• Research by Twill and Nonfiction,“The Invisible Weight of Pregnancy,” exposes that a majority of pregnant Americans felt difficult or dark feelings in their most recent pregnancy
  • Based on conversations with over 1,000 survey respondents made up of those who have been pregnant in the last two years and a range of medical experts, the report explores the hidden emotions felt by pregnant Americans, how the US healthcare system fares under the needs of that weight, and offers a blueprint for improving emotional care
  • In response to industry-wide challenges associated with finding affordable and accessible care, Twill launches its Pregnancy Sequence, a digital-first comprehensive solution designed to address the emotional stressors for healthier and more emotionally supportive pregnancies, especially in vulnerable populations.

    NEW YORK, N.Y. – November 3, 2022 – Twill, weaving together the best of digital and human support to guide people to the healthcare they need, has partnered with Nonfiction Research to release “The Invisible Weight of Pregnancy,” a new in-depth report that sheds light on the gap between need and care for mental health care among pregnant Americans. “Pregnancy is one of the biggest psychological transformations a person can experience,” said Lindsey Wehking, Head of Investigative Strategy at Nonfiction Research. “It can open a mix of fears, insecurities, and even deep psychological wounds from childhood. These difficult emotions during pregnancy are what we have termed the invisible weight.” 

    Twill commissioned research to survey over 1,000 Americans who have been pregnant in the last two years and experts including ob-gyns, 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, a majority of the women surveyed (82%) claim that they weren’t able to discuss their negative feelings honestly with their OBGYNs.

    Key findings of the mental health care crisis around pregnancy include:

    • 63% of pregnant Americans admitted they were not adequately prepared to experience negative feelings during their pregnancy
    • Untreated maternal mental health conditions cost about $32,000 per mother & infant, a national total of $14 billion from pregnancy through five years postpartum (MMHLA, 2020)
    • 35% of those surveyed admitted they were so worried about having a miscarriage it made it difficult to be excited about being pregnant

    “The mental health challenges that can arise during pregnancy are seriously overlooked today,” said Dr. Murray Zucker, Chief Medical Officer at Twill. “It’s critical that this gap between need and care is filled in a manner that’s accessible for moms-to-be regardless of their background as good mental health is the start point for a healthy pregnancy.”

    The healthcare system is failing pregnant Americans

    The healthcare system is doing very little to acknowledge or support the Invisible Weight pregnant Americans carry. Due to systemic failures and provider shortages, the OB-GYN relationship is falling short in providing the kind of emotional care pregnant Americans desperately need, with 26 percent of women surveyed saying they felt misunderstood by their provider and 21 percent saying they felt their concerns were dismissed. It’s estimated that over half a million Americans who became pregnant in the last year had a provider ignore a request for emotional help.

    To add to that, per the American College of Obstetricians and Gynecologists (ACOG), there is a nationwide shortage of 6,000-9,000 OB-GYNs countrywide , and nearly half of all counties in the US don’t 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 can struggle to get access to quality physical care, let alone emotional or mental support.

    Giving pregnant Americans the emotional care they deserve

    As the research shows pregnant Americans are suffering under the Invisible Weight of difficult and dark emotions, and that the need for better emotional care during pregnancy is increasingly prevalent, the report identifies 4 ways to begin to meet those needs. Solutions include:

    • Normalize difficult and dark feelings during pregnancy
    • Integrate Therapists into OB-GYN practices 
    • Create partnerships with outside emotional care specialists 
    • Use digital tools to fill gaps in emotional care

    The release of this report coincides with the launch of Twill’s Pregnancy Sequence, a digital-first solution that is 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 impact maternal health outcomes. Twill’s Pregnancy Sequence is scientifically designed to provide mental health support to expecting and newly pregnant people in a personalized way through a non-prescription digital therapeutic (NPDT), coaching and telebehavioral programs, and a support community. 

    “Twill's digital-first solution is designed to address the access to care issue that many pregnant women face, in this instance for mental health care,” said Megan Callahan, Chief Operating Officer at Twill. “Given the shortage of providers facing the US, 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's Pregnancy Sequence has the potential to provide a solution that is as close as your mobile phone.” 

    Twill’s Pregnancy Sequence will be available in two versions, with one tailored specifically for populations underrepresented in access to care, such as Medicaid. 

    For more information about Twill, visit our website at twill.health. 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 Americans pregnant in the last two years, experts, and a nation-wide survey. The nationwide survey was conducted with Americans who have been pregnant in the last two years (including those who were pregnant at the time of the survey). Adhering to standard practices for quantitative representation, Nonfiction collected 1,029 survey responses. To account for historically underrepresented experiences, the demographic makeup of this sample emphasized the presence of persons of color and those insured by Medicaid—but all findings were tested for broader applicability in the survey. The 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™, shortening the gap between need and care by intelligently guiding each person to the care they need, when they need it, in the way they want. The company delivers Sequences™, fully configurable, scientifically designed, digital-first solutions that support the care journey for specific medical conditions. Twill does this for pharmaceutical companies, health plans, jumbo employers, and those they serve. Available across 10 languages and covering more than 18 million lives, Twill creates a more precise, personal, engaging, and effective experience at scale for the many, not the few. For more information, visit twill.health.

    About Nonfiction

    Nonfiction Research is an independent research company who studies the gaps 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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