The Florida Department of Health (Department) identified the following priority needs for women/maternal health during the annual reporting year, as reflected in the State Action Plan Table: 

 

• Improve access to health care for women to improve preconception and interconception health, specifically women who face significant barriers to better health.
• Promote tobacco cessation to reduce adverse birth outcomes and secondhand smoke exposure to children. 
• Reduce maternal mortality and morbidity. 

 

The Department reassessed, updated, and aligned the strategies and objectives to address the state priority to improve access to health care for women to improve preconception and interconception health, specifically women who face significant barriers to better health. The National Performance Measure (NPM) selected for this priority is NPM 1: Percent of women with a past year preventive medical visit. The realignment incorporates the Department’s State Health Improvement Plan, Agency Strategic Plan, and Title V MCH Block Grant strategies and objectives, providing a universal approach to addressing women’s health across the lifespan.

 

In 2020, a total of 27.7 percent of women aged 18-44 in Florida did not have a routine checkup (BRFSS). In 2020, a total of 39.9 percent of non-Hispanic white women, 26.3 percent of non-Hispanic Black women, and 42.3% percent of Hispanic women did not have a routine checkup in the last year (BRFSS, 2020).  

 

The Department takes a comprehensive approach to women’s health care. There are a variety of contributing factors that affect a woman’s health such as genetic, social, cultural, economic, and environmental conditions in which she lives. As women move from childhood into early adulthood, an increasing number of women of childbearing age already suffer from chronic conditions or use substances that can adversely affect pregnancy outcomes, leading to miscarriage, infant death, birth defects, or other complications for mothers and infants. According to the 2020 Pregnancy Risk Assessment Monitoring System (PRAMS), among women aged 14-50 who recently gave birth in Florida, approximately 8.5 percent had asthma, 14.5 percent had hypertension, 2.29 percent had diabetes, 13.7 percent had depression, 39.7 percent were overweight or obese, 2.78 percent were underweight, and 13.5 percent smoked before becoming pregnant. Additionally, 25.8 percent of women aged 15-44 received information about how to prepare for a healthy pregnancy and baby prior to pregnancy. Furthermore, according to FLHealthCHARTS, the number of congenital syphilis cases among women aged 15-44 years decreased from 1,788 in 2019 to 1,769 in 2020. 

 

In 1991, the Florida Legislature enacted Healthy Start, one of the most comprehensive maternal and child health initiatives in the nation (Section 383.14, Florida Statutes). This legislation requires the Department to develop a universal screening process that includes a risk assessment instrument to identify pregnant women who are at risk for a preterm birth or other high-risk condition(s). Upon its enactment, the risk screen was developed by the Department in collaboration with the Healthy Start Advisory committee, which included representatives from Florida’s county health departments, universities, the legislature, and the private health care sector. The primary maternal health care provider completes the risk screen and reports the results so that the woman is referred to appropriate health, education, and social services. The risk screen assesses risk factors for adverse health outcomes in order to refer identified individuals to appropriate services to best meet their needs. In Fiscal Year (FY) 21/22, 130,629 pregnant women were screened for potential risk of a preterm birth or other high-risk condition(s).

 

If the screen indicates a pregnant woman is at risk, she is referred to Florida’s Coordinated Intake and Referral system, known as CONNECT. This serves as a single point of entry into home visiting programs in Florida and provides families with the opportunity to learn about and select the home visiting program that best fits their needs.

 

The current prenatal risk screening process is paper-driven and has not changed since its implementation in 1992. Title V Maternal and Child Health (MCH) Block Grant funds were used during the reporting year to develop Phase 1 of an electronic screening system. An electronic system will result in more efficiencies and “real-time” assessment and referral, resulting in quicker identification and linkage to services and supports.

 

The Department’s MCH Section contracts with 32 non-profit community agencies, known as Healthy Start Coalitions (Coalitions), for Florida’s Healthy Start program. Coalitions establish private and public partnerships that include state and local government, community organizations, and MCH providers, for the provision of coordinated community-based prenatal and infant health care. Florida’s Heathy Start program serves pregnant women and infants from birth, up to age three, who score at-risk on the universal prenatal or infant risk screen. Self-referrals and referrals provided by health care providers and other agencies are also accepted. The priorities of Florida’s Healthy Start program are:

 

• Reduce the occurrence of infant deaths.
• Reduce the number of low birth weight and preterm births.
• Recue the occurrence of maternal deaths.
• Improve infant and toddler developmental outcomes.

