Women/Maternal Health - Annual Report FY19
Illinois’ Title V priority for the Women and Maternal Health Domain is:
- Assure accessibility, availability, and quality of preventive and primary care for all women, particularly for women of reproductive age (Priority #1)
There are some concerning trends for the health of Illinois’ women and mothers. In recent years, the maternal mortality and severe maternal morbidity rates have worsened slightly and continue to show large racial disparities. In Illinois, non-Hispanic black mothers are about twice as likely to experience a severe maternal morbidity and more than three times as likely to die as non-Hispanic white mothers (NOM #2, NOM #3). Building on improvements over the last several years, the teen birth rate in Illinois continues to fall to an all-time low in 2018 (NOM #23), representing more than a 50% decrease since 2010.
Most Illinois women are accessing important health care services; about 3 in 4 women of reproductive age received at least one preventative visit in the last year (NPM #1) and 3 in 4 pregnant women received prenatal care beginning in the first trimester (NOM #1). However, there are still opportunities to improve the receipt of needed these needed health services, particularly for women with lower educational attainment, lower income, or those on Medicaid or who are uninsured. There are also particular types of services, such as dental care and mental health care, that are more challenging for women to receive. For example, the proportion of pregnant women having their teeth cleaned during pregnancy has remained in the 40% range, and has not substantially improved since we began monitoring this indicator in 2012.
The rate of chlamydia infections among women ages 15-24 is one of the indicators with the highest racial/ethnic disparities in Illinois – with the infection rate being nearly 6 times as high among Black young women as it is among White young women. For this reason, Illinois will continue to monitor this indicator as SOM #1 and seek to improve reproductive health services through school-based health centers, the state’s family planning program, and coordination with the state STI program.
The IL Title V utilized the following strategies to address the Women and Maternal Health Domain priority:
A. Support dissemination of the Illinois Healthy Choices, Healthy Futures Perinatal Education Toolkit, which includes resources about pre-/inter-conception health and the transition to postpartum care.
In collaboration with EverThrive Illinois, IL Title V supports the ongoing enhancement, dissemination and tracking of the Illinois Healthy Choices, Healthy Futures Perinatal Education Toolkit. The toolkit was initially created by the Child Health Insurance Program Re-Authorization Act (CHIPRA) Quality Demonstration Grant workgroup to provide patient-focused information on preconception, prenatal, postpartum, and inter-conception health topics, provider-focused information on postpartum care transition strategies, a prenatal care quality assurance tool, and a high-risk referral crosswalk, developed by the American Congress of Obstetricians and Gynecologists (ACOG) and the Illinois Academy of Family Physicians (IAFP). The toolkit is accessible via a website maintained by EverThrive Illinois: http://healthychoiceshealthyfutures.org/. The primary audience for the toolkit is perinatal health providers.
During FY2019, EverThrive Illinois hosted, updated, and promoted the Healthy Choices, Healthy Lifestyles Perinatal Education Toolkit. More specifically, EverThrive engaged social service providers in providing direct feedback on the tool to ensure the relevance and accessibility of the Perinatal Education Toolkit. Home visitors, doulas, and case managers and other key stakeholders were convened to participate in focus groups. This activity led to a comprehensive update and re-organization of the toolkit to reflect the needs of this primary audience. According to EverThrive’s data, the toolkit received over 500 views within the first 6 months of FY2019.
B. Partner with the Illinois Department of Corrections and two state women’s correctional centers to support ongoing health promotion activities for incarcerated women (including health education programs and lactation support) and prison staff training.
During FY19, Illinois Division of Population Health Management (DPHM), which is a division of OWHFS, continued its collaboration with the Illinois Department of Corrections (IDOC). Illinois is home to three women’s correctional facilities, Logan Correctional Center (LCC), Decatur Correctional Center (DCC) and Fox Valley Adult Transition Center (ATC). Combined, these facilities house more than 2,500 women. There are a total of eight Mom and Baby joint housing units at the facilities.
DPHM has been able to establish a strong partnership with IDOC which allows DPHM to provide education and support to pregnant women and new mothers and infants housed within two of the facilities (LLC and DCC). The education and support consist of pregnancy education, breastfeeding education, and lactation support and counseling. The healthcare staff receives prenatal and delivery education as well.
