NPM #1 Well Women Care – Improve pre-conception, prenatal and postpartum health care services for women of childbearing age
The health and well-being of a woman before, during, and after pregnancy is important not only for the woman but also for the newborn. Women who maintain a healthy lifestyle, characterized by behaviors that promote well-being and reduce disease prevalence, during the preconception period are less likely to experience adverse pregnancy and obstetric outcomes and are also more likely to experience better postpartum health extending across their life span.
According to the 2023 BRFSS, 76.3% of Missouri women between 18 and 44 years reported having a preventive health care visit within the past year. This is higher than the national proportion of 73.0% for 2023. There were differences in racial/ethnic backgrounds in the proportion of women who had a preventive health care visit, with Missouri being similar to national levels and more non-Hispanic Black women (77.5%) than non-Hispanic White women (75.9%) receiving a preventive visit in the past year (Figure 1). A higher percentage of insured women (78.8%) than uninsured women (42.0%) received a preventive visit. A lower percentage of those with a high school education (50.5%) received a preventive visit in the past year than those with some college (79.2%) or college graduates (78.8%). The proportion of Missouri women with an education of some college or college graduate who received a preventive medical visit in the past year was higher than the national level respectively (74.1%, 76.7%). In Missouri, 68.1% of those with a household income less than $25,000 had a preventive visit in the past year, compared to 74.0% among those with a household income greater than $75,000. A higher percentage of married women (80.3%) had a preventive visit in the past year than unmarried women (73.3%).
According to the 2023 Missouri Pregnancy Risk Assessment Monitoring System (PRAMS), 89.1% of Missouri women received a postpartum checkup. This proportion is similar to the 89.3% reported for 2022. Privately insured women had a higher rate of receiving a postpartum checkup (94.2%) than their Medicaid-insured counterparts (83.5%). Non-Hispanic Black women had lower rates of receiving a postpartum checkup (82.5%) compared to non-Hispanic White women (89.7%). Women with less than a high school diploma had lower rates of receiving a postpartum checkup (76.0%) than women with a high school diploma (85.8%), some college (85.5%), and a college degree or higher (98.0%).
Initiatives to Promote Women and Maternal Health
The Office on Women’s Health (OWH) provided education and resources to promote well woman care. To increase access and uptake of resources, OWH developed a new online order form for materials. This proved to be incredibly successful, and OWH distributed over 2,000 booklets of the WOMEN: Take Charge of Your Health publication and the My Health Tracking Card, shown below. The WOMEN: Take Charge of Your Health publication includes information on topics such as preventive health, preconception health, obesity prevention, breastfeeding, postpartum depression, and disease prevention. It is updated as needed to include evidence-based information, resources, and recommendations from experts and leaders in women’s health, including hotlines like 988, Tobacco Quitline, and the domestic violence hotline. The WOMEN: Take Charge of Your Health publication is now available in English and Spanish and can be accessed online and in print. The most recent printing of the book included a QR survey code to collect data regarding participant learning and resource utilization. While no participants have completed the survey to date, OWH has contact information from the online ordering form and will follow up with community members using the resource to ask for their input. The My Health Tracking Card tracks blood pressure, cholesterol, and weight. Resources are provided to the public, LPHAs, and others who contact the OWH or visit the website. The Women’s Health Network listserv comprises organizations and individuals concerned with women’s health. The Network’s purpose is to provide timely information about current issues in women’s health, such as changes to services for women, changing technology in women’s health, available resources, training opportunities, events, and funding opportunities. The Women’s Health Network newsletter moved to a monthly format in 2024, in response to requests for fewer distributions with more information in each update. OWH continued sharing educational, funding, and resource opportunities with the Women’s Health Network listserv.
The Missouri Women’s Health Council met twice in 2024. The Council is an advisory group of thought leaders with expertise in women’s health and the various factors affecting women’s health outcomes and well-being. The DHSS Director appoints council members who reflect the geographic and demographic variation across Missouri. The council is charged with informing and advising DHSS regarding women’s health risks, needs, and concerns and recommending potential strategies, programs, and legislation to improve the health and well-being of all women in Missouri. The council comprises women from various professions, including health care providers, researchers, healthcare administrators, social workers, and directors of crucial social services foundations serving women throughout Missouri.
