by Kelly Nielsen, Executive Director of Omaha Pathways Community HUB
Kelly Nielsen
Kelly Nielsen has more than 20 years of experience advancing community health and equity. She serves as executive director of the Omaha Pathways Community HUB and is pursuing a Doctor of Public Health (DrPH) at the University of Nebraska Medical Center College of Public Health, where her studies build on her commitment to translating evidence into practice and advancing healthy communities for everyone. Nielsen testified at the legislative hearing for LR383, State Senator Spivey’s interim study on maternal mental health.
The most important message about maternal mental health in Nebraska is that it is common, treatable and when not treated leads to preventable harm. The findings I’m presenting here come from a maternal mental health landscape assessment for coursework at UNMC in partnership with Sara Howard at First Five Nebraska.
Across each stage of pregnancy, women are impacted; 1 in 5 Nebraska women report depression within the three months before pregnancy and 1 in 6 experience depression during pregnancy. Nebraska Hospital Association data show that with approximately 3,750 deliverers each year, about 15% of births, are to women with a behavioral health diagnosis. And that number is almost certainly low.
One in four Nebraska women report needing mental health services within the year after birth. Importantly, 30% of those women report they can't get the help they need. All of these rates tend to be worse than the United States overall and are increasing.
These rates are not evenly distributed.
Rural women report higher rates of depression
This is a statewide issue, and rural Nebraska carries a heavier share. Rural women report higher rates of depression before, during and after pregnancy than women in urban areas. At the same time, more than half of Nebraska counties are maternity care deserts, and more than one million Nebraskans live in a designated mental health professional shortage area.
Coverage matters, too. Depression during pregnancy is nearly twice as high among women on Medicaid in our state—22.5% , compared to 12% for women with private insurance. Medicaid covers close to 40% of pregnant and postpartum women in Nebraska, highlighting the importance of ensuring access to care for this population.
And rates differ sharply across communities. Postpartum depressive symptoms are nearly double for women from minority populations, specifically Black and Native American populations, compared to the state overall.
If untreated, impacts child’s development, family stability
When untreated, maternal mental health has significant impacts on infant health (injury and death), birth outcomes, child development, family stability and healthcare and economic costs.
For example, studies show that untreated maternal mental health costs approximately $32,000 per mother-child pair due to increased healthcare costs, missed work and reduced economic productivity. Children experience delayed development when their parents have untreated mental health conditions, and families are at increased risk for food insecurity, housing instability, unemployment and more. This issue has wide, sweeping impacts and unfortunately in some cases, severe consequences.
Nebraska’s own Maternal Death Review Team found that mental health conditions were the underlying cause of 15.5% of pregnancy-associated deaths—the second leading cause of death. Every one of those deaths was determined to be preventable.
The issue of maternal mental health is common, treatable and preventable and we have tremendous opportunity to make a positive change in Nebraska.
Read Kelly Nielsen’s report: LR383: Maternal Mental Health in Nebraska Interim Study Report