Women and Maternal Health Domain Annual Report for October 1, 2023 – September 30, 2024

 

For Women and Maternal Health (WMH), New York’s Title V Program selected National Performance Measure (NPM) 1: Percent of women, ages 18 through 44, with a preventive medical visit in the past year. New York selected this NPM because 1) preventive medical visits for individuals of reproductive age are foundational to health throughout the life course, 2) population health data demonstrate a need for continued improvement in this area, and 3) it relates directly to priorities voiced by women and families at community listening forums held across New York State (NYS). During the community listening sessions as part of the prior comprehensive needs assessment in 2019-2020, women and families expressed priority needs that include increased awareness of and access to community resources, quality health care, transportation, and social support. This NPM also aligns directly with the NYS Prevention Agenda goal to increase the use of primary and preventive health care services among women of all ages, especially women of reproductive age.

 

While NPM 1 directly measures annual preventive medical visits, it should be viewed as part of a continuum of primary and preventive care that includes preconception, reproductive and sexual health, family planning, prenatal, and postpartum care, as well as encompassing a full spectrum of medical, mental/behavioral health, oral health, dietary/nutritional, and other supports and services.

 

The New York State Maternal Mortality Review Board (MMRB) has identified increasing access to comprehensive, high quality health care services as a key element of efforts to improve mortality and morbidity outcomes. NYS is ranked 23rd in the nation for the rate of maternal mortality. While NYS’s overall maternal mortality rate has declined from its peak, there are differences in rates of maternal death by demographic information that persist. Severe maternal morbidity (SMM) also affects the lives of people who give birth, as well as their newborns, families, and health care provider teams, in profound and sometimes life-altering ways. SMM can result in prolonged hospital stays, substantial medical costs, higher life-long burden of health problems, physical and emotional stress, and interference with maternal-newborn bonding. Additionally, SMM is associated with an increased risk for maternal death. Perinatal depression is among the most common morbidities during pregnancy and the postpartum period, with significant implications for the health and well-being of the entire family. During listening sessions, NYS women and families consistently highlighted maternal depression as a challenge requiring more attention and supports.

 

Domain Objectives: The following specific objectives were established to align with this national performance measure:

 

Objective WMH 1: Increase the percent of women, ages 18 through 44, with a preventive medical visit in the past year by 5%, from 79.6% in 2018 to 84.6% in 2022. (BRFSS)

 

Objective WMH 2: Reduce the maternal mortality rate by 10%, from 17.8 deaths per 100,000 live births in 2014-2018 to 16 deaths per 100,000 live births in 2018-2022. (NVSS)

 

Objective WMH 3: Reduce the rate of severe maternal morbidity per 10,000 delivery hospitalizations by 5%, from 80 delivery hospitalizations with an indication of severe morbidity per 10,000 delivery hospitalizations in 2017 to 76 delivery hospitalizations with an indication of severe morbidity per 10,000 delivery hospitalizations in 2021. (HCUP-SID)

 

Objective WMH 4: Reduce the percent of women who have depressive symptoms after birth by 5%, from 13% in 2017 to 12.4% in 2021 (PRAMS)

 

Four strategic public health approaches were identified to accomplish these objectives. These strategies are presented in the State Action Plan Table, and each is described in more detail with specific program and policy activities that will be implemented to advance the broader strategic approach in the upcoming year.

 

Strategy WMH 1: Integrate specific activities across all relevant Title V programs to promote the health and wellness of people of child-bearing age, including enrollment in health insurance, routine well visits, pregnancy planning and prevention, and prenatal and postpartum care.

 

Improving the health of individuals of reproductive age requires a life course approach to be most effective. Preventive medical visits are a key opportunity for delivering health education and reinforcing health-promoting behaviors. Preventive visits for individuals of reproductive age help identify chronic conditions, such as hypertension and diabetes, which may contribute to maternal morbidity and mortality. Family planning and reproductive health visits ensure that individuals of reproductive age have access to contraception for pregnancy prevention, as well as counseling for reproductive life planning, appropriate birth spacing, and preconception health. Title V programs also provide enabling services, such as social support and referrals or linkages to a wide range of community services to holistically address health and wellness, including mental health and broader social needs that may impact a person’s ability to access health care and to healthy options. Incorporating specific activities across programs leverages the public health infrastructure and capacity supported through previous and ongoing Title V investments.

 

Through the Perinatal and Infant Community Health Collaboratives (PICHC) programs, community health workers (CHWs) conduct basic health and well-being assessments in the prenatal and postpartum periods using standardized evidence-based and/or validated screening tools to identify and prioritize the needs of the individuals and families they serve. Assessments are completed at enrollment and updated throughout clients’ service periods and individualized care plans are developed based on the needs identified. CHWs receive periodic training on 1) communicating with families on difficult and sensitive topics such as mental health and depression, 2) using a trauma-informed care approach, and 3) managing emergency situations. CHWs also connect clients and families to needed services and provide enhanced social support. CHWs help ensure early and consistent participation in preventive and primary health care services, including early prenatal care, particularly for those individuals not engaged in care and other supportive services. CHWs also provide health information to increase clients’ knowledge and their ability to self-advocate and make informed health care decisions with the goal of helping families achieve optimal health, self-sufficiency, and overall well-being.

 

PICHC programs’ coordinated outreach and engagement activities complement and collaborate with other home visiting programs serving the same communities including programs supported by New York’s funding from HRSA for the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) initiative. The MIECHV initiative provides funds to promote and improve the health, development, and well-being of children and families, who are most at risk for not receiving services, through evidence-based home visiting programs. The PICHC and MIECHV programs coordinated outreach, referral, assessment, and intake processes help identify and engage pregnant and parenting families to ensure they connect with home visiting programs and supportive services responsive to their needs.  

