New research sheds light on the mental health crisis surrounding pregnancy

NEW YORK–(BUSINESS WIRE)–Twill, combining the best of digital and human support to guide people to the health care they need, has partnered with Nonfiction Research to release “The Invisible Weight of Pregnancy,” an in-depth new report that sheds light on the gap between need and care for mental health among pregnant Americans. “Pregnancy is one of the greatest psychological transformations a person can experience,” said Lindsay Weking, head of investigative strategy at Nonfiction Research. “It can open up a mix of fears, insecurities and even deep psychological wounds from childhood. These difficult emotions during pregnancy are what we called the invisible weight.

Twill commissioned the study to survey more than 1,000 Americans who have been pregnant in the past two years and experts including obstetricians, certified doulas, midwives, nurse practitioners, clinical therapists and clinical social workers. Twill and Nonfiction found that over two-thirds (69%) of respondents self-reported experiencing anxiety during pregnancy, and over half (53%) experienced depression. What’s more, the majority of women surveyed (82%) said they had not been able to honestly discuss their negative feelings with their OB/GYN.

Key findings of the pregnancy mental health crisis include:

  • 63% of pregnant Americans admit they weren’t adequately prepared to experience negative feelings during their pregnancy

  • Untreated maternal mental illness costs about $32,000 per mother and baby, a total of $14 billion for the country from pregnancy to five years after birth (MMHLA, 2020)

  • 35% of respondents admit that they are so worried about miscarriage that it is difficult for them to get excited about pregnancy

“The mental health challenges that can arise during pregnancy are severely overlooked today,” said Dr. Murray Zucker, chief medical officer at Twill. “It is vital that this gap between need and care is filled in a way that is accessible to mothers-to-be, regardless of their background, as good mental health is the starting point for a healthy pregnancy.”

The health care system is failing pregnant Americans

The health care system does very little to acknowledge or support the invisible weight that pregnant Americans carry. Due to systemic failures and provider shortages, the OB/GYN relationship is not providing the emotional care that pregnant Americans desperately need, with 26 percent of women surveyed saying they felt misunderstood by their provider and 21 percent saying they felt worried you’re fired. It is estimated that over half a million Americans who became pregnant in the past year had a provider who ignored a plea for emotional help.

To add to that, according to the American College of Obstetricians and Gynecologists (ACOG), there is a nationwide shortage of 6,000-9,000 OB-GYNs, and nearly half of all US counties do not have a single OB-GYN. Twill’s research also shows how the “Invisible Weight” becomes even more pronounced and complex in the experiences of pregnant Americans of color, as well as those on Medicaid, who may struggle to access quality physical care, let alone emotional or psychological support.

Giving pregnant Americans the emotional care they deserve

As research shows that pregnant Americans suffer under the invisible weight of difficult and dark emotions, and that the need for better emotional care during pregnancy is more prevalent, the report identifies 4 ways to begin meeting those needs. Solutions include:

  • Normalizing difficult and dark feelings during pregnancy

  • Integrate therapists into OB/GYN practices

  • Create partnerships with outside emotional care professionals

  • Use digital tools to fill emotional care gaps

The launch of this report coincides with the launch of Twill’s Pregnancy Sequence, a digital-first solution designed to provide comprehensive support for healthier and more emotionally supportive pregnancies. The risk of preterm birth is 25–60% higher among pregnant women with “high” levels of stress (NCBI, 2016), highlighting the clear need to address emotional stressors that can affect maternal health outcomes. Twill’s Pregnancy Sequence is scientifically designed to provide mental health support to expectant and recently pregnant people in a personalized way through over-the-counter digital therapy (NPDT), coaching and telebehavioral programs, and a support community.

“Twill’s digital-first solution is designed to address the issue of access to care that many pregnant women face, in this case mental health care,” said Megan Callahan, COO at Twill. “Given the shortage of providers in the U.S., as well as the shame many pregnant Americans feel when admitting negative emotions during a time that is supposed to be synonymous with happiness, Twill Pregnancy Sequence has the potential to provide a solution that is so close to your mobile phone.”

Twill’s Pregnancy Sequence will be available in two versions, one specifically tailored for underserved populations such as Medicaid.

For more information about Twill, visit our website at The Invisible Weight research report can be found here.


This research was conducted between January 2022 and September 2022 and consisted of in-depth interviews with pregnant Americans over the past two years, experts and a nationwide survey. The nationwide survey was conducted with Americans who had been pregnant in the past two years (including those who were pregnant at the time of the survey). Adhering to standard quantitative reporting practices, Nonfiction collected 1,029 survey responses. To account for historically underrepresented experiences, the demographic makeup of this sample emphasized the presence of people of color and Medicaid, but all findings were tested for broader applicability in the study. One-on-one interviews were conducted with members of the same audience. Experts interviewed included OB/GYNs, certified doulas, midwives, nurse practitioners, clinical therapists, and clinical social workers.

About Twill

Twill (formerly Happify Health) is The Intelligent Healing Company™, bridging the gap between need and care by intelligently guiding each person to the care they need, when they need it, how they want it. The company delivers Sequences™, fully configurable, scientifically engineered, digital-first solutions that support the care journey for specific medical conditions. Twill does this for pharmaceutical companies, health plans, giant employers and those they serve. Available in 10 languages ​​and reaching more than 18 million lives, Twill creates more precise, personal, engaging and effective experiences at scale for the many, not the few. For more information, visit

About non-fiction

Nonfiction Research is an independent research company that studies the divide between America’s public and private lives. Their work has been covered by MSNBC, CNBC, ABC News, Fox News, Axios, Fast Company.

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