Missouri’s latest Pregnancy‑Associated Mortality Review (PAMR) reveals that mental‑health conditions, including depression, anxiety and substance‑use disorders, contributed to almost 25% of pregnancy‑related deaths between 2019 and 2023. The report, released this week, highlights missed opportunities in the state’s health system and recommends that every provider who interacts with a pregnant woman or new mother complete a brief mental‑health screening.
Screenings Not Yet Mandatory
While Missouri has introduced programs to help doctors and social‑service workers identify at‑risk patients, the state does not require mental‑health questionnaires. The screening itself takes only a few minutes, yet in 38 of the 108 reviewed deaths, providers failed to complete the assessment.
Rural Communities Face Greater Barriers
Women in rural parts of the state are 21% more likely to experience perinatal depression than those in urban areas, according to a 2020 study. Limited provider availability often forces families to travel long distances for care. “The majority of the trend I notice is frustration with the fact that we don’t have anybody in Mexico that delivers babies,” said therapist Haley Walker, who works in Mexico, Missouri.
Disparities Persist
The review found that pregnancy‑related mortality was 2.9 times higher for women on Medicaid than for those with private insurance, and Black women died at a rate 2.5 times that of white women. Nearly 80% of the deaths were deemed preventable, including every death linked to mental‑health or substance‑use issues.
Experts Stress Early Intervention
Perinatal psychiatrist Dr. Nancy Byatt of the University of Massachusetts Chan Medical School explained that many cases of postpartum depression begin before birth. “If we wait to start screening until somebody’s postpartum, we’ve missed a window,” she said.
Alison Williams, director of the Missouri Perinatal Quality Collaborative, recounted her own experience with postpartum anxiety, noting that the term “baby blues” understates the seriousness of the condition.
Proposed Solutions
The PAMR board recommends that all providers who encounter new families conduct a screening during pregnancy, not just after delivery. After a positive screen, providers should connect patients with therapy, medication, or social‑support resources. However, Dr. Byatt cautioned that simply referring every patient to a psychiatrist is unrealistic given the shortage of specialists, especially in rural areas.
To bridge the gap, Missouri is piloting the Maternal Health Access Project, modeled after programs in 31 other states. The initiative allows primary‑care and urgent‑care clinicians to consult with psychiatric experts remotely, helping them determine whether a patient needs specialty care or can be managed locally.
Looking Ahead
State officials, including incoming PAMR chair Dr. Kimberly Brandt, emphasize that the review’s findings are a call to action rather than a criticism of individual providers. “Can we see in their care — was there a point where somebody offered to help?” Brandt asked.
By making mental‑health screenings a standard part of prenatal and postpartum visits, Missouri can reduce preventable deaths and ensure that mothers receive the support they need to care for their newborn children.
Original reporting: The Beacon (Kansas City) — read the source article.
