BILL ANALYSIS Ó
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Date of Hearing: June 14, 2011
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
ACR 53 (Roger Hernández) - As Introduced: April 26, 2011
SUBJECT : Kelly Abraham Martinez Act: perinatal depression
prevention.
SUMMARY : Enacts the Kelly Abraham Martinez Act which would urge
hospital providers, mental health care providers, health plans,
and insurers to invest resources to educate women about
perinatal depression risk factors and triggers. Specifically,
this resolution :
1)Urges hospital providers, including, but not limited to,
instructors of childbirth and breast-feeding classes, delivery
nursing staff, obstetrician-gynecologists, and other medical
providers, mental health care providers, health plans, and
insurers to invest resources to educate women about perinatal
depression risk factors and triggers.
2)Requests a statewide collaborative network of stakeholders
focused on the areas of health, maternal health, and infant
and child development, along with the American Congress of
Obstetricians and Gynecologists (ACOG), the American Academy
of Pediatrics, the California Psychological Association, the
Los Angeles County Perinatal Mental Health Task Force, and
Postpartum Support International to collaborate to explore
ways to assist with the development of perinatal depression
prevention educational materials.
3)Makes various declarations and findings, including the
following:
a) Perinatal depression and other mood disorders related to
pregnancy and childbirth can take many forms, including
depression, anxiety, panic disorder, obsessive-compulsive
disorder, and psychosis, with onset occurring during
pregnancy and after childbirth and, therefore, it is
clinically referred to as perinatal mood and anxiety
disorder (PMAD);
b) PMAD is a serious, debilitating, and sometimes tragic
disorder and afflicts between 10% to 20% of new mothers and
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pregnant women and can afflict any woman regardless of
race, ethnicity, socioeconomic level, and level of
educational attainment. Research also indicates that a
growing number of fathers experience postpartum depression;
c) PMAD is largely preventable when women, their families,
and medical providers understand the risk factors and
potential triggers and are encouraged to take precautionary
measures;
d) Risk factors for PMAD include, but are not limited to:
i) Personal or family history of depression,
anxiety, or other mental illness, including at other
times of reproductive change or in response to
fertility drugs;
ii) Stressors related to finances, legal needs,
interpersonal relationships, or immigration;
iii) History of personal trauma including domestic
violence;
iv) Early childhood loss of a parent or recent loss
of a parent;
v) Sleeping difficulties prior to pregnancy,
including, but not limited to, insomnia;
vi) The inability to relax or sleep even if
competent help for the baby is available;
vii) Difficulty conceiving or a medically complicated
pregnancy;
viii) Unwanted pregnancy or ambivalence toward
motherhood;
ix) Premature birth or infant health complications;
x) Prior miscarriage or prior traumatic birth;
xi) Traumatic childbirth as perceived by the mother
or birth that did not go as expected;
xii) Lack of support or negative judgment from
partner, other family, or other social networks;
xiii) Breast-feeding difficulties; and,
xiv) Thyroid dysfunction or family history of thyroid
dysfunction.
e) Research suggests that the following interventions may
prevent or lessen the intensity and duration of perinatal
depression:
i) Early recognition during pregnancy of perinatal
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depression risk factors;
ii) Early detection of symptoms present in pregnancy
or postpartum;
iii) Planning of emotional support for mothers when
symptoms are anticipated or present, including, but not
limited to, immediate connection with other mothers and
time alone or with a partner.
iv) Planning for practical support, including, but
not limited to, food preparations, care of other
children in the home, and providing time and space for
the new mother to sleep;
v) Limited highly conflict-ridden familial
relationships and finding support from other services;
vi) Psychotherapeutic interventions centered on
improving maternal competence and the quality of
bonding between the mother and the baby;
vii) Intervening early in breast-feeding
difficulties; and,
viii) Providing additional support and counseling
during pregnancy and the postpartum period for women
with more severe psychiatric histories, including, but
not limited to, prep-pregnancy consultation, medication
management, and psychotherapeutic interventions.
f) Increasing awareness about perinatal depression and
related risk factors and increasing awareness of the need
to educate women and their families at the earliest
possible point about perinatal depression and its risk
factors and triggers are imperative among hospital
providers, including, but not limited to, instructors of
childbirth and breast-feeding classes, and the nursing
staff of delivery units, obstetrician-gynecologists and
other medical providers, health plans, and insurer.
