“Advocacy in Action” supports the APA Board-Approved Recommendations on Strategic Planning that included “working to end disparities in mental healthcare” and “advocating for health equity and policies for undoing racism and discrimination within local, state, and federal government, and health professional organizations.”

Through this section our goal is to bring to the forefront mental health equity legislation that you, our members, tirelessly advocate for to end disparities and attain mental health equity for all. For this quarter, we thank our Advocacy, Policy & Practice Advancement colleagues for their update focused on health equity and maternal mortality legislation.

APA recognizes and supports the use of inclusive language beyond “woman, mother or motherhood,” for example, birthing persons or pregnant people. This article will be using the terms utilized in the legislation APA is currently advocating for, but APA supports the wider and ongoing discussion around gender equity.

As a core component of APA’s advocacy strategy, promoting federal legislation that improves health and mental health outcomes for minority and underserved populations is central to combating the current lack of equitable healthcare available to all Americans.

Maternal mortality is a mental health issue, and legislative policies combating maternal mortality can directly increase health equity in the United States.

Over the past two decades, the maternal death rate in the United States has more than doubled. Underlying mental health conditions, including substance use disorders, are now the leading cause of maternal mortality and morbidity in the U.S. (as of 2021, 23%). One in five women will suffer from mental health conditions during pregnancy and the postpartum period, but only 25% of them will receive treatment. As a result of this and other barriers to care, the maternal mortality rate increased nearly 40% from 2020 to 2021 (23.8 to 32.9 deaths per 100,000 live births).

Currently, the maternal mortality rate is more than twice as high for Black women than non-Hispanic white women across all income levels and socioeconomic factors. Black mothers are twice as likely to experience maternal mental health conditions but half as likely to receive treatment. The risk of maternal mortality is 10 times higher in the U.S. than in comparable wealthy and democratic nations, and more than 20 times higher for Black and Native and Indigenous.

Maternal mental health conditions include anxiety and depression, PTSD, bipolar disorders, obsessive-compulsive conditions, and substance use disorders, among others. Untreated maternal MH/SUD is associated with high-risk pregnancy and a range of negative outcomes for the pregnant person and their offspring, including spontaneous abortions, fetal distress, preterm birth, and negative neurodevelopmental trajectory. Yet, pregnant persons are often considered “therapeutic orphans” due to low rates of psychiatric treatment and a lack of research on best practices.

These negative health outcomes and the strong economic case to address maternal mental health drive bipartisan efforts to address this crisis. Maternal morbidity across all U.S. births in 2019 alone cost America an estimated $32.3 billion (extending from pregnancy through the child’s fifth birthday). The conditions with the largest costs were maternal mental health conditions at $18.1 billion. The cost of untreated maternal mental health per mother-child pair is $32,000.

APA supports addressing maternal mortality as a key component of improving mental health equity. Last year during the APA Federal Advocacy Conference, Dr. Dionne Hart and Dr. Regina James presented a session with Government Relations titled “Health Equity: Maternal Mortality and Maternal Mental Health.” This was an opportunity for members to receive facts and figures, an overview of the federal legislative landscape and bills, a clinical perspective on how it impacts the patients we serve, and a congressional meeting how-to. Approximately 150 APA members were in attendance and participated in this hands-on session.

The current 118th Congress continues to advance important policies to tackle American maternal mortality and perinatal mental healthcare access. There is bipartisan support for legislation to address the maternal care crisis, including several bills endorsed and advocated for by APA.

The Preventing Maternal Deaths Reauthorization Act (H.R.3838/S.2415), introduced by representatives Michael Burgess (R-TX), Robin Kelly (D-IL), Buddy Carter (R-GA), Diana DeGette (D-CO), Kat Cammack (R-FL), and Kathy Castor (D-FL), and by senators Shelley Moore Capito (R-WV) and Raphael Warnock (D-GA), has passed the House and awaits a full floor vote in the Senate where it has strong support. The legislation ensures continued support for state maternal mortality review committees (MMRCs) examining pregnancy-related deaths and promotes disseminating best practices to providers. MMRCs are multidisciplinary committees that convene at the state or local level to comprehensively review deaths that occur during or within a year of pregnancy (pregnancy-associated deaths). They are vitally important to help Congress and Americans understand the size and scope of the current maternal mortality crisis.

Take action and urge the Senate to pass this bill into law.

Fiscal Year 2025 (FY25) federal appropriations for maternal health programs have also seen historic increases due to advocacy on and support for addressing this issue. Despite political turmoil, existing programs like the Maternal Mental Health Hotline and new programs designed to address maternal mental health conditions have been included in both Republican and Democratic proposals for federal funding.

As part of APA’s advocacy on these issues, in 2023 APA hosted a briefing on Capitol Hill to educate congressional members and staffers on “Maternal Mortality and the Mental Health Crisis.” In collaboration with the offices of representatives Lauren Underwood and Robin Kelly, it focused on the above legislative initiatives to confront the crisis and included APA members as expert panelists. That event also highlighted APA’s Maternal Mental Health White Paper and Toolkit developed in partnership with the CDC Foundation. Beyond this one event, APA members have also served on related panels and forums to lead the conversation on this issue, such as through the APA Looking Beyond webinar series.

APA continues to work with congressional champions and partners across the mental health, maternal health, and house of medicine to support these key programs. As Congress moves through a contentious election cycle, it is affirming to see maternal mortality and mental health equity as an area of bipartisan support. Such efforts are currently buoyed by the Biden administration, as the White House has built out supportive actions within agencies through the Biden-Harris Blueprint for Addressing the Maternal Health Crisis. APA remains committed to advocating for increased health equity through maternal mortality and other equally vital policies as the political landscape evolves.