The past few years have brought dramatic changes in reproductive rights in the United States, starting with the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, which overturned Roe v. Wade in 2022 and left abortion policy to the states.

While communities grapple with the legal ramifications of the Dobbs decision, mental health professionals are experiencing the ripple effects—a surge in anxiety, depression, and other mental health issues among families at all stages of the reproductive cycle.

Fear: A New Variable

Postpartum depression had already been steadily increasing.An analysis by the CDC showed that it was seven times higher in 2015 than in 2000. According to the American PsychiatricAssociation (APA), one in five pregnant women, or about 500,000 in the U.S. annually, will experience a mental health disorder during the perinatal period, and that puts them at risk for other serious conditions, including poor nutrition, inadequate sleep, substance abuse, and psychosis. 

Post Dobbs, however, depression and anxiety are no longer confined to the perinatal period, and they are affecting families in entirely new ways. Our news feeds are filled with tragic stories of women like 28-year-oldAmberThurman from Georgia, who died of a pregnancy-related infection that doctors say would have been treatable if she had lived in a state with different laws.

This has created a new baseline of anxiety and fear surrounding the inability to get medical care for life-threatening conditions. A recent article in Frontiers in Psychiatry noted that the lack of access to abortion care will have profound and far-reaching physical and mental health consequences. The fear is leading families to seek care in other states, move away from their support systems, and make difficult choices regarding their fertility.

The fear is exacerbated by a legal and political landscape that keeps changing. Several states voted on contentious abortion measures in the last two years, and 10states had abortion measures on the ballot for the November 2024 election.

Expanding Access to Care

In this climate, the need has never been greater to improve access to behavioral health care for entire families during the reproductive years.

Thus far, we have begun to strengthen the foundation. The Policy Center for Maternal Mental Health reports some recent legislative progress: 15 states took action in 2023 with 30 maternal mental health bills, compared to 10 states and 10 bills in 2022.

Additionally, 25 states currently have PerinatalPsychiatry Access Programs, and several more state programs are coming soon. Psychiatry Access Programs connect primary care providers—OB/GYNs, pediatricians, family practitioners, etc.—to psychiatry specialists who can help them manage their patients in the primary care setting. These programs are successfully expanding care, tapping into psychiatry resources at major institutions and enabling them to help care for patients in underserved areas throughout the state. Trayt Health is proud to support several of these statewide programs. Our technology provides the framework for Access Programs, integrating workflow tools with a data platform that helps clinicians make better diagnosis and treatment decisions.

However, within programs and throughout day-to-day care, how do we as a mental health community rise to meet the need for behavioral healthcare in the age of reproductive uncertainty?

First, we must think beyond postpartum depression. We can no longer wait until pregnancy to start the clock on maternal mental health. Instead, OB/GYNs and family practitioners must look for mental health issues among all people in their reproductive years. Our teen patients may be confused and frightened as they enter puberty. Our young adults may need counseling as they weigh new risks in family planning. Mental health professionals and primary care providers must be on alert to spot potential challenges across the full continuum.

Universal screenings will help make that happen. The American College of Obstetricians and Gynecologists recommends mental health screening three times during and after pregnancy, but data from the Healthcare Effectiveness Data and Information Set (HEDIS) shows less than 20% of patients are in fact screened. If providers are trained to screen all patients routinely for mental health issues, they will identify not only pregnancy-related issues but also depression and anxiety for all family members at any point in the reproductive cycle. The Trayt platform facilitates the universal screening process, as well as provides powerful data analytics to measure results and improve clinical decision making for diagnosis and treatment.

Finally, when those screenings detect issues, we need an infrastructure of interconnected mental health programs to refer people for treatment. While Psychiatry Access Programs are designed to treat specific patient populations—maternal mental health, child and adolescent mental health, substance abuse, etc.—the Trayt platform can connect them on the back end, making it easy to refer patients to other programs as their circumstances change.

The primary care setting is the first line of defense and our best opportunity for early detection and intervention for maternal mental health conditions. If providers are mindful of the unique stressors families face in this age of reproductive insecurity, we can get them the mental healthcare they so desperately need.

Malekeh Amini is Founder and CEO of Trayt Health, is a technology company dedicated to improving behavioral health outcomes through integrated, evidence-based clinical intelligence, workflow, and data management solutions. Trayt Health’s technology platform supports some of the most successful Psychiatry Access Programs in the country, including programs for maternal mental health.