DPHM also partners with outside agencies to support the women’s needs once a baby is delivered. A partnership with the Illinois Department of Children and Family Services (DCFS) assists in identifying appropriate parenting education curriculum. Another key partnership is the collaboration with the Women, Infants, and Children (WIC) program. This partnership helps to ensure that the women and babies are receiving the needed care through the services available while residing in IDOC.
There were several noteworthy activities during FY2019. OWHFS partnered with IDOC to open the Pregnancy Wing at LCC in March 2019. This wing houses all pregnant women in the facility in one location. In addition, DPHM provided the facilities with new breast pumps, pumping kits, milk storage bags, and breast pads. Secondly, it strengthened its partnership with the Baby Talk Program to provide enhanced educational services for new mothers and babies up to three years old who resided at DCC. Lastly, it encouraged and supported internal staff development. One of DPHM’s health educators became a Certified Lactation Counselor to better assist the women and babies during and after their pregnancy.
OWHFS and Title V leveraged the expertise of the regional Administrative Perinatal Center (APC) to provide additional trainings at both facilities. Specifically, four healthcare trainings were conducted between both facilities with approximately fifty staff being trained. The healthcare training team of the regional APC as well as the Maternal & Fetal Medicine (MFM) Physician have participated in the trainings. Establishing this relationship is important because it allows the MFM to meet with the women in their home setting prior to any office visits and address questions as well as identify anyone who may be experiencing a high-risk pregnancy. These interactions occur during the healthcare trainings and are part of a Q&A with all of the pregnant women present.
OWHFS’ work with IDOC is also supported by Title V’s perinatal nurse located downstate. During FY19, she attended hospital meetings discussing the care of women from the correctional centers and how perinatal regionalized care transports improve maternal and neonatal outcomes. The Title V perinatal nurse collaborated with the regional APC Network Administrator and the maternal-fetal medicine physician APC co-director to draft plans for health education programming for both centers. The Title V perinatal nurse collaborated with other OWHFS staff and proposed the educational plan for health programming to the administration of the LCC. Obstetrical and neonatal simulation training was provided on multiple occasions at the LCC to nurses, mid-level providers, nursing administration, and a physician. Based on the positive feedback from staff, obstetrical and neonatal simulation training was also provided on multiple days at the DCC. The Logan Correctional Center agreed to an unannounced simulation for staff which occurred in July 2019. This simulation allowed for staff to test their obstetrical and neonatal skills and allowed them the opportunity to debrief afterwards to identify other opportunities to improve the quality of care for pregnant women.
C. Identify pregnancy-associated deaths and facilitate two state Maternal Mortality Review Committees (one focused on pregnancy-related deaths and one focused on violent deaths)
Illinois was one of the first states to implement maternal mortality review and created the state Maternal Mortality Review Committee (MMRC) in 2000. Additionally, a second state committee, the Maternal Mortality Review Committee on Violent Deaths (MMRC-V) was formed in 2015 to review deaths of women who died within a year of pregnancy due to homicide, suicide, or drug overdose. These committees are structured as sub-committees of the state’s Perinatal Advisory Committee, with the purpose of providing expert recommendations to IDPH on how to improve maternal and infant health.
Since 2002, Illinois has followed the CDC recommendation to identify all pregnancy-associated deaths. Illinois uses multiple methods simultaneously to ensure pregnancy-associated deaths are accurately identified and counted each year. First, the state database of death certificates is used to identify deaths that may be pregnancy associated. There is a checkbox on the death certificate that indicates whether a woman was pregnant at the time of death or pregnant within the last year.
Some cause of death codes indicate that a death may have been related to pregnancy. Death certificates for any woman age 15 to 50 years are also checked against the databases of birth certificates and fetal death certificates to look for matching information. If there is a birth or fetal death record in the twelve months prior to a woman’s death, her death is flagged as a pregnancy-associated death. In addition to the state data systems, there are other ways that maternal deaths are identified in Illinois. All Illinois hospitals are required by the State to report any known pregnancy-associated deaths to IDPH within 24 hours. In addition, IDPH completes regular searches of major newspapers throughout Illinois to identify articles or obituaries that indicate the death of a woman while pregnant or within one year of pregnancy. For example, if an obituary mentions that a deceased woman has a surviving child who is less than one year old, the woman’s case is flagged as a potential pregnancy-associated death.