 

Services provided by Florida’s Healthy Start program include: 

 

• Interconception education and counseling
• Breastfeeding education and support
• Care coordination
• Childbirth education
• Smoking cessation
• Health and parenting education
• Education, counseling, and referrals for access to care
• Nutrition counseling

 

In FY 21/22, Florida’s Healthy Start program provided home visiting services to 47,882 clients. The MCH Section continued to adopt, implement, and integrate evidence-based practices into the Healthy Start program to address issues that affect the health of women and infants. The Healthy Start program uses the Department’s Health Management System and the Coalition’s Well Family System to enable the program to track the type and number of services provided to participants for data collection purposes. To improve these efforts, and to enhance data collection practices that increase the effectiveness of services provided statewide, the MCH Section worked in collaboration with procured consultants (ISF, Inc.) to complete an assessment of provider outcome performance objectives and ongoing quality improvement processes. Completing the assessment will allow the Department’s MCH Section to better measure and report the impact of Florida’s Healthy Start program.

 

The Department uses Title V MCH Block Grant funds to provide interconception care (ICC), which is not reimbursable by Medicaid, through the Healthy Start program. The ICC services are available to all women who participate in the program. During the prenatal participant’s third trimester, Coalitions ask participants, “Would you like to become pregnant in the next year?” Based on her response, the participant will complete either the Show Your Love Baby-to-Be plan, or the Show Your Love Healthy Woman plan. The goals she sets in her reproductive life plan will be the guiding factor for the curricular education provided during face-to-face visits.

 

In addition to contracting with Florida’s Healthy Start Coalitions, the MCH Section contracted with, and provided oversight of, the following contracts to address maternal and women’s health priorities:

 

• Eleven Fetal Infant Mortality Review (FIMR) projects through Coalitions to provide for the implementation of FIMR services to address the behavioral, environmental, and structural processes that may impact fetal and infant deaths, to learn more about why infants die and to propose recommendations for change. These contracts were funded with Title V MCH Block Grant funds.
• The Family Health Line is a statewide, toll-free hotline offering counseling information and community referrals about pregnancy, infant and toddler issues. The goal of the hotline is to improve the health status of Florida's pregnant women and their children by providing callers with information on helpful community resources and answering basic questions about pregnancy, breastfeeding, childbirth education and other pregnancy-related concerns. The Family Health Line is available in English, Spanish, and Haitian Creole. The contract is funded with Title V MCH Block Grant funds, state general revenue, and other funding sources.
• The Ounce of Prevention Fund of Florida to identify, fund, and evaluate innovative prevention programs for at-risk children and families and raise awareness of maternal and child health initiatives such as safe sleep, Reach Out and Read, and Count the Kicks campaigns throughout the state, with a focus on television and radio advertisements. This contract is funded through state general revenue funds.
• The Florida Association of Healthy Start Coalitions to implement the Nurse Family Partnership Program in four counties of Florida (Brevard, Hillsborough, Orange, and Miami-Dade, respectively). This contract is funded through state general revenue funds.
• A Safe Haven for Newborns to promote the Safe Haven Law through a statewide outdoor advertising and community outreach campaign.  This includes the use of materials that educate and inform the public about where to obtain support and the identification of safe venues for parents considering abandoning their infants. This contract is funded through state general revenue funds.
• The Florida Pregnancy Care Network to implement the Florida Pregnancy Support Services Program (FPSSP). The program is a network of nonprofit pregnancy support centers that provide support and assistance to women, men, and their families primarily faced with unplanned pregnancies. Services include free pregnancy tests, peer counseling, and referrals. Most of the centers offer classes on pregnancy, childbirth, parenting, and personal finance management. Wellness services are also provided that include, but not limited to, smoking cessation counseling, sexually transmitted disease testing, blood pressure screenings, diabetes screenings, and pap smears. The program is governed through section 381.96, Florida Statues, and funded through state general revenue funds.