 

The goal of the PICHC initiative is to improve perinatal health outcomes and timely access to high-quality and respectful care. Funded programs implement strategies to improve the health and well-being of individuals of reproductive age and their families with a focus on individuals in the prenatal, postpartum, and interconception periods. PICHC programs are required to implement individual-level strategies to address perinatal health behaviors, and community-level strategies to address the broader social issues that can impact health outcomes. The core individual-level strategy is the use of CHWs to outreach and provide supports to individuals who have increased needs, low income, Medicaid-eligible, and are at risk for or who have a previous history of adverse birth outcomes. Community-level strategies involve collaboration with community partners, including community residents, to mobilize community action to address broader social needs that can impact perinatal health outcomes. In July 2024, a contract was established with Cicatelli Associates, Inc to support PICHC programs with the implementation of best practice community-based strategies to improve perinatal and infant health outcomes through the provision of technical assistance, training, and quality improvement efforts, including development of core trainings for CHW and CHW Supervisors.

 

PICHC utilizes a data management information system (DMIS) which is maintained by the Research Foundation of the State University of New York to collect and monitor PICHC program data.

 

The NYS Family Planning Program (FPP) supports 37 health facilities that are regulated by the Department under Article 28 of NYS Public Health Law (these include hospitals, clinics, health departments, federal qualified health centers) that operate 164 family planning clinic sites across the state. NYSFPP providers use funds to support comprehensive, confidential reproductive health services for low-income, uninsured, and underinsured women and men of reproductive age. Services provided include contraceptive services; preconception planning and counseling services; pregnancy testing and related counseling; preventive services such as basic health screening, screening for sexually transmitted diseases, HIV counseling and testing, and breast and cervical cancer screening; appropriate referrals; and health education. To address barriers to receiving reproductive health care, the NYSFPP applied for and was awarded a one-year telehealth grant (7/15/22-5/31/23) from the Office of Population Affairs to provide funds to FPP providers to support telehealth infrastructure, improve access to telehealth services, and support training and technical assistance for the FPP providers. Due to administrative challenges, we were granted a one-year extension through May 31, 2024. Thirty-one telehealth grants were awarded to support the enhancement of telehealth at family planning sites, ensuring continued access to core primary and preventive services.

 

As reinforced by the Needs Assessment community forums, increasing awareness of available resources among both consumers and providers is critical.  Home visiting programs are encouraged to promote use of the state’s Growing Up Healthy Hotline service which, in turn, provides callers with linkages to local community resources, supports, and services including Supplemental Nutrition Program for Women, Infants and Children (WIC), Medicaid, Family Planning, prenatal care, and the NYS Early Intervention Program. Social media and other emerging communication platforms increase the potential to reach New York’s population which is large and spread out geographically. Title V staff incorporate a science-based health messaging approach when developing social media campaigns, with the goal of educating New Yorkers to positively influence their health care decision-making capabilities and improving overall health outcomes.

 

Strategy Progress: The NYS Title V Program led the following specific program and policy activities to advance this strategy during the 2023-24 reporting period:

 

WMH 1.1 Across all Title V programs, enhance promotion of the NYS Growing up Health Hotline (“the Hotline”) to increase awareness of available community resources, supports, and services including WIC, Medicaid, family planning, and prenatal care.

 

The Hotline contracts with the state preferred vendor, Goodwill of the Finger Lakes, was established through a noncompetitive procurement for July 1, 2023 – June 30, 2026. As part of this contract, the Department is working with the Hotline and a third-party vendor to build text messaging capacity for the Hotline, giving New Yorkers another mechanism to get information about services they are interested in or need. During the program year, Department staff worked with internal stakeholders to support the build-up of the framework for the texting platform and developed decision trees for priority topics including WIC, children and youth with special health care needs, and parent and perinatal support that will be used for consumers texting the GUHH. Development of the texting platform, along with planning for a statewide multimedia awareness campaign continue into the 2024-25 program year.

 

Staff promoted the Hotline across WIC, perinatal home visiting programs, and family planning programs, as well as the NYS Early Intervention Program. When feasible and relevant, the Department includes the Hotline information as a key resource for programs serving the maternal, infant, and child health populations. This includes social media posts, and inclusion of the website, phone number, and/or QR codes on brochures and presentations. Additionally, information about the Hotline is included in state-supported insurance program materials (Medicaid, Child Health Plus, New York State of Health).

 

During FFY24, the GUHH handled 16,444 calls, most of which resulted in a referral to WIC local agencies. Other callers were referred to the NYS Marketplace for health insurance coverage or local departments of health for early intervention services.  NYS WIC continues to promote the GUHH in brochures and via the online chat service “Wanda”.

 

WMH 1.2 Through the Regional Perinatal Centers (RPCs) and their networks of affiliated birthing hospitals, support and enhance capacity to provide high quality perinatal telehealth services and perinatal subspecialty providers, particularly to rural communities and communities with limited access to such services.

 

Telehealth services are tailored based on regional assessments of provider and affiliate hospital needs, including routine prenatal and postpartum care and/or specialty care such as maternal-fetal medicine, radiology, and genetic counseling. Each of the five upstate RPCs that serve a significant rural population identified needs and capacity. RPCs continue to develop and expand telehealth services to increase local access to maternal-fetal medicine specialists. Examples of telehealth services provided this year include lactation consultations, opioid use disorder education, and transfer consultations by the RPCs with affiliates. Tele-ICU services are currently in development with Albany Medical Center and affiliates.  Data are not yet available to assess outcomes or delivery of services, as there were significant delays in project implementation due to COVID-19 and nationwide microchip and equipment shortages. Title V funding for these programs ended during the program year, and staff are working to summarize the processes and lessons learned from this program.

 

See Strategy PIH 1.5 for more detail on Telehealth Services for Neonatal Services

 

WMH 1.3 Through the PICHC and MIECHV programs, integrate virtual home visiting services to increase acceptance and support of services for families who have been difficult to reach and stay connected.

