The high-profile US murder trial of Lindsay Clancy, a woman who says she suffered from postpartum psychosis before strangling her three young children, has sparked a debate in the United States over maternal mental health.

The 36-year-old nurse does not deny strangling Cora, 5, Dawson, 3, and Callan, eight months, with fitness bands in their home in Duxbury, Massachusetts in January 2023. 

She then jumped out of a second-story window, leaving her paralyzed from the waist down and using a wheelchair.

Clancy however has pleaded not guilty by reason of insanity, saying she heard a voice ordering her to kill her children. Her lawyers say this was caused by postpartum psychosis. 

Prosecutors have rejected her argument, saying she had planned to murder her children and was able to understand the consequences of her actions.

For the past several weeks, dozens of women dressed in pink have come to the court in Plymouth to show their support for Clancy -- and to make a statement about women's health more generally.

Kelly Woods, a lawyer from Chicago, said she was attending the trial as a "big advocate" for people who suffer from postpartum psychosis.

"That is a very under-considered element of this case," Woods told AFP on Thursday, when jury deliberations began. 

"I certainly hope that the medical community can learn from this," she said. "I ultimately hope that there is more advocacy for postpartum depression and psychosis." 

Psychiatrists and people close to Clancy, as well as her estranged husband, described her distress during the five-week trial.

The nurse faces life in prison without the possibility of parole if found guilty. 

'Slipped through the cracks'

Postpartum psychosis is a medical emergency that affects about one to two women in every 1,000 births, said Sally Wilson, national training coordinator at the UK-based charity Action on Postpartum Psychosis.

Clancy's case is "an incredibly distressing and rare outcome of postpartum psychosis," Wilson told AFP.

During closing arguments, Clancy's lawyer Kevin Reddington recalled that the mother had made several pleas for help before the killings and received "lousy medical care" from the doctors she consulted.

"She was doing everything that she could to get help, and for whatever reason, she still slipped through the cracks," said Adrienne Griffen, executive director of the nonprofit Maternal Mental Health Leadership Alliance.

"That is the question that everybody is asking, is how do we prevent something like this from happening in the future," Griffen said, adding that mothers need to be connected with better resources.

The trial has revived memories of a similar case that also captivated the country 25 years ago: Andrea Yates, a Texas mother who drowned her five children in 2001.

Yates was initially convicted and sentenced to life in prison, but she was found not guilty by reason of insanity at a 2006 retrial and committed to a psychiatric hospital.

Good mother vs bad mother

Prosecutors acknowledged that Clancy was "suffering from mental illness" and tried to kill herself, but they argued that the killings were planned and particularly cruel.

Right-wing political voices have condemned the level of violence in the killings and the supporters who have gathered outside the courthouse.

"Lindsay Clancy deserves to die for murdering her three children," Katie Miller, a podcaster and wife of President Donald Trump's senior aide Stephen Miller, wrote on social media.

Juliet Williams, a professor of gender studies at the University of California, Los Angeles (UCLA), said the trial and debate around it shows "how profoundly invested Americans and the world remain in the figure of the mother."

She said the case has become an opportunity "for people not just to condemn a tragedy" but also show how "this figure of the good mother and then of course the bad mother becomes a dividing ground in our society."