Mental health deaths may be missed in maternal data
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Suicides and drug overdoses likely contribute significantly to Arkansas' maternal mortality rate, but stigma and a lack of data make reporting difficult, psychiatrist Shona Ray told Axios.
Why it matters: These deaths not being labeled as pregnancy-related can lead to less awareness, funding and research concerning mental health-related causes of death during and following pregnancy, she said.
Driving the news: The University of Arkansas for Medical Sciences (UAMS) recently hosted a maternal health summit in Fayetteville, where one of the discussions focused on mental health issues like postpartum depression. Ray, who is based at UAMS in Little Rock and specializes in pregnant and postpartum patients, and NWA-based UAMS psychiatrist Erin Jefferson spoke.
Stunning stat: Up to 20% of postpartum deaths in the U.S. are suicides, and most occur between six and 12 months after giving birth, Jefferson said.
- Postpartum depression affects approximately one in eight people who give birth.
- Postpartum psychosis — a mental health emergency — is much rarer, happening after 1 in 1,000 deliveries. Women are 23 times more likely to have their first affective psychosis episode within the first four weeks after giving birth than at any other time in their lives, Jefferson said.
Zoom in: Arkansas has several risk factors for mental health problems, including high poverty rates, lack of access to care, growing rates of uninsured patients and high trauma rates, she said.
How it works: The Arkansas Maternal Mortality Review Committee reviews deaths of Arkansans who die while pregnant or within a year of giving birth. The committee decides whether a death is pregnancy-related, meaning the person died from a "pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of pregnancy." These deaths are included in the state's maternal mortality statistics, Ray told Axios.
- The other options are pregnancy-associated or pregnancy-associated but unable to determine the link.
- The committee, established in 2019, is made up of 18 people, including medical professionals in obstetrics/gynecology, maternal fetal medicine and cardiology. Arkansas surgeon general Kay Chandler and state crime lab chief medical examiner Theodore Brown are on the panel.
What they're saying: Ray, the lone psychiatrist on the committee, says suicides among those with postpartum depression should be labeled pregnancy-related, as should many cases where new moms die of drug overdose.
- Case in point: For example, people who use opioids and stop because they're pregnant — therefore lowering their tolerance and making an overdose more likely if they return to the same dosage — might take opioids once their babies are born and die of accidental overdoses.
- Yes, but: While committee members are willing to flag suicide and overdose deaths as pregnancy-related, they sometimes vote that a case isn't pregnancy-related because they do not have enough information from health care providers. That's often because patients aren't coming into contact with providers, she told Axios.
By the numbers: Of the reviewed deaths from 2018-22, 69 were deemed pregnancy-related, 80 were considered pregnancy-associated, and 21 were associated but unable to determine relatedness, according to the committee's December 2025 legislative report.
- Of the pregnancy-related deaths, five were attributed to mental health.
Between the lines: Stigma and lack of education can contribute to people's ideas of what constitutes a death caused at least in part by a pregnancy, Ray said. Doctors can consider suicides after childbirth a mental health problem, not a postpartum problem, or moms who die of a drug overdose can be written off as "bad moms."
The bottom line: More could be done to better screen and treat patients for mental health problems, such as giving pediatricians resources to screen and refer new moms who are bringing their babies in for their appointments, as discussed at the summit.
- Some states also interview family members and friends of people who have died to investigate further whether their deaths should be labeled pregnancy-related when they don't have enough data from health care providers, Ray said.
If you or someone you know may be considering suicide, call or text the National Suicide Prevention Lifeline at 988. Ayuda disponible en español.