The U.S. Maternal Mental Health Crisis: A Systematic Review of Theoretical Frameworks, Policies, and Interventions to Promote Health Equity

Background and Purpose: Maternal Mental Health (MMH) conditions, such as perinatal depression, anxiety, and trauma-related disorders, are among the most common complications of pregnancy and childbirth in the U.S., that disproportionately affecting women of color, low-income women, and other marginalized populations. Despite growing recognition of MMH as a public health crisis, systemic barriers—such as fragmented care, workforce shortages, and structural inequities—prevent many from receiving needed care. This systematic review aims to synthesize theoretical frameworks, policy responses, and evidence-based interventions addressing MMH disparities and to identify gaps in advancing holistic and equitable MMH care. In doing so, the review is guided by the following questions: (1) What frameworks have been used to understand MMH disparities? (2) What policy efforts exist to address these disparities? (3) What interventions have been implemented, and how comprehensively do they meet the bio-psycho-social needs of perinatal individuals and families?

Methods: A systematic search was conducted across multiple databases, including PubMed, PsycINFO, Social Work Abstracts, Scopus, Academic Search Complete, and Google Scholar, for peer-reviewed literature published since 2010. The following search terms were used in combinations to create the dataset for the review: (“maternal health” OR “maternal health care teams” OR “maternal and infant welfare”) AND (“perinatal mood and anxiety disorders” OR “postpartum anxiety” OR “postpartum depression” OR “prenatal depression”). Additionally, relevant government and organizational reports were reviewed through the websites of the Centers for Disease Control and Prevention (CDC), Health Resources and Services Administration (HRSA), the Policy Center for Maternal Mental Health, and the National Strategy to Improve Maternal Mental Health Care (SAMHSA). Studies were included if they addressed MMH disparities, theoretical frameworks, policies, or interventions for U.S. populations. Titles and abstracts were screened for relevance, followed by full-text review. Findings were synthesized narratively using a thematic approach guided by the research questions.

Results: Theoretical frameworks such as the Social-Ecological Model, the Biopsychosocial Framework, and Social Determinants of Health provide critical guidance for understanding the complex, multi-level factors influencing MMH. Federal and state efforts—such as Medicaid expansions, MMH screening mandates, and community-based programs—represent important progress but often address only fragmented aspects of mothers' bio-psycho-social needs. Integrated care models combining mental health, obstetric, and social services are promising yet remain limited in scale, availability, and cultural relevance. Significant gaps persist in workforce capacity, standardized protocols, implementation strategies, and data infrastructure. Stigma, fragmented care delivery, and structural inequities further hinder equitable access to MMH care and therein their effectiveness with many populations at risk for negative post-natal outcomes.

Conclusions and Implications: This review highlights the urgent need for integrated, interdisciplinary MMH care models that address the bio-psycho-social needs of mothers, infants, and families. Future research should prioritize testing the effectiveness of integrated models, developing implementation protocols, and expanding evidence-based interventions across diverse settings. It is essential to center the voices and lived experiences of marginalized mothers—particularly women of color and low-income women—to inform research, policy, and practice, and to promote health equity in MMH care.