Women Find Support As Families Grow

At the Medical University of South Carolina (MUSC), the Women’s Reproductive Behavioral Health Division is bringing innovative care to pregnant women and new mothers, addressing a historically unmet health care need and bringing needed expertise, resources and care to help close critical health care gaps in the Palmetto State and across the U.S.

In the U.S., maternal mortality rates (the numbers of women who die from health conditions related to pregnancy) are at the highest level since 1965, and rank among the highest of any developed nation. Maternal mortality rates among black and indigenous women in the U.S. are three times higher than those of white women.

On top of these physical stressors, insidious mental health challenges wreak devastating, sometimes fatal impacts on U.S. women and their families.

“Nationally, and in our state, mental health conditions are the leading cause of maternal mortality, and that’s by suicide and drug overdose,” says Dr. Constance Guille, MD, MSCR, the founder and Director of the Women’s Behavioral Health Division at MUSC.

With support from The Duke Endowment, the Women’s Reproductive Behavioral Health Division at MUSC was created, and is growing to better meet the mental health needs of women, especially minority women and those who live in rural areas.

For expectant and new mothers, the division offers a range of mental health services and supports including counseling, medications, monitoring and evaluation, and a crisis hotline. These services can be accessed digitally through telehealth and virtual platforms, reducing the reticence of women who may feel socially stigmatized after experiencing mental health challenges during a traditionally happy time of life.

For health care providers, the division offers training, education and awareness resources to help providers meet the mental health needs of pregnant women and new mothers, and their families.

Among a panoply of health challenges that can face pregnant women and new mothers, mental health challenges too often go unspoken and undiagnosed. As a result, these mental health conditions continue to grow over time. The data make a compelling case for urgent action and sustained efforts.

• Nationally, 1 in 5 women suffer from a mental health disorder in the months before or after giving birth, according to a 2023 study from the American Psychiatry Association.

• Recommendations shared for women’s reproductive health from the American College of Obstetricians and Gynecologists (ACOG) as of 2024 include at least three perinatal mental health (PMH) screenings for women during the perinatal period (the time between when women become pregnant and up to a year after giving birth.)

• In 2019, national data developed by the National Committee for Quality Assurance (NCQA) from Medicare, Medicaid and commercial health insurance plans — known as the Healthcare Effectiveness Data and Information Set (HEDIS) — included data on maternal depression for the first time. This data show that:

• In one analysis, fewer than 20 percent of women were asked about mental health by health care providers, and 50 percent of women with postpartum depression go undiagnosed;

• In a second analysis, only 22 percent of women diagnosed with mental depression receive mental health treatment.

Guille points to this data as a compelling rationale for the ground-breaking work of the Women’s Reproductive Behavioral Health Division at MUSC, and as the basis for the Endowment’s visionary support. “There has been a siloing of mental health and psychiatry as if it’s separate. (But) every single person has mental health, they have a psychology. We need to be aware of that, and we need to build the skills that we need to address that,” Dr. Guille comments.

The programs and supports offered by the division are poised to expand across South Carolina with a focus in rural areas and among minority groups. For many women in these areas, awareness of mental health challenges they may face is low. Even with awareness, care may be difficult to obtain or unavailable in their local community or through their health care provider.

“I really hope that people are starting to recognize the amount of support that is actually needed for this population, and that we can surround women and families with that throughout pregnancy and the post-partum year,” says Guille.

Dr. Patrick J. Cawley, CEO of the MUSC Health System, affirmed MUSC’s commitment to rise to the important moment Guille describes. “We are doubling down on all things rural across South Carolina,” Cawley said. “Thirty percent of South Carolinians live in rural areas. If we’re not thinking about that 30 percent, then who is?”

The work of health care educators and experts at the Medical University of South Carolina in collaboration with The Duke Endowment bolsters James B. Duke’s vision of health care as a critical part of the Endowment’s commitment to the people and communities of both Carolinas. Over the past century, and in the promise of the century ahead, innovation stands as an enduring hallmark of the historic relationship between the two institutions.

“Here we are wishing The Duke Endowment a happy birthday in their 100th year, Cawley said. “This is MUSC’s 200th birthday, and it’s great to have two institutions, both dedicated to the community celebrating a birthday at the same time. Two institutions that have worked very well together, and hopefully we can do that for another 100 years.”

Learn more about the Women’s Reproductive Behavioral Health Division at MUSC.