 

Virtual home visits conducted in the context of the response to the COVID-19 pandemic have helped to maintain communication and allow essential home visiting services to continue including providing health information, support and referral and follow-up for preventive and prenatal care visits. The use of virtual tools for home visiting, outreach, education, and further social supports continued to be integrated as a supplement to safe, in-person services during the COVID-19 pandemic. During the reporting period, PICHC programs conducted 29,661 visits with clients, of which 41% (12,270) were virtual visits. Home visitors continuously disseminated guidance from reputable sources, such as the NYS Department of Health and CDC, on infectious diseases and perinatal health as it became available.

 

WMH 1.4 Through the PICHC program, continue to support home visitors to conduct outreach to find and engage high-risk pregnant and postpartum families in consistent, comprehensive preventive and primary care services, including prenatal, interconception and postpartum care.

 

The PICHC programs supported home visitors to conduct outreach to find and engage high-risk pregnant and postpartum families in consistent and comprehensive preventive and primary care services, including preconception, prenatal, and postpartum care. From October 1, 2023, to September 30, 2024, a total of 5,436 clients were enrolled in the PICHC programs. Home visitors routinely screened clients for health insurance enrollment and health care engagement, assisted them in getting care through referrals as needed, and provided ongoing social support and reinforcement for health care utilization. They also provided clients with health information and social support to increase their knowledge and ability to self-advocate and make informed health care decisions, including help developing birth plans. During this period from October 1, 2023, to September 30, 2024, visitors engaged 2,904 prenatal clients to create a birth plan. Visitors also issued a total of 25,778 referrals, with the top five referral categories overall being clothing/baby care items, transportation, food pantry, housing assistance and dental services.

 

 WMH 1.5 Through the Family Planning Program, continue to support the delivery of comprehensive, confidential reproductive health services for low-income people of reproductive age who are uninsured or underinsured.

 

Addressing barriers to accessing reproductive health services continues to be a priority of all FPP work. An example was an additional one-time federal grant award to continue supporting telehealth services in service areas beyond the COVID 19 pandemic. Thirty-one family planning providers received telehealth funding to enhance telehealth services in their communities. This allowed providers to develop social media campaigns, purchase advertisements, develop telehealth educational materials, upgrade their infrastructure, equipment and software to enhance telehealth visits and provide mobile health services to high-risk zip codes.

 

To increase awareness of services offered, the NYSFPP developed a statewide awareness campaign (2/27/24- 3/7/25) to promote the availability of high-quality services that are free to low cost for the most vulnerable communities in New York State. Media platforms involved social, digital, radio and out-of-home mediums (transit and place-based advertising). Messaging and images developed for all platforms, aimed to increase knowledge of the availability of Family Planning services including contraceptive education, preconception health services, counseling and testing for HIV, testing and treatment for sexually transmitted infections, routine screening for chest/breast cancer or other preventive reproductive/sexual health services.

 

Family Planning Providers continue to support dispensing 12-month supplies of contraceptives when appropriate and continue to assist uninsured clients in enrolling in the most appropriate health insurance plans including Medicaid, Family Planning Benefit Program (FPBP), and Family Planning Extension Program (FPEP).

 

WMH 1.6: Continue to support prevention and response services for sexual violence through the Sexual Violence Prevention Unit. Women’s health and reproductive health are significantly interconnected with sexual assault.

 

Women between the ages of 12 and 34 are at the highest risk for sexual violence. In the short term, sexual assault can lead to unintended pregnancies, sexually transmitted infections, and injuries. However, there are many more long-term health consequences from sexual assault that range from depression, anxiety, and suicide to obesity, cancer, high-blood pressure, fibromyalgia, fibroids, preterm labor, miscarriages, fetal growth issues, placental abruption, and frequent cesarean sections (The Sexual Abuse to Maternal Mortality Pipeline). The NYS Rape Prevention and Education program aims to prevent the perpetration and victimization of sexual violence using a public health approach by prioritizing the primary prevention at the broader community and societal levels to shift social norms, policies, practices, and the built environment. To support survivors of sexual violence, 70 Department-approved Rape Crisis Programs sites provide support and advocacy services. Finally, the Sexual Assault Forensic Examiners (SAFE) Program consists of hospital programs, training programs, and examiners to respond to survivors of sexual assault and collect forensic evidence.

 

WMH 1.7 Continue to provide training to PICHC and MIECHV programs on the CDC Learn the Signs Act Early (LTSAE) campaign and collaborate with the NYS Council on Children and Families (CCF) on the Early Childhood Comprehensive Systems (ECCS) grant, which supports dissemination of LTSAE materials.

 

In December 2023, PICHC and MIECHV-funded home visiting staff attended a webinar presented by developmental pediatrician and LTSAE ambassador, Dr. Elizabeth Isakson, provided LTSAE training, and a representative from the NYS Council on Children and Families provided an update on developmental monitoring materials which can be obtained without cost and provided to families. Throughout the year, staff met internally and with the Council to learn more about the resources and to identify ways by which the resources could be distributed. LTSAE provides easy-to-understand information about developmental milestones for infants and young children and steps to take if there are concerns.

 

WMH 1.8 Through the MIECHV Initiative, direct American Rescue Plan Act (ARPA) Act funds to MIECHV-funded programs.

 

Staff allocated ARPA funds to Healthy Families New York (HFNY) programs via a new Memorandum of Understanding (MOU) with the NYS Office for Children and Family Services (OCFS), which oversees HFNY programs. New contracts were established with Department-managed Nurse Family Partnership (NFP) programs. In FFY23, NFP and HFNY programs, continued to use ARPA funds to support families participating in home visiting by provision of internet-connected technology and met the emergency needs of clients by supplying prepaid grocery cards, diapers, and other infant supplies. Programs have also used funds to provide technology for home visitors to conduct virtual home visits and bolstered recruitment or retention of home visiting staff with incentive payments.

 

WMH 1.9: Through public awareness campaigns, promote messages about maternal warning signs to educate pregnant and postpartum women about when to seek help for untoward conditions associated with perinatal complications.

