Mental Health Care Disparities Among US Pregnant Individuals in 2020–2021: A Cross-Sectional Study

Purpose To examine maternal characteristics associated with perceived unmet mental health needs and mental health care settings, focusing on residential rurality and race/ethnicity. Methods This cross-sectional study analyzed self-reported unmet mental health needs and mental health care settings among 1097 pregnant respondents in the 2020–2021 National Survey on Drug Use and Health, incorporating the complex sampling weights for national representativeness. Findings Non-Hispanic Black pregnant individuals and those living in nonmetro rural areas reported lower odds of unmet mental health needs compared to those in large metro areas and non-Hispanic White individuals. Pregnant individuals in nonmetro rural areas and non-Hispanic other pregnant individuals also reported lower odds of utilizing virtual mental care services, while non-Hispanic other pregnant individuals were less likely to receive prescription medication than their non-Hispanic White counterparts. Conclusions Disparities in mental health care access by rurality and race/ethnicity reveal increased barriers for nonmetro rural and minority pregnant populations, particularly regarding virtual and prescription-based care. The lower unmet health needs among Black pregnant individuals and those living in nonmetro rural areas may reflect adjusted expectations or reliance on informal support systems, emphasizing the need to understand these perceptions. COVID-19’s impact on access patterns further highlights the need for more research on barriers to maternal mental health treatment. Tailored mental health interventions and policy reforms are needed to enhance accessible, culturally sensitive maternal mental health services across diverse communities.