 

The Department implements the statewide Florida Healthy Babies (FHB) program through all 67 county health departments (CHDs). The purpose of the program is to ensure all counties have a maternal and child health infrastructure in place to assure women and children have access to health care; and address broad social, economic, cultural, and environmental factors within their respective counties. The MCH priority areas for the FHB program are maternal mortality, infant mortality, well woman care, prevention of unexpected pregnancy, dental and oral health, and access to care. These priority areas were identified based on the Statewide MCH Needs Assessment, State Health Improvement Plan, Agency Strategic Plan, MCH Program National Performance Measures, and Healthy People 2030. Each CHD submits an annual workplan detailing their selected priority areas and evidence-based programs and initiatives they plan to implement over the year. The workplan also includes the data and justification for the identified priority areas. Quarterly and annual reports summarizing the status of activities, updated data, and expenditures are submitted and analyzed by the Department. The Department is currently exploring technology options that can track and report FHB program outcomes at the county and state level. Title V MCH Block Grant funds are utilized to support the FHB program.

 

In FY 21/22, 19 CHDs selected to work on strategies for well woman care; 24 selected to work on dental and oral health; 52 selected to work on infant mortality; 39 selected to work on prevention of unintended pregnancy and teen pregnancy; and 4 selected to work on strategies to reduce maternal mortality. CHDs provided many services to women such as family and reproductive health planning; STD and HIV/AIDS screening, prevention, treatment, and control; breast and cervical cancer screening; immunizations; prenatal care; health assessments; community education; teen pregnancy prevention; and family planning services and other activities.

 

The Department is committed to helping Florida residents reach their fullest health potential by living tobacco free lives through prioritization of NPM 14.1. Promoting tobacco cessation to reduce adverse birth outcomes and secondhand smoke exposure to children remains a priority for the Department. The Department selected NPM 14.1: Percent of women who smoke during pregnancy to address this priority.

 

In Florida, the state rate for resident live births for women who smoked during pregnancy was 3.7 in 2020 (FLCharts, 2020). However, the range by county is extreme, with Miami Dade’s rate being .5 while Layfayette County’s rate is 21.3. Eight counties have rates between 13.4 and 21.3 and eleven additional counties have rates between 9.0 and 12.7. Smoking during pregnancy increases the risk of miscarriage and certain birth defects such as cleft lip or cleft palate. It can also cause premature birth and low birth weight and is a risk factor for Sudden Infant Death Syndrome (SIDS). Secondhand smoke exposure doubles an infant’s risk of SIDS and increases a child’s risk of respiratory infections and common ear infections. Children with asthma who are exposed to secondhand smoke are likely to experience more frequent and more severe attacks, which can put their lives in danger. 

 

The Smoking Cessation Reduction in Pregnancy Treatment (SCRIPT) curriculum, an evidence-based program for smoking cessation, has been incorporated in the Healthy Start program and coding specifications for smoking cessation have been revised to measure SCRIPT implementation. From the time SCRIPT was adopted as the tobacco cessation counseling intervention, provider training has been revised based on feedback from staff. 

 

The Tobacco Free Florida program brings awareness to the dangers of tobacco, while also providing free resources that help tens of thousands of Floridians to quit. The program has made remarkable progress in helping reduce tobacco use across the state. The Department also continued to promote Tobacco Free Florida’s Quit Your Way. Family planning providers across the state continued to screen clients for tobacco use and provide information on the Quit Your Way program.

 

The Florida Quitline is available 24 hours a day, seven days a week, offering telephone counseling in English, Spanish, and other languages through a translation service. Pregnant tobacco users who are ready to quit receive expanded services including 10 counseling sessions, and with a medical release, they may receive a two-week starter kit of nicotine replacement therapy. Self-help materials are also provided by mail.

 

Tobacco users also accessed resources to help them quit through Florida’s Web Coach online service. Tobacco users can plan their quit date and even receive nicotine replacement therapy through the free online service. The telephone and online services also provide another feature to help tobacco users quit, Text2Quit. Text2Quit is a new digital service that texts positive messages to tobacco users before, during, and after they quit.

