Maternal and Child Health Care Access Gaps Persist Across U.S.

Despite a growing mental health crisis among America's youth, the system is still failing a massive number of children, while maternal health outcomes worsen in states with restrictive abortion laws. Recent studies highlight persistent gaps in accessing critical health care services for both children and mothers across the United States.

Nearly one-quarter of children who need mental health treatment are not receiving it, according to analysis led by researchers at the Harvard Pilgrim Health Care Institute in Boston. They looked at survey data gathered from more than 173,000 households between June 2023 and September 2024. Researchers found that roughly 1 in 5 homes (20%) had at least one child in need of mental health support. However, for nearly 25% of those families, those needs went unmet. Even among those who did manage to find care, nearly 17% reported that the process was an uphill battle.

The research letter, published Feb. 16 in JAMA Pediatrics, found that certain family situations make it much harder to navigate the health care system. Families with multiple children saw a 28% rate of unmet needs, compared to 21% for single-child homes. Single-parent households also struggled more, reporting greater difficulty securing appointments.

Education and insurance status also played major roles. Homeschooled children were more likely to have unmet needs (31%) than those in public schools (25%), likely because they lack access to school-based counselors. Financial barriers were also reported: About 40% of families on Medicaid or without insurance reported that they couldn't get care specifically because it was too difficult to access.

The data showed that families of all minority races and ethnicities faced higher rates of unmet needs compared to non-Hispanic white households. However, Black households reported less difficulty accessing care (13%) than white households (17%). Researchers noted that common barriers to care include financial costs, limited availability of clinicians and logistical challenges.

In maternal health, increased numbers of state-level abortion restrictions in the U.S. are linked to a parallel increase in maternal deaths between 2005 and 2023, according to findings presented at a meeting of the Society for Maternal-Fetal Medicine in Las Vegas. States with five or more abortion restrictions had higher rates of maternal deaths compared to those states with fewer restrictions.

Researchers reviewed state-level data on nearly 22,400 deaths that occurred across the nation between 2005 and 2023 among pregnant women aged 15 to 54. The data came from the U.S. Centers for Disease Control and Prevention (CDC), and included all deaths while pregnant or within 42 days of delivery. Researchers compared deaths in each state before and after the enactment of 10 of the most common state-level abortion laws.

During the study period, the average number of abortion restrictions doubled, rising from 2.7 to 5.3 restrictions per state. In 2005, only five states had five or more abortion restrictions. By 2023, the number of states considered most restrictive had increased to 27, with Arkansas, Louisiana, Nebraska and Wisconsin leading the pack.

Results showed that six of the 10 common abortion restrictions were associated with higher rates of maternal death. These included bans on Medicaid funding for abortion; Affordable Care Act Marketplace insurance coverage bans; mandated waiting periods; ultrasound requirements; second-trimester abortion bans; and biased counseling laws. Further, four of the 10 restrictions were linked to higher rates of violent death from homicide and suicide — Medicaid and ACA Marketplace coverage bans; waiting periods; and requirements that abortions be provided by physicians only.

Pain during pregnancy and after delivery can significantly increase a woman's risk of postpartum depression, a new evidence review has concluded. Further, there are specific pain-related risk factors that influence the odds of postpartum depression among women in racial and ethnic minorities, researchers reported in the journal Current Psychiatry Reports.

About 10% to 20% of women in the U.S. experience postpartum depression, and the highest rates are among women in racial and ethnic minorities. To see how pain might influence depression risk, researchers analyzed data from 23 U.S.-based research studies conducted during the past five years. All the studies explored risk factors for postpartum depression.

From these previous studies, researchers crafted a list of factors that can increase women's risk of pain and postpartum depression. They are: mental health during pregnancy (such as depression and anxiety); delivery method (especially Cesarean); pain management practices; discrimination toward racial and ethnic minorities; and overall neglect of pain.

Pain following a C-section is a particularly powerful driver of postpartum depression, but researchers found doctors tend to limit their management of this surgical pain. Although 95% of doctors agreed that women need pain management following a C-section, they most often prescribed not opioids but instead ibuprofen, ice packs and acetaminophen.

Poor communication between patients and providers often hindered pain management, increasing the risk of postpartum depression, researchers found. Black and Latina women regularly reported that doctors overlooked, dismissed or ignored their pain-related concerns and preferences, the study said. It also found that patients sometimes withheld or limited info they shared with their providers that might help manage their pain, such as a history of opioid use disorder or cultural beliefs about pain management.

Results also indicated that nurses are the first line of defense against pain, but do not always feel equipped to treat it.