EXISTING LAW :
1)Authorizes and requires the Department of Public Health (DPH)
to implement various disease prevention and health promotion
programs, including a program for maternal and child health.
Authorizes the Maternal and Child Health Program to include
the provision of educational, preventative, diagnostic, and
treatment services, including medical care and facilitating
services directed toward improving the health of mothers and
children.
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2)Establishes the comprehensive community-based perinatal
program to provide comprehensive perinatal care for the
purpose of reducing maternal, perinatal, and infant mortality
and morbidity through contracts, grants, and agreements with
health care providers through the Medi-Cal Program.
FISCAL EFFECT : None
COMMENTS :
1)PURPOSE OF THIS RESOLUTION . According to the author and
sponsors of this resolution, current law expresses legislative
findings that PMAD care is an essential service necessary to
ensure maternal and infant health. The author maintains that
it is critical that women, their families and providers be
educated about risk factors and triggers and that women be
encouraged to take precautionary measures to prevent PMAD.
Such education, according to the sponsor, will assist with
reducing the stigma related to PMAD and assist women with
connecting with providers, support networks and appropriate
community resources.
2)BACKGROUND . A 2003 study featured in an article in the
Journal of Women's Health indicates that one in five pregnant
women suffered significant symptoms of depression, and only
14% of them reported receiving any formal treatment for it.
According to the United States Centers for Disease Control and
Prevention (CDC), nearly 12% of mothers report being
moderately depressed and 6% report being severely depressed
after delivery. Maternal depressive symptoms have been shown
to affect a mother's responsiveness to her child in its first
few months. Children of depressed women are also at increased
risk for child abuse, depression, and other psychiatric
illnesses such as conduct disorder. The CDC also states
postpartum depression affects marital relationships.
ACOG advocates addressing psychosocial issues of women in their
childbearing years. In a Committee Opinion published in
August 2006, the ACOG Committee on Health Care for Underserved
Women states psychosocial screening should be performed at
least once each trimester for all women seeking pregnancy
evaluation or prenatal care. The Committee Opinion states
women who receive psychosocial screening each trimester are
half as likely to have a low-birth-weight or preterm baby.
The Committee Opinion also states the prevalence of major
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depression in pregnancy is 11%, and if not treated, is
associated with unfavorable health behaviors and subsequent
fetal growth restriction, preterm delivery, placental
abruption (a cause of bleeding and maternal and fetal
mortality), and newborn irritability.
Recent national legislative efforts aim to improve detection of
and treatment for PMAD. On March 23, 2010, President Obama
signed the Patient Protection and Affordable Care Act (PPACA);
Public Law (P. L.) 111-148, as amended by the Health Care and
Education Reconciliation Act of 2010; P. L. 111-152. The
PPACA contains two sections with implications for PMAD. The
first section 2713, pertaining to preventive services,
requires all new health plans to cover comprehensive women's
preventive care, including screening for PMAD. And, section
2952, a law previously introduced as the Melanie Blocker
Stokes MOTHERS Act, authorizes $3 million annually to support
a national public awareness campaign on postpartum mental
health as well as research into maternal mental health, PMAD
and the benefits of PMAD screening.
3)KELLY ABRAHAM MARTINEZ . This resolution is named in honor of
Kelly Abraham Martinez. According to the author, while
pregnant, Kelly Abraham Martinez, a registered nurse, went out
of her way to be as healthy as possible for both herself and
her unborn daughter. Like many other pregnant women, her
routine included eating the right amounts and types of food,
exercising, maintaining a healthy weight, attending all of her
prenatal appointments, and attending private birthing classes
to prepare for the birth of her daughter.
However, according to the author, Kelly was not evaluated to
determine her risk factors for getting postpartum depression.
