The United States has one of the highest maternal mortality rates among high-income countries, significantly driven by mental health and substance use disorders (SUD). These behavioral health conditions contribute to over 20 percent of postpartum deaths, primarily through suicide and SUD overdoses. Stigma, discrimination, and lack of integrated care are just a few of the obstacles hindering access to care for pregnant and postpartum individuals with mental health disorders and SUD, contributing to poor outcomes for both mothers and babies. However, new evidence-based models focusing on integrated, team-based care, community supports, and medication for addiction treatment, are emerging nationwide, offering hope for improved outcomes and greater birth equity.

With 41 percent of U.S. births covered by Medicaid and new extended postpartum coverage benefits available in nearly every state, there are significant opportunities for Medicaid to enhance perinatal care and reduce maternal and infant mortality. This report from the Center for Health Care Strategies examines access to care challenges for individuals with mental health disorders and/or SUD and outlines recommendations for evidence-based, person-centered perinatal services. The report highlights innovative, community-rooted programs that seamlessly integrate services through a no-wrong door approach. These examples and recommendations can guide states, health plans, health systems, providers, and community-based organizations in improving maternal health and building healthier futures for all.