Once the list of potential cases is complete, IDPH contacts the hospitals and health centers where the women received care to request records from the time of her most recent pregnancy to her death. These medical records provide details about the woman’s death and her medical history. For instance, records are routinely requested from the hospital where the woman died, the hospital where she gave birth, and the physician office or health center where she received prenatal care. When relevant, records are also requested from police departments, sheriff’s offices, and medical examiner or coroner’s offices. IDPH is constantly reviewing records to identify additional hospitals or health care providers that may be able to send more records that provide information on the case. Hospitals and medical providers are required to provide copies of all medical records related to maternal deaths within 30 days of IDPH’s request. IDPH compiles this information to confirm and accurately track the number of pregnancy-associated deaths in Illinois each year.
Though information from death certificates and other public health records may help identify counts of maternal deaths, these records cannot determine the preventability of cases or the factors involved in the case. The CDC recommends review of maternal deaths by a multidisciplinary committee as a means of gathering additional information about how the woman died, whether the death was preventable, and opportunities for preventing future maternal deaths.
During 2017, IDPH implemented a new review process to align with best practices promoted by the CDC. The goal was to improve several key components of the review process, including standardizing case abstraction, increasing review efficiency through structured meeting facilitation, and shifting to a population-health focus (instead of a purely clinical emphasis) to also consider how social and non-medical factors that may have contributed to a death. Overall, IDPH saw a need for more structured administrative and technical support to the committees, especially in terms of chart abstraction and data analysis. As a result, IDPH committed to taking a more active role in supporting the committee meetings, participating in reviews, and collecting and analyzing data. To align with national work, Illinois adopted the use of standard CDC data collection forms and resources. This ensured that the data collected by the Illinois MMRC and MMRC-V would be consistent with each other and with other review committees across the country.
During 2019, Illinois continued to implement the maternal mortality review process for deaths potentially related to pregnancy. From October 2018-September 2019, the MMRC held 5 meetings during 2019 and reviewed 27 cases, and the MMRC-V held 2 meetings and reviewed 25 cases. IDPH completed its report of the cases reviewed during FY18 and published its first-ever maternal morbidity and mortality report in October 2018. The report disseminated information about adverse maternal outcomes and outlined specific recommendations for prevention. A press conference was held to publicize the report in October 2018. There was much interest in the findings and recommendations of the report. Numerous state legislation passed during the 2019 Legislative Session included the following:
- PA 101-0038 – Task Force on Infant and Maternal Mortality Among African Americans. This act creates the Task Force on Infant and Maternal Mortality Among African Americans Act. The task force, under the purview of the IDPH, is charged with establishing best practices to decrease infant and maternal mortality among African Americans in Illinois. The task force is to be compromised of various healthcare professionals and associations representing healthcare professionals, as well as a hospital administrator. The task force is to meet quarterly to review data and research to better understand the causes of high infant and maternal mortality among this population and produce an annual report to the General Assembly detailing its findings and any recommendations.
- PA 101-0091 – Maternal Blood Pressure Equipment. This act, effective Jan. 1, 2020 requires hospitals to have proper instruments available for taking a pregnant woman’s blood pressure.
- PA 101-0386 – Maternal Mental Health Insurance Coverage. This act requires insurance coverage for mental health conditions that occur during pregnancy or during the postpartum period.
- PA 101-0390 – Hospital Hemorrhage Training. Effective Jan. 1, 2020, this law requires all birthing facilities, defined as a hospital with at least one obstetric or neonatal intensive care bed, to conduct annual continuing education for providers and staff of obstetric medicine and emergency departments that may care for pregnant or postpartum women. This education must include management of severe maternal hypertension and obstetric hemorrhage. Applicable hospitals must demonstrate compliance with these education and training requirements.
Additionally, IDPH is required to “support” the Illinois Perinatal Quality Collaborative (ILPQC) to improve birth equity and reduce peripartum racial and ethnic disparities. The initiative is to include the development of best practices for implicit bias training and education in cultural competency to be used by birthing facilities in interactions between patients and providers.
