84% of U.S. Women Live in Areas Lacking Adequate Maternal Mental Health Care

The United States has nearly doubled its maternal mental health workforce in two years, but the vast majority of women of childbearing age still live in communities without adequate access to care.

The number of maternal mental health providers increased from 4,506 in 2023 to 9,694 in 2025. Despite that growth, only 16% of the childbearing population lives in counties with sufficient maternal mental health resources.

That leaves 84% living in areas with inadequate care.

Research by Simmrin Law Group examined how the provider shortage intersects with a broader deterioration in maternal mental health, growing geographic disparities and rare but severe cases in which postpartum psychiatric disorders become relevant to the criminal justice system.

The study found that approximately 800,000 U.S. families are affected by maternal mental health disorders every year, while 75% of affected women receive no treatment.

Maternal Mental Health Has Declined Sharply

Between 2016 and 2023, the percentage of American mothers describing their mental health as excellent declined from 38.4% to 25.8%.

At the same time, the percentage reporting fair or poor mental health increased 64%.

Maternal mental health conditions cover a wide range of disorders, including anxiety, depression, PTSD, OCD, bipolar disorder, substance use disorders and psychosis.

Postpartum depression affects up to 15% of new mothers.

Postpartum psychosis is much rarer, occurring in approximately one to two mothers per 1,000 births, but can involve severe delusions, hallucinations, paranoia and loss of contact with reality.

Women are 23 times more likely to experience psychosis during the month following childbirth than at any other point.

Postpartum psychosis can recur in as many as 50% of cases and is associated with infanticide in approximately 4%.

Three-Quarters of Affected Women Go Untreated

Despite the number of families affected, 75% of women experiencing maternal mental health conditions remain untreated.

The consequences extend beyond individual health.

Maternal mental health disorders account for 27.7% of pregnancy-related deaths, making them the leading cause of pregnancy-related mortality.

Untreated conditions are also estimated to cost approximately $32,000 per mother-infant pair, producing roughly $14 billion in annual economic costs.

Barriers include the cost of treatment, lack of providers, transportation and childcare problems, stigma, shame and distrust of authorities.

For millions of women, those obstacles exist during a period when accessing healthcare may already be difficult.

America Remains Short 9,500 Providers and Programs

Even after the number of providers more than doubled, the United States remains short an estimated 9,500 maternal mental health providers and programs.

Some metropolitan counties face particularly large gaps.

Harris County, Texas; Bexar County, Texas; Wayne County, Michigan; Shelby County, Tennessee; and Jackson County, Missouri collectively account for more than 200,000 births every year.

Those five counties alone are estimated to lack 840 providers.

The shortage becomes even clearer when comparing national figures.

The problem is therefore not simply the prevalence of maternal mental illness. It is the gap between need and available treatment.

Severe-Risk Counties Nearly Quadrupled in Two Years

While provider numbers increased nationally, maternal mental health risk worsened in many communities.

The number of high-risk counties climbed from 700 in 2023 to 796 in 2025, an increase of nearly 14%.

Severe-risk counties increased even faster, rising from just 24 to 92, nearly four times the previous total.

Nevada, North Carolina and Ohio experienced some of the largest increases.

Esmeralda County, Nevada, and Henderson County, North Carolina, recorded particularly large increases in their maternal mental health risk scores.

The factors associated with higher risk included poverty, unemployment, intimate partner violence, community violence, unintended pregnancies, single parenthood, teen births, premature births, lower educational attainment and limited emotional support.

Maternal Mental Health “Dark Zones” Are Concentrated in the South

The study also examined maternal mental health “dark zones,” defined as counties combining high maternal mental health risk with severe shortages of providers or programs.

Nationally, the number of dark zones declined from 155 in 2023 to 145 in 2025.

But the national improvement masks significant state-level differences.

Tennessee experienced the greatest improvement, with 11 counties leaving the category and only one becoming a dark zone.

Five Arkansas counties were also removed from the classification.

Alabama experienced the opposite trend. Fourteen Alabama counties became dark zones, while only two left the classification.

Texas, Alabama, Louisiana, Oklahoma and Tennessee contain some of the largest populations of reproductive-age women living in high-risk communities with limited maternal mental health resources.

Texas alone accounts for more than 40% of the provider shortage in dark zones, representing an estimated deficit of 623 providers.

Geography Can Determine Access to Maternal Mental Health Care

The highest maternal mental health risk scores are concentrated throughout the Deep South, Mississippi Delta, Gulf Coast and Appalachia, along with parts of New Mexico and Arizona.