 

As in previous years, the Department continued its support and implementation of the Hear Her Campaign statewide. This campaign continues to be recommended through the NYS Maternal Mortality Review Board to increase awareness about the importance of recognizing early urgent maternal warning signs for pregnant and recently pregnant people. The simple message is that listening and acting quickly could save a life. The campaign ran in September – October 2024. The Department utilized social media platforms (Facebook, Instagram, and Snapchat) to convey information to pregnant people and their partners, friends, and family about pregnancy-related complications. In addition to previously developed palm cards, the campaign also used a new palm card series tailored to Native American and Alaskan Native birthing people, and one for their family and friends. These palm cards were co-branded, printed, and distributed to NYS home visiting programs for use with clients. The palm cards were translated into the ten languages most commonly spoken in NYS and are available on the Department’s website at NYS Hear Her Campaign (ny.gov) for downloading and printing, or they can be ordered from the distribution warehouse free of charge. In addition, the Department co-branded and printed the CDC’s Urgent Maternal Warning Signs poster (https://www.cdc.gov/hearher/maternal-warning-signs/index.html; in English and Spanish).

 

All media were prioritized to reach areas with higher incident rates, areas with Native American reservations, and/or locations with higher concentrations of pregnant women, such as birthing facilities.

 

Strategy WMH 2: Strengthen coordination between birthing hospitals, outpatient health care providers, and other community services to make support for birthing parents and their families more comprehensive and continuous.

 

Coordination between birthing hospitals, community providers, and community-based organizations that provide essential support to birthing persons and their families is critical to maintaining optimal health and well-being and ensuring continuity of care during this period in a person’s life. PICHC programs routinely coordinated with a wide variety of community-based organizations that provide health and social support services to address needs related to both physical and mental health, and broader needs such as safe housing, transportation, poverty, and nutrition. Birthing hospitals in NYS are required to provide similar referral services through support and social services. As noted above, telehealth services have emerged as a promising approach to delivering clinical care that can be tailored to the needs of each region and community, both urban and rural. Strengthening the connection between the PICHC providers and individual birthing hospitals ensures that pregnant New Yorkers, including those with high-risk pregnancies and chronic conditions, are connected to the highest quality of birthing services and support services, including timely postpartum care.

 

Strategy Progress:

 

WMH 2.1 Establish regulations to require birthing hospitals to provide referral and support for ancillary services, including mental health, alcohol and substance use treatment, and other services. Note: Activity modified due to delayed progress in past reporting periods.

 

The Perinatal Services regulation package, covering five sections/parts of Title 10, New York Codes Rules and Regulations, was developed to update and support perinatal services and perinatal regionalization were published for public comment on May 31, 2023, for a 60-day public comment period. This resulted in over 100 submissions from a wide array of stakeholders and interested parties. The Department began review and analysis of the public comments, identifying several hundred individual comments specific to the proposed regulations. Additionally, the Department considered revised Standards for Levels of Neonatal Care, published on May 22, 2023.

 

Comments and revised standards were reviewed and incorporated into an assessment of public comment. Due to the sheer volume of comments received and other technical challenges, the Department was unable to submit revised regulations for further consideration in accordance with the required timeframes. Title V staff continue to review and assess comments, and incorporate changes to the proposed regulations, now anticipated to be published anew in late 2025 or early 2026.

 

WMH 2.2 To improve coordination and increase bilateral referrals between birthing hospitals and home visiting programs, Title V staff will assist in connecting PICHCs with their local birthing hospitals and support formal meetings. Additionally, Title V staff will share promising and best practices from established home visiting-birthing hospital partnerships across the state to encourage collaboration.

 

Prior to the reporting period, Title V staff and two public health graduate student interns conducted surveys and key informant interviews to understand the current state, promising and best practices to support and strengthen bidirectional relationships between birthing facilities and community-based home visiting programs. Title V staff continued to work on this project during the reporting period. This activity will be advanced when new program staff begin and are able to work on the remaining elements of the project, which will include developing resources and presentations to share information with both stakeholder groups. Further activity will be reported in future annual reports.

 

New Activities: In addition, Title V staff made progress or completed additional activities related to this strategy:

 

WMH 2.3: Implement a Vaccine Hesitancy Media Campaign to promote COVID-19 vaccination among pregnant and postpartum individuals and their families.

 

No significant activity was completed during the reporting period.

 

Strategy WMH 3: Apply public health surveillance and data analysis findings to improve services and systems related to maternal and women’s health care.

 

Data-driven, evidence-based practice is essential to achieving public health goals for the Title V program. Across all Title V programs, continuous effort is needed to enhance the collection, analysis, and sharing of data to inform the planning and implementation of Title V-funded programs and related policy work. Sharing data with stakeholders, including providers and community members, is critical to raise awareness, empower community action, and facilitate quality improvement efforts at all levels. 

 

Title V staff have implemented a comprehensive review process with the multidisciplinary NYS Maternal Mortality Review Board (MMRB) for the purpose of reviewing maternal deaths and maternal morbidity. NYS has an established public health surveillance process in place to identify and review cases of maternal death through multiple sources of data and chart reviews. The cases are identified within one year of the date of death and the case reviews are completed within two years of the date of death. The 2021 maternal death cohort review was completed by the end of calendar year 2023. The 2022 maternal death cohort review was completed by the end of calendar year 2024.

 

Analysis of NYS Perinatal Quality Collaborative (NYSPQC) project data provided by participating birthing facility teams helps to improve services and systems related to maternal health care. The NYSPQC, with support from the American College of Obstetricians and Gynecologists District II of NY (ACOG-NY), Healthcare Association of New York State (HANYS) and Greater New York Hospital Association (GNYHA), has led to a specific improvement project related to access to respectful care during birth, an important area related to maternal mortality and morbidity.

