Association of state postpartum depression legislation and maternal mortality in the United States

Objective: State legislation addressing postpartum depression varies widely across the U.S. and may play a critical role in shaping access to mental health care and supports that influence state level maternal mortality outcomes. This study examined the relationship between U.S. state legislation on postpartum depression (PPD) and state-level maternal mortality rates. Methods: Data from PPD-related legislation in 32 states were reviewed and were categorized based on their scope and funding. State-level maternal mortality data was obtained from the CDC, and uninsured rates from the U.S. Census Bureau's American Community Survey. Results: States with highest policy quality PPD legislation, especially those with funding, and with more PPD-related legislation had lower maternal mortality rates, even after adjusting for uninsured rates. In regression analyses, uninsured rate explained 23% of the variance in maternal mortality; number of PPD policies explained 13%, and PPD policy quality explained 12%. Conclusions: Higher quantity and highest quality of PPD-related state legislation are associated with lower state-level maternal mortality.