Many of these communities face overlapping challenges involving poverty, healthcare access, geographic isolation and social instability.

Other regions perform considerably better.

Minnesota, the Atlanta metropolitan area and the Northeast Corridor generally have lower maternal mental health risk levels because of comparatively stronger support systems.

The geographic divide means that a mother’s access to treatment can depend substantially on where she lives.

Black Mothers Face Higher Rates but Lower Screening

Access disparities are also evident across racial and ethnic groups.

Approximately 40% of Black mothers experience maternal mental health conditions, representing one of the highest burdens identified in the study.

Postpartum depression among Black mothers increased from 9% in 2010 to nearly 25% in 2021.

Despite that increase, Black mothers are 46% less likely to be screened and are less likely to receive treatment.

Hispanic and Latino, American Indian and Alaska Native, Asian American and Pacific Islander and South Asian mothers also experience disparities connected to healthcare access, discrimination and shortages of culturally responsive services.

The issue also extends beyond mothers.

Approximately one in 10 fathers experiences postpartum depression, while 5% to 15% experience anxiety during pregnancy or within the first postpartum year.

Severe Postpartum Psychosis Can Create Complex Criminal Cases

The overwhelming majority of people experiencing maternal mental health conditions are not violent. However, severe postpartum psychosis can occasionally intersect with the criminal justice system.

Postpartum psychosis typically develops within two weeks after childbirth and can produce hallucinations, paranoia, delusions and detachment from reality.

Research examined in the Simmrin Law Group study found that psychiatric disorders peak during the first three months after childbirth.

That is also the period when 58% of maternal infanticides occur.

Infanticide generally refers to the killing of an infant under one year old. Neonaticide refers specifically to killing a baby within 24 hours of birth, while filicide describes a parent killing a child.

An infant younger than one is killed every day in the United States, with the highest risk occurring on the day of birth.

Mental illness is only one of several identified risk factors. Financial hardship, poor access to healthcare, limited social support, domestic violence, substance use, trauma, unstable relationships and social isolation can also be involved.

The U.S. Has No Specific Infanticide Law

The legal response differs significantly between countries.

The United Kingdom, Canada and Australia have specific infanticide laws that allow the psychological effects associated with childbirth to be considered when determining criminal responsibility and treatment.

The United States has no comparable dedicated infanticide statute.

Cases are generally prosecuted using existing homicide laws. Maternal mental illness may instead become relevant through insanity or diminished-capacity defenses.

That distinction has played a significant role in some of America’s most prominent maternal mental health cases.

Andrea Yates drowned her five children in Texas in 2001 while experiencing severe postpartum psychosis. Her initial murder conviction was overturned, and she was subsequently found not guilty by reason of insanity.

The case remains a prominent example of the difficulty courts can face when severe psychiatric illness and criminal responsibility overlap.

Safe Haven Laws Have Reduced First-Day Homicides

Safe Haven laws, introduced beginning in 1999, allow parents to legally surrender newborns rather than abandon them.

Still, 1,639 infants were illegally abandoned between 1999 and 2022, and 934 were already deceased.

Houston experienced a particularly concerning trend, with infant abandonments increasing 500% between 2022 and 2024.

First-day-of-life homicide rates declined after Safe Haven laws were introduced, but the risk remains higher on the first day of life than during any other stage of infancy.

From 2008 through 2017, 2,851 infants were homicide victims.

Children born to mothers younger than 20 faced homicide rates more than twice those born to mothers ages 20 to 29 and seven times those born to mothers 30 and older.

Nearly 75% of victims were born to unmarried mothers.

The U.S. Earned an F for Parental Support

The provider shortage exists within a broader support problem.

The 2026 Maternal Mental Health Report Card gave the United States an overall C grade, while the country received an F for parental support.

No state earned an A.

The United States also ranks last among high-income nations in UNICEF’s assessment of family-friendly policies, including paid family leave.

Postpartum care frequently consists of a single six-week OB-GYN appointment, even though continuous postpartum care during the first three to 12 weeks is recommended.

The findings compiled by Simmrin Law Group ultimately reveal a contradiction in America’s response to maternal mental health.

The number of providers more than doubled between 2023 and 2025, yet 84% of women of childbearing age still live in areas without adequate maternal mental health care.

At the same time, high-risk counties increased from 700 to 796, severe-risk counties nearly quadrupled and three-quarters of women experiencing maternal mental health conditions remain untreated.

For hundreds of thousands of families each year, the shortage means maternal mental illness is not simply a question of whether treatment exists. It is whether appropriate care can be reached before a manageable condition becomes a crisis.