 

Additionally, the Tobacco Free Moms and Babies Collaborative, established in 2019, and continued in FY 20/21, identified counties with elevated smoking rates and engaged them in targeted smoking cessation efforts. The Bureau of Tobacco Free Florida provides dedicated funding to these 26 identified counties and conducts periodic technical assistance calls to support their efforts. This initiative has successfully connected tobacco prevention staff with maternal and child health staff to enhance tobacco prevention and cessation efforts. 

 

As a continuing component of Florida’s Healthy Babies program, the MCH Section collaborated with the Bureau of Tobacco Free Florida on the Tobacco Free Moms and Babies Collaborative to expand existing tobacco cessation activities. The Bureau of Tobacco Free Florida provided additional funding to CHDs that could be used for staffing, education materials, and training that support cessation objectives.

 

The Department’s MCH Section is focused on improving the health of women of childbearing age in Florida, as well as improving maternal and infant birth outcomes by reducing maternal mortality. From 2016-2020, Florida’s total pregnancy-related mortality ratio (PRMR) fluctuated from 12.9 in 2016 to 21.0 deaths per 100,000 live births in 2020. The PRMR exhibited consistent racial disparities. The gap between non-Hispanic Black and non-Hispanic White women increased from 2.0 in 2019 to 3.9 in 2020. In 2020, the non-Hispanic Black PRMR was 50.0 deaths per 100,000 live births; 12.9 for non-Hispanic White women; and 16.3 for Hispanic women. From 2016-2020, the overall leading causes of pregnancy-related deaths were hemorrhage, thrombotic embolism, infection, hypertensive disorder, and cardiovascular disorder. The leading causes of pregnancy-related deaths for non-Hispanic Black women were cardiomyopathy and cardiovascular conditions; for non-Hispanic White women, the leading causes were hypertensive disorder and infection; for Hispanic women, the leading causes were hemorrhage and thrombotic embolism. In 2020, the leading preventable causes of death were hypertensive disorder, infection, hemorrhage, and cerebrovascular accident.

 

Since 1996, the Florida Maternal Mortality Review Committee (Florida MMRC) has been operating as a formal surveillance of maternal mortality in the state. The administrative functions, infrastructure, and medical record abstraction for Florida’s MMRC process is supported through the Title V MCH Block Grant.

 

The Florida MMRC seeks to explain gaps in care, identify systemic service delivery issues, and make recommendations to facilitate improvements in the overall systems of care. The Florida MMRC involves data collection and examination of maternal deaths to promote evidence-based actions for individual behavior changes, health care system improvements, and prevention of pregnancy-related deaths. The Department uses Florida MMRC data, including contributing factors and care improvement recommendations, to prioritize areas for quality improvement. The Florida MMRC process begins by identifying all pregnancy-associated deaths within a specified period.

 

Florida MMRC abstractors capture information from the medical, prenatal, labor and delivery, postpartum, emergency room, the Department’s prenatal risk screen, social service, care coordination, medical examiner, and terminal events records. The Florida MMRC meets quarterly to review and discuss the abstracted cases and concludes with a determination that each case is either pregnancy-related or not pregnancy-related. The Florida MMRC provided recommendations to the Department last year to improve the health care system and the quality of outcomes for all women. Examples of recommendations and actions based on Florida MMRC findings include establishing evidence-based initiatives that promote preconception health, screening for depression, screening for domestic violence, and the reduction of preterm births as well as promoting patient education to increase awareness of preventable risk factors and improve access to family planning, prenatal, and primary care services.

 

The Florida MMRC operates as a one-year retrospective surveillance. Deaths to pregnant and postpartum women that occurred in 2019 were abstracted and reviewed by the Florida MMRC in 2020. The Florida MMRC data analyst completed the analysis of the 2019 maternal mortality data in the Spring of 2021. The methods used included descriptive analysis for quantitative, and theme identification for qualitative analysis. The 2019 Florida MMRC data was used to develop the Pregnancy-Related Deaths Due to Hemorrhage, 2010-2019, data brief. The brief presented an overview of pregnancy-related deaths due to hemorrhage in Florida during 2010-2019 and provided evidence-based recommendations intended to reduce the risk of maternal deaths due to hemorrhage. The brief was released in 2021 and was posted to the Department’s website and was shared electronically with local and state partners.

