Maternal health

In New Jersey, addressing mood disorders in postpartum Black women

Kristin Gourlay

About one in nine mothers experiences postpartum depression or another mood disorder in the U.S., a condition that can be crippling for a new mother and affect a newborn’s development. For Black mothers, rates of postpartum depression may be even higher, but many are never diagnosed. Horizon Blue Cross Blue Shield of New Jersey (Horizon) experts believe that highlights another racial disparity in the way Black mothers receive care, disparities that have led to this alarming statistic: New Jersey has the highest maternal mortality rate in the nation (among states that report this data). So the health plan is on a mission to make sure Black mothers and babies thrive. It’s just one part of Horizon’s pledge to eliminate health disparities.

Identifying the root causes and the smartest interventions

The key is a unique partnership between the state’s Medicaid agency, Horizon, which manages more than a million Medicaid members and the state’s largest health system, RWJBarnabas Health. University of Chicago researchers are guiding the team’s work, using evidence-based strategies. Together, they’ve been digging into the root causes behind disparities in postpartum depression or other mood disorder diagnosis rates and mapping out the best ways to intervene.

Postpartum depression may not be expressed the same way by Black women. They may experience physical symptoms. They may experience stigma in their own communities when it comes to depression.

Why Black women may not be getting equitably diagnosed or treated

Many doctors use a standard method for screening for postpartum depression. But Horizon’s Valerie Harr says that method may fall short for Black mothers “Postpartum depression may not be expressed the same way by Black women,” says Harr. “They may experience physical symptoms. They may experience stigma in their own communities when it comes to depression,” which means they may not be as comfortable reaching out for help.

Harr says the team’s analysis also found that Black mothers may not be able to access postpartum care as easily as their white counterparts. They may need transportation, child care or help paying out-of-pocket costs for appointments. Medicaid patients face the biggest barriers to care.

In addition, there may be stigma associated with seeking behavioral healthcare.

Designing a new approach to helping Black mothers receive postpartum care

Harr says Horizon will pilot some solutions with Medicaid patients in Newark, N.J., an area with some of the most tragic outcomes for Black mothers and babies. In the near future, Harr says Horizon can:

  • Tap into the expertise of community health workers and doulas to address the social determinants of health that affect participants

  • Provide culturally sensitive health education for participants and healthcare providers

  • Help raise awareness among clinicians about how to find and make effective referrals for postpartum behavioral health treatment

The health plan and its partners will also be piloting programs to:

  • Educate clinicians about culturally appropriate ways to diagnose postpartum mood disorders

  • Encourage providers to reach out proactively to Black mothers for follow up visits

  • Help providers make treatment referrals

  • Tap into a network of trusted community health workers who can help moms get to follow up appointments

  • Empower doulas, women trained to support and educate moms through and after childbirth, to connect women with postpartum care

Harr says that while the initiative continues to evolve, the team is committed to making New Jersey a model for improving maternal health.

Horizon Blue Cross Blue Shield of New Jersey is an independent licensee of the Blue Cross Blue Shield Association, an association of independent, locally operated Blue Cross and Blue Shield companies.

RWJBarnabas Health is the largest, most comprehensive academic health care system in New Jersey with a service area covering nine counties with five million people.

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