2025 Maternal Mental Health Risk and Resources in the US: Key Findings from the Policy Center for Maternal Mental Health

The Policy Center for Maternal Mental Health just published its 2025 county-level analysis highlighting maternal mental health (MMH) disorder risk and the availability of maternal mental health resources in the United States.

While there is some good news, the report reveals a worsening crisis in maternal mental health across the United States. The analysis, which updates county-level risk and resource data published in 2023, highlights persistent and growing disparities that demand urgent action.

Rising Risk Across the United States

Consistent with previous studies, the current report indicates that risk for maternal mental health disorders varies by geographic location.  To quantify risk, the Policy Center for Maternal Mental Health developed a Risk Factor Score (RFS) system using 22 evidence-based risk factors associated with poor maternal mental health, including single marital status, younger age, intimate partner violence, living in poverty, unintended pregnancy, and social isolation.

The RFS scale was used to estimate risk for poor maternal mental health in individual counties across the United States.  “High-risk” counties are those with an RFS of 25 or more. Counties with an RFS of 33 or above were  categorized as “severe-risk”.

• The number of U.S. counties with a severe risk for maternal mental health disorders has nearly tripled since 2023, rising from 24 to 92. 
• Counties in the Deep South, Mississippi Delta, Gulf Coast, Appalachia, and parts of New Mexico and Arizona show the highest risk.  In these areas, risk is primarily driven by poverty, social instability, and isolation.
• RFS improved in 56 counties.  Improvements in RFS were mainly due to reductions in domestic violence, crime, and child poverty.
• While rural counties remain disproportionately affected, several large urban counties, including Harris County (Houston), Los Angeles County, and Miami-Dade County, also face severe resource shortages due to high birth rates and insufficient provider growth.
• In 2025, 60 counties were categorized as low risk, with an RFS of 5 or less.  This represents a significant decline from 93 in 2023.  In both reports, low-risk counties tend to be in the Midwest and the Upper East Coast.

Rising Numbers of Mental Health Providers, But “Dark Zones” Exist

Between 2023 and 2025, the number of maternal mental health providers has more than doubled; however, increases in providers and resources were more commonly observed in areas with low risk for maternal mental health disorders. While higher risk counties did report increases, albeit smaller, in the number of MMH providers, most reproductive-aged people continue to live in counties with inadequate numbers of providers. 

In 2023, the Policy Center identified “Dark Zones”, counties that have a high risk of mental health disorders, as well as an inadequate number of MMH providers.  Maternal mental health “Dark Zones” are defined as counties with a RFS of 25 or greater and a Provider/Program Shortage Gap. 

The report notes that the distribution of providers is misaligned with risk.  Most providers and programs  are clustered in metropolitan areas with the lowest risk for poor MMH.

• The number of MMH providers grew from 4,506 to 9,694 between 2023 and 2025, largely in lower-risk areas. 
• The number of counties identified as Dark Zones has decreased slightly from 157 to 146.  
• Nonetheless, 84% of birthing-aged women still live in areas with a shortage of MMH resources.
• Populations in Texas, Alabama, Louisiana, Oklahoma, and Tennessee face the largest gaps
• The U.S. still needs over 9,500 additional MMH providers and programs to close the gap.

Policy Recommendations

Over the last 20 years, we have focused on increasing public awareness and improving efforts to screen for and treat perinatal mood and anxiety disorders; however, the current report suggests that in order to meaningfully  improve maternal mental health, we also need to address other factors that contribute to poor maternal mental health.  Federal and state policymakers urgently need to support interventions addressing the needs of childbearing individuals in the United States, especially those in counties with the greatest risk. Solutions could include:

The report calls for targeted federal and state interventions to address the maternal mental health crisis:

• Invest in Holistic Support: Increase funding for Family Resource Centers and community-based organizations, especially in high-risk counties. 
• Expand Healthcare Coverage: Ensure comprehensive healthcare access for pregnant and postpartum women, including mental health services up to one year after birth. 
• Support Innovative Care Models: Encourage Medicaid and commercial insurers to cover group prenatal care, mental health therapies, and other interventions to improve access to care. 
• Establish Task Forces: Especially in high-risk,underserved counties, create cross-sector state or county commissions to develop tailored strategies to address local, county-specific barriers. 
• Strengthen Psychiatric Consultation: Fund and maintain psychiatric consultation services for OB/Gyns to improve provider capacity and expertise. 
• Require Insurer Coverage of Birth Doulas, Postpartum Doulas, and Home Health Nursing Care: States should require Medicaid and commercial insurers to cover birth and postpartum doulas and postpartum home visits. 

While the 2025 report indicates that the United States has made progress in training and deploying more maternal mental health providers, the risk for maternal mental health disorders is actually rising, and resource gaps remain acute in many regions. Bridging these disparities requires innovative, coordinated policy changes and sustained investment in both clinical and community-based supports.