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 Abstract

Excerpted From: Paige Ferise, Minding Baby: The Link Between Maternal Depression and Infant Health and Development, 18 Indiana Health Law Review 371 (2021) (238 Footnotes) (Full Document)

In 2018, during the State of the State Address, Indiana Governor, Eric Holcomb, declared that Indiana would have the lowest infant mortality rate in the Midwest by 2024. This was a lofty goal in light of Indiana's historically poor ranking in infant mortality. In the two years since Governor Holcomb made this promise, several steps have been taken to work towards caring for mothers' and babies' physical health, but very little has been done to address maternal mental health or maternal trauma.

There is a genetic and cyclical nature to trauma that causes mothers and babies to be disproportionately affected. Mothers who experience trauma in childhood are more likely to experience depression during or after pregnancy. Similarly, infants born to mothers who experienced untreated depression are at a higher risk for childhood trauma. Much of the policy surrounding maternal care focuses on important aspects of prenatal care such as physical health, but largely ignores mental health. Maternal depression can have devastating effects on babies ranging from attachment disorders to developmental delays. Left untreated, maternal depression can cause adverse health outcomes; not only for the mother but also for the baby.

Maternal mental health and trauma screenings during pregnancy and postpartum should be the required standard of care for all Medicaid mothers, or for all mothers who are not enrolled in Medicaid, but whose child is Medicaid eligible. Screening for, and offering services to treat, maternal mental health disorders can reduce adverse outcomes for infants--including infant death--and end the epigenetic cycle of mental illness and toxic stress that is particularly rampant in low-income communities.

A. Road Map

This Note will begin with an overview of the background of maternal mental health in the United States. Section II will first describe in detail what maternal depression is and how it affects both mothers and infants. This section will give a brief history of maternal mental health in the United States and where the country, as well as the State of Indiana, currently stands in terms of maternal depression screenings. Section II will then draw a connection between maternal mental health and infant mortality. This section will delve into specifics on infant mortality in the United States as well as in the State of Indiana. Finally, Section II will discuss the concept of adverse childhood experiences (“ACEs”) and the role that these experiences play on maternal mental health and infant health. This section will define ACEs as well as toxic stress and draw connections between trauma and public health.

In Section III, this Note will present a full literature review. First, Section III will give a literature review of the connection between maternal depression and adverse outcomes in infant health. This portion will dive further into research about the severe effect that maternal mental health can have on infant mortality. Next, Section III will provide a full review of the research regarding the generational effect of maternal mental health and trauma. This section will define the term epigenetics and will provide research on the generational effects of toxic stress and mental health disorders on pregnant women and mothers. Finally, Section III will provide an overview of research connecting maternal ACEs and toxic stress with infant health outcomes. Specifically, this section will present research that draws a connection between maternal trauma and infant mortality rates.

Section IV will give a policy review of different jurisdictions in the United States. This section will go over various policies that touch on maternal mental health screenings, maternal ACEs screenings, as well as billing and reimbursement policies. Section IV will compare and contrast policies in states that are geographically near Indiana or states that are also in the bottom ten nationally for infant mortality. This portion will also discuss where Indiana currently stands on maternal mental health policies.

Finally, Section V will give policy recommendations for the State of Indiana. This portion will draw from other state policies and make a proposal for how Indiana can change and improve policy so as to better care for the mental health of mothers, and in turn, reduce infant mortality.

[. . .]

Current Indiana policy surrounding maternal health addresses many important aspects of physical health, but largely disregards the importance of mental health. Unlike many surrounding and similarly situated states, Indiana does not require, recommend, or even allow for reimbursement for maternal depression screenings during well-child visits. This ultimately is causing significant costs to the State both socially and financially.

There is a significant financial cost to ignoring maternal mental health. Maternal mental health affects more than just the mother. For each infant born preterm, with birth defects, or birth complications, an estimated $93,800 is spent on health care for the child's first year of life with most of that cost being borne by Medicaid. Life-long adverse outcomes are possible for the infant. The ultimate cost of ignoring maternal mental health is too high. By shedding light on the reality of maternal depression and the effect of trauma on maternal health, Indiana can become a national leader in maternal and infant health, and ultimately lower the infant and maternal mortality rate. Nearby states, as well as states that (like Indiana) are ranked in the bottom ten for infant mortality rates, have all taken action to combat maternal depression. If Indiana is serious about lowering the infant mortality rate in this State it is time to follow the lead of other states, as well as the AAP's screening recommendations, which encourage screening Medicaid mothers for maternal depression.

J.D. & M.P.H Candidate, 2022, Indiana University Robert H. McKinney School of Law & Fairbanks School of Public Health; B.A. 2017, Butler University.

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