 

Based on analysis of qualitative data obtained from the 2018 listening sessions that engaged over 200 women statewide, the Department developed and implemented a comprehensive interdisciplinary hospital quality improvement project focused on access to respectful care. The NYS Birth Improvement Project launched in January 2020 and has engaged birthing facility staff from clinical, administrative, and executive levels to analyze policies and procedures that may impede access to high-quality, respectful care and develop strategies to improve outcomes. In Fall 2024, project planning was finalized for an expansion in January 2025 to the NYSPQC Birth Access & Safe Reduction of Nulliparous, Term, Singleton, Vertex (NTSV) Cesarean Birth Project, adding an emphasis to reducing the NTSV cesarean birth rate.  This included the development of a recruitment package, driver diagram, and project measures.  The project has and continues to include a comprehensive training curriculum. As with all NYSPQC projects, Title V staff have been collecting and performing analysis of project data throughout the project period. Details on the expansion will be reported on in the 2024-25 Annual Report.

 

Strategy Progress: The Title V Program led the following specific program and policy activities to advance this strategy during the 2023-24 reporting period:

 

WMH 3.1 Summarize, share, and discuss findings of the Maternal Mortality Review Board (MMRB) with key partners, including the Maternal Mortality Advisory Council, to inform statewide prevention strategies.

 

As of September 2024, the Maternal Mortality Review Board (MMRB) was comprised of 29 multidisciplinary experts who served and represented the breadth of the population of New York State. The MMRB reviews examines information related to pregnancy-associated deaths and issues findings and recommendations to advance the prevention of maternal mortality. MMRB recommendations largely focused on engaging hospitals in quality improvement collaboratives and efforts to improve access to high-quality, respectful care. In March 2024, the Department published the MMRB’s report, New York State Report on Pregnancy-Associated Deaths in 2018-2020. This statewide report summarizes findings and recommendations from the comprehensive review of New York State pregnancy-associated deaths that occurred in 2018, 2019, and 2020. Statewide, 386 pregnancy-associated deaths of New York State residents occurring in 2018-2020 were identified. Of the 386 pregnancy-associated deaths, 121 were found to be pregnancy-related, 202 were found to be pregnancy-associated but not related, and 63 were found to be pregnancy-associated but unable to determine relatedness. The MMRB developed 685 recommendations for the 2018-2020 maternal death cohort, 18 of which were designated as key recommendations and listed in the statewide report.

 

The MMRB shared this report with the Maternal Mortality and Morbidity Advisory Council, which is comprised of 19 multidisciplinary experts, including community members, community-based organizations, midwives, physicians, and healthcare executives knowledgeable in the fields of maternal mortality, women’s health and public health. MMMAC members reviewed the MMRB’s maternal mortality recommendations and developed their own recommendations on policies, best practices, and strategies to prevent maternal mortality and morbidity. In March 2024, the MMMAC published a report, the New York State Maternal Mortality and Morbidity Advisory Council Report 2023, that summarizes the activities of the MMMAC, as well as details the MMMAC’s key recommendations to prevent maternal mortality and morbidity. The MMMAC made 12 recommendations to reduce maternal mortality and morbidity and address maternal health outcomes. In June 2024, the MMMAC developed a presentation that summarized its report findings for use in the community. The presentation was used by council members to highlight the work and recommendations of the MMMAC and MMRB in their communities.

 

WMH 3.2: Issue a maternal mortality report to provide data and information that can be used to improve maternal outcomes. 

 

The NYC Department of Health and Mental Hygiene’s Maternal Mortality Review Committees (MMRC) published findings and recommendations from its 2016-2020 review of NYC maternal deaths and presented this information during a citywide event on September 25, 2024, Ending Maternal Mortality in New York City: A Blueprint.

 

During the reporting period, the MMRB met virtually five times to review maternal death cases. The MMRB assessed the causes of death, factors leading to the death, and preventability for each maternal death reviewed. Staff developed a written report of the findings and recommendations for the 2018-2020 maternal death cohort to prevent future deaths and reduce risks. In March 2024, the findings of the 2018-2020 maternal death case reviews and related key recommendations were published in the New York State Report on Pregnancy-Associated Deaths, 2018-2020 (https://www.health.ny.gov/community/adults/women/maternal_mortality/docs/maternal_mortality_review_2018-2020.pdf).  The NYS Department of Health’s report integrates deaths in NYC, and which were reviewed by the city’s MMRC.

 

In November 2023, MMRB members released the issue brief Spotlight on Perinatal Substance Use Disorder (https://www.health.ny.gov/community/adults/women/maternal_mortality/docs/2023-11_spotlight.pdf).  Review findings and recommendations for the 2021 cohort will be published in the next reporting period. Title V staff developed dedicated Maternal Mortality pages which were deployed to the NYS Department of Health’s website and can be found at https://www.health.ny.gov/community/adults/women/maternal_mortality/.

 

WMH 3.3: Identify cases of Severe Maternal Morbidity (SMM) through hospital discharge data and conduct an analysis using linked birth data and hospital discharge data to define the major causes of maternal morbidity.

 

The planned Severe Maternal Morbidity (SMM) analysis has been completed and is under Departmental review. Analytic staff identified cases of SMM through hospital discharge data and conducted an analysis using linked birth data and hospital discharge data to define the major causes of maternal morbidity. This project will culminate in the release of a statewide report on SMM, spanning a decade of data. More information will be reported on in the 2024-25 Annual Report.

 

WMH 3.4: Through the New York State Perinatal Quality Collaborative (NYSPQC), continue work with birthing hospital teams and community-based organizations, through the NYS Opioid Use Disorder (OUD) in Pregnancy & Neonatal Abstinence Syndrome (NAS) Project.

 

While the active phase of the NYSPQC’s Opioid Use Disorder (OUD) in Pregnancy & Neonatal Abstinence Syndrome (NAS) Project closed in mid-2023, the NYSPQC has continued to focus on the topic by offering educational webinars, distributing resources, and spreading awareness on learning opportunities related to the topics. The NYSPQC produced two new brochures and a poster on Naloxone, the life-saving medication that can reverse opioid overdose, for people who are pregnant, people who recently gave birth, and their support persons. The posters are available in English and Spanish, and the brochures are available in the top 11 languages spoken in NYS. During the reporting period, the NYSPQC received supplemental grant funding, allowing for continued focus on OUD in pregnancy and NAS work. Specifically, the funding has supported ongoing educational curriculum focused on OUD in pregnancy and NAS for all NYS birthing facilities and perinatal care providers. Additionally, the NYSPQC has developed and shared resources with partners via the listservs, Basecamp, website, and conferences and events.