The Office of Dental Health (ODH) continued to educate mothers and children about the importance of oral health for their overall health and well-being during pregnancy and throughout the lifespan, including the promotion of dental visits during pregnancy. This information is shared through distribution of literature developed by the ODH to women through an ongoing successful collaboration with the Women, Infants, and Children (WIC) Program and the Title V funded Home Visiting programs. Materials are also distributed through LPHAs, Federally Qualified Health Centers (FQHCs), and dental offices and at community outreach events. Through Title V funding, ODH created 10,000 oral health kits for pregnant women. The kits contained oral care supplies for mom and her newborn baby, literature on the importance of oral health and the safety of a dental visit for the pregnant woman, and instructions on proper teeth brushing technique. The kits were disseminated through LPHAs and other organizations across the state who worked with pregnant women.
The ODH continued a program to fund five LPHAs through their WIC office to provide oral health education and supplies, fluoride varnish, and a warm hand off to a dental provider. The LPHA staff encouraged mothers to keep dental appointments by emphasizing the importance of oral care during pregnancy. The ODH provided technical assistance to Uzazi Village in Kansas City to provide dental care to pregnant and postpartum women. Uzazi Village is a non-profit organization offering perinatal health care to pregnant women who are medically underserved and eligible for MO HealthNet for Pregnant Women. ODH coordinated the donation of the larger dental equipment needed for the clinic and the purchase of smaller equipment and supplies and engaged a dental provider in the area to provide dental care two days a month, serving an average of eight women each day. Medicaid was billed for the dental services provided.
Community Health
The MCH Services Program contracted with LPHAs to support a leadership role for LPHAs at the community level to build community-based systems and expand the resources those systems can use to respond to priority women and maternal health issues, while providing and assuring women of childbearing age and mothers have access to quality health services. Twenty LPHAs selected improving pre-conception, prenatal, and postpartum health care services for women of childbearing age as their priority health issue. The four examples below highlight some innovative strategies and achievements.
- The Atchison County Health Department increased breast and cervical cancer screenings and referrals among women 18-44 years. To increase knowledge around the importance of women’s health screenings, the health department launched a social media campaign, sharing 508 women’s health messages on their Facebook page. To increase awareness of women’s health services provided at the health department, a monthly activity calendar was developed and shared each month in the local newspaper, with community service providers, the local food pantry, and in the waiting room of the health department. 47 women 18-44 years received a breast and cervical cancer screening, six women were referred for abnormal cervical screening results, and 29 women received additional laboratory testing to screen for sexually transmitted infections. In addition, 47 women (all ages) were referred for a mammogram.
- The Howell County Health Department increased breast and cervical cancer screenings among women aged 18-44 by 24.9%, as compared to FY 2022.
To increase the number who completed their scheduled appointment, a team of nurses called clients who missed and/or were due for an upcoming annual visit. A nurse, versus an office clerk, can inform the client of what screenings are needed and answer any medical-related questions. To increase access to women’s health services, the health department began using its mobile unit to provide women’s health services in outlying, rural areas with transportation barriers. The mobile unit alternated between two locations each month, using the parking lots of organizations in the middle of each town, so walking to the location was an option. Appointments were preferred, but walk-ins were welcome. A nurse practitioner was on-site and provided cervical and breast cancer screenings.
- The Phelps/Maries County Health Department increased knowledge among women of childbearing age and families regarding prenatal, postpartum, and newborn care from a baseline of zero in FY 2022 to 170 women at the end of FY 2024. The health department used the Growing Great Kids curriculum, an evidence-based home-visiting curriculum available in both English and Spanish. The courses can be provided both in-person and online with the goal of cultivating secure attachments, bolstering child development while building parenting, family strengthening, and other essential life skills with parents who themselves have experienced childhood adversity and other traumatic events, learning to balance risk and protective factors. To increase awareness and participation in classes, the health department partnered internally with the case management program and externally with Missouri Department of Social Services, Family Support Division (FSD). FSD accepts completion of the course as acceptable for families working with the court system.