 

In 2021, the data linkage process identified 199 Florida resident pregnancy-associated deaths from 2020. The Florida MMRC case selection subcommittee selected 59 cases to abstract and review. The multidisciplinary Florida MMRC met quarterly to thoroughly discuss each case, determine pregnancy-relatedness, identify contributing factors, assess preventability, and create recommendations for prevention. Upon review of the 59 selected cases, the Florida MMRC determined 44 (75%) were pregnancy-related deaths. Of the 44 pregnancy-related cases, 30 (68.2%) were preventable at either the individual, provider, facility, care system, or community level.

 

The Department uses Florida MMRC data, including contributing factors and care improvement recommendations to prioritize areas for quality improvement. In 2021, the Department executed a two-year contract with the Florida Perinatal Quality Collaborative (FPQC) to implement quality care improvement initiatives in Florida’s birthing hospitals with an emphasis on leading contributing factors of maternal deaths in the state. For example, Florida MMRC reviews have shown an increase of maternal deaths due to substance use disorder and mental health conditions. This analysis led to the implementation of an FPQC initiative called “Maternal Opioid Recovery Effort (MORE)”. The purpose of MORE is to work with providers, hospitals, and other stakeholders to improve identification, clinical care, and coordinated treatment and support for pregnant women with opioid use disorder and their infants. The areas of focus include opioid use disorder screening, prevention, treatment, comprehensive discharge planning, and hospital policies and procedures.

 

Based on the most recent data available, the rate of pregnant women diagnosed with opioid use disorder (OUD) during labor and delivery in the U.S. more than quadrupled from 1999 to 2014, according to a 2018 analysis by the Centers for Disease Control and Prevention (CDC). In Florida, the rate increased from 0.5 per 1,000 delivery hospitalizations in 1999 to 6.6 in 2014 based on a 2018 report by Haight and colleagues. According to the CDC Pregnancy Risk Assessment Monitoring System (PRAMS), 7% of women reported using prescription opioids in pregnancy, and one in five of those women reported misuse. The Department has several initiatives to address this in the state, including partnership with the Florida Perinatal Quality Collaborative (FPQC), housed at the University of South Florida. The purpose of the FPQC is to improve Florida’s maternal and infant health outcomes through the delivery of high quality, evidence-based, quality improvement initiatives at Florida hospitals. In collaboration with the Department, the FPQC implemented two quality improvement initiatives to support hospitals who provide services to pregnant women with OUD and infants with Neonatal Abstinence Syndrome (NAS). The first project was the NAS initiative. The purpose of this project was to standardize approaches to address variability in NAS management and decrease neonatal length of stay related to NAS. NAS was implemented in November 2018 through June 2021. The second initiative was the Maternal Opioid Recovery Effort (MORE). The purpose of MORE was to improve the identification, clinical care, and coordinated treatment and support for pregnant women with opioid use disorder and their infants. MORE was implemented from November 2019 through June 2022. Although the initiatives have concluded, hospitals continue to implement the strategies obtained through participation in the projects.

 

At the onset of the COVID-19 pandemic, communities in several parts of the state were reporting increases in emergency calls for overdoses. The Department worked with the FPQC to conduct brief calls with hospital and community teams to discuss local needs. Although education regarding naloxone was a component of MORE, feedback from hospitals and communities resulted in a shift to helping hospitals give naloxone kits, not just prescriptions, directly to women at risk of overdose shortly after the delivery of their infant. Since that effort was initiated, 8 hospitals have been able to implement a naloxone-in-hand effort using free kits from the Overdose Prevention Program (OPP) from the Department of Children and Families (DCF). Ongoing work with the Florida Hospital Association, AHCA, DCF and the Florida Society of Health System Pharmacists has resulted in the development of sample policies and protocols that hospitals can use to establish free naloxone-in-hand programs that benefit new mothers or any other person at risk of overdose following hospital discharge.

 

The Department’s partnership with the FPQC also resulted in the establishment of a workgroup to examine barriers and challenges that reduced access to Medication Assisted Treatment for pregnant and postpartum women with OUD. A series of listening sessions with obstetric providers identified training as an area of need to improve the number of obstetric providers who were willing and able to treat women for OUD, including normalizing conversations about SUD and increasing the number of providers trained in screening motivational interviewing, and treatment women with OUD.

