Earlier this month, when Georgia’s Senate approved expanding postpartum Medicaid coverage from six months to a year, reproductive health advocates hoped the vote signaled a shift in the public perception of one of the most stereotyped groups in America: low-income pregnant and new mothers.

That’s because the growing body of research evidence surrounding maternal mental health and postpartum depression points to one inescapable conclusion: the public image of who is vulnerable to these mental health threats is largely based on socio-economic status.

In commercials, movies and public service announcements, the middle class or wealthy mother who can’t shake the feelings of overwhelm or despair deserves our acknowledgment, empathy, and support.

The poor mother who misses doctor’s appointments or doesn’t bond with her baby is either lazy or neglectful. God forbid she harms a child while in crisis, which usually leads to criminal charges instead of mental health treatment.

Is this argument merely another case of over-indulgent, touchy-feely posturing? No, it’s the reality for millions of new mothers on pregnancy-related Medicaid coverage in America.

Postpartum depression has been termed the most underdiagnosed obstetrical complication in the U.S. When left untreated, it can result in important activities like feeding, sleeping and adhering to doctors’ appointments being compromised or completely ignored.

But for women with pregnancy-related Medicaid coverage in Oklahoma, their health insurance evaporates two months after the birth of their child.

On July 1, 2021, about 200,000 Oklahomans became newly eligible for health coverage, thanks to Medicaid expansion made possible by the Affordable Care Act. It was a massive victory for Oklahoma for bringing health coverage to many Oklahomans.

Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure said, “Medicaid is a lifeline for millions of people in this country and a step in the long road to achieving health equity by providing access to essential health care.”

If Medicaid is a lifeline for millions of Americans, isn’t it just as much of a lifeline for moms who recently gave birth and who qualified for Medicaid only because of their pregnancy? Is it only important for the baby to have the necessary resources to maintain health and seek medical support?

Twenty-six states have enacted or are planning to seek federal approval for extension of Medicaid postpartum coverage, but some have coverage limited to six months after delivery or only for certain populations. Oklahoma is not among those 26 states, and there is currently no pending state action to extend Medicaid postpartum coverage.

According to the CDC, about 1 in 3 pregnancy-related deaths occur one week to one year after delivery. A pregnancy-related death can happen during pregnancy, at delivery, and even up to one year postpartum.

Pregnant women on Medicaid will lose their health insurance coverage 60 days after delivering a child. But they are still at risk for maternal mental health and pregnancy-related deaths.

I have spoken with doulas and midwives who provide services to expectant mothers and their families. They have seen family structures and relationships dissolve as families attempt to navigate mental health challenges without even realizing they are dealing with issues like depression, mania or anxiety.

Many times, moms who need support do not access services due to lack of ability to pay or lack of postpartum mental health service providers. And because many of these women don’t have insurance of any kind, the doorway to help becomes permanently sealed.

What if there was more to be done to support maternal mental health? What if Oklahoma followed the lead of Georgia and extended coverage for postpartum moms?

What if a Medicaid extension could allow moms to seek treatment for mental illness without worrying about how to pay for it? What if Medicaid mothers in Oklahoma had the information to identify their mental health challenges and a pathway to resolving them?

As a society, we must not only radically adjust our response to mental health challenges; we must broaden the lens to include those who are inarguably the most vulnerable to psychological crises — those for whom the term “health equity” is no more than words in a social construct.