- The Miller County Health Center increased the number of community- serving organizations for women of childbearing age who have policies addressing women receiving early prenatal care and wrap around services from a baseline of zero in FY 2022 to three at the end of FY 2024. The health department hosted an annual Community Pool Party, inviting all community-serving organizations to attend and host a table with information about services they provide. On average, 375-400 community members attend the pool party each year, and 15 organizations are in attendance. As a result, partnerships continued to form with the goal of identifying ways to better serve the community. In FY 2024, the health center partnered with the local Citizens Against Domestic Violence, a non-profit service organization, established in 1984, that provides crisis intervention, emergency shelter, legal advocacy, hospital advocacy, weekly empowerment groups, and support to victims of domestic violence, sexual assault, and human trafficking. The health department also partnered with the FQHC and local diaper bank to increase knowledge and skills regarding health and safety and access to services. The health department refers those without a medical home, especially pregnant women without an OB provider, to the FQHC. The monthly diaper bank distribution day was held in tandem with the health department providing on-site child passenger seat inspections and education about MCH services provided at the health department. The health department has not been tracking any correlation between the education regarding MCH services and the utilization of services but plans to track the correlation moving forward.
The MCH Services Program supported LPHA efforts to provide education on the importance of adequate dental care and overall oral health, collaborating with the ODH to share resources with LPHAs, including:
- Dental Health During Pregnancy is important! rack card. (See infographics below.)
- LPHAs collaborated with partners to provide screening, referral, and direct provision of preventive dental services and increase the number of women receiving a preventive dental visit during pregnancy.
The TEL-LINK Program provided over 3,500 health care service referrals to increase access to care. The program promotes this service through search engine campaigns to provide outreach to underserved populations. TEL-LINK collaborated with DSS, DMH, LPHAs, ParentLink, ODH, the Injury Prevention Program, Home Visiting, Safe Cribs for Missouri Program, Special Health Care Needs programs, Tobacco Quitline, WIC Program, and more to provide referrals on various services, such as smoking cessation, WIC clinics, dental care, and many more. Over 8,000 individuals clicked on the ad through this campaign to learn more about TEL-LINK’s services. The search engine strategy utilizes geographic and demographic targeting, which directs individuals to TEL-LINK, where operators connect them to the closest resources. The program collaborated with ParentLink, WIC, and DSS to promote TEL-LINK.
The Newborn Health Program (NHP) continued to partner with a variety of community health providers to raise awareness and educate the MCH population on MCH resources for women of childbearing age and their families, including preconception, prenatal, and postpartum care, smoking cessation, postpartum mood disorders, and the importance of taking folic acid. The program accomplished this through the free distribution of the Pregnancy and Beyond books and a wide variety of educational materials. All resources contain information to improve pre-conception, prenatal, and postpartum health care services for women of childbearing age. The NHP distributed 260,000 resources to Missourians and obtained the following feedback from partners:
- “Thank you for supplying this wonderful information. We have this at the bedside, this helps our patients make informative decisions based on facts.”
- “So appreciate having these resources guides. Also like that the presentation as far as format, pictures, color, etc. are well done. This makes them eye-catching and more appealing to the client so are more apt to read them.”
- “Patients are always happy to receive this book. We do pregnancy testing in our clinic and see a lot of first-time moms-to-be. This book is very well done and easy to understand.”
The Healthy Births and Babies Unit utilized and promoted an informal MCH internal work group to maximize outreach opportunities at conference exhibits, webinars, virtual baby showers, health fairs, and through the Home Visiting programs by distributing various educational materials.
The Missouri WIC Program promoted the importance of depression screening by utilizing the Patient Health Questionnaire-2 (PHQ-2) for prenatal, breastfeeding, and non-breastfeeding woman. The purpose of the PHQ-2 is not to establish a final diagnosis or to monitor depression severity, but rather to screen for depression in a “first step” approach. WIC continued referring families to Home Visiting programs, TEL-LINK Program, the Missouri Primary Care Association, and other support programs. WIC also continued outreach efforts to enroll women in the WIC Program in their first trimester.