Finally, IDPH’s Maternal Mortality Review Committee is to make available to all birthing facilities best practices for timely identification of all pregnant and postpartum women in the emergency department for appropriate and timely consultation with an obstetric provider. Applicable hospitals must update their policies to ensure they are identifying pregnant and postpartum women seeking care in their emergency departments. Hospitals may use telemedicine to meet this consultation requirement.
- PA 101-0445 - Pregnancy and Childbirth Rights. This law, effective Jan. 1, 2020, amends the Medical Patient Rights Act by setting forth certain rights that women have with regard to pregnancy and childbirth. The 19 rights outlined include appropriate access to care prior to, during and after the pregnancy, choice in the type of provider for her maternity care professional and the setting in which she receives her care. Healthcare providers, including hospitals, are required to post information about these rights in a prominent place in their facilities and on their websites.
- PA 101-0446 – Reporting of Infant and Maternal Mortality. These changes to the Hospital Report Card Act adds the following information that hospitals must submit as part of their quarterly reports to IDPH: (1) Each instance of preterm birth and infant mortality within the reporting period, including the racial and ethnic information of the mothers of those infants; and (2) Each instance of maternal mortality within the reporting period, including the racial and ethnic information of those mothers.
- PA 101-0447 – Maternal Levels of Care. This act requires IDPH to establish levels of maternal care for hospitals in Illinois. These levels of care are to be complimentary but distinct from the perinatal levels of care system. IDPH, by rule, will develop criteria for the designation of hospitals based on their capabilities. The department will also collect additional data on maternal mortality and morbidity to lead any future changes to the maternal levels of care.
- PA 101-0512 – Maternal Mental Health Education. This creates the Maternal Mental Health Conditions Education, Early Diagnosis, and Treatment Act. Effective Jan. 1, 2020, this act requires that the Department of Human Services (DHS) to develop educational materials on maternal mental health conditions, and make them available to birthing hospitals, defined as those hospitals with licensed obstetric beds. Starting Jan. 1, 2021, applicable hospitals must distribute those materials to employees regularly working with pregnant or postpartum women, as well as supplement those materials with information and resources relevant to their facility or region. Similar requirements currently exist in the Perinatal Mental Health Disorders Prevention and Treatment Act. Hospitals should review their policies to see how they can simultaneously comply with both requirements.
- PA 101-0390 - IDPH must support ILPQC efforts to implement an initiative to improve birth equity and address peripartum racial and ethnic disparities.
- PA 101-0390 - IDPH, in consultation with the MMRC, shall make available to all birthing facilities best practices for timely identification of all pregnant and postpartum women in the emergency department and for appropriate and timely consultation of an OB provider to provide input on management and follow-up.
- Budget passed with language extending Medicaid eligibility.
A second maternal morbidity and mortality report is scheduled for release in FY21.
In FY2019, IDPH pursued grant opportunities and partnerships that would enhance its efforts to improve maternal health and reduce maternal mortality in Illinois. IDPH successfully applied for a CDC Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE-MM) Grant. This grant supports IDPH’s efforts to support and manage the MMRCs. In addition, IDPH partnered with the UIC CoE-MCH on its HRSA Maternal Health Innovation Grant. IDPH is serving as a co-lead and the Title V Director is co-chairing the IL Maternal Health Task Force. Finally, IDPH has a key role on the Merck for Mothers Grant with EverThrive Illinois and the Alliance (a network of FQHCs). This grant seeks to improve prenatal care provided at FQHCs.
D. Conduct reviews of severe maternal morbidities (SMM) through the regional administrative perinatal centers and convene statewide SMM review sub-committee to develop recommendations for improving local reviews of SMM.
According to the Centers for Disease Control and Prevention, severe maternal morbidity (SMM) has increased over 200% between 1993 and 2014. In collaboration with the 10 Illinois Administrative Perinatal Centers and the UIC Center for Research on Women and Gender, Illinois began the Severe Maternal Morbidity (SMM) Surveillance and Review Project during 2017. In this project, all Illinois obstetrical hospitals identify and report on SMM cases, defined as a pregnant or postpartum (up to 42 days) woman who was admitted to an intensive care unit (ICU) and/or transfused with four or more units of packed red blood cells. The UIC Center for Research on Women and Gender (UIC-CRWG) developed a standardized SMM Review form in partnership with the APCs, which is being used by hospitals and APCs to collect more information on the circumstances surrounding SMM events, preventability, and opportunities for intervention. APCs are reporting the SMM Review forms into the ePeriNet database, which will allow for population-based analysis of SMM over time.
