Sarcouncil Journal of Internal Medicine and Public Health

Abstract: Perinatal mood and anxiety disorders affect approximately one in five women in the United States and are major contributors to maternal morbidity and mortality, including suicide and substance-related deaths in the postpartum period. Although national professional organizations are encouraging universal screening of the populations during pregnancy and in the postpartum period, there are still gaps that lead to missing the screening and proper medication. This critical review considers the attitudes of healthcare providers concerning obstacles to the provision of perinatal mental healthcare in the United States and places these experiences into the context of the larger structural organization of the health system. Policy, health services, and workforce literature synthesis show that the causes of provider-reported difficulties lie in financing fragmentation, such as Medicaid coverage discontinuity and behavioral health carve-outs; regulatory heterogeneity across states; and long-term underinvestment in the behavioral health workforce. The timely referral and follow-up are further restricted by geographic maldistribution of specialists, administrative complexity, and organizational productivity pressures. Structural racism is intertwined with the instability of insurance and surveillance policy-oriented approaches to address access and outcome inequities. Combined, these results imply that provider-identified barriers are systemic indications of policy misfit and not individual reluctance or lack of training. To eliminate disparities in perinatal mental health care, there is a need to coordinate reform, such as nationally standardizing postpartum Medicaid coverage, universal maternity behavioral health reimbursement, investing in workforce perinatal psychiatry, aligning across states, and equity-focused policy interventions. It is also necessary to reframe perinatal mental health care as a structural-level issue of the system so that the providers can render guideline-concordant and equitable care.