Home Visiting
The Title V funded Home Visiting programs at DESE shared information with all contracted local implementing agencies (LIA) to help home visitors link families with resources for accessing health care insurance, including Missouri Medicaid. Home visiting staff assisted enrolled clients in accessing insurance for prenatal, postnatal, and well-woman care through emails and postings within the monthly Office of Childhood (OOC) Home Visiting Section Newsletter, reaching 516 school district Parent Education Programs and 11 supervisors of the Home Visiting Programs. Through a standard agenda topic on the monthly sub-recipient monitoring and support calls with each LIA supervisor, Home Visiting Program Specialists continued to address the need for updated resources for accessing a regular and ongoing source of healthcare, including current guidelines for accessing and maintaining insurance coverage. 91% (71/78) of mothers enrolled in home visiting prenatally or within 30 days after delivery received a postpartum visit with a health care provider within eight weeks of delivery.
Additional Title V funded Home Visiting program services included:
- Promoted smoking cessation for all primary caregivers who reported smoking at enrollment and/or the subsequent 6-month visit. 53% (9/17) of primary caregivers who reported smoking, tobacco use or other forms of nicotine delivery, including e-cigarettes, at enrollment were referred to tobacco cessation counseling or services within three months. In addition, home visitors provided tobacco cessation information and resources, such as the Baby and Me Tobacco Free (BMTF) Program, Tobacco Quitline, and TEL-LINK, to enrolled participants. Home visitors also educated families about the risks and effects of child exposure to second hand smoke;
- Provided information and resources to all enrolled pregnant women promoting the benefits of continuing healthy pregnancies to the full 40 weeks. These resources included DHSS and March of Dimes educational materials. Title V funded Home Visiting Program Specialists assessed the distribution and use of these resources during monthly sub-recipient monitoring calls and annual monitoring visits with the LIAs;
- Screened all clients enrolled prenatally for symptoms of depression within three months of delivery. Primary caregivers not enrolled prenatally were screened within the first three months of enrollment. Home visitors utilized the Public Health Questionnaire 9 (PHQ-9) depression screening tool during prescribed timeframes and anytime home visitors recognized potential symptoms of depression, and individuals who screened positive were referred to appropriate services. 53% (64/121) of primary caregivers enrolled in home visiting were screened for depression. Additionally, 21% (6/29) of individuals who screened positive for depression were referred. Current resources on mental health were shared with contracting LIAs through the monthly newsletter, including a new resource, the University of Missouri Maternal Health Access Project (MHAP), which provides perinatal psychiatry consultation for providers seeking assistance with finding resources for enrolled individuals; and
- Provided contracted home visitors with oral health resources from the ODH, promoting the importance of receiving preventive dental care during pregnancy and at all stages of life for primary caregivers and their families, to share with enrolled primary caregivers.
Environmental Health
Lead exposure can pose a risk for women of childbearing age as well as the developing fetus or nursing infant. The most severe effects of high levels of lead during pregnancy are miscarriage and stillbirth. Other problems during pregnancy, such as gestational hypertension, low birth weight, and premature delivery, can also occur. Prenatal lead exposure impairs children’s neurodevelopment, placing them at increased risk for developmental delay, reduced IQ, hearing impairments, and learning and behavioral problems.
Lead poisoning prevention team members continued to perform the following activities to prevent or decrease blood lead poisoning among pregnant women and their babies:
- Provided community lead education through various outreach events, such as the Man Show, the Randolph County Bike Rodeo, the Missouri Chiropractic Physicians Association Conference, the Conference on the Young Years, the Coordinated School Health Conference, and health fairs;
- Participated in updating outreach materials, such as the “Pregnancy and Beyond” booklet and other pamphlets and brochures, which are distributed to expectant and new parents;
- Contacted pregnant women and their health care providers when a woman’s blood lead level was 5 mcg/dL or higher (tracked by the Adult Blood Lead Epidemiology and Surveillance staff); and
- Provided lead education and resource materials to health care providers, LPHA and health plan lead case managers, and WIC Program staff regarding the need to discuss lead poisoning prevention and lead testing with clients. This included providing LeadCare Analyzers and lead test kits to LPHAs that do not have the capacity to provide accurate lead screenings, allowing them to offer this service on a regular basis.
