For those who want to start a family, Minnesota certainly seems like a great place. We consistently rank among the very top of nationwide lists for measures like “best place to give birth,” to “raise children,” and to “be a working mother.” These high ranks are impressive, but they obscure a harsh reality: For nonwhite Minnesotans who give birth, the picture is bleak.
Life after giving birth can be difficult for many reasons, including facing challenges like postpartum depression. In Minnesota, African-American women are more than twice as likely to experience postpartum depression (PPD) as whites. This disproportionate risk of PPD for African-Americans is anchored in risk factors like exposure to trauma and economic instability, and lack of access to mental health services — all of which are exacerbated for this population.
The effects of postpartum depression are insidious, and shouldn’t be understated. A mother’s postpartum mental health affects her capacity to make decisions, bond with her child, breastfeed, and much more. Further, it affects her child’s cognitive and emotional development, and long-term physical health. Wilder Research showed that the cost of each case of untreated maternal depression in Minnesota is nearly $23,000 annually, including direct (treatment of infant health complications) and indirect (workforce productivity loss) costs. One in 5 mothers of color suffer, compared with 1 in 10 whites. This means we pay out millions: a lose-lose situation.
Inequity then, inequity now
While the overall rate of PPD is declining for most Minnesota moms, the disparity remains unchanged. To understand why racial health disparities like this exist, we must take a hard look at our past. History reveals decades of residential segregation, which concentrated poverty in communities of color. This has manifested in dramatically lower income and wealth levels, widespread unemployment, and an incarceration rate that is nine times higher for African-Americans than whites. Housing insecurity and poverty are inextricably linked with mental health.
Each factor named is a direct risk for postpartum depression: exposure to trauma, prenatal stress, contact with (or have a partner in) the criminal justice system, and lack of access to health care services. Structural factors compound the effects of interpersonal racial discrimination, and those who experience it are at a higher risk for adverse mental health outcomes.
Let me clear the air right now: I am a white woman who is not a mother. I cannot speak from personal experience, so perhaps it seems strange that I desperately want our state to address a problem that will ostensibly never apply to me directly. But here’s the thing: It actually will.
For one, I’m a public health professional with a career focus on improving population health and addressing inequities in our state. Postpartum mental illness is a glaring example of a treatable condition, with potential benefits that span generations. I’m also a taxpayer, and I’d rather see my tax dollars fund prevention, screening, and treatment for postpartum depression than the social support services needed by families that suffer untreated mental illness. Most important, just like our liberty, our collective health is bound together. I am ashamed of this “unequal distribution of health” in Minnesota, and I’m ready to acknowledge my privilege and take action to right the wrongs for women of color.
What now?
While current Minnesota statutes support mothers by requiring PPD education materials to be distributed by health care providers, and do mention “implementing changes to reduce racial disparities,” there is a noticeable lack of targeted interventions to address this severe disparity, and of funding to implement them. If we want to make a dent in this problem, we must specifically support those who need it the most: mothers of color. There is no “magic bullet” solution, but several possibilities show real potential. Policymakers should consider bolstering evidence-based family home visiting programs for particularly underserved areas like Ramsey County. But regardless of how we address this, one thing is clear: Doing nothing will continue to cost us significantly in state dollars and human suffering.
For most of us, Minnesota is an incredible place to start a family. But this opportunity does not always extend to all residents. This must change.
Mariana Tuttle is a graduate student in Health Policy & Administration at the University of Minnesota.
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