Report on Maternal Mental Health Disparities and the Sustainable Development Goals

Executive Summary

Postpartum depression (PPD) presents a significant public health challenge, with profound implications for achieving key Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being), SDG 5 (Gender Equality), and SDG 10 (Reduced Inequalities). Analysis reveals severe racial and socioeconomic disparities in the diagnosis, treatment, and outcomes of PPD, especially among Black women in the United States. Systemic failures within healthcare, coupled with economic barriers, undermine progress toward ensuring healthy lives and promoting well-being for all at all ages.

SDG 10: The Challenge of Reduced Inequalities in Maternal Care

Statistical Overview of Racial Disparities

The prevalence of PPD highlights a critical failure in achieving SDG 10, which aims to reduce inequality within and among countries. Data indicates a stark disparity in maternal mental health outcomes based on race.

• The rate of PPD among Black women nearly tripled between 2010 and 2021, increasing from just over 9% to almost 25%.
• Black mothers are 46% less likely to be screened for PPD compared to their white counterparts.
• A significant treatment gap exists, with only 37% of Black women receiving treatment for maternal mental health conditions, compared to 67% of white women.

These statistics underscore the urgent need to address systemic barriers that prevent equal access to care, a core tenet of SDG 10. Personal accounts, such as that of Kay Matthews who experienced a stillbirth, illustrate how feelings of abandonment and racial bias within the medical system directly contribute to untreated trauma and depression.

SDG 3: Threats to Good Health and Well-being

Impact on Maternal and Infant Health

Untreated PPD poses a direct threat to SDG 3, which encompasses reducing maternal mortality and promoting mental health. The consequences extend beyond the mother to affect the entire family unit.

1. Maternal Mortality: Mental health conditions, including depression and anxiety, are a leading driver of maternal deaths, accounting for 23% of such fatalities. The experience of Dr. Joy Baker, whose patient died by suicide after a missed PPD diagnosis, exemplifies this tragic link.
2. Pregnancy Complications: Chronic stress associated with PPD and systemic inequities can lead to elevated cortisol levels, creating a hostile intrauterine environment. This is linked to higher risks of preterm birth, low infant birth weight, hypertension, and diabetes during pregnancy.
3. Infant and Family Development: PPD is associated with adverse outcomes for children, including poor maternal-infant attachment, difficulties with breastfeeding, stunted growth, and delays in cognitive and language development.

Systemic and Economic Barriers to Universal Health Coverage

Achieving SDG Target 3.8, universal health coverage, is impeded by both systemic and economic factors.

• Systemic Racism: Experiences of neglect and dismissal within healthcare settings, as reported by Black mothers, demonstrate how discriminatory practices undermine health outcomes, directly opposing the principles of SDG 3 and SDG 5 (Gender Equality).
• Socioeconomic Stressors: Low socioeconomic status is identified as a major stressor contributing to depression and anxiety. A significant portion of births (40-50%) are covered by Medicaid, highlighting the vulnerability of low-income mothers.
• Cost of Treatment: The high cost of specialized PPD medication, such as Zurzuvae which can cost approximately $8,700 for a two-week course without insurance, creates an insurmountable barrier for many, making access to care dependent on economic status.

Progress and Future Challenges for Sustainable Development

Community and Institutional Interventions

In response to these challenges, targeted initiatives are emerging that align with the SDGs. These efforts aim to build stronger, more equitable health systems as envisioned in SDG 16 (Peace, Justice and Strong Institutions).

• Community-Led Support: Nonprofits like the Shades of Blue Project, founded by Kay Matthews, provide essential support services and supplies to women nationwide, addressing gaps in the formal healthcare system and promoting community resilience.
• Policy Reform: In states like Georgia, which has one of the nation’s highest maternal mortality rates, efforts are underway to create standardized hospital directives for handling patients at risk for PPD, representing a crucial step toward institutional accountability.