The Prenatal Substance Use Prevention Program promoted the importance of prenatal substance use prevention to promote healthy pregnancy and childbirth. The program partnered with statewide community-based partners to house substance-exposed infant manikins to demonstrate the effects of drugs and alcohol during pregnancy. In the 2024 calendar year, 214 sessions were held at community placement sites. 4,913 participants attended these sessions, including expectant parents, grandparents, substance use disorder treatment clinics, WIC clients, educators, students, health care providers, and Parents as Teacher clients. Participants examined three newborn infants (drug-affected, fetal alcohol syndrome, and healthy) together to compare the effects of substance use during pregnancy. Visualizing the possible outcomes of an individual’s behavior can help empower them to succeed and strive for a healthy newborn infant. During the program evaluation, it was reported that after four months of being educated with the substance-exposed manikin project, a pregnant woman using methamphetamines, marijuana, and alcohol ended up having a healthy substance-free newborn. Also, two pregnant individuals (three and five months along) had been using many substances during their pregnancy. With their work with the Family Counseling Center and the substance-exposed manikin project, they have both been substance-free for two months. The program also had awareness campaigns to promote healthy pregnancy and abstaining from all substances before, during, and after pregnancy. Campaign ads were run for one month and displayed to 511,239 individuals. The campaign utilized geographic, demographic, and life stage targeting.
The Safe Cribs for Missouri Program continued to educate each crib recipient on smoking cessation and the consequences of smoking during pregnancy. Information shared included the Missouri Tobacco Quitline tip cards and MO HealthNet resources.
Maternal Mortality
OWH continued to abstract and review all pregnancy-associated mortalities in Missouri. These reviews led to the identification of strategies to prevent maternal mortalities. Strategies include training, following standards of care, funding health insurance programs like MO HealthNet for postpartum extension, collaborating across agencies to deliver comprehensive care, and improving community safety. DHSS reported findings from the Pregnancy-Associated Mortality Review (PAMR) and collaborated with partners and other key stakeholders to implement PAMR recommendations.
DHSS received continued funding through a five-year grant awarded through the Centers for Disease Control and Prevention’s (CDC) Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM) Program. This funding directly supports agencies and organizations that coordinate and manage Maternal Mortality Review Committees (MMRC) to identify, review, and characterize maternal deaths and identify prevention opportunities. OWH continued to refine and improve internal processes to expedite maternal mortality case identification, abstraction, and review by working with the Bureau of Vital Records to use provisional death files. Furthermore, maternal mortality cases are grouped by date of death for abstraction and review, with deaths at the beginning of the year abstracted first, if possible, and brought to the PAMR Board. A Patient Abstract System (PAS) linkage was developed during year two of the grant to identify additional hospitalizations/emergency room visits to aid in case abstraction. OWH contracts with the MHA through the ERASE MM grant to implement patient safety bundles in Missouri birthing facilities, clinics, and critical access hospitals. MHA continued implementing the “Care for Pregnant and Postpartum [Women] with Substance Use Disorder” (CPPSUD) bundle. According to the 2019-2022 PAMR reports (published between 2022 to 2025), mental health conditions were the leading underlying cause of pregnancy-related deaths, followed by cardiovascular disease, every year except 2021, when they were the second leading underlying cause - highlighting the need for this work. The Maternal/Infant Mortality Coordinator worked closely with the PAMR Board and MCH leadership to implement the initiatives in this grant.
Soon after launching the Missouri Maternal-Child Learning and Action Network (MC-LAN) in 2018, DHSS and MHA partnered to join the American College of Obstetricians and Gynecologists (ACOG), as funded by the Health Resources and Services Administration, Alliance for Innovation on Maternal Health (AIM). Through this effort, MHA leads the implementation of maternal safety bundles in Missouri’s birthing facilities. As the first initiative, Missouri implemented the AIM “Severe Hypertension in Pregnancy” patient safety bundle. Since the start of implementing these initiatives, the MC-LAN has become the Perinatal Quality Collaborative (PQC). The PQC has since started implementing the AIM CPPSUD patient safety bundle. MCH Leadership and OWH continued collaborating with MHA and other critical stakeholders through the PQC to provide guidance, knowledge-sharing, and peer support in developing strategic quality initiatives based on the Triple Aim principles of improving and evaluating perinatal quality and population-based programs. The PQC provided strategic guidance, focused on high-value opportunities to improve clinical, operational, and outcome performance, and developed collaborative partnerships to achieve these aims. In addition, the committee partnered with the communities it serves to achieve better communication and educate the public on quality and safety initiatives of the health care community. This committee met three times with additional virtual meetings as needed. 53 of 59 Missouri birthing facilities, representing 94% of Missouri births, are participating in the MO PQC and reporting data metrics into the AIM data portal. DHSS and MHA assisted birthing facilities with data submission to minimize burden on the facilities and leverage key stakeholders to assist with AIM bundle implementation.
