Year of Publication



Public Health

Date Available


Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Dr. Caitlin Pope

Committee Member

Angela Carman

Committee Member

Kathryn Cadarelli


In the United States, maternal mortality has become a growing public health concern after recent studies revealed significant disparities in maternal health outcomes when compared to other high-income countries (The Commonwealth Fund, 2020). The World Health Organization (WHO) defines maternal mortality as the death of a pregnant woman or the death of a woman within 42 days of delivery, miscarriage, termination, or ectopic pregnancy (Centers for Disease Control and Prevention, 2022a). From 2017-2019, the maternal mortality in Saint Louis, Missouri, the state’s largest and most populated metropolitan area, was determined to be 36.4 maternal deaths per 100,000 live births. This is over twice the national rate of 17.4 maternal deaths per 100,000 live births (Flourish, n.d.). The Missouri Department of Health and Senior Services determined that mental health conditions contributed to 32.7% of pregnancy-related deaths nationally and were the leading underlying cause of pregnancy-related deaths statewide (Missouri Department of Health and Senior Services, 2022).

To address this public health issue, the City of St. Louis Department of Health proposes implementing the ROSE (Reach Out, Stay Strong, Essentials for mothers of newborns) program. Replicated studies have shown that the ROSE program is effective in reducing postpartum depression among pregnant women (Care New England, 2023). While the impact of the ROSE program on maternal mortality has not been directly studied, it is proposed as an evidence-informed program because of its significant impact on maternal mental health, a major risk factor for maternal mortality in Missouri. The ROSE program targets maternal mental health through four prenatal sessions and one postpartum booster session that cover topics such as psychoeducation on postpartum depression, motherhood and relationship management techniques, self-care techniques, and goals (Care New England, 2023). The medium-term outcome of the program includes a decrease in postpartum depression and maternal mental health disorders. The long-term outcome of the program includes a decrease in maternal mortality. To evaluate the program execution and impact, four process evaluation questions and two outcome evaluation questions were developed. The process evaluation uses data collected in the enrollment survey, during sessions, and records. The outcome evaluation uses data collected from the Edinburgh Postnatal Depression Scale (EDPS) questionnaire that is distributed before and after the program and the Missouri Pregnancy Risk Assessment Monitoring Systems (PRAMS) data from before and after the program’s implementation in St. Louis, Missouri.

The Specific Aims of the ROSE program are:

  1. To adapt the ROSE program for the target population.
  2. Implement the ROSE program in St. Louis.
  3. Evaluate the impact of the program on maternal health.

Included in

Public Health Commons