BILL ANALYSIS Ó
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THIRD READING
Bill No: ACR 53
Author: Roger Hernández (D)
Amended: As introduced
Vote: 21
ASSEMBLY FLOOR : 75-0, 6/20/11 (Consent) - See last page
for vote
SUBJECT : Kelly Abraham Martinez Act: perinatal
depression prevention
SOURCE : Junior League of Los Angeles
Junior Leagues of California, State Public
Affairs Committee
Los Angeles County Perinatal Mental Health Task
Force
DIGEST : This resolution 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.
ANALYSIS :
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
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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.
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.
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,
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
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perinatal mood and anxiety disorder (PMAD);
B. PMAD is a serious, debilitating, and sometimes
tragic disorder and afflicts between 10 percent to 20
percent of new mothers and 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:
(1) Personal or family history of depression,
anxiety, or other mental illness, including at
other times of reproductive change or in
response to fertility drugs;
(2) Stressors related to finances, legal
needs, interpersonal relationships, or
immigration;
(3) History of personal trauma including
domestic violence;
(4) Early childhood loss of a parent or
recent loss of a parent;
(5) Sleeping difficulties prior to pregnancy,
including, but not limited to, insomnia;
(6) The inability to relax or sleep even if
competent help for the baby is available;
(7) Difficulty conceiving or a medically
complicated pregnancy;
(8) Unwanted pregnancy or ambivalence toward
motherhood;
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(9) Premature birth or infant health
complications;
(10) Prior miscarriage or prior traumatic
birth;
(11) Traumatic childbirth as perceived by the
mother or birth that did not go as expected;
(12) Lack of support or negative judgment from
partner, other family, or other social networks;
(13) Breast-feeding difficulties; and,
(14) 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:
(1) Early recognition during pregnancy of
perinatal depression risk factors;
(2) Early detection of symptoms present in
pregnancy or postpartum;
(3) 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;
(4) 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;
(5) Limited highly conflict-ridden familial
relationships and finding support from other
services;
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(6) Psychotherapeutic interventions centered
on improving maternal competence and the quality
of bonding between the mother and the baby;
(7) Intervening early in breast-feeding
difficulties; and,
(8) 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.
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
percent of them reported receiving any formal treatment for
it. According to the United States Centers for Disease
Control and Prevention (CDC), nearly 12 percent of mothers
report being moderately depressed and six percent 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.
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FISCAL EFFECT : Fiscal Com.: No
SUPPORT : (Verified 7/6/11)
Junior League of Los Angeles (co-source)
Junior Leagues of California, State Public Affairs
Committee (co-source) Los Angeles County Perinatal Mental
Health Task Force (co-source) 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 Professionals
ARGUMENTS IN 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.
ASSEMBLY FLOOR : 75-0, 6/20/11
AYES: Achadjian, Alejo, Allen, Ammiano, Atkins, Beall,
Bill Berryhill, Block, Blumenfield, Bonilla, Bradford,
Brownley, Buchanan, Butler, Campos, Carter, Cedillo,
Chesbro, Conway, Cook, Davis, Dickinson, Donnelly, Eng,
Feuer, Fletcher, Fong, Fuentes, Furutani, Beth Gaines,
Galgiani, Garrick, Gatto, Gordon, Grove, Hagman, Hall,
Hayashi, Roger Hernández, Hill, Huber, Hueso, Huffman,
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Jeffries, Jones, Knight, Lara, Logue, Bonnie Lowenthal,
Ma, Mansoor, Mendoza, Miller, Mitchell, Monning, Morrell,
Nestande, Nielsen, Norby, Olsen, Pan, Perea, V. Manuel
Pérez, Portantino, Silva, Smyth, Solorio, Swanson,
Torres, Valadao, Wagner, Wieckowski, Williams, Yamada,
John A. Pérez
NO VOTE RECORDED: Charles Calderon, Gorell, Halderman,
Harkey, Skinner
CTW:kc 7/6/11 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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