Credit: (AP Photo/Rogelio V. Solis)

New Jersey has experienced a surge of interest in improving its maternal health outcomes, among the worst in the nation, especially for Black women. Now advocates could have a clearer road map to healthier births.

On Tuesday the New Jersey Health Care Quality Institute, a nonprofit focused on policy improvements, released its maternity action plan — or MAP, as advocates call the document. The 40-page plan is designed to help focus and guide the work of state regulators, hospitals and other health care providers, insurance companies, philanthropic organizations and community groups seeking to reduce maternal mortality and racial disparities in these deaths.

“We asked, ‘What are the key policy areas that need to be strengthened or improved in some way to advance all of the recommendations of the Nurture NJ plan’,” said Linda Schwimmer, the quality institute’s president and CEO. That quest led the group to focus on four basic aims: a stronger, more diverse maternal health workforce; better data collection and use; payment reform to reward holistic care models, and better social supports like housing and child care.

The Nurture NJ plan, released in January 2021 by first lady Tammy Murphy, outlines nearly 100 recommendations to achieve what advocates say is a bold goal: halving maternal deaths within five years and ending the racial disparities, which the governor’s wife largely attributes to systemic racism.

New Jersey ranks 47th nationwide for its high maternal mortality rate — with 46.5 fatalities per 100,000 live births — and Black women are seven times more likely to die in childbirth here than white mothers, it notes.

The plan also includes both broad and detailed steps to address New Jersey’s racial disparities in maternal health, including calling for state government to declare racism a public health threat and establish a statewide diversity, equity and inclusion office.

“When you start to acknowledge (the negative impact of racism),” Schwimmer said, “by necessity the plan should work to address those issues. We are not going to get there if we are not intentional about it.”

Ongoing process

Some changes envisioned in Nurture NJ have been put in place — and hospitals have reported other gains in maternal health outcomes in recent years. But creating sustainable change will take time.

To help meet these goals, the plan — which includes input from the first lady’s office — seeks to scale up and sustain pilot projects that are working, provide direction for reforms yet to take root and generally accelerate the pace of change.

“It’s not meant to be a replacement for other plans out there” like Nurture NJ, said Kate Shamszad, the quality institute’s Medicaid policy director. “This just gives much more specificity” to the process, she said, calling it “concrete steps and guidance.”

While efforts to improve maternal health outcomes are not new — the quality institute has focused on the topic for nearly a decade — Schwimmer said the conversation is no longer considered a “niche topic.” Women’s voices have gained agency, the impact of racism is more openly discussed and political leaders — both in New Jersey and nationwide — have prioritized maternal health, she said. The maternal-health blueprint released by the White House in late June shares many similarities with the New Jersey plan, Schwimmer added.

“I think we are in a completely different environment than we were before,” Schwimmer said. “We think the time is right, the partnerships are right.”

The quality institute’s work on the plan was supported by the Robert Wood Johnson Foundation, among others. The Partnership for Maternal and Child Health of Northern NJ will host four online discussions about aspects of the plan over the coming weeks, starting Wednesday at noon with a session focused on diversifying the workforce.

Highlights of the plan

Building a more robust, diverse workforce:

• Develop a public-communications plan on the benefits of doula and midwife care; encourage providers to better integrate community-based health workers in maternal care; bolster the maternal health workforce pipeline.
• Secure commitments from professional societies to improve maternal health outcomes; develop pre- and post-licensing education for health providers; create an equity designation for private-sector providers.

Collecting and using data to improve equity and quality:

• Encourage the state health department to reframe targets for its Healthy NJ 2030 plan to eliminate racial disparities; improve the data quality and process used by the Maternal Mortality Review Committee; better integrate community feedback and data.
• Urge the department to develop a more data-driven and focused approach to addressing social disparities related to health and to better hold licensed providers accountable for racial inequities in outcomes.
• Require birthing centers to meet or exceed cesarean birth targets; insist hospitals better accommodate doulas and institute safe birth practices; empower regional health hubs to work with others to map Black maternal health hotspots, where services are lacking.

Reforming payment systems to create more holistic maternal/infant care:

• Ensure comprehensive family planning services are available to all residents; expand the use of perinatal risk assessments, which can identify problems early, as well as payment “bundles” that reward good outcomes. “Payment-system changes drive behavioral changes. It’s just a fact,” Schwimmer said.
• Expand access to breastfeeding support, evidence-based home-visit programs for newborns, child care assistance and trauma-informed care.
• Increase the number of baby-friendly designated hospitals, especially in maternal-mortality hotspots; support proven programs like CenteringPregnancy, which engage pregnant women and others in their care and with each other.

Improving community-based social supports:

• Invest more in safe, clean affordable housing; require private housing developers to create more homes for those who are pregnant and women with young children; address environmental factors impacting maternal and child health.
• Increase access to Earned Income Tax Credit and paid family leave; ensure participation in the Early Head Start program and expand child care opportunities with targeted state grants.