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Ivanka Trump is what Siri would be like if you programmed her to speak only in semi-feminist platitudes. Her every word seems to be pre-selected from a miniscule list of options. She doesn’t answer the question she’s been asked. And odds are her responses won’t help you.
Ivanka, play an ironic statement!
Witness the latest example: Last week, Ivanka Trump revealed (opens in new tab) her battle with postpartum depression just as Republicans in the Senate tried to pass the Graham-Cassidy bill, legislation that would have stripped millions of Americans of their mental health and maternity care.
“With each of my children, I had some level of postpartum depression. It was a very challenging time for me, because I felt I was not living up to my potential as a parent or as an entrepreneur, or an executive,” Ivanka told Dr. Oz on September 21. “I had had such easy pregnancies that in some way the juxtaposition hit me even harder.” I’m sure Ivanka did have incredibly easy pregnancies, just like I’m sure her children pose naturally in well-lit pastoral settings, her house is always as clean as the inside of a space station, and every family gathering bring the words “joyful,” “blessed,” and/or “amazing” to mind. I’ve seen the woman’s Instagram. And so the revelation that she suffered from postpartum depression is likely meant to be relatable, a perceived “flaw” that the masses can understand.
Given that Ivanka’s last attempt to seem “flawed” involved being photographed (opens in new tab) in a ponytail, it’s kind of a step forward.
If Ivanka were someone else, or if Trump hadn’t won the election last fall, Ivanka's confession would have seemed braver. Mental-health stigma is real—especially for mothers who are expected to be "perfect" women. But Ivanka works steps from the Oval Office; and when you have the ear of the President of the United States, even this one, it’s not enough to share a personal anecdote without a plan for action. In her role, Ivanka Trump is in a position to push for real initiatives, real research, and real funds that would improve the lives of women with PPD.
Instead, while she murmurs about it on television, her father’s administration tries to slash the very resources that could help women in far less fortunate positions than her own.
First, let's just address the matter of incredible hypocrisy. Graham-Cassidy, the umpteenth attempted ACA repeal just since Trump took office, is dead in the water. Still, since we’re likely to see similar attempts to overthrow Obamacare in the future, it’s worth a revisit. As it was written, the bill would have made both mental health and maternity coverage optional (opens in new tab) for insurers, returning Americans to a time before the ACA, when 38 percent of insurance plans on the individual market didn’t cover mental health care and a staggering 75 percent did not cover pregnancy. (If you’re wondering: the standard cost (opens in new tab) of an uninsured pregnancy is around $30,000 for a vaginal birth and $50,000 or more for a C-section. Want an insurance rider to cover your care? Great. Before the ACA, it would set women back over $1,000 per month (opens in new tab).) But Graham-Cassidy wasn't done. It also would have gutted Medicaid, which currently covers half of all births in the United States and a full 25 percent of all mental health care nationwide.
Some well-off mothers would still be able to get coverage for their postpartum depression by purchasing special mental-health riders (opens in new tab)—which would come on top of the already-expensive riders they’d have to purchase to cover their pregnancies. But for most women, treatment wouldn't be a realistic option.
For now Republicans are out of repeal-and-replace options, but Ivanka didn’t know that when she revealed her postpartum depression on Dr. Oz. As she has done over and over—on parental leave, on LGBT rights (opens in new tab),on Syrian refugees (opens in new tab), on women, generally—Ivanka went out in public and made a bunch of empathetic statements about people in need, all while her bosses set out to punish the very same population for their circumstances.
This matters because postpartum depression does not get the support it needs as it is—and the people most likely to suffer from it do not look anything like Ivanka. Nor, for that matter, do they look like Gwyneth Paltrow, or Courteney Cox, or Brooke Shields, or any of the other “13 Celebrity Moms Who Overcame Postpartum Depression (opens in new tab)” readers can find in this Parents slideshow. As Ruth Graham notes (opens in new tab) at Slate, postpartum depression has become a popular and relatively safe target for “awareness raising” among high-profile and privileged women: “It was once taboo for role-model mothers to talk about PPD, regarded as a confession of weakness or unnaturalness,” she writes. “But it has now become a mainstay of women’s magazines and tabloids.”
