Editor’s note: If you or someone you know may be considering suicide or is in crisis, call or text 988 to reach the suicide and crisis lifeline.
While President Trump wants to encourage Americans to have more babies and reverse declining birth rates, his administration has also stopped collecting key data to better understand the health of new mothers.
For more than three decades, the Centers for Disease Control and Prevention has surveyed moms through pregnancy and postpartum using the Pregnancy Risk Assessment Monitoring System, or PRAMS.
But this work has been paused as part of sweeping layoffs at the Department of Health and Human Services.
Kara Zivin, a professor of psychiatry at the University of Michigan, says she knows about the importance of PRAMS both personally and professionally.
“I think what we don’t talk about, we don’t study – we don’t treat,” she said. “So if people are not aware of the whole range of experiences that people can have both during pregnancy and afterwards, then they can’t get the care that they need.”
Zivin had a difficult pregnancy with her son and often shares her own mental health struggles to help raise awareness of why it’s crucial to track data about mothers.
“I think especially when we’re talking about mental health conditions, that can be the most isolating. You know, I didn’t realize how many other people were out there like me,” she said. “And yet suicide is the leading cause of maternal morbidity and mortality, and the United States has the highest rate of maternal mortality in developed countries, so clearly there are many people struggling and not necessarily getting the help they need.”
4 questions with Kara Zivin
Your own difficult pregnancy 14 years ago helps inform your work today. What happened to you?
“I experienced severe depression, anxiety and insomnia during my pregnancy. I had stopped taking an antidepressant because I had hoped to have a happy, healthy pregnancy like many that I saw around me, but that’s not what happened. And so as my pregnancy continued, my health got worse, leading me to take an overdose of my prescription medications a month before I was due to have my baby.
“I ended up hospitalized and receiving treatment from members of my own university and academic department, where I was an early career faculty member studying mental health, and despite that, I was not able to prevent myself from struggling with this condition. And so even though it has been difficult to talk about this publicly, I think it’s important to try to increase awareness about mental health during and after pregnancy and to try to help other women who may be struggling in silence.”
What should we know about how new mothers currently navigate the medical system?
“Women have a lot of doctor’s appointments during pregnancy, but then after delivery, they basically have one visit that’s usually six weeks after delivery. And so they don’t necessarily have the same opportunities to talk to their doctors about struggles they might be having.
“One of my colleagues likens it to thinking about, the baby is a candy and the mother is the wrapper. Once the candy is no longer inside the wrapper, then the wrapper can get tossed aside. And sometimes we can think of that in terms of how mothers experience health care once they’re no longer pregnant.”
Why does the Pregnancy Risk Assessment Monitoring System matter?
“PRAMS collects information from almost all states, and for almost 40 years, the goal has been to improve both maternal and infant health by collecting data on maternal experiences before, during and after pregnancy. And this is information we really don’t get any other way.
“It doesn’t necessarily appear in your medical records at the doctor’s office and [there are] a number of questions that are highly sensitive and people may not necessarily feel comfortable talking about yet population-based surveys like these give women the opportunity to talk about these issues anonymously that hopefully will provide information on how to, say, allocate resources to help them get care they need.”
If the government does not continue PRAMS, can states do this survey on their own?
“There are discussions going on that states are thinking about and trying to shore up resources so that they can continue the surveys on their own. The challenge is states are facing a number of concerning situations right now.
“We’re looking ahead and seeing what if something happens to Medicaid. Medicaid is the largest insurance provider of births, so if we lose access or access changes to Medicaid, then that’s also gonna have a really significant impact on mothers and families so I think that states are going to want to do what they can or at least some states but there’s also a number of concerns in this area.”
This interview has been edited for clarity
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Ashley Locke produced and edited this interview for broadcast with Catherine Welch. Locke also adapted it for the web.
This article was originally published on WBUR.org.
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