Discussions with key partners identified the need for a comprehensive plan for maternal mortality prevention, with targeted funding and initiatives. DHSS leveraged Title V funding to propose a new state-funded budget initiative to implement a Maternal Mortality Prevention Plan (MMPP). The Governor’s final approved state fiscal year 2024 budget included $4.35 million to implement the Plan and effect simultaneous transformation through five domains of action affecting maternal health, with the community and population-level factors that influence MCH outcomes interwoven throughout all five domains. Implementation of the Plan, including a robust evaluation plan to monitor progress, measure success, ensure accountability, and inform ongoing maternal mortality prevention efforts, was launched through partnerships with internal and external maternal health partners. Improved maternal health data collection, standardization, harmonization, transparency, and support will enhance data quality and access, identify poor outcomes during pregnancy and make improvements to support healthy pregnancy, delivery and postpartum outcomes. The Plan included the development of a MCH Dashboard, published in June 2024, along with a new MCH Data Sources webpage. DHSS contracted with the University of Missouri to establish a collaborative hub and spoke model Maternal Health Access Project (MHAP), inclusive of perinatal mental health, with a single point-of-entry system for referrals to prenatal care providers and community-based agencies, resources, programs, and services for prenatal women. Through a contract with MHA, DHSS initiated implementation of three of the domains: 1) standardized, evidence-based maternal quality care protocols; 2) standardized maternal care provider trainings, using creative modalities, on trauma-responsive and culturally and linguistically appropriate care and screening, referral, and treatment of mental health conditions during and after pregnancy; SUD during and after pregnancy; cardiovascular disorders associated with pregnancy; and gestational diabetes and other endocrinology disorders associated with pregnancy; and 3) a Postpartum Plan of Care to plan for and optimize comprehensive postpartum care.
Other Title V MCH Activities Related to the Women/Maternal Health Domain
OWH supported several initiatives to assist women of childbearing age. Through the Uninsured Women’s Health Services Program, a collaboration with DSS, OWH reimbursed medical providers for women’s health services. These included approved methods of contraception; sexually transmitted disease testing and treatment, including pap tests and pelvic exams; family planning, counseling, and education on various methods of birth control; and drugs, supplies or devices related to the women’s health services described above, when a physician or advanced practice nurse prescribed them. OWH continued to work with DSS and the Women’s Health Council to identify areas for improvement in the program, such as application processes and eligibility. OWH maintained a public listing, indexed geographically and available online, of pregnancy assistance information and ultrasound providers. OWH supported a prenatal care program in Kansas City to provide free, demographically congruent group prenatal care to 38 women. OWH supported tobacco cessation for pregnant and postpartum women and their households through telehealth with the BMTF Program. OWH worked with BMTF to publicize the program and offer it at no cost to participants across the state. OWH led a doula training program to increase the number of doulas and doula training organizations across the state. OWH also represented DHSS on several statewide task forces and commissions, including the Missouri Sexual Assault Response Team and the Combatting Human Trafficking and Domestic Violence Commission. Finally, OWH supported the statewide Sexual Assault Nurse Examiner Telehealth Network, which launched to expand access to forensic exams across the state. The following services were provided through these efforts: 516 free tobacco cessation sessions, 446 free prenatal and postpartum visits, 222 women received a total of 4,272 doula service appointments, 142 medical providers received training about doula care and services, and 15 people received training as doula trainers.