 

WMH 3.5: Collaborate with the NYS Department of Health’s AIDS Institute and the New York City Department of Health and Mental Hygiene on efforts to address significant increases in the number and rate of infectious (primary, secondary, and early latent or P/S/EL) syphilis among NYS females of childbearing age.

 

See PIH 3.5 for details.

 

Additionally, in April of 2024, the Family Planning Program, funded by Title X, was invited by the Office of Population Affairs (OPA) to participate in a pilot program to decrease congenital syphilis. Monroe County, which has a high index of congenital syphilis cases, was chosen and a Title X clinic was selected.  The clinic was provided with equipment, training, and additional resources to offer point-of-care syphilis testing to each person who has a positive pregnancy test in the clinic at the time of their positive pregnancy test. The pilot program completed in December of 2024.

 

New Activities: In addition to these activities, Title V staff supported additional activities related to this strategy, including:

 

WMH 3.6: Appoint a perinatal psychiatrist to the MMRB to enable recommendations and strategies to reduce maternal mortality related to mental health conditions in pregnant and postpartum women.

 

A perinatal psychiatrist was appointed to the MMRB to enable recommendations and strategies to reduce maternal mortality related to mental health conditions in pregnant and postpartum individuals.

 

WMH 3.7: Through the New York State Perinatal Quality Collaborative (NYSPQC), engage NYS birthing facilities in a comprehensive interdisciplinary quality improvement project focused on implicit bias.

 

The NYS Birth Improvement Project (NYSBIP) launched in January 2020. The project seeks to assist birthing facilities in identifying how individual and systemic issues impact birth outcomes and in taking action to improve both the experience of care and perinatal outcomes for all people in the communities they serve. (See Strategy WMH 4 below for further detail).  In Fall 2024, a recruitment package, driver diagram, and project measures were developed for the project expansion to the NYSPQC Birth Access and Safe Reduction of NTSV Cesarean Birth Project, adding a focus to reduce the NTSV cesarean birth rate.  Details on the expansion will be reported in the 2024-25 Annual Report.

 

In addition, the NYSPQC began developing the NYSPQC Birth Improvement Toolkit, which contains presentations, tools, resources, and data forms created by the project and participating facility teams. The toolkit will assist birthing facilities that participated in the project with continued efforts and sustainability related to improved access to high-quality and respectful birth care. It will also provide resources to non-participating birthing facilities.  The toolkit distribution will occur in the next reporting period.

 

Over 75 New York State birthing facilities are participating in the expanded project, which seeks to assist birthing facilities in identifying how individual and systemic issues impact birth outcomes at their organizations and taking action to improve both the experience of care and perinatal outcomes for all people in the communities they serve, as well as to reduce the NTSV cesarean birth rate. Monthly data collection and analysis for the project began in April 2021 and is ongoing. Participating facilities have taken part in educational opportunities perinatal health care, as well as reducing the NTSV cesarean birth rate, developed new and/or improved existing policies related to these topics, and worked to ensure they are centering the experience of people who are giving birth through the implementation of a Patient Reported Experience Measure (PREM). The PREM, which was implemented in July 2021, is administered to birthing people prior to their discharge from participating hospitals. 

 

As of September 30, 2024, more than 70,000 PREMs have been submitted. The data collected through the PREM is analyzed by Title V staff and reported back to facilities. 82% of facilities have implemented a Patient Reported Experience Measure (PREM) survey that is offered to every birthing person prior to discharge. 88% of facilities are collecting demographic data for birthing people; 50% are using perinatal data stratified by demographic information to develop specific actions to support their patients. In response to the project scope expansion, a new outcome and balancing measures report was developed for facilities’ use, related to NTSV cesarean births.

 

WMH 3.8: The Rape Prevention and Education Program created Regional Profiles to serve as living documents of publicly available data across the 17 counties covered by the six Regional Centers for Sexual Violence Prevention. These profiles are used to assist the Regional Centers in making informed decisions when working with their communities utilizing various data sources such as the State Liquor Authority, New York State Education Department and the US Census.

 

The Rape Prevention and Education Program created “Regional Profiles” to serve as living document of publicly available data across the 17 counties covered by the six Regional Centers for Sexual Violence Prevention in New York State. This work was completed in the 2022-23 reporting period, and no further work was done in this reporting period.  

 

In addition to the updates above, the Division of Family Health through the Title V program is advancing public health surveillance and data analysis to improve services and systems related to perinatal and infant health care. A new Bureau of Data Analytics, Research and Evaluation (BDARE) was created to support research and data needs across DFH. The consolidation of data and analytic staff into one Bureau under the direction of a new Bureau Director with a DrPH in Epidemiology will create efficiencies and cross training as well as provide professional development opportunities to further advance the use of data in MCH programs and policy decisions.

 

Strategy WMH 4: Address broader social issues that impact women’s health and their ability to access and use health care across the life course.

 

Women and Maternal Health outcomes are impacted by the broader social issues that are influenced by the conditions in which people are born, live, work, play, learn, and age. These social issues include factors like socioeconomic status, education, community environment, employment, social supports, and access to health care services. Systematic differences in the distribution of resources are barriers to people’s ability to access services and the quality of clinical care. All ten priorities that emerged from community members' input during the needs assessment touch upon these broader social issues and needs. These factors impact the health outcomes of both individuals and entire communities.

 

The NYS Title V Program strives to contribute to broad-based efforts to address these broader social needs. Strategies focus on improving outreach to find and engage high-need women and their families in health insurance and health care; increasing knowledge of available community resources and supports; working with community stakeholders to improve delivery of care and services; developing supports, opportunities and social norms that promote and facilitate healthy behaviors across the lifespan; involving community members in program implementation and policy development; and promoting community engagement and mobilization to proactively address community and systems-level factors impacting these social issues.