Most of those disclosures look like Ivanka’s: inspirational, first-person tales, rather than any concerted political action. Like philanthropic gestures or wearing ribbons to award shows, it gives stars the chance to associate themselves with political causes without forcing them to assume a political stance, to examine the issues that makes these problems worse.
Maybe this seems unduly cynical. It's true that it can help to hear that someone you admire has gone through what you have and survived it. And at its best, “consciousness raising” can generate a deeper awareness of a misunderstood condition. That’s good, as far as it goes. Though some hear the word “depression” and envision sadness, PPD is a real and dangerous disease. Since it’s triggered by hormonal changes and sleep deprivation, it can affect even women with no experience with mental illness, which means sufferers often don't recognize it immediately. Untreated PPD can lead to suicidal thoughts, failure to bond with the infant, and even psychosis. Women have killed their children because of this illness. Women have killed themselves. Finally, because mother and infant are so dependent on each other, even less extreme cases can cause developmental and cognitive problems (opens in new tab) for babies—it’s been linked to everything from newborn colic to psychiatric problems in adolescence.
Here’s something else to know about PPD: It is much, much more likely to occur and to proceed to dangerous levels if you are poor and/or a woman of color. Partly, this is because all forms of depression are more common if you’re poor; financial stress is a well-known risk factor. But there’s also a growing body of research showing that pregnancy outcomes in the US are not equally distributed. White and Asian babies get preferential treatment (opens in new tab) in NICUs. Black women are up to 2.7 times more likely than white women (opens in new tab) to die in childbirth. And among parents of any race, poverty is a significant contributing factor (opens in new tab) to Sudden Infant Death Syndrome. Postpartum depression is another potentially fatal illness where social inequalities manifest—black women report postpartum depression less than white women with comparable incomes (opens in new tab), but even when they do report it, they receive a lower standard of care. And while the most common statistic is that PPD affects one in nine mothers, or just over 11 percent, in one study of low-income women, the rate was 56 percent (opens in new tab). Meanwhile, the GOP has decided to target Medicare and Medicaid, specifically—which is to say, exactly the resources to which low-income women could turn to get help.
But even now, with the ACA intact, the disease gets less attention than it deserves. The ACA that was passed in 2010 included the MOTHERS Act, which mandated research into treatment for postpartum depression, including how to treat PPD across racial and cultural lines; it's been seven years, and Congress has still not assigned (opens in new tab) any funding to that research, which means none has been done. Plus, postpartum mothers have different requirements for treatment, especially low-income women who may not have reliable childcare or the flexibility to take time off work. To reach them, experts have suggested psychiatric centers inside women’s healthcare clinics or “day hospitals” where women can go for treatment while their children stop off in free childcare. As of 2012, we had one such day hospital (opens in new tab) and one specialized inpatient center (opens in new tab) for PPD patients nationwide. And to make matters worse, since even the ACA doesn’t force all insurance plans to cover mental health care, some women can't get coverage no matter what.
To be clear, this is an illness that is responsible for enormous amounts of suffering and death. Women during their childbearing years constitute the largest group of Americans dealing with depression. Suicide is a major cause of maternal mortality—in the UK, where more direct research has been done, a 2016 report (opens in new tab) found that suicide is “the leading cause of direct maternal deaths within a year of childbirth.” The cost of untreated maternal depression, in lost productivity and income alone, is $7,200 per woman (opens in new tab)—an estimated $5.7 billion dollars per year.
First-person anecdotes from women in power will not fix this. Until we treat postpartum depression and maternal health as social justice issues, and allocate real resources and support to them, the status quo won’t change—and as long as we live in a society that doesn’t value women, “female” illnesses like postpartum depression will never be seen as urgent concerns.
Ivanka could be—and, in a functioning presidential administration, someone would be—doing something to actually provide the material support that women who suffer from PPD need. Instead, she’s the friendly, smiling mask the administration straps on as they work to cut women’s lifelines. But, though Ivanka may represent the utmost in a certain variety of hollow, self-aggrandizing celebrity activism, she is, as always only a symptom of a deeper problem. We still live in a culture that prioritizes inspiration over activism, that talks a big game about valuing mothers while doing little or nothing to support them, that substitutes celebrity empathy for political action. Siri only responds the way we program her to, after all.
Jude Ellison Sady Doyle is the author of 'Trainwreck: The Women We Love to Hate, Mock, and Fear ... And Why.'
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