Natalie Eilbert and Madison Lammert - Milwaukee Journal Sentinel

When the Wisconsin Maternal Mortality Review Team examines the state’s pregnancy-related deaths, the cause is often behavioral health conditions. In such cases, every death is preventable.  

It’s an ongoing crisis that often goes unspoken. Between 2016 and 2017, more than half of all Wisconsin pregnancy-related deaths were the result of mental health conditions, including suicide, substance use disorders and overdoses.

It’s not just a problem in Wisconsin. Each year, 38 states across the United States, including Wisconsin, submit maternal mortality data to the Centers for Disease Control and Prevention. And, overwhelmingly, each year, mental health conditions are the most common underlying. 

But it doesn’t have to be this way, say Wisconsin Sen. Tammy Baldwin and Rep. Gwen Moore of Milwaukee. 

“Right now we’re really coming up short in terms of supporting the mental health needs of new and expecting mothers, and we’re seeing the impacts,” Baldwin said. 

That’s why, along with other federal Democratic lawmakers, they’ve introduced the federal bill called the Mental Health and Making Access More Affordable (MAMA) Act. This prospective legislation aims to expand access to services for mental health and substance use disorders during pregnancy and postpartum.

Cost is the top barrier to receiving mental health help. Democrats say their new bill reduces barrier. 

The Mental Health and MAMA Act would remove copayments, coinsurance and deductibles for pregnant and postpartum patients seeking services for mental health and substance use disorders up to one year following childbirth.

The bill applies only to specific types of insurance — commercial and governmental insurance plans, including Federal Employees Health Benefits (FEHB) — that already cover such services. The bill does not require insurance companies that don’t already do so to add behavioral health coverage, Moore said.

It builds off continuity of care requirements outlined in the No Surprises Act, enacted in 2020 by Congress. That law protects pregnant patients covered under group and individual health plans from getting surprise medical bills, which could happen if an insurer removes a pregnant patient’s current provider from their network. But the timeframe for these protections is limited. The Mental Health and MAMA Act would extend it to one year postpartum. 

Research from the Substance Abuse and Mental Health Services Administration (SAMHSA) shows the No. 1 reason why people do not seek mental health treatment is cost. Wisconsin-specific data backs that up, with half of the state's mothers reporting they're impacted by financial insecurity. 

Another main reason why perinatal patients — the timeframe that encompasses one year prior to pregnancy through two years following childbirth — don’t receive mental health treatment is the lingering stigma, according to the Alliance for Innovation on Maternal Health and SAMHSA data. Many with mental health concerns fear their friends and family's opinion about them would change if they learned they were seeking help, and many worry about the consequences of expressing thoughts of self-harm or harming their babies to a health care provider

Moore and Baldwin say the Mental Health and MAMA Act hits on the two factors of cost and stigma, and the bill can go a long way in encouraging more people to seek help.

In Wisconsin, women of color make up one-quarter of all births, but nearly half of all pregnancy-related deaths

Those who are the most vulnerable to mental health and substance use concerns during pregnancy also tend to have the least access to care. It’s a point of frustration for Moore, who has spent her political career working on international women’s issues. 

“Once I got involved in international work and international women's issues, it was embarrassing for me to see the high maternal mortality rates in the United States,” Moore said. 

The numbers in Wisconsin speak for themselves.

Combined, Black, Asian and Hispanic mothers comprise just one-quarter of all births in Wisconsin, but they account for nearly half of its pregnancy-related deaths, according to the latest comprehensive report from the state. 

Black women are more likely than women of other races to experience perinatal depression. For example, nearly 30% of Wisconsin’s Black mothers have depression during pregnancy, compared to 17% of white mothers, according to the 2018-19 Wisconsin Pregnancy Risk Assessment Monitoring System. Previous data shows the depression rates for mothers, regardless of race, are climbing each year. 

And when struggling with depression and anxiety, people are more prone to engage in risky behaviors. Between 2016 and 2019, nearly half of all maternal mortalities in Wisconsin were the result of overdoses. Depression and anxiety are often powerful barriers to quitting smoking cigarettes, according to state data.

By increasing access to services for mental health and substance use disorders, both before and after birth, Moore and Baldwin hope to lessen these disparities. 

“We want to make sure that seeking behavioral health or substance abuse disorder treatment … is not going to be associated with large out-of-pocket costs, because people will simply not pursue the treatment if they can’t afford it,” Baldwin said.

Women and children are 'canaries in the coal mine' of community health, says U.S. Rep. Gwen Moore

When mothers thrive, their babies thrive. This has a compounding impact on the community, Moore said. 

The mental health concerns a pregnant person faces can impact their baby’s development, and even their behavioral health later in life, studies show. Once an infant is born, their health continues to be intertwined with that 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 mitigate struggles for entire families. And when families succeed, Moore said, communities flourish. 

“I think women and children are the canaries in a coal mine,” she said. “If the women and children are not doing well, the community cannot be doing well at all.”

What's next for the Mental Health and MAMA Act?

Moore said this bill builds on the Mental Health Parity and Addiction Equity Act. Signed into law in 2008, this watershed legislation requires select insurance companies to provide mental health and substance use disorder benefits just as it does medical and surgical benefits. 

But, as Moore and Baldwin said, more needs to be done to level the playing field between mental health and traditional health coverage – especially when it comes to perinatal patients. 

The Mental Health and MAMA Act is one of many steps to do so. In the same vein, there’s the Black Maternal Mental Health Momnibus Act of 2023 that aims to bolster maternal health outcomes. The package, championed by both Baldwin and Moore, contains 13 bills, including a measure they have introduced as a standalone bill, the Perinatal Workforce Act. None has yet to be signed into law, although some of the individual bills within that package have advanced at the committee level.

“What we learned is that your body doesn’t have a chance if your mind is not working well,” Moore said.

Baldwin and Moore are working to garner support for their new bill. It has yet to be heard in committee.

Natalie Eilbert covers mental health issues for the Milwaukee Journal Sentinel. She welcomes story tips and feedback. You can reach her at neilbert@gannett.com or view her Twitter profile at @natalie_eilbert. Madison Lammert covers child care and early education across Wisconsin as a Report for America corps member based at The Appleton Post-Crescent. To contact her, email mlammert@gannett.com. Please consider supporting journalism that informs our democracy with a tax-deductible gift to Report for America by visiting postcrescent.com/RFA