Searching for Consensus

State Rep. Ellen Story was knocked out by a nasty respiratory flu last week. But that didn’t stop her from celebrating encouraging signs that her bill to support new mothers, several years in the making, finally appears headed to become a law.

Story, an Amherst Democrat, is the primary sponsor of the Post Partum Depression bill, which would strengthen public support for new mothers experiencing emotional stress after giving birth. Earlier this month, the bill received a favorable report from the Joint Financial Services Committee, where supporters had earlier feared it might languish; it now moves on to the House Committee on Ways and Means.

Among its provisions, the bill calls for a legislative task force to review existing postpartum resources in the state and gather information about treatment options in other parts of the country, with an eye to developing the best policies in Massachusetts. It also instructs the Mass. Department of Public Health to make postpartum depression a priority.

“This bill is a small but important step in the right direction, because every step forward this bill takes raises awareness and provides hope for families coping with postpartum depression,” Story said in a press release announcing its advancement.

To move the bill forward, Story removed one key element that had proved to be controversial: in its original incarnation, the bill called for universal screening of all new mothers for postpartum emotional issues, to be covered by insurance providers. That provision had met with protest from critics who felt it violated women’s privacy rights, and others who feared it would subject women to unwarranted psychiatric treatments. It also met with resistance from insurance providers, who, predictably, balked at the notion of a universal requirement.

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The universal screening requirement of the original bill was an attempt to identify mothers whose postpartum problems might otherwise be missed. While statistics vary, a 2008 Centers for Disease Control report that looked at pregnant women in several states found that between 11 and 20 percent experienced postpartum depression. Often symptoms go unnoticed in the early, stressful days of parenthood, which can have disastrous results for mothers, their children and the newly developing bond between them.

In its original draft, the bill required insurance providers to cover at least seven maternal screenings, starting during pregnancy and continuing over the first year after giving birth. By making the screenings universal, backers hoped to remove the stigma or embarrassment that might be felt by women who felt they had been singled out.

In January, the bill had a hearing at the Statehouse that drew numerous supporters, including healthcare professionals and women who shared personal stories of their own postpartum struggles.

But the bill also had its share of critics, including The Freedom Center, a Northampton-based organization that’s critical of the mainstream mental health establishment. The Freedom Center held a counter rally raising concerns about Story’s bill in Northampton. In an open letter to MotherWoman—an Amherst nonprofit that runs postpartum support groups, and that supports Story’s bill—the Freedom Center’s Lee Hurter expressed concerns about mandatory mental health screenings in general, which the group suggested find their way into public health policy as a way to benefit large pharmaceutical companies.

“It is also important to understand that even if the proposed postpartum depression screening program is not as immediately corrupt as some of the screening programs in the past, the program is still likely to lead to an increase in postpartum depression diagnoses. These diagnoses risk being dangerous in many ways,” continued the letter, which also bore the signature of two other activist groups, Arise for Social Justice and OutNow. Those risks, the groups wrote, include nursing mothers being treated with drugs that could be harmful to their infants.

“There is also a concern that having more people being officially diagnosed with ‘postpartum depression’ could become a self-fulfilling prophecy. If a person is having a hard time and is told that it is a disease of some sort, they are less likely to understand their experience as something natural or something that will pass,” the letter continued.

In addition, the groups wrote, such diagnoses threaten to distract attention from the social and economic issues that contribute to the stress faced by new parents, especially poor people, people of color, people with disabilities and gay families.

“A psychiatric diagnosis is individualized and often implies that the problem is the person’s to own or that it’s somehow inherent to their body, rather than looking at issues of marginalization and/or oppression,” they wrote.

In an email to the Advocate last week, Hurter, who was out of town, offered her thoughts on the revised version of the bill: “While we are really happy to see these screenings are no longer going to be mandated, we are still concerned that there is some danger in the way that this bill is likely to increase postpartum depression diagnoses. By increasing the number of people who have these diagnoses, there is an increased risk of getting mothers involved in a profit-driven psychiatric system that is not always set up to serve them,” she wrote. “We fear that the increase in the diagnoses will take our communities away from having a bigger understanding of some of the social, economic, and political factors that play into having a difficult time in the postpartum period.”

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The bill’s progress, Story said, has been “a long and complicated journey,” and incorporated feedback from numerous sources, including Valley activists concerned about universal screening and insurers who resisted being required to cover the screenings. Some doctors resisted a law that included specific requirements about how and when to conduct screenings. (“Doctors, just like legislators, don’t like to be told what to do,” Story said.)

With that kind of resistance appearing to be sinking her bill, Story met with a local health insurance executive whom she respects to ask his thoughts on how to advance the bill. Story said the executive focused on the fact that the bill had no enforcement to ensure the mandatory screening took place, or penalties if it didn’t.

“That took the scales off my eyes,” Story said. “The whole sticking point was the mandates, and if the mandates were meaningless, why include them? … We could mandate it up one side and down the other, but if we could not enforce it or track it, it made no sense.”

The new version of the bill does mandate that insurance companies report annually to the state on their efforts to address postpartum depression, including screening, as well as calling for improved resources statewide. Removing the mandated screening component, Story said, won the bill the support it needed to move forward from the Financial Services Committee. That committee’s favorable report came two days before Mother’s Day—prompting MotherWoman to describe it, in a press release, as the Legislature’s “Mother’s Day Gift to MA Moms.”

Story said she’s anxious to see the bill pass this year. “We had just an unbelievable hearing on January 27,” she said. “People came in and told these wrenching, wrenching stories. I don’t want to have to ask people to come and do that again.”

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Those speakers included Liz Friedman, who is now director of MotherWoman’s Postpartum Support Initiative. The Initiative runs facilitated support groups for new mothers and offers professional trainings. It also offers resource and referral information, ranging from therapy to at-home doula care to complementary therapies such as acupuncture and massage.

Friedman told the Advocate she appreciated hearing from all the people who spoke out about their concerns about the bill. “Their voices were heard … and included in the dialogue,” she said. MotherWoman, she added, “feels very pleased that we’ve had this conversation about screening. But, really, we’ve had a conversation about how we care for women with postpartum emotional complications.”

Women, Friedman noted, can experience a lot of stress after the birth of a child: sleep deprivation, income loss, hormonal changes, a shifting sense of identity. “There’s so much going on, it’s no wonder that women can have an intense emotional experience at that time,” she said.

Some women, Friedman said, find a mental health diagnosis empowering, a way to understand what’s happening to them; to others, it can carry a stigma that makes things even more difficult.

“We don’t need to label them necessarily with a mental health diagnosis. We need to get them the help they need to get back on their feet,” she said. “In the end, we all want them to have the care they need so they don’t end up in further crisis.”

Author: Maureen Turner

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