 

The PICHC program incorporates a multi-faceted approach to ensure that addressing these broader social needs are embedded in the program’s framework. The overall intended outcomes of PICHC are to help families achieve an optimal level of health, self-sufficiency, and overall well-being.

 

As part of the PICHC contractual agreement, Title V staff worked to ensure that home visitors are compensated with a living wage and afforded promotional opportunities to the greatest extent possible. Title V staff continue to provide information to PICHC programs about living wages when PICHC programs are hiring new program staff. Title V staff also continue to support the use of the CHW to CHW Supervisor pathway developed by Title V staff which supports experienced CHWs to advance to a supervisory role using a specific development plan that includes submission of the CHWs resume, a one-year probation period and additional training on Mental Health First-Aid, Case Management, Identification of Child Abuse and Maltreatment, Crisis Intervention, and Identification of Intimate Partner and Domestic Violence.

 

CHWs conduct enhanced outreach, perform intake screening assessments using evidence-based tools, issue referrals and follow-up for needed services, work with clients to develop birth and postpartum plans, and connect or provide support groups for clients on topics related to breastfeeding, parenting/childbirth classes, doula support, financial and health literacy resources, and referral to classes and grief support groups for families who have lost a parent or infant/child.

 

On a community-level, PICHC programs are required to conduct community mobilization, engagement and advocacy activities which include:

 

1. Start a new community action board (CAB) if none exist in the catchment area (with 25% of the board consisting of community members) or participate in an existing CAB whose focus is improving perinatal and infant health. Participation in these boards is intended to facilitate partnership and collaboration, including identifying gaps and barriers in the community, and developing strategies to address these gaps and broader social issues that impact perinatal health outcomes. CABs are also required to develop and utilize mechanisms to obtain community input and provide pertinent information back to the community at large.
2. Promote civic engagement by training community members to participate on CABs and other advocacy groups, and train 10-20 community members annually to develop leadership and advocacy skills.

 

Strategy Progress: The Title V Program led the following specific program and policy activities to advance this strategy during the 2023-24 reporting period:

 

WMH 4.1 Through the PICHC programs, contracted staff, including CHWs, routinely worked with community stakeholders, including community residents, to identify and collaboratively address issues and barriers impacting maternal and infant health outcomes at the community level, including:

• Actively participated in local community advisory boards, consortiums, or coalitions to address issues impacting perinatal and infant health and identify effective strategies for addressing the broader social issues impacting those outcomes.
• Engaged and partnered with stakeholders from a wide array of community sectors including community residents, grassroots organizations, community-based service organizations, health care providers, local government, local foundations, and local businesses. This included working with over 7,809 community partners at more than 941 coordinated outreach events.
• Worked collaboratively with community partners to address relevant community issues such as safe housing, availability and accessibility of resources and services (e.g., health care, mental health, substance abuse services, home visiting, family support resources), social norms (e.g., related to use of preventive care services, breastfeeding, or personal health behaviors), and community mobilization to effectively identify and address community problems. CHWs issued more than 25,778 health care and social support referrals to PICHC clients.  The top five social support referrals are clothing/ baby care items, transportation, food pantry, housing assistance, and WIC.

 

WMH 4.2 Through the PICHC and MIECHV-funded programs, provide supports to individual clients and their families to address behavioral social determinants of health outcomes.

 

Title V staff continue to provide support to PICHC and MIECHV-funded programs by sharing information on available community resources for needs related to housing, food, employment and job training, transportation, and other basic needs; requiring that programs screen for health insurance enrollment, assist with enrollment or referral to enrollment Navigators or Community Health Advocates; conduct screenings using standardized, evidence-based or validated tools for domestic violence, substance use, smoking, and depression, and make referrals for follow-up as needed; connect families to enhanced social support resources and programs including parenting classes, peer support groups, childbirth education and resources to develop birth and postpartum care plans, and breastfeeding education, and directly support clients to develop birth plans.

 

WMH 4.3 Collaborate with partners, including but not limited to, the Office of Mental Health’s Project TEACH, ACOG-NY, home visiting programs and other community-based organizations, to address mental health in pregnant and postpartum people by increasing screening and follow-up support.

 

Title V staff continued to collaborate with partners, including the NYS Office of Mental Health’s Project TEACH, ACOG-NY, home visiting programs, and other community-based organizations to address mental health in pregnant and postpartum people by increasing screening and follow-up support. A webinar was planned for March 2025 focusing on the Project TEACH and resources available to Mental health Professionals across New York State.

 

WMH 4.4 Collaborate with NYSPQC on the NYS Birth Improvement Project.

 

Through a Learning Collaborative model, NYS continued to assist birthing hospitals and centers in identifying how individual and systemic issues impacts birth outcomes within their organizations and in taking action to improve both the experience of care and perinatal outcomes for individuals who give birth.

 

See WMH 3.7 above.

 

WMH 4.5 Through the Infertility Reimbursement Program (IRP), provide reimbursement for out-of-pocket costs associated with in vitro fertilization (IVF) and fertility preservation services to individuals who meet eligibility criteria.

 

The NYS Department of Health awarded six contractors (one upstate and five downstate) to participate in the Department’s Infertility Reimbursement Program (IRP), formerly known as the Infertility Demonstration Program, for the award period of 10/1/2022 – 9/30/2024. On 3/13/24, a request to extend the six contracts for two years (10/1/24 – 9/30/26) was approved.  Eligibility requirements were updated to align with new state insurance law, effective January 1, 2020, that requires all large cap insurance plans to provide three cycles of in vitro fertilization (IVF) and fertility preservation services (FPS) as well as adding requirements that prevent decisions based on an individual’s information to prevent the services from being covered. The new law also includes a new state definition of infertility. Based on these changes to the law, the Department developed new criteria for patient and provider participation in the IRP, in consultation with expert stakeholders, including ACOG and the Association of Reproductive Medicine, using the CDC’s Assisted Reproductive Technology (ART) Success Rate Report to obtain objective performance data on provider eligibility. Patient participation now includes Medicaid recipients, making the program more accessible to individuals with limited income, the unemployed, or those lacking insurance through their employer.