A Precarious Future

Despite progress, future advancements are at risk. Potential legislative changes affecting funding for Medicaid and social support services threaten to reverse gains made in maternal health. Such cuts would disproportionately impact low-income communities and communities of color, further jeopardizing the achievement of SDGs 1, 3, 5, and 10. Stakeholders express grave concern that a reduction in resources will have an “astronomical impact” on this work, potentially erasing progress and exacerbating existing inequalities.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

   The article on postpartum depression (PPD) in Black women touches upon several interconnected Sustainable Development Goals. The primary SDGs identified are:

   • SDG 3: Good Health and Well-being: This is the most central SDG, as the article’s entire focus is on maternal mental health (PPD), its impact on maternal mortality, infant health, and the significant gaps in healthcare access and quality.
   • SDG 10: Reduced Inequalities: The article explicitly details the racial and socioeconomic disparities in maternal healthcare. It highlights how Black women are disproportionately affected by PPD and are less likely to receive screening and treatment compared to white women, pointing directly to inequalities in health outcomes and access.
   • SDG 5: Gender Equality: While the focus is on women, the article addresses specific challenges faced by women in the context of maternal health. The discussion around the “strong, Black woman” trope and the dismissal of their pain relates to harmful gender and racial stereotypes that create barriers to care, which is an aspect of achieving genuine gender equality.

2. What specific targets under those SDGs can be identified based on the article’s content?

   Based on the issues discussed, several specific SDG targets are relevant:

   • Under SDG 3 (Good Health and Well-being):
     • Target 3.1: By 2030, reduce the global maternal mortality ratio. The article directly connects PPD to maternal mortality, stating that mental health conditions “account for 23% of maternal deaths” and noting that Georgia has the “second-highest rate of maternal mortality in the nation.”
     • Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being. The article highlights PPD as a major mental health disorder and mentions a patient who “died by suicide,” a form of premature mortality directly linked to a lack of mental health support.
     • Target 3.8: Achieve universal health coverage, including access to quality essential health-care services and access to affordable essential medicines. The article points to failures in this area by describing how Black women are less likely to be screened or treated, the prohibitive cost of medication like Zurzuvae (“can cost roughly $8,700”), and the critical reliance on Medicaid for coverage.
   • Under SDG 10 (Reduced Inequalities):
     • Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of race, ethnicity, or economic or other status. The article’s core theme is the exclusion of Black women from adequate maternal mental healthcare, as evidenced by Kay Matthews’ story of being ignored and the statistical disparities in care.
     • Target 10.3: Ensure equal opportunity and reduce inequalities of outcome. The statistics cited—that Black mothers are “46% less likely to be screened for PPD” and that only “37% of Black women received treatment” compared to 67% of white women—are clear examples of inequalities of outcome that this target aims to eliminate.
   • Under SDG 5 (Gender Equality):
     • Target 5.1: End all forms of discrimination against all women and girls everywhere. The article describes discriminatory treatment within the healthcare system, such as caregivers questioning Kay Matthews’ partner because he was a Black man, which constitutes discrimination based on intersecting race and gender identities.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

   Yes, the article provides several quantitative and qualitative indicators that align with the official SDG indicators or serve as practical measures of progress.

   • Maternal Mortality Ratio (Indicator 3.1.1): The article explicitly mentions this by citing Georgia’s rank as having the “second-highest rate of maternal mortality in the nation” and stating that mental health conditions contribute to “23% of maternal deaths.”
   • Suicide Mortality Rate (Indicator 3.4.2): Progress can be measured by tracking this rate. The article provides a tragic example of a patient who “died by suicide” due to an undiagnosed mental health disorder, highlighting this as a critical indicator.
   • Prevalence of Mental Health Disorders: The article provides specific data on the prevalence of PPD, noting it increased to “almost 25%” for Black women by 2021. Tracking this prevalence is a direct way to measure the scale of the problem.
   • Coverage of Essential Health Services (related to Indicator 3.8.1): The article provides clear data points that serve as indicators of coverage gaps: the percentage of Black mothers screened for PPD (46% less likely) and the percentage receiving treatment (37% for Black women vs. 67% for white women).
   • Proportion of Population with Access to Affordable Medicines (related to Indicator 3.8.1): The high cost of PPD medication ($8,700) is a clear indicator of the lack of affordability. The proportion of patients who can access such treatments through insurance like Medicaid (which covers “40% of the nation’s births”) is another key metric.
   • Proportion of Individuals Reporting Discrimination (related to Indicator 10.3.1/16.b.1): Kay Matthews’ personal account of being treated as if she were alone despite her partner being present serves as a qualitative indicator of racial discrimination within the healthcare system.

Summary Table: SDGs, Targets, and Indicators

Source: wordinblack.com