health Benefits (FEHB) — that already cover such services. The bill does not require insurers to add behavioral health coverage if they haven’t already done so, Moore said.
The legislation builds on continuity of care requirements outlined in the No Surprises Act, enacted by Congress in 2020. That law protects pregnant patients with group and individual health insurance from surprise medical bills that can occur when their insurer takes a pregnant patient’s current provider out of network. But those protections only last a limited time. The Mental Health and MAMA Act extends that to one year after delivery.
According to a survey by the Substance Abuse and Mental Health Services Administration (SAMHSA), cost is the number one reason people don’t seek mental health treatment, and data specific to Wisconsin backs that up, with half of mothers in the state reporting being affected by financial anxiety.
Another major reason perinatal patients (those in the period from one year before pregnancy to two years after giving birth) don’t seek mental health treatment is persistent stigma, according to data from the Coalition for Maternal Health Innovations and SAMHSA. Many patients with mental health concerns fear that their friends or family will change their opinion of them if they know they’re seeking help, and many worry about the repercussions of sharing thoughts of harming themselves or their baby with a healthcare provider.
Moore and Baldwin say the Mental Health and MAMA Act focuses on two factors: cost and stigma, and that the bill will go a long way in encouraging more people to seek help.
In Wisconsin, women of color account for a quarter of births but nearly half of pregnancy-related deaths.
Those most vulnerable to mental health and substance use issues during pregnancy also tend to have the least access to medical care, a source of frustration for Moore, who built her political career working on international women’s issues.
“As I became more involved in international work and international women’s issues, it was humiliating to see the high maternal mortality rate in the United States,” Moore said.
Wisconsin’s numbers tell the story.
According to the state’s most recent comprehensive report, black, Asian and Hispanic mothers together account for just a quarter of all births in the state, but nearly half of all pregnancy-related deaths.
Black women are more likely to experience perinatal depression than women of other races. For example, about 30% of black mothers in Wisconsin suffered from depression during pregnancy, compared with 17% of white mothers, according to the 2018-19 Wisconsin Pregnancy Risk Assessment and Monitoring System. Previous data has shown that rates of depression in mothers have increased annually, regardless of race.
People who suffer from depression or anxiety are also more likely to engage in risky behavior: Overdoses were responsible for nearly half of all maternal deaths in Wisconsin between 2016 and 2019. Depression and anxiety are often major barriers to quitting smoking, according to state data.
By increasing access to mental health and substance use disorder services, both before and after birth, Moore and Baldwin hope to reduce these disparities.
“We want to make sure that seeking treatment for behavioral health or substance abuse disorders doesn’t come with a huge out-of-pocket expense, because if people don’t have the money, they’re not going to get treatment,” Baldwin said.
Women and children are the “canaries in the coal mine” for community health, says U.S. Rep. Gwen Moore
Healthy mothers mean healthier children, which has compounding effects on communities, Moore said.
Research has shown that mental health concerns during pregnancy can affect a baby’s development and even behavioral health later in life. Once an infant is born, their health continues to be intertwined with the health of their caregivers, infant mental health experts often say.
By removing barriers to accessing perinatal mental health care, Moore and Baldwin hope the bill will ultimately alleviate struggles for families overall. And when families thrive, communities thrive, Moore said.
“I think women and children are the canaries in the coal mine,” she says. “If women and children aren’t doing well, there’s no way the community is going to do well.”
What does the future hold for mental health and the MAMA Act?
Moore said the bill builds on the Mental Health Parity Act and Addiction Parity Act. Signed into law in 2008, the landmark legislation requires certain insurers to offer mental health and substance use disorder benefits, as well as medical and surgical benefits.
But as Moore and Baldwin noted, more needs to be done to ensure equity between mental health and traditional health insurance, especially when it comes to perinatal patients.
The Mental Health and MAMA Act is one of many steps towards that goal. Similarly, there is the Black Maternal Mental Health MAMA-NIV Act of 2023, which aims to strengthen maternal health outcomes. The bill, sponsored by Baldwin and Moore, includes 13 bills, including the Perinatal Workforce Act, which was introduced as a standalone bill. Several of the individual bills included in the bill have advanced at the committee level but have not yet become law.
“What we’ve learned is if your mind isn’t working well, your body doesn’t have a chance,” Moore said.
Baldwin and Moore are working to rally support for the new bill, which has not yet reached committee status.
Natalie Aillbert covers mental health issues for the Milwaukee Journal Sentinel. She welcomes story tips and feedback. Contact her at email address Or check out our Twitter profile Natalie Ailbert. Madison Lammert is a Report for America corps member based out of The Appleton Post-Crescent, covering child care and early childhood education across Wisconsin. To contact her, email Email:. Please consider supporting the journalism that informs our democracy Donations to Report for America are tax deductible Visit Click here for details
