Maine’s Title V Maternal and Child Health program recognizes the importance of supporting women’s health through screening, early identification, prevention and education. To this end, the focus is to support the health care infrastructure utilized to support the most vulnerable women. This is achieved through services that support and sustain the training infrastructure that provides care to Maine women. The goal is to ensure a highly capable provider infrastructure to lead women to access the health care system. This strategy creates a comprehensive women’s health care structure that addresses the health disparities that exist in our state.

Maine Family Planning’s mission is to ensure that all Maine people have access to high-quality, affordable reproductive health care, comprehensive sexual health education, and the right to control their reproductive lives. Maine Family Planning provides affordable, gender-affirming reproductive health care services for all Mainers, as well as primary care, help for new parents and families, and transgender health services. Through their 18 clinics and network of more than 40 partners, they provide statewide services.

Maine Center for Disease Control and Prevention (Maine CDC) public health nurses are registered professional nurses, working to improve, preserve, and protect the health and quality of life for all Maine citizens. Using nursing theory, research, evidence-based practice and the nursing process (assessment, diagnosis, planning, implementation and evaluation), public health nurses continually work to improve the health of individuals, populations, cultures and communities. Public Health Nursing serves the perinatal and maternal population with the best standard of care in their homes. They also hold vaccine clinics to ensure children are up to date on their immunizations including COVID-19. In addition to direct service to women, children and families, Public Health Nursing also provides educational events and outreach at the community level. This work includes hosting health clinics or educational sessions depending on the community need.

The Perinatal Outreach Education and Consultation (POEC) Services is a program designed to provide services to health care providers who care for Maine's birthing people and their newborns. POEC services are provided upon request to all Maine perinatal care providers including physicians, nurses, certified nurse midwives, certified professional midwives, and other individuals or groups with interest in healthy outcomes for birthing people and infants. This work includes direct consultation, training, webinars, lectures, and quality improvement programs. Using data from program evaluations, participant surveys and health outcomes in Maine, the training and support is tailored to the local level to promote investment in program quality improvement.

POEC efforts also include development and implementation of the perinatal system of care. The POEC works with birthing hospitals to ensure they are delivering services at the appropriate level of care and provides technical assistance to hospitals as needed in meeting this goal. Through a partnership with Maine’s Office of Population Health Equity, the POEC coordinator is working with non-birthing hospitals and Emergency Medical Technicians (EMT) to ensure they are trained to manage a delivery in an emergency situation. This effort is being piloted with EMTs serving the most rural areas of Maine.

Priority: Increase Women’s Access to High Quality Healthcare

Performance Measure (NPM): Percent of women, ages 18 through 44, with a preventive medical visit in the past year.

In 2020, about 75% of Maine women of reproductive age had a preventive medical visit in the previous 12 months; the U.S. rate was 71.2%. Maine ranked 13th highest in the U.S. on this measure and has slowly been improving since 2018. Maine women with health insurance were more likely than uninsured women to have had a preventive medical visit (79.8% vs. 41.3%), but otherwise there were no differences in receipt of preventive care by education, income, marital status, and rurality. Based on data from 2016-2020 among women 18-64 years of age, Hispanic and multi-racial women were the least likely to have had a preventive medical visit (71.8% and 66.9%, respectively). Black women in Maine were the most likely to report having had a preventive medical visit (89%). Among White women, 79.8% reported having a preventive health visit in the past year.

Maine’s FY21 efforts focused on establishing baseline data and engagement of maternal child health partners throughout the state working on improving access to care for women both preconception and primary care.

Strategy: Statewide affordable health care services by promoting access to both clinical and at home health care services.

Maine Family Planning (MFP) Association has direct or contractual agreements with 59 clinical sites. Services range from primary care sites operated by MFP, family planning clinics, planned parenthood clinics, federally qualified health centers and school-based health centers. In total these locations provided services to over 31,417 individuals.

Maine currently has 35 public health nurses (PHNs) and four contracted service providers in the more densely populated areas of the state. PHN and community health nursing contracts provide both prenatal and postpartum services for birthing persons. PHNs visits include breastfeeding, safe sleep, weight checks and consultation on cleft lip and/or palate diagnoses.

In addition, to family planning and clinical home visiting services, Maine recently changed the MaineCare eligibility rules for postpartum people from six weeks to one year. This change has the potential of providing services to birthing people with an SUD as well as services to people with postpartum mood and anxiety disorders. The eligibility change went into effect August 1, 2022.

Strategy: Maintain a training infrastructure for health care and community providers to promote high quality supportive services for women’s health

Maine offered four, 75-minute webinars on the following topics: Introducing the 2020 Best Practices in STI/HIV and Pregnancy Prevention; Creating a Safe Learning Environment; Supporting LGBTQ youth (in collaboration with OUT Maine and Equality Maine); and Accessing Sexual Health Services. A total of 73 educators attended the live sessions. Recordings of the webinars were made available to those not able to attend in person.

Strategy: Maintain a training infrastructure for community partners to promote well-women visits with their program participants

• WIC partnered with MFP to train all WIC site staff on women’s health issues and referring for well women visits. The training took place in March 2021.

• Participated in four community coalitions, providing education to other providers about MFP clinical and educational programming.
• Attended two Regional Learning Exchanges through the Youth Leadership Advisory Team to share challenges, solutions in serving target populations and providing information about services offered by MFP clinics.
• Provided five educational programs to youth; Queer Sex Ed for OUT Maine, North American Family Institute, Youth Leadership Advisory Team (YLAT) Conference presentation, YLAT Youth Session, and Queer Sex Ed for Equality Maine.

Strategy: Increase annual well visit referrals among women through perinatal programs (WIC, Public Health Nursing, Family Planning and MIECHV).

Public Health Nursing trained 22 staff members and Maine Families Home Visiting trained four new staff on effective communication and referrals for families.

Priority: Improve Care for women’s mental health

Performance Measure (SPM): Percent of women who report that they were asked about depression in the 12 months before they become pregnant.

In 2020, about 1 in every 4 pregnant persons had depression in the three months prior to getting pregnant. Young women (44%), those with less than a high school education (41.8%) and those with low incomes (37%), were especially at high risk for depression. About 75% of pregnant persons had a health care visit prior to becoming pregnant. Unfortunately, younger women with lower incomes and less education were the least likely to have had a health care visit. Of those who had a health care visit, about 74% reported that a health care worker screened them for depression. Screening rates did not vary based on age, income, or educational attainment. These data suggest that Maine’s strategies of increasing the proportion of women who receive preventive care and encouraging mental health screening at these visits can effectively identify women with mental health challenges and refer them to treatment.

Maine’s initial focus on this measure was to gain a stronger understanding of the current status of perinatal mood disorders and readiness of providers to address gaps in services. Key activities included:

• Six meetings were held with key partners and stakeholders to discuss the current practice and assess readiness to invest in system improvements.
• Conducted a survey with the Perinatal Leadership Coalition to obtain feedback.
• Initiated discussions with State leadership from various Maine DHHS Offices (i.e., Office of MaineCare Services) and the Substance Exposed Infant Taskforce to determine the most effective strategies for moving forward with this work.

Other planned activities have been delayed due to the unavailability of the provider to conduct the planned training series. Efforts will continue to implement the activities.