The Troubling Decline in Maternal Mental Health

Written By SACCounty Healthy Beginnings
Depressed Black pregnant woman crying at home on her bed

If it feels like more pregnant and postpartum people are struggling with anxiety, depression, or burnout, it’s not your imagination. Across the last decade, maternal mental health has been drastically declining. In a large U.S. study of nearly 200,000 mothers of children under 18, those reporting “excellent” mental health fell from 38.4% in 2016 to 25.8% in 2023, and reports of fair/poor mental health climbed by roughly 64% over the same period. The pattern held across socioeconomic groups, with the steepest declines among single mothers and families with fewer socioeconomic resources.

This isn’t just about feeling blue. In the United States, mental health conditions – including depression, anxiety, and substance use disorder – are now the leading underlying cause of pregnancy-related deaths (22.7%), ahead of hemorrhage and hypertensive disorders. That risk peaks in the first year, with approximately 1 in 8 mothers experiencing postpartum depression symptoms. 

The state of parental stress was even addressed by the US Surgeon General in an advisory issued in August 2024: “Parents Under Pressure." The report identified parental mental health and well-being as a key public health problem that deserves immediate attention. In Sacramento County, we understand the seriousness of these findings and will continue to prioritize maternal mental health, allocating resources, bolstering programs, and working tirelessly to ensure that our mothers and children have healthy starts.

Contributing Causes

  • The pandemic aftershock: Reviews through 2023–2024 show higher rates of postpartum depression and anxiety during COVID-19, driven by stress, isolation, disrupted care, and economic strain.

  • Care deserts and fragmented systems: Across the nation, many regions lack obstetric or behavioral health providers. And even where they do exist, coordinated care between OB/GYN, pediatrics, primary care, and psychiatry is often fragmented.

  • Coverage cliffs and social stressors: The American Rescue Plan Act (ARPA) of 2021 extended the postpartum period from 60 days to 365 days. Expanding Medicaid to 12 months postpartum has been a bright spot, but implementation varies by state, and coverage alone doesn’t address access, stigma, or barriers to childcare and transportation. California’s expansion plan was approved in May 2022.

Best Practices and Sacramento’s Approach

Healthcare teams can take proactive measures to:

Close up of doctor holding stethoscope listening to pregnant woman's belly

  1. Normalize routine screening and mind high-risk flags
    The American College of Obstetricians and Gynecologists 2023 Clinical Practice Guideline recommends screening at least once during the perinatal period with validated tools. Prior mood or anxiety disorders, traumatic birth, NICU stays, intimate partner violence, substance use, and social isolation elevate risk. In Sacramento County, clinicians can strengthen these efforts by tapping into the provider resources for validated screening instruments, multilingual patient education, and culturally responsive referral pathways: 

    • Sacramento County Behavioral Health Services

    • Sacramento Maternal Mental Health Collaborative (SMMHC) 

    • Be Mom Aware 

    • African American Perinatal Health Program

    • Community Nursing

    • Black Infant Health

    • Nurse-Family Partnership Program

  2. Build collaborative care into OB and pediatric settings
    Collaborative care – integrating behavioral health managers and psychiatric consultation into perinatal care – has one of the strongest evidence bases. Sacramento County Behavioral Health Services and community organizations, such as A Mother’s Heart, facilitate cross-system networking and screens, while also offering support and referrals for individuals to appropriate local services.

  3. Plan for the fourth trimester
    Before discharge, schedule proactive mental health touchpoints in the first 2–6 weeks postpartum. Sacramento providers can link patients to Maternal, Child, and Adolescent Health (MCAH) programs – such as Black Infant Health, which include ongoing mental health screening and culturally tailored case management.

Pregnant woman sitting on a sofa at home holding her belly with another woman providing emotionalsupport.

For those who are pregnant or postpartum, or support someone who is, there are also proactive steps you can take. Recognize the signs that indicate you or someone else is struggling and know they are not weaknesses – they’re symptoms that warrant compassion and attention. In Sacramento, you can self-refer to the Maternal Support Line (916-681-2907) or contact the BHS SAC (Behavioral Health Services, Screening and Coordination) at 916-875-1055 or visit dhs.saccounty.gov. Additionally, free or low-cost group and virtual supports exist throughout Sacramento County, including those that are bilingual and culturally relevant. In emergencies, call 988 Suicide & Crisis Lifeline or visit the Mental Health Urgent Care Clinic (MHUCC), which provides 24/7 crisis services on an open basis to individuals of all ages needing mental health and/or co-occurring substance use supports with no appointment necessary.

A shared mission

Declining maternal mental health is not inevitable – it’s a system problem with system solutions. For clinicians, this means integrating evidence-based screening and collaborative care into routine obstetric and pediatric practices, and connecting patients to proven local supports and resources, such as those available in Sacramento County. For families and the public, it’s recognizing symptoms early, reducing stigma, and making getting help as normal as a blood pressure check. Treating perinatal depression and anxiety improves birth outcomes, strengthens parent-infant bonding, and supports healthier child development. Together, we can strive to ensure healthy beginnings for all of our mothers and children. 

 
SACCounty Healthy Beginnings
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Stigma and Bias in Prenatal Care