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Key points
- Caregivers want comprehensive, long-term mental health and physical care, not just temporary fixes.
- Expanding care for perinatal disorders must include non-birthing parents and support the entire family system.
- Consistent screenings, insurance coverage, and culturally responsive care are critical for equitable access.
Over the past two decades, awareness of perinatal mental health has grown, sparking public discourse and legislative efforts. This evolution provides valuable lessons for advocates working to improve care. Understanding where we’ve been and where we are now helps shape strategies for the future, ensuring all caregivers—birthing and non-birthing—receive the mental health support they need and deserve.
A History of Perinatal Mental Health Support in the U.S.
The journey toward comprehensive perinatal mental health support in the United States has been gradual but significant. Early efforts to address maternal postpartum depression have evolved into more expansive policies aimed at supporting mental health during pregnancy and postpartum, with growing attention to both birthing and non-birthing caregivers. Federal and state-level initiatives reflect growing momentum, but gaps persist, revealing critical areas for improvement.
The TRIUMPH for New Moms Act
In 2023, the TRIUMPH for New Moms Act marked a major milestone by creating a national task force to coordinate efforts to support perinatal mental health. This bipartisan initiative set goals to improve PMADS screening rates, integrate peer support and doulas into community care, advocate for insurance coverage of mental health services, and foster partnerships across agencies providing perinatal care. Senator Maggie Hassan, a co-author of the bill, described it as "an important step toward supporting maternal mental health and ensuring that moms have the support they need through every step of their journey."
In 2024, the task force published a report to Congress highlighting systemic challenges, including disparities in access, workforce shortages, and fragmented services. It emphasized the need for equitable, trauma-informed, and culturally responsive care systems and outlined a national strategy to expand data collection and research, strengthen federal and state partnerships, and share best practices for prevention, screening, and treatment. Aligned with broader federal initiatives like the White House Blueprint for Addressing the Maternal Health Crisis, the task force’s work will continue through September 2027. Advocates hope to see improvements in service coordination and efforts to dismantle barriers to treatment.
Challenges and Gaps in Perinatal Mental Health Policies
Despite federal progress, significant challenges remain. State-level policies vary widely. For example, while states like New Jersey and California mandate screenings during prenatal and postpartum visits, others only encourage them. These inconsistencies contribute to uneven care across the country.
Access to care is a persistent issue, particularly for marginalized, low-income, and rural populations. Medicaid expansion has improved access for some, but barriers such as limited insurance reimbursement, provider shortages, and inadequate integration of mental health into routine perinatal care remain. These challenges are most acute in states with narrow definitions of “caregivers,” which often exclude non-birthing parents or those outside traditional family structures.
What Caregivers Want: Insights from Research
In our recent study of over 1000 caregivers, caregivers' stories highlighted the disconnect between existing policies and their needs. They consistently expressed a desire for:
1. Comprehensive, long-term physical and mental healthcare
Caregivers repeatedly stressed that mental health support needs to extend beyond the standard six-week postpartum checkup. Many face mental health challenges that persist well into the first year—or longer—after birth. Current policies often provide only short-term care, leaving families without ongoing support. As one caregiver shared:
"I wish both prenatal and postnatal care were equally focused on the birthing partner and baby. The system made me feel like I was the candy wrapper that a cute baby came from... God forbid I need actual care beyond my baby’s checkups."
2. Accessible, responsive therapy and counseling
Therapy and counseling services are essential but frequently inaccessible due to high costs, insurance barriers, and provider shortages. Caregivers also pointed out that many mental health professionals lack specific training in perinatal mental health, limiting the effectiveness of care. One mother explained:
"I needed therapy, but between my insurance not covering it and waitlists being months long, I just gave up trying."
3. Reduced stigma around PMADs and help-seeking
Many caregivers expressed feeling judged when seeking mental health support, with concerns that being honest might lead to being labeled an “unfit” parent. Fear of Child Protective Services involvement also prevents open communication. As one participant revealed:
"I was terrified to admit how I was feeling. I thought they’d take my baby away if they knew how much I was struggling."
4. Financial support to delay postpartum workforce reentry
Returning to work too soon was another pressing concern. Many caregivers described how economic pressures forced them back to work before they were ready, exacerbating their mental health struggles. One mother recalled:
"I needed a longer leave… I needed to protect my mental health… I was too anxious to leave my child."
These needs underscore the importance of policy solutions that address both immediate care and broader societal factors, such as economic pressures and workplace policies.
The Path Forward for Perinatal Mental Health Support
The future of perinatal mental health in the U.S. holds both challenges and opportunities. The incoming administration has a pivotal role to play in strengthening and aligning federal and state policies, expanding access to care for all caregivers, and fully integrating mental health services into routine perinatal care. Progress will require addressing systemic inequities and recognizing the diverse needs of all caregivers. Advocacy efforts must focus on creating policies that treat mental health with the same urgency as physical health during pregnancy and postpartum. Through advocacy and policy innovation, a healthier and more equitable future for children, caregivers, and communities is within reach.