The author maintains that if Kelly had been evaluated, she
could have been identified as being high risk. Sadly, Kelly
did develop a severe case of postpartum depression after the
birth of her daughter, and Kelly's postpartum depression
devolved into a postpartum psychosis that claimed her life
shortly before her daughter reached three months of age in
early 2010. The author argues that if Kelly and her family
had been made aware that she was at high risk, they could have
made different choices, and Kelly might still be with us
today. The author maintains that Kelly's story represents
thousands of women in California who are unknowingly at risk
of experiencing PMAD.
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4)SUPPORT . The Junior League of Los Angeles, the Junior Leagues
of California, State Public Affairs Committee and the Los
Angeles County Perinatal Mental Health Task Force, sponsors of
this resolution, all stress that, through no fault of their
own, some women are at greater risk of experiencing PMAD.
Each organization stresses the importance of women, their
families and providers of being educated about risk factors
and triggers for PMAD. According to the Junior League of Los
Angeles, evidence suggests that when a woman is adequately
informed, screened or treated for PMAD, not only is her
individual suffering alleviated there is an increased
likelihood of positive outcomes for herself, her baby and the
entire family. The Los Angeles County Perinatal Mental Health
Task Force states in support that this resolution will help
prevent women from needlessly falling victim to PMAD and will
help women form lifelong healthy bonds with their babies
enabling them to thrive.
5)PREVIOUS LEGISLATION .
a) ACR 105 (Nava), Resolution Chapter 9, Statutes of 2010,
establishes May, each year, as Perinatal Depression
Awareness Month in California and requests that
stakeholders work together to increase awareness and
improve women's access to culturally competent mental
health care services.
b) AB 159 (Nava) of 2009, would have authorized DPH to
establish a statewide task force to develop a best
practices model for public awareness and a standard of care
for PMAD to be used by health care providers and
organizations. AB 159 died on the Assembly Appropriations
Committee Suspense File.
c) AB 420 (Salas) of 2009, would have required DPH to
conduct the PMAD Community Awareness Campaign to increase
awareness and provide education to pregnant women and new
mothers on PMAD and to convene a workgroup, which would
have been required to prepare recommendations relating to
the implementation of the awareness campaign. AB 420 would
have authorized DPH to use nonpublic sources of funding to
support the activities of the workgroup and fund the
campaign, and prohibited the use of public funds. AB 420
died on the Assembly Appropriations Committee Suspense
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File.
d) AB 2317 (Koretz) of 2006, would have required DPH Ýthen
Department of Health Services (DHS)] to conduct the PMAD
Community Awareness Campaign. The Governor vetoed AB 2317,
stating, "As crafted, the bill is technically flawed. It
will not result in an effective community awareness
campaign because it establishes program parameters and a
time frame that are not workable, and lacks proper
funding."
e) AB 291 (Koretz) of 2005, would have required DPH (then
DHS) to prepare an information sheet on postpartum mood and
anxiety disorders and would have required health care
providers to provide a copy of the information sheet to
pregnant women, as specified. AB 291 was not heard in the
Assembly Health Committee at the request of the author.
f) AB 367 (Koretz) of 2003, would have established the PMAD
Information Program in DPH (then DHS) Maternal and Child
Health Branch and would have required the program to
include continuing medical education activities, the
posting of relevant information on the DPH Website, and
communication through radio, TV, and billboards. AB 367
was held in the Assembly Appropriations Committee.
g) ACR 51 (Koretz), Resolution Chapter 50, Statutes of
2003, Proclaims May 2003 as Postpartum Mood and Anxiety
Disorder Awareness Month.
REGISTERED SUPPORT / OPPOSITION :
Support
Junior League of Los Angeles (cosponsor)
Junior Leagues of California, State Public Affairs Committee
(cosponsor)
Los Angeles County Perinatal Mental Health Task Force
(cosponsor)
American Academy of Pediatrics
California Psychological Association
California Public Defenders Association
Mental Health Association in California
Postpartum Support International
United Nurses Associations of California/Union of Health care
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Professionals
Opposition
None on file.
Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916)
319-2097