 

Although the MORE has concluded, the lessons learned from this model will be sustained and supported by multiple partners throughout the state. Ultimately, 33 hospitals enrolled in the two phases of MORE, 21 in 2020 and an additional 12 in 2021. Of those 33 hospitals, 21 successfully reported data during the pandemic, and they reported improvements across several measures. Of the 21 hospitals reporting data, universal SUD screening for pregnant women increased from 61% in Q1 2020 to 92% in Q1 2022. In addition, screening for intimate partner violence increased from 84% to 97% in the same period, screening for mental health increased from 91% to 99%, and infectious disease screening (particularly Hepatitis C) increased from 58% to 81%. Education about naloxone increased from 8% in the first half of 2020 to 35% by the end of 2021.

 

To identify NAS cases, the Department currently uses a passive case ascertainment methodology that relies on linked administrative datasets and diagnostic codes indicative of NAS. First, birth certificate records from the Bureau of Vital Statistics are linked to the infant’s birth hospitalization record, which is provided as part of quarterly submission of inpatient hospital discharge data by hospitals to the AHCA. Each discharge record includes International Classification of Diseases, Clinical Modification (ICD) diagnosis codes documented during the hospital encounter. Prevalence rates of NAS in Florida increased from 2.8 to 67.3 per 10,000 live births from 1998-2015. After 2015, the prevalence of NAS decreased to 53.5 per 10,000 live births in 2020. This prevalence rate equates to an average of 1,400 cases of NAS per year in Florida since 2011(most recent data available). According to data from the Healthcare Cost and Utilization Project (HCUP), the most recent NAS rate for the nation was 6.8 per 1,000 newborn hospitalizations in 2018 compared with the Florida 2018 rate of 6.9 per 1,00 newborn hospitalizations.

 

The Florida MMRC also supported implementation of an innovative maternal mental health initiative called the Florida Behavioral (BH) Improving Maternal and Pediatric Access to Care and Treatment (IMPACT) program. This is a collaborative initiative by the Department, Florida State University College of Medicine, University of Florida, and the Florida Maternal Mental Health Collaborative. The goal of the Florida BH IMPACT program is to improve the identification and treatment of pregnant and postpartum women who experience behavioral health and substance use disorders in the state of Florida. The program currently works with obstetric providers in twenty-four counties. The Florida BH IMPACT program promotes maternal and child health by building the capacity of health care providers through professional development, expert consultation and support, and dissemination of best practices. The program has five main components: 1. Access for patients and clinicians to comprehensive referral resources and services in the region for mental health and substance use. 2. Clinician access to telephone consultation with a psychiatrist during normal business hours. 3. The use of brief, valid screening tools for depression, anxiety, and substance use. 4. Tracking and reporting of information and measures related to the programs processes and outcomes. 5. Training of obstetric providers in best practice maternal behavioral health screening, treatment, and risk issues. The BH IMPACT program is supported with funds received from the Health Resources and Services Administration for the “Safeguarding Two Lives: Expanding Early Identification & Access to Perinatal Mental Health” grant.

 

In 2021, members of the Florida MMRC submitted a research letter entitled “Decrease in Florida's pregnancy-related mortality from 2009 to 2018: reducing the Black-White disparity” to the American Journal of Obstetrics & Gynecology that was accepted for publication. The research letter highlighted the decrease in the pregnancy-related mortality ratio overall in Florida by 29% from the period 2009-2013 to 2014-2018 and the decrease in pregnancy-related mortality ratio among non-Hispanic black women during the same time period. The improvement in data was attributed in part to the surveillance of the Florida MMRC, the development of effective messaging highlighting the leading causes of maternal mortality, and the collaboration and partnership with the FPQC.

 

During the reporting period, the Department received the Centers for Disease Control and Prevention (CDC) grant entitled Preventing Maternal Deaths: Supporting Maternal Mortality Review Committees. The purpose of the grant is to support agencies and organizations that coordinate and manage Maternal Mortality Review Committees to identify and characterize maternal deaths for identifying prevention opportunities. The grant period is September 30, 2021, through September 29, 2024. Florida is using the grant to support the following activities:

 

• Expand maternal mortality reviews in mental health cases, such as suicide and substance abuse deaths.
• Develop an outreach campaign that empowers pregnant and postpartum women to be self-advocates.
• Develop a peer-to-peer, comprehensive outreach campaign for health care providers on the 2020 five leading preventable causes of pregnancy-related deaths.
• Contract with a licensed clinical social worker to develop and implement an informant interview process based on guidance from the CDC, during case abstraction.
• Contract with a data analyst to identify system improvement to correct inconsistencies on death certificates (i.e., check box, ICD code errors).

