The FDA approval of Zurzuvae (zuranolone), the first oral medication, has offered new hope to mothers who have exhausted all other treatment options to cope with their postpartum depression. This is a milestone in recognizing the maternal mental health crisis that plagues our country. The benefit of this drug is that it offers a new approach to treating postpartum depression and brings postpartum health into the spotlight. With Zurzuvae and other treatments gaining recognition in mainstream media, postpartum health is becoming an essential topic in society. And yet, Zurzuvae is a reactive sparkling toy distracting from the root causes of postpartum depression.
One in seven women suffers from postpartum depression. Some factors that have led us to a maternal mental health crisis include a social stigma surrounding postpartum depression, lack of universal paid family leave, childcare concerns, barriers to health care access in terms of equity and race, and a postpartum medical care system in which 40 percent of women do not attend their appointments, to name a few. We have created a system for mothers to fail, and now we are in crisis mode.
Each of the above “lack of” could be its own book. My lens is through the medical field. I graduated from medical school in 2003. Since then, saying the health care landscape has drastically changed would be an understatement. Though we have attempted to create policies that support prevention (expansion of Medicaid/Medicare under the Affordable Care Act), we are constantly in reactive mode, as evident by the national COVID response.
My training continued as a pediatrician who further specialized in neonatology and lactation. Admittedly, I didn’t realize the massive holes until I personally tested America’s postpartum system through my own four diverse pregnancies. It’s a system that demanded my return to pediatric appointments mere days after I delivered with a broken body and a newborn to support. Then, repeating the process several times in the first month in exchange for ten to fifteen minutes of infant care. No wonder my mind fractured months later with undiagnosed postpartum depression and postpartum anxiety.
Postpartum depression is not something that can be treated with a pill alone. The current medical care system does not adequately address a postpartum mother’s healing. One underutilized and economically sound solution for preventing postpartum depression (PPD) is in-home postpartum visits. Home visits allow for more quantitative and qualitative PPD screening.
In 2017, MIECHV (Maternal Infant and Early Childhood Home Visitation Program) demonstrated an average PPD screening rate of 75 percent. The federally funded MIECHV supports more than 3,200 state and local agencies that conduct home visits via 20 different models. Economically, MIECHV programs see a return on investment of $1.89 for every dollar spent. Families benefiting from MIECHV home visits also report an increase in household income. According to the Center for American Progress, every $1 invested in home visiting programs yields a $3 to $5 return to society.
Other benefits from at-home health care include reduced maternal and infant mortality and improved breastfeeding rates. These outcomes lead to significant reductions in health care expenses.
As we applaud the national spotlight placed on maternal mental health, we cannot overlook the systemic, social, and medical barriers that have led us here. Concurrently, as we pour resources into scientific research, we need to economically support the real, granular issues impacting maternal mental health. America’s postpartum health care system needs to change to prioritize prevention rather than glorify quick fixes. Otherwise, we will keep placing band-aids over what is none other than a hemorrhaging crisis.
Sonal Patel is a pediatrician, neonatologist, and breastfeeding specialist whose work centers on infant nutrition, early development, and maternal well-being in the fourth trimester. In 2018, she founded NayaCare, a home health clinic dedicated to improving postpartum care.
She has written widely on maternal and infant health, with articles published in Scary Mommy, KevinMD, and The Colorado Sun. She is also the author of The Doctor & Her Black Bag, which explores maternal mortality through historical and personal perspectives while offering solutions to reduce it. A TEDx speaker, she presented The Economics of the 4th Trimester.
She cofounded and serves as co-executive director of the Center for 4th Trimester Care, a physician-led national nonprofit working to transform maternal health care. She also recently cofounded Pulse Med AI to bring physician voices into the AI digital space.
