Blue Cross Blue Shield NLO on Maternal Mental Health and Union Workers

Merrilee Logue, Executive Director of the Blue Cross Blue Shield's National Labor Office, and Arin McClune, Clinical Quality Senior Program Manager at BCBSA, joined the America's Work Force Union Podcast for a candid and important conversation on maternal mental health, one of the most common and most underaddressed complications of pregnancy and childbirth.

With 68 percent of mothers with children under six years old in the labor force and up to 20 percent of all women experiencing maternal mental health disorders, the two guests made the case that unions have both the opportunity and the obligation to ensure their members know what conditions exist, what resources are available and that seeking help is not a sign of weakness. The conversation carried special weight during Mental Health Awareness Month and in a labor movement where women are joining unions in growing numbers every year.

• Up to 20 percent of all women experience maternal mental health disorders — making them the most common complication of pregnancy and childbirth. However, fewer than 20 percent of patients are screened for depression or other mental health conditions during pregnancy and the postpartum period. Further, mental health conditions are the leading cause of pregnancy-related deaths, frequently by suicide or overdose, according to Logue and McClune. The statistics are both devastating and largely preventable with proper screening and treatment, the pair said.
• Women of color are twice as likely to experience maternal mental health disorders as white women, but only half as likely to receive treatment. It’s a disparity the Blue Cross Blue Shield Association National Labor Office has been working to address over the past four years by accelerating access to maternal health programs within the labor community and advocating for reimbursement parity, integrated behavioral health workflows and expanded provider training.
• Maternal mental health disorders extend well beyond postpartum depression and include substance use and abuse, postpartum psychosis, bipolar disorder, schizophrenia and extreme anxiety. When conditions are identified early, and treatment is accessible, risks including inadequate prenatal care, preterm birth, stillbirth, harm to self or baby, failure to bond and reduced workplace productivity can be mitigated.

A Topic Too Few People Talk About — During the Month When We Should

Mental Health Awareness Month provides the backdrop for one of the most important conversations the America's Work Force Union Podcast has hosted this year. Maternal mental health affects up to 20 percent of all women who give birth, making it the single most common complication of pregnancy and childbirth. It is also among the least discussed, least screened and most stigmatized health issues in the American workforce, according to Logue.

Merrilee Logue, executive director of the Blue Cross Blue Shield Association National Labor Office, and Arin McClune, a clinical quality senior program manager with more than 20 years of experience as an obstetric nurse, joined America's Work Force Union Podcast to change that.

The Scale of the Problem

While up to 20 percent of all women experience a maternal mental health disorder, fewer than 20 percent are screened for depression or other mental health conditions during pregnancy or the postpartum period. Unfortunately, mental health conditions are now the leading cause of pregnancy-related deaths in the United States, frequently by suicide or overdose. McClune, who has spent decades at the bedside in labor and delivery, described encountering new mothers struggling with depression and anxiety, which makes caring for a newborn, let alone themselves, profoundly difficult.

The conditions involved are not limited to the postpartum depression that occasionally enters public conversation. They include substance use and abuse, postpartum psychosis, bipolar disorder, schizophrenia and severe anxiety. The risks of leaving these conditions undiagnosed and untreated are equally serious. They can lead to inadequate prenatal care, higher rates of emergency room visits, preterm birth, stillbirth, risk of harm to the mother or child, disrupted parent-child bonding and measurably reduced workplace productivity.

Women of Color Carry a Disproportionate Burden

Women of color are twice as likely to experience maternal mental health disorders as white women, Logue said, and only half as likely to receive treatment. The disparity is a matter of access, awareness and a healthcare system that has historically underserved communities of color, she added. The Blue Cross Blue Shield Association National Labor Office has been working over the past four years to accelerate access to maternal health programs within the labor community. Still, Logue acknowledged that the work is far from finished.

Why Unions Have a Role to Play

With 68 percent of mothers with children under six years old currently in the labor force — and women joining unions in growing numbers — the labor movement is increasingly where these women's healthcare needs intersect with their professional lives. Logue and McClune both believe Union leaders can and should inform members about the programs available through their plans, advocate for flexible scheduling and remote work options for new mothers. They can also help promote a workplace culture where a young mother does not feel she has to hide what she is going through.

Logue was also careful to frame maternal mental health as a family issue, not solely a female one. Family members of new mothers need to be alert to signs that something is wrong, because the mother herself may not recognize that what she is experiencing is a genuine, treatable illness and not a personal failing.

The Barriers That Need to Come Down

McClune and Logue identified several structural barriers that prevent new mothers from accessing the care they need. Reimbursement and payment parity for perinatal mental health screening and treatment remain inconsistent. Behavioral health is not routinely integrated into maternal care workflows, meaning mental health screening often does not happen during prenatal and postpartum visits unless someone specifically prioritizes it. Complex billing and coding practices create administrative delays. And many clinicians lack the specialized training to confidently identify and refer perinatal mental health conditions. Addressing each of these barriers — through standardized screening protocols, provider training, streamlined billing and accessible referral pathways — would make it far more likely that conditions are caught early and treated effectively.

Stigma remains a barrier in its own right, McClune and Logue added. Many mothers do not speak up to anyone out of fear of judgment or of appearing weak. These conditions are common, they are treatable and seeking help is not weakness, Logue and McClune said. It is exactly what any member of the labor movement who believes in solidarity should feel empowered to do.

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