The Missouri Maternal Health Multisector Action Network (the Network) continued efforts to connect stakeholders with existing resources and toolkits and foster partnerships amongst stakeholders. The Network worked closely with key partners in the state to evaluate the gaps in the support system for mothers and their young children affected by maternal substance use and mental health and assure the Network is positioned to address identified gaps. The Network continued to engage and connect stakeholders to increase collaborations and decrease siloes. The Network workgroups focused on actions to address the evolving needs of the mothers and their children and recruit mothers to participate in the Moms’ Advocacy Network, launched in FY 2024, to prepare mothers to participate in and lead discussions where service delivery, policy and support decisions are explored. The collective voice, experiences, perspectives, and knowledge of the participating mothers guide the direction of the Action Network.
The MCH Director led Missouri’s participation in the National Governors Association (NGA) Center for Best Practices Improving Maternal and Child Health in Rural America: State and Territory Policy Learning Collaborative to address the priority area, “Build Infrastructure for Sustained Success: State-level strategic planning, reporting, supportive platforms, collaboratives and centers contribute to improved, sustained outcomes for mothers, infants and their families, and increased accountability.” The Core Team, comprised of the MCH Director, DHSS Chief Medical Officer, Senior Policy Advisor from the Governor’s Office, Director of MO HealthNet, MHA Senior Vice President of Quality, Safety and Research, and Executive Director of the MHAP at the University of Missouri, partnered with SSM Health St. Louis - Women's Services to submit a proposal for the state Maternal Health Innovation Program through HRSA, with the plan leverage and expand the existing Maternal-Child Learning Action Network at MHA to serve as a maternal health task force and develop a statewide maternal health strategic plan.
As the state’s chief maternal child health strategist, the MCH Director continued efforts to broaden the scope of MCH partnership beyond DHSS and other state agencies. As a convener of multidisciplinary, cross-sector collaborations and facilitator of meaningful and varied partnerships, DHSS brings MCH partners and programs together across programmatic silos and organizational boundaries to promote the health of the MCH population and address community factors that influence health outcomes. The MCH Director actively engaged in statewide collaborative efforts to promote the health of women of childbearing age, including but not limited to engagement in the PAMR, MC-LAN, Women's Health Council, the DSS Maternal/Infant Health Efforts coordination meetings, the Uplift Connection, the ParentLink Advisory Council, and the Missouri Association for Infant and Early Childhood Mental Health. The MCH Director continued to collaborate with the two Healthy Start grantees (Nurture KC and Missouri Bootheel Regional Consortium) and their partners to facilitate sharing of information and resources, shared learning, and identification of opportunities for alignment and collective impact.
Additional Performance Analysis
To increase program efficiency and effectiveness and improve pre-conception, prenatal and postpartum health care services for women of childbearing age, OWH goals include reducing the amount of time it takes to abstract cases of maternal mortality, the amount of time to review cases, and the amount of time to prepare and publish the annual report for maternal mortality; updating the Women’s Health Council to the Women’s Health Advisory Committee and returning to the original authorizing legislation; and hosting two meetings of the Women’s Health Advisory Committee in 2026.
The Pregnant Women Need Dental Care Too contracts with three LPHAs have demonstrated success, with the number of pregnant women covered by MO HealthNet for Pregnant Women who received dental services increasing in those jurisdictions. ODH also received extremely favorable feedback on the pregnant mom oral health kits and received requests for more kits than were available.
Challenges
Home Visiting had difficulty maintaining current resources for health care coverage and accessing affordable dental supplies for families. Home visitors encouraged taking young children to the dentist; however, recommendations by oral health care providers vary across the state regarding when a young child should be seen by a dentist. The conflicting information regarding when young children need to begin dental care created challenges for home visitors.
OWH was challenged to abstract and report on the number of maternal mortality cases in a timely manner, given the need for team members to address all the emerging maternal health initiatives in Missouri.
Limited funding creates barriers to providing the full scope of services, including oral health care services, for pregnant women.
Opportunities
Home Visiting Program Specialists partnered with DHSS to provide an informational webinar to promote the Baby and Me Tobacco Free program and continue to search for current resources to share with families. OOC is planning to provide training for LIA staff on performing an annual functional assessment of hearing, vision, and health (including oral health) on all enrolled children. Performance measures indicating need for improvement will be discussed during annual professional development events.
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