The UIC-CRWG provides in-depth technical assistance to the hospitals and APCs as they conduct reviews and evaluate the quality of the data reporting into ePeriNet. Monthly data quality reports are sent by UIC-CRWG to each APC administrator to support local review processes and to inform changes to the review form and ePeriNet data collection system. The UIC- CRWG team presented on project progress at five APCs and a joint meeting of the APC co-directors during the reporting period. The UIC team also creates an annual report for IDPH that summarizes the data.
E. Participate in ASTHO Long-Acting Reversible Contraceptives (LARC) State Learning Collaborative and advise state family planning program and contraceptive initiatives.
Although the ASTHO Long-Acting Reversible Contraceptives LARC Learning Collaborative ended in FY18, Illinois will continue to work to increase education and support of health care providers and patients around the use of LARC. This includes working with the Illinois Department of Corrections to incorporate family planning into the two women’s prisons to offer family planning services to women prior to release, collaborating to expand the efforts of ILPQC’s immediate postpartum LARC initiative and integrating the Title X Family Planning Program with school-based health centers.
F. Collaborate with IDPH Division of Oral Health to convene stakeholders and develop a statewide strategic plan and resource manual for oral health during pregnancy and early childhood (same as strategy #3-C).
IL Title V and the Division of Oral Health recognize that oral health is an essential component to improving the overall health for the women, children and families across Illinois. Anticipatory guidance, education, and risk-based care is routinely provided within the prenatal and primary care provider health care system. The Illinois Oral Health During Pregnancy and Early Childhood Project focused on the development of the Oral Health During Pregnancy and Early Childhood in Illinois resource manual. The resource manual presents actionable activities that encourage adoption of an oral health focus within the health care environment. This focus supports prenatal and primary care providers to educate, assess, and refer patients for oral health issues.
With a patient-focused and systems-oriented approach, prenatal and primary care providers can easily implement the field- tested oral health integration concepts provided in the resource manual. Oral Health During Pregnancy and Early Childhood in Illinois is divided into three main sections addressing educational information. The sections are: “General Information”, “Oral Health Practice Guidelines for Pre- and Perinatal Women”, and “Early Childhood and Families with Young Children”.
Further subsections detail strategies to implement for in-office system change. The appendices, inserts, and resources provide additional information aimed at improving health literacy, encouraging routine self-care practices, promoting prevention activities, and addressing access to treatment services.
To promote a change within inter-disciplinary systems, the Oral Health During Pregnancy and Early Childhood in Illinois resource manual establishes a care coordination protocol to close the communication loop between providers. The protocol includes a referral form for use by health care/support services providers to initiate a referral to an oral health care provider. To close the communication loop, the oral health provider completes the oral health section of the referral form and returns it to the referring provider. By using these forms, the communications between providers are standardized and coordinated.
G. Lead CoIIN- Social Determinants of Health workgroup to assess, quantify, and describe the impact that childcare has on prenatal, intrapartum, and postpartum care in Illinois and develop optional strategies and approaches that could be implemented in clinic and hospital settings to address childcare.
The iteration of the CoIIN-Social Determinants of Health workgroup focusing on childcare began in Fall 2017. Through focus groups and informal discussion with health care providers, the Illinois CoIIN team identified childcare, or lack thereof, during pregnancy, childbirth, and postpartum as a non-traditional social determinant of health that may negatively impact health outcomes for the mother and her baby. In informal discussions with Illinois’ birthing hospitals we learned that the lack of child care during pregnancy, at childbirth, and in the postpartum period is not only a barrier to timely access to health care, but has resulted in poor outcomes including the death of a mother, who while very ill, refused to go to the emergency department because she had no one to watch her new baby and another mother who miscarried because she left the hospital, against medical advice, to get home to other children who were unsupervised.
In the past, the lack of childcare has never been quantified. To begin to tackle this issue and make the case for changes in policy/procedures at the local, community, and state levels, the Illinois CoIIN team developed a three-pronged approach to collect data which consisted of surveying birthing hospitals, surveying Federally Qualified Health Centers (FQHCs), and interviewing Healthy Start clients.