Additionally, recommendations from the Florida MMRC included increased need of health literacy of women and their reproductive health, knowing when to seek emergent medical assistance, and improved patient and clinician relationship. These recommendations served as inspiration for the development of the “Power of Mom” campaign. The campaign aims to promote maternal health and end maternal mortality. The focus is empowering pregnant and postpartum women to use their voice to advocate for their health and the health of their babies. The campaign arms moms with critical information that can mitigate the chances of mortality, such as physical and mental health warning signs, C-section risks, and ways to navigate their pregnancy and postpartum journey. The campaign also encourages health care providers and a mother’s support team (friends and family) to actively listen to her health concerns and provide the support or treatment she needs. The campaign will be promoted across the state through prenatal clinics and at facilities that provide birthing services. Partners include the Agency of Health Care Administration (AHCA); FPQC; CHDs; Family Planning programs; Florida Healthy Babies; Healthy Start Coalitions; Pregnancy Care Networks; Women, Infants, and Children (WIC); as well as university affiliated providers.

 

In alignment with the most recent American College of Obstetricians and Gynecologists guidelines, the Florida MMRC recommended that postpartum care be an ongoing process rather than a single encounter. As a result, the Department funded a project using Title V MCH Block Grant funds for early and ongoing postpartum screening through the University of Florida (UF). The Department provided financial and technical assistance to UF to develop and pilot the UF Gator MOMitor™ smart phone application (app). The app provides daily risk assessments of women up to six weeks postpartum by their health care team, with the goal to reduce maternal morbidity and mortality. The app is currently being piloted to patients seen at the UF Health Shands Hospital in Alachua County. The app presents users with assigned questions based on their identified risk factors. These questions are designed using Ecological Momentary Assessment technology, which offers repeated sampling of participants’ experiences and possible symptoms in real time. Questions are created using a focused approach to assess participants and notify the health care team based upon the user’s response. Customized risk assessment plans for each participant are created prior to discharge from UF Shands to identify relevant screening questions based on her individual risk factors and health conditions. However, every woman participating in the pilot is screened for postpartum depression. Other conditions the app monitors include hypertension, surgical wound infection, and diabetes. Women who experience hypertension are also provided a blood pressure cuff for home monitoring free of charge. 

   

Stakeholders across the state and the U.S. have taken notice of C-section delivery rates, including their impact on morbidity, mortality, and health care costs. As such, the Department partnered with the FPQC to implement the Promoting Primary Vaginal Deliveries (PROVIDE) initiative. The goal of the PROVIDE initiative is to improve maternal and newborn outcomes by applying evidence-based interventions to promote primary vaginal deliveries at Florida’s delivery hospitals and ultimately reduce Nulliparous, Term, Singleton, Vertex (NTSV) cesareans. Over 70 Florida birthing hospitals implemented the best practice guidelines developed in the FPQC PROVIDE initiative toolkit. With efforts of the PROVIDE Initiative, Florida went from having one of the highest NTSV C-section delivery rates in 2016 at 37.4 percent, to 27.8 percent in 2022, which is a decrease of 7.4 percent and faster than the nationwide reduction rate at 1.5 percent. In 2021, 17 of the participating hospitals in the PROVIDE initiative reached or succeeded the Healthy People 2030 Cesarean delivery goal.

 

The Department and the AHCA recognized hospitals that achieved the Healthy People 2030 goal of low-risk, primary C-section rates at or below 23.6% percent in the prior year. The Department and AHCA were able to recognize 26 hospitals for achieving this goal. The State Surgeon General, Secretary for the AHCA, and other state leadership toured the state to hand deliver the awards to the 26 hospitals, present on the importance of reduction of NTSV C-sections, and meet the medical staff and administration who implemented strategies to achieve the award.