Every Mother, Every Time - Petition for Universal Mental Health Screening

Earlier this month, perinatal mental health researcher, advocate and writer Walker Karraa, PhD, created a White House petition entitled "Every Mother, Every Time: Universal Mental Health Screening for Every Pregnancy and Postpartum Woman." The deadline to reach 100,000 signatures for the petition to pass is Friday, April 4. Giving Birth with Confidence encourages you to take 5 minutes to sign the petition and SHARE it, asking others to do the same.

Tell us more about what the mental health screening for pregnant and postpartum petition, what it's asking for, and what it would do if fulfilled.

 Suicide is a leading cause of death for women during the first year after childbirth. 1 in 7 women will experience a mood or anxiety disorder during pregnancy or postpartum, yet nearly 50% remain untreated. In pregnancy, maternal mental illness negatively affects fetal development, and leads to adverse birth outcomes such as low birth weight and premature delivery. Perinatal mood and anxiety disorders (PMADs) can impair infant and early childhood cognitive and emotional development. Despite overwhelming empirical evidence, there is no universal mandate for care providers to screen pregnant and postpartum women for depression, anxiety, or family history of mental illness -- a well-established risk factor. The petition calls to screen every mother, every time to prevent and treat perinatal mental illness.

For people reading this who have never experienced a mental health disorder (either first hand or otherwise), can you help explain why screening for mental health, especially for women who are pregnant or have just had a baby, is so important?

 Well, I think I would say that we know someone who has a mental illness. The data is just too strong to think otherwise. We might not know it, but we all know someone who is, or has been struggling with mental illness. I say we might not know it, because of stigma. Stigma about mental illness shuts people down, and shames them into silence. The stigma of being mentally ill in this culture is so strong that we simply cannot share our suffering with others at risk of rejection, discrimination, and stereotyping. We run the risk of losing out on jobs, loss of dignity within our communities, being marginalized from volunteering in our schools, communities, churches. That is how strong the stigma is for mental illness. If you talk about your disease, you run a risk of being stigmatized in all areas of your life. Even with your partner.

So we may not have had a direct conversation with someone who said, "I have a mental disorder"  but we are working with them, loving them, learning from them and engaged with them every day.

Why is screening so important?

 Because mental illness left untreated can be life threatening. And for women who experience a mental illness during pregnancy or postpartum? The baby is also affected. We now know that as early as implantation : around 5-7 days post conception  that a woman's stress hormones present in depression, anxiety, and posttraumatic stress are carried to the baby. We know that even before conception -- in preconception -- that untreated mental illness of mother and father create stress response conditions that can impact pregnancy down the line.

We know that pregnant women with untreated depression or anxiety disorders have higher risk of preterm birth, low birth weight, and babies with lower APGAR scores.

So to me, screening for mental illness in pregnancy and postpartum is not different than screening for any other health condition that poses a risk to the health of the mother and child  just like gestational diabetes, HIV, Hepatitis, and the basic blood panel drawn to screen for anemia, etc. We have our heart rate and blood pressure checked, we have our babies heart rate and growth tracked, we have our protein in our urine checked. This is routine. So why is it so hard to ask a woman about her mental health while she's there?

By 2030, the WHO predicts depression to be the leading cause of disease in the world. Mental illness, such as depression, is a physical disease that has devastating impact on personal and public health. We know that current global estimates are that 1 in 4 people have a mental illness. Depression is the second most common cause of hospitalization for all women in the U.S.; the first being childbirth (Blenning & Paladine, 2005; Gold & Marcus, 2008). Current estimates are that in the United States, postpartum depression (PPD) alone impacts 15% to 25% of women annually (N. Gavin et al., 2005; Keyes & Goodman, 2006; Zittel-Palamara, Cercone, & Rockmaker, 2009). It has been reported that there is a seven-fold increase in the risk of psychiatric hospitalization for all women following childbirth (Harlow et al., 2007), and that perinatal and postpartum mood and anxiety disorders affect up to 48% of women living in poverty (Knitzer et al., 2008). The World Health Organization (WHO) has suggested that global prevalence rates for women suffering from PPD are as high as 34% to 55% (WHO, 2003).

The list of public health, obstetric and pediatric organizations that endorse prevention is long. But U.S. organizations fall short of mandating universal screening, despite availability of free and validated tools that include a two-question screen.

What are the two questions?

 They are two simple yes-or-no questions:

Over the past 2 weeks, have you often been bothered by:

1. Little interest or pleasure in doing things?

2. Feeling down, depressed, or hopeless?

If a woman answers yes, then she is given a more complete screening questionnaire..


What spurred you to create the petition?I am tired of being told it can't be done, or that it has to be done a certain way, with certain peopleI just don't buy it. I know the strength of women who have suffered from a perinatal mental illness, and we will not be stopped. Our greatest threat is trying to own different parts of a cause, or brand it for ourselves.

I have been greatly disheartened by the lack of support the petition has received. A petition for Alaska to secede to Russia received 6,000 signatures in 2 days, and yet this position has had only about 2,000 signatures in three weeks. And it's not from lack of trying! Is it a lack of vision and lack of willingness to risk being seen as crazy to endorse something like a White House petition because it's not guaranteed to work? We must do better -- for ourselves, for our daughters, for our granddaughters, for all women.


Why isn't something like this already in place?

 My personal opinion? Stigma. It condones complacency and allows for systems of care to have more invested in women staying sick, than they do systems that help women achieve health and wellness. Stigma that is perpetuated in the mediacombined with horrific lack of knowledge about the facts. Additionally, many allied maternal health associations have not prioritized the issue.


What else, in addition to universal mental health screening, can be done to improve the detection and treatment options for women with mental health disorders?

 At this point? Women have to do it themselves. We have to take it upon ourselves to learn about the risk factors, namely a family history of mental illness or previous episodes of depression or anxiety. Then, unfortunately, we have to push through the stigma and tell our care providers. Especially if we have a history of bipolar disorders, or a first-degree relative with bipolar disorder. Women have fought for rights before -- this isn't our first rodeo -- we now must fight for the right to mental health.



Walker Karraa, PhD is a perinatal mental health researcher, advocate and writer. She has been a regular perinatal mental health contributor for Lamaze International's Science and SensibilityGiving Birth With Confidence. Walker has interviewed leading researchers, clinicians, and advocates such as Katherine Wisner, Cheryl Beck, Michael C. Lu, Karen Kleiman, Pec Indman. Walker was a certified birth doula CD(DONA), and the founding President of PATTCh, an organization founded by Penny Simkin dedicated to the prevention and treatment of traumatic childbirth. Walker is currently the Program Co-Chair for the American Psychological Association (APA) Trauma Psychology Division 56. Her book, Postpartum Depression: Trauma and Transformation, is being published by Praeclarus Press, LLC and is based on her extensive research into the ways women experience personal growth through postpartum depression. Walker is the founder of a community blog site, Stigmama.com, dedicated to breaking the cycle of stigma against mothers who have mental illnesses



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