Alliance Webinar on Maternal Mental Health

Carmen thanked the Alliance for partnering with RH Impact to support state-level early childhood advocates to learn more and engage authentically in policy change to improve maternal health. She framed RH Impact’s work in the values and principles of reproductive justice, a framework created by Black reproductive health advocates that focuses on the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.

RH Impact recently transformed as an organization, taking on a shared leadership model made up of six vice presidents and a focus on a broader range of reproductive health issues. RH Impact’s vision is to create a world where Black communities can achieve our full potential for reproductive health, wellbeing, safety, and joy. In collaboration with communities, RH Impact challenges systemic inequities to achieve reproductive justice and equity. They apply research and evaluation to policy equity, capacity-building, and power-shifting strategies while centering the lived experiences, scholarship, and activism of Black communities. 

In the policy and advocacy space, RH Impact works at both the federal and state levels, primarily in Texas and Louisiana for the moment. Core activities of their policy and advocacy team include legislator and legislative staff engagement, coalition engagement, community engagement, resource development, and testimony and speaking engagements.  Storytelling and sharing experiences is a major part of Black feminist methodology, helping to bring the discussion back to our shared humanity. The intersectional and life force ways in which Black women and families experience reproductive health, rights, and justice is a similar perspective that they hope to bring to the early childhood space.

RH Impact’s focus on reproductive equity and justice is meant to reframe work in maternal health. It’s essential to acknowledge and heal from the injustices inflicted upon Black women. Rather than recognizing the so-called “Father of Gynecology” who experimented on enslaved women, RH Impact honors the “Mothers of Gynecology,” who were the subjects of these experiments, Anarcha, Lucy, and Betsey. Similarly, the unauthorized use of Henrietta Lack’s cells in research and the Tuskegee Experiment demonstrate reproductive injustices inflected upon Black people. The free health clinics established by the Black Panthers, which served as a prototypes for today’s public clinics, reinforces the power and strength of Black communities.  Everything related to reproductive health connects back to the family structure.  Early childhood issues related back to the reproductive justice tenant focused on the right to raise our children in safe and sustainable communities.

After laying out the theory and positionality that are foundational to RH Impact’s work, Carmen shifted to the data related to maternal mental health. Twenty percent of pregnant and postpartum birthing people experience depression and/or anxiety. Twenty-five percent of women of color will suffer from a maternal mental health condition at some point, compared to 14.3 percent of White women. This can be attributed a range of factors, including racism, generational trauma and the lasting impacts of the trans-Atlantic slave trade, medical apartheid and colonization. Some of the risk factors for maternal mental health issues include racism, age, unemployment, socio-economic inequities, and stress.

Carmen shared that Pritzker seems to be unique among funders in recognizing that maternal and child health issues intersect – anything a mama is going through, the infant or the child is going to experience as well. Centering mom has cascading benefits for the whole family. Poor maternal mental health is associated with problematic parenting behaviors and the child’s social, emotional, and behavioral development. However, cumulative disadvantage and Afrocentric perspectives reframe the narrative, suggesting that poor child outcomes are not solely caused by maternal health but are influenced by multiple factors. The Afrocentric perspective emphasizes a holistic approach, considering various interconnected factors like maternal mental health, support systems, societal forces, and more.

RH Impact is deviating in its approach to maternal mental health to be more holistic and how that translates into their approach to state policy. For example, some advocates of color have pushed back on an emphasis on infant mental health rather than on maternal mental health. Maternal mental health is more quantifiable, with clearer interventions and impacts. By focusing on maternal mental health, infant mental health also benefits. To realize racial equity on mental health we must acknowledge the role of cultural oppression, fight against political, economic and cultural oppression, and build on the strengths of the community. Equity is a revolutionary act.

Issues that impact maternal mental health yet are under-researched and under-resourced include reproductive health access (elimination of abortion access in many states), reproductive health quality, infertility or bias related to the number of children a person has, chronic reproductive health issues like fibroids, endometriosis, and cancer as well as a lack of holistic maternity care, including trauma-informed care, maternal morbidity, obstetric racism, and access to the midwifery model of care. There are very few tools to measure the impacts of racial bias and obstetric violence in maternity care. If the harm is preventable then the impacts on maternal mental health are also preventable. Postpartum and early childhood programs like care integration, postpartum depression screenings, WIC, Healthy Start and Head Start can also play a protective role in maternal mental health. Supports for growing families are also key to maternal mental health including parental leave, SNAP, TANF, and other programs that help families to sustain a minimum standard of living. How do we work together to create a narrative about these programs that will help policymakers understand their role in supporting maternal mental health?

In partnership with the Shades of Blue Project, RH Impact has identified a range of policy solutions to support maternal mental health including the twelve bills that make up the Momnibus as well as the Moms Matter Act and the Kira Johnson Act. Their policy agenda also calls for policymakers to permanently extend postpartum Medicaid to 12-months, including mental health coverage and to extend Medicaid coverage for doula and midwifery services. Services and supports for gender diverse community members are also essential. 

Carmen encouraged attendees to take action to support maternal mental health by engaging with state legislators, exploring reputable news outlets, checking policy research organizations, reviewing academic and research publications, and using online databases. These actions will help to identify potential allies, champions, and opponents. Consider scheduling a meeting with one of RH Impact’s Policy and Advocacy team members, requesting data or research from RH impact to support policy advocacy efforts in your state, and inviting RH Impact to speak at a maternal health meeting or conference. Connect with RH Impact on social media (@RHImpact_ on Facebook, Twitter (X), TikTok, and Threads and Reproductive Health Impact on LinkedIn and YouTube), email them at statepolicy@rhimpact.org or policy@rhimpact.org, and subscribe to their newsletter.

During the Q&A portion of the webinar, the discussion flowed from Medicaid coverage of abortion services, actions that managed care organizations can take to protect maternal mental health, and the ways in which health plans and Medicaid influence each other. Carmen advocated for the creation of validated tools and measures that assess patient experience in addition to the safety measures that hospitals are required to report. The experiences that impact maternal mental health are not being measured.