 

WMH 4.6 Improve uptake of the COVID-19 vaccination among people who are pregnant, in the postpartum period and/or lactating, and of those people's families.

 

This work was completed in the 2022-2023 reporting period. No further work was done during this reporting period.

 

WMH 4.7 Improve the NYS Sexual Assault Victim's Bill of Rights (SAVBOR), including updates to improve health literacy, and translation into the 10 most common languages in New York State.

 

The SAVBOR was initially developed in 2019. During the reporting period, the SAVBOR was significantly updated to improve plain language and align with new legal requirements. This involved significant consultation and collaboration with a variety of community-based stakeholders and state and local government agencies. The SAVBOR was also redesigned into a poster, a flyer, and a pocket card for printing and distribution to hospitals. Not yet completed during the reporting period is the translation of materials into the 10 most common languages in New York State, updating the Department’s website to include critical information for survivors of sexual violence, and further distribution and awareness of the revised SAVBOR to hospital emergency departments, urgent care centers, and other key stakeholders statewide.

 

WMH 4.8 Collaborate with intra- and inter-agency partners to support breastfeeding activities, such as provider and consumer education, staff training, and other opportunities.

 

Title V staff participated in the Breastfeeding Grand Rounds planning committee in collaboration with the Division of Chronic Disease and the Division of Nutrition. The Impact of Social Media on Breastfeeding was the topic of the 2024 Breastfeeding Grand Rounds, which was held on December 18, 2024 to an audience of public health and health care professionals. Additional information will be provided in the 2024-25 annual report.

 

WMH 4.9 Develop and deliver a health training to staff within the Division of Family Health staff about sexual violence prevention initiatives.

 

The Sexual Violence Prevention Unit’s Rape Prevention and Education Program hired a consultant to develop and deliver a training series for 50 internal staff. This training consisted of six live, two-hour virtual trainings from October to December 2023. The consultant also submitted a final report of evaluations from each individual training and an aggregate assessment of the combined trainings with recommendations for potential future training about ways the Division can better support access to high-quality and respectful care. 

 

WMH 4.10 Collaborate with the Office of Drug User Health to support family planning and reproductive health among people who use illicit substances, creating partnerships to strengthen reproductive healthcare and primary care.

 

Within the NYS Department of Health, the Family Planning Program partners with the AIDS Institute Office of Drug User Health (ODUH) to support access to reproductive and sexual health care in the substance using population. This population is in high need of family planning services, and family planning clinics are uniquely positioned to help de-stigmatize substance use disorders and address sexual and reproductive health needs from a harm reduction perspective. The goal of this work is to strengthen collaboration to increase access to reproductive and primary healthcare. Building off the 2022 survey responses and the two networking sessions held in 2023, the NYSFPP and their training and technical assistance partner, JSI, incorporated this work into the May 2024 Family Planning Provider Day. During the meeting, a session titled Increasing Linkages Between Sexual/Reproductive Health and Substance Use Service Settings: A Toolkit for Practitioners was provided with the goal of better meeting the sexual and reproductive health needs of people who use substances.

 

WMH 4.11 Provide resources for birthing people to advocate and communicate effectively with healthcare providers.

 

During the reporting period, the Division of Family Health provided support and oversight to an Empire Fellow, who worked to develop a consumer guide to talking with healthcare providers during the prenatal through postpartum period. The Empire Fellow drew from her experience as an Early Head Start provider in New York City and worked with staff to fine-tune messaging and recommendations. The materials were submitted for approval, graphic design, and translation into the top 12 non-English spoken languages during the reporting period.

 

New Activities: In addition, Title V staff engaged in additional activities relevant to this strategy:

 

WMH 4.12 Continue to review gestational surrogacy program application sections relevant to DFH areas of expertise, including a gestational surrogacy program policy and procedure for screening of potential gestational surrogates (per Department guidelines), screening of intended parents (per American Society for Reproductive Medicine), appropriate use and monitoring of Surrogates' Bill of Rights, and appropriateness of Informed Consent.

 

Gestational surrogacy has been legal and regulated in New York State since 2020. Title V staff and other Department colleagues continue to review and approve new applicants. Additionally, staff review any updated guidance documents as agencies apply for their annual licensure renewal.  During the program year, the Department newly licensed four new gestational surrogacy programs and reapproved 34 programs, bringing the total to 38 programs currently licensed as of 9/30/2024.  Surrogacy programs have reported a total of 47 live births between 1/1/22 and 12/31/23. Data are collected on an annual basis, and data for 2024 are not yet available.

 

Additionally, during the reporting period, Division staff collaborated with the Office of Primary Care and Health Systems Management (primary oversight of the Gestational Surrogacy Program) and Division of Legal Affairs to review and provide feedback on a significant proposed bill that would modify the requirements of the Gestational Surrogacy Program, including minor updates to the Surrogates’ Bill of Rights. Legislation was not put into effect during the reporting period.

 

Evidence-based Strategy Measures (ESMs)

 

The NYS Title V Program established two ESMs to track the programmatic investments and inputs designed to impact NPM1:

 

ESM WMH 1: Percent of PICHC program participants engaged prenatally who have created a birth plan during a visit with a CHW.

 

Data for this measure is obtained from monthly reports submitted by PICHC contractors10/1For the time period of 10/1/2023 to 9/30/2024,67.6% of PICHC program participants engaged prenatally created a birth plan during a visit with a CHW.  

 

ESM WMH 2: Percent of Family Planning Program clients with a documented comprehensive medical exam in the past year.

 

Data for this measure will come from FPP clinic visit record (CVR) data. For the time period from 10/1/2022 to 9/30/23, 35.7% of FPP clients had a documented comprehensive medical exam. This is a slight decline from the 38.7% figure in the previous period.