New parental support metrics give US an "F" for paid leave and childcare policies

Although state efforts to address maternal mental health (MMH) are improving incrementally, significant gaps in clinical care systems and baseline structural supports remain widespread across the United States, according to the fourth annual Maternal Mental Health State Report Cards derived from the Policy Center for Maternal Mental Health and researchers at the George Washington University Milken Institute School of Public Health.^1,2

Every year, approximately 1 in 5 mothers in the country experience MMH conditions, such as postpartum depression, with the majority failing to receive necessary support and treatment. When left untreated, these disorders carry lasting consequences for maternal well-being, family stability, and childhood development, costing the United States an estimated $14.2 billion annually.¹

“Maternal mental health conditions are a leading cause of maternal mortality. The stressors stacking up on US families are contributing to the severity of these conditions,” said Caitlin Murphy, research scientist at the George Washington University Milken Institute School of Public Health, in a statement. “The Maternal Mental Health report cards serve as a guide for states to take action and provide families with the support they need and deserve.”¹

In the 2026 assessment, the United States’ overall grade rose slightly to a C, moving up from a C- in 2025.¹ This national shift reflects incremental progress on a state level, with 26 states increasing their grades, whereas 9 states saw their grades decline.² A total of 10 states earned a B grade, which is the highest mark awarded this year, as no states received an A.¹ Among these, 6 regions earned a B for the first time, including the District of Columbia, Illinois, Indiana, Louisiana, Massachusetts, and New York.¹ The majority of states (26) clustered at a C grade, and 15 states received a D.¹^,² Notably, Mississippi and Alabama, which both received failing F grades in 2025, climbed to a D in the 2026 evaluation.¹

Clinical gaps across 27 evaluation measures

The 2026 grading framework utilized 27 distinct measures divided across 4 key domains: screening/detection, providers and treatment, policy and payment, and a newly introduced parental support domain.¹^,² To increase grading accuracy, the research team implemented structural modifications to its clinical criteria, adding points for states establishing perinatal psychiatry consultation programs for obstetric providers and adjusting the baseline ratio for MMH-certified psychiatric provider prescribers to match realistic annual caseloads.²

Despite the slight lift in overall grades, the report highlighted widespread deficits in clinical infrastructure across most states. A detailed breakdown of the data reveals specific shortages in specialized mental health care, as follows:

• 47 states lack a sufficient number of therapists and nonprescribers with distinct specialties in treating MMH disorders.²
• 45 states and the District of Columbia do not have at least one dedicated MMH inpatient or residential treatment program.²
• 28 states lack at least one MMH intensive outpatient or partial hospitalization program.²
• Screening rates remain critically low, with 29 states showing low prenatal depression screening rates and 41 states demonstrating low postpartum screening rates under Healthcare Effectiveness Data and Information Set guidelines.²

Sharp deficits revealed in parental support domain

A major development in the 2026 scorecard was the integration of the Parental Support domain, which evaluated states on a 5-star scale based on 6 specific policy measures concerning paid family leave and childcare access.¹^,² These measures scored states on the availability of mandated public parental leave of at least 8 to 12 weeks, full wage replacement for low-income families making under 100% of the federal poverty level, and local childcare affordability and slot availability.²

The nationwide results in this domain were low, resulting in an overall equivalent grade of an F for the United States.¹^,² The report cards showed that 31 states earned less than 1 star out of 5, and only 14 states managed to secure 2 or more stars.¹^,² Within this small group of higher-performing states, 12 states earned exactly 2 stars, Virginia earned 3 stars, and Maine achieved the highest national ranking with 3.5 stars.²

The structural deficiencies driving these low parental support marks are extensive, as follows:

• 36 states do not offer any mandated public paid parental leave program.²
• 49 states and the District of Columbia fail to provide 100% wage replacement during leave for the lowest-income individuals.²
• 36 states suffer from a childcare availability gap greater than 20% between open slots and the number of children requiring care.²
• 41 states and the District of Columbia feature average childcare costs that exceed 30% of the median single-income household earnings, passing the national average cost of 35%.²

“While we applaud the progress states are making, the US is providing mediocre maternal mental health care at best,” said Joy Burkhard, CEO of the Policy Center for Maternal Mental Health, in a news release.¹ “It’s critical that mothers and families have adequate paid leave and child care, which is not only necessary for families to return to work if they choose to, but for women to heal from birth, attend medical and mental health appointments.”

References

1. 2026 Maternal Mental Health State Report Cards released: the US receives an “F” on new parental support measures. News release. Milken Institute School of Public Health. May 27, 2026. Accessed May 28, 2026. https://publichealth.gwu.edu/2026-maternal-mental-health-state-report-cards-released-us-receives-f-new-parental-support-measures
2. 2026 Maternal Mental Health State Report Cards. Policy Center for Maternal Mental Health. May 27, 2026. Accessed May 28, 2026. https://policycentermmh.org/2026-maternal-mental-health-state-report-cards/