“I gaze at my newborn, but I don’t feel anything,” the patient murmurs as she holds her 3-week-old infant. “I experience so much guilt … at times, I wish I weren’t here.” Yet, she is not alone. Her sentiments reflect the silent yet escalating public health crisis of perinatal mental health.

Around 1 in 5 women encounter mental health issues during the perinatal phase. As reported by the Centers for Disease Control, perinatal mental health conditions have become the primary cause of maternal mortality in the U.S., constituting 23 percent of pregnancy-related fatalities. Specific causes of death linked to mental health issues include suicide and overdose/poisoning associated with substance use disorder. Furthermore, perinatal mental health conditions not only affect maternal morbidity and mortality but also infant outcomes through diminished rates of breastfeeding initiation, hindered maternal-infant bonding, and increased risk of developmental delays.

Despite the well-recognized burden of perinatal mental health, substantial obstacles persist in accessing care, screening, and managing these conditions. Even with the 2021 Medicaid expansion for postpartum coverage to 12 months, disparities in mental health access continue and differ by state. In a nationally representative survey of pregnant individuals, nearly 65 percent of those experiencing a major depressive episode were not given a diagnosis, and half did not receive treatment. Common barriers to treatment included cost, personal hesitation, and stigma related to mental health conditions. Additionally, the Policy Center for Maternal Mental Health discovered that 84 percent of the perinatal demographic live in areas with a lack of mental health providers, highlighting the unequal distribution of mental health resources nationwide.

The American College of Obstetricians and Gynecologists (ACOG) suggests screening for depression and anxiety at least once during the perinatal phase. Despite these guidelines, screening remains inconsistent in clinical environments, leading to delayed diagnosis and inadequate management of perinatal mental health conditions. According to findings from the Pregnancy Risk Assessment Monitoring System (PRAMS), 1 in 5 women reported not being asked about depression during prenatal appointments, and 1 in 8 stated the same during postpartum visits. Another examination of obstetricians and primary care providers noted uncertainty in addressing perinatal mental health conditions, alongside considerable variability in recognizing symptoms. This discrepancy may stem from a lack of formal education in perinatal mental health for providers, as the Accreditation Council for Graduate Medical Education (ACGME) currently does not require specific mental health training for Obstetrics and Gynecology (OB/GYN) residency programs.

Tackling this public health crisis requires systemic reform. Firstly, screening for perinatal mental health conditions should be universal and uniform among providers. In addition, coordinated multidisciplinary care involving obstetricians, primary care providers, and behavioral health specialists should commence at the hospital bedside and continue throughout the postpartum period. Moreover, the Accreditation Council for Graduate Medical Education (ACGME) should enforce the necessity of dedicated mental health training for OB/GYN residents to ensure they are prepared to recognize, treat, and assist patients. Telehealth services should also be expanded into resource-limited areas to promote equitable access to mental health care. Finally, we must work to reduce stigma around perinatal mental health conditions through education and compassionate, patient-centric care.

We can no longer ignore that mental health issues are the leading cause of maternal mortality in the U.S. This concerning reality calls for a transformation in our understanding of and approach to mental health during and after pregnancy. Mental health ought to be viewed as a fundamental aspect of the care provided to pregnant and postpartum individuals. We must urge health systems, policymakers, and the ACGME to take immediate action and establish a reality where no mother’s life is lost to a treatable perinatal mental health condition.

*Sheila Noon is a medical student.*