In FY2019, the workgroup had great success in partnering with hospitals and local community health centers. The survey was disseminated a total of 98 hospitals and 44 FQHCs complete the survey. After reviewing the data from the completed survey, the workgroup explored the process for field testing questions it could potentially add to the state’s PRAMS project. Surveying postpartum women would add an individuals’ perspective to the need for emergency childcare in the prenatal, labor/delivery and postpartum periods. Approaching this systematically would enhance the PRAMS surveillance system in Illinois and potentially other states. The workgroup plans to draft and submit a formal field-testing report to the CDC so that the selected questions can be reviewed and hopefully added to the bank of questions from which state PRAMS projects can choose.
The workgroup activities have helped to strengthen IL Title V’s relationships with the Healthy Start Programs across Illinois. The team developed seven questions to survey among postpartum Healthy Start participants to gain insight on childcare related issues among postpartum women. A total of 29 women completed the surveyed. It is expected that another 15 women will complete the survey by the end of the calendar year. These women, however, will not necessarily represent Healthy Start participants.
For FY2019, one other notable activity was securing a Title V summer intern and two masters level interns over the summer. These interns help to write up preliminary results on the hospital and FQHC surveys and conducted a literature review. One of the interns, will continue at IDPH beyond the summer and will assist in developing a policy/status brief on emergency childcare in Illinois.
H. Participate in Partnership for Integrating Oral Health Care into Primary Care project with IDPH Division of Oral Health and a local health department to integrate the interprofessional oral health core clinical competencies into primary care practice, particularly for pregnant women and adolescents.
IL Title V, the IDPH Division of Oral Health, the Partnership for Integrating Oral Health Care into Primary Care project and the Champaign-Urbana Public Health Department (C-UPHD) coordinated to integrate the Health Resources and Services Administration’s interprofessional oral health core clinical competencies into primary care practice. This project will assist primary care health professionals and support staff at C-UPHD in conducting oral health risk assessments, screenings, preventive interventions, education, and interprofessional collaborative activities and, care coordination services, as applicable.
I. Establish well-woman care mini-grant program to assist local entities in assessing their community for need and barriers and developing a plan to increase well-woman visits among women ages 18-44.
To assist in addressing NPM #11, the IL Title V launched the Planning Grant to Increase Well-Women Visits in Your Community Program. The overall goal of the program is to increase the percent of women ages 18-44 with a preventive medical visit (well-woman visits). To accomplish this goal, grant applicants must develop a plan to positively influence the number of women seeking well-woman care within their respective communities. More specifically, applicants must define and describe the community served, including barriers to accessing health care; identify locations ln the community where women are seen for Well-Woman visits; and develop a plan to describe the increased well-women care utilization in the community. The official launch of the program launches in FY20, but in the interim, OWHFS staff developed the notice of funding opportunity and began to make key stakeholders aware of the opportunity.
More information will be provided in the FY20 Annual Report when the program is officially launched.
J. Partner with UIC Center for Research on Women and Gender to implement a program at two clinic sites to expand the capacity of health care providers in the state of Illinois to screen, assess, refer, and treat pregnant and postpartum women for depression and related behavioral health disorders.
The University of Illinois at Chicago's Center for Research on Women and Gender received Title V funding in FY19 to implement a program at two clinic sites to expand the capacity of health care providers in the state of Illinois to screen, assess, refer, and treat pregnant and postpartum women for depression and related behavioral health disorders. The long- term goal of the project is to pilot a combination of strategies to increase the capacity of perinatal providers to screen, assess, refer, and treat behavioral health disorders, and to increase awareness of and access to affordable and culturally- appropriate services to improve the mental health and well-being of pregnant and postpartum women and their infants in the State of Illinois. The main objectives of this project are: 1) Provide in-person workshop training and resources on screening, diagnosis, and referral for maternal depression and related behavioral disorders to perinatal providers; 2) Provide real-time psychiatric consultation and care coordination for providers; 3) Screen women for depression, anxiety, suicide risk, and substance use during the perinatal period using Computerized Adaptive Testing (CAT); 4) Increase access to depression prevention and treatment for medically underserved women using a telehealth intervention; 5) Increase access to substance use treatment for pregnant women; 6) Plan for scale-up and sustainability to implement the project components statewide.
To Top
Narrative Search