The Wisconsin Title V program views infant and perinatal health as part of an ongoing cycle or continuum of women’s health, including pre-pregnancy, pregnancy, delivery, postpartum, and reintegration into primary care. Unfortunately, Wisconsin lacks a coordinated system to successfully engage women and pregnant women throughout this continuum, and the Title V program is working to build such a system. This work spans both the Women/Maternal Health population domain, as well as the Infant/Perinatal Health population domain. Please review the narratives from both population domains for the most detailed account of this work.

 

National Performance Measure 04: Percent of infants ever breastfed; percent of infants breastfed exclusively for 6 months

 

While this document may use the term “breastfeeding,” the Title V program intends for this information to be inclusive of all families.

 

Objectives

	2016-2018 PRAMS	2019-2020 PRAMS	2020-2021 PRAMS	2021-2022 PRAMS	2022-2023 PRAMS
Increase the proportion of non-Hispanic Black women who ever breastfeed in Wisconsin from 74% to 80% by 2025. (Baseline: 74%, 2016-2018 Wisconsin Pregnancy Risk Assessment Monitoring System, or PRAMS)	74%	76%	73%	72%	73%
	2016 National Immunization Survey	2018 National Immunization Survey	2019 National Immunization Survey	2020 National Immunization Survey	2021 National Immunization Survey
Increase the percent of infants who are breastfed exclusively through 6 months in Wisconsin from 33% to 37% by 2025 (Baseline 33.4%, 2018 National Immunization Survey).	28.9%	33.4%	31.3%	34.2%	30.6%

 

Evidence-Based Strategy Measurement

Measure	2021 Data	2022 Data	2023 Data	2024 Data
Number of hospitals in Coffective’s Community Match Online Platform	48	Not  Available*	Not Available*	Not Available*
Percent of non-Hispanic Black infants ever breastfed**	54.8% (2021 Birth Records)	65.3% (2022 Birth Records)	65.0% (2023 Birth Records)	66.5% (2024 Birth Records, provisional)
	74.7% (2020 PRAMS)	70.9% (2021 PRAMS)	73.8% (2022 PRAMS)	73.1% (2023 PRAMS)
Percent of non-Hispanic American Indian/Alaska Native infants ever breastfed	63.5% (2021 Birth Records)	71.4% (2022 Birth Records)	73.3% (2023 Birth Records)	76.5% (2024 Birth Records)
	76.3% (2020 PRAMS)	75.5% (2020-2021 PRAMS)	73.1% (2020-2022 PRAMS)	80.4% (2023 PRAMS)

*Measure was discontinued in 2022 due to Coffective’s restructure of the Community Match online platform, based on customer feedback.

 

**The “ever breastfed” measure from the birth record is based on a healthcare provider’s report about whether the birthing person was breastfeeding at discharge while the measure from PRAMS is based on a birthing person’s self-reporting whether they ever breastfed their baby. Therefore, the data from the two sources are capturing slightly different things. While data from birth records are more stable, they are likely also under-counting “ever-breastfed” babies.

 

OVERALL REFLECTIONS

 

Wisconsin's 2024 work on breastfeeding focused on improving perinatal outcomes, improving health outcomes for women, and promoting optimal nutrition through targeted breastfeeding initiatives. The plan included quarterly meetings with funded state partners to facilitate communication and to highlight opportunities for collaboration. A significant effort was made to enhance support to local and tribal agencies by working with them to strengthen breastfeeding practices across prenatal, maternity, and postpartum care settings.

 

In collaboration with the Family Foundations Home Visiting Program, Wisconsin’s version of the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, and Wisconsin WIC, the Title V program has partnered with Michigan Breastfeeding Network for the past several years to provide free lactation-related webinars with focus on improving breastfeeding outcomes for the maternal and child health workforce in Wisconsin. The webinars are designed to support practice changes based on core values: access, evidence, and relevance. Webinars and associated continuing education hours are available for one year after their initial air date. The Title V program required local and Tribal health agencies implementing breastfeeding strategies with their annual Title V funding to participate in the webinar series. Wisconsin participants represented 35.6% of the overall participation with 25.6% being nurses, 21.1% home visitors and 35.6% other maternal and child health workforce. One Wisconsin participant stated, “These are wonderful opportunities for further growth as a lactation counselor. Thank you for providing them at no cost.” Another commented, “I learned about the importance of advocating for clients and understand how they feel emotionally regarding difficult situations!” One of the local health departments working on breastfeeding projects stated, “We have been viewing the Michigan Breastfeeding webinars as they become available.”

 

Seventeen local and tribal health agencies used Title V funds to support worksites, childcare programs, and community sites who offer training, resources, and technical assistance related to breastfeeding support. They reported that the following factors facilitated their work: partnerships (94%), access to trainings and other professional development opportunities (88%), staff interest (82%), and high interest or alignment with partners, providers, community members, or others (71%). Barriers to the work included staff capacity (71%), partners’ staff capacity (59%), staff vacancies/turnover (47%), and competing priorities or initiatives (47%).

 

Local and Tribal health agencies also worked toward assuring MCH populations achieve their full potential as well as incorporating community engagement into their breastfeeding work. The most commonly reported activities included partnering with other organizations to better reach populations of the greatest need, actively working to connect with communities (e.g., involvement in community events), and participating in trainings or professional development. Agencies also shared examples of hiring independent contractors who are representative of the community or who are able to communicate with community members in languages other than English.

 

Coffective supported local agencies at quarterly learning community calls by providing time for networking, sharing of lessons learned, and discussions around current issues in breastfeeding. Topics included community engagement, progress reporting, local coalitions, policy development and implementation, available data, and discussions specific to each breastfeeding strategy. Calls also featured updates and presentations from state and national-level partners. Evaluations of these calls were overwhelmingly positive, with attendees reporting that they encouraged collaboration and motivated them in their work. Agencies shared resources with each other, discussed common challenges, and generated new ideas together.

 

Work with local and Tribal health agencies to increase lactation support in workplaces and early childhood settings.

 

Six local and tribal health agencies opted to focus on increasing breastfeeding support in worksites and childcare sites with their annual Title V funding. Local and tribal health agencies that were connecting with worksites in their communities continued to use information from the Wisconsin Breastfeeding Coalition, including emerging resources to support the implementation of newer federal lactation-related laws, like the Providing Urgent Maternal Protection for Nursing Mothers Act (PUMP Act), the Pregnant Workers Fairness Act, and Title IX regulations for schools. Agencies continued their focus on building relationships with employers and offering support for activities like establishing a space for expressing milk, improving space/facilities for expressing milk, and changing organizational policy to protect lactation in the worksite. Local and Tribal health agencies completed outreach to 45 worksites with 21 sites receiving shared materials/resources. Fifty-four employees received training, education or resources.  

 

Local health agency staff worked to reestablish relationships with local childcare programs and reached out to new programs. Many childcare programs continued to struggle with staff turnover and shortages, limiting their capacity to engage in quality improvement activities, such as the Breastfeeding Friendly Child Care initiative. Local agencies assisted three new childcare providers in becoming recognized as Breastfeeding Friendly in 2024 and helped six programs renew their recognition status, meaning they still met the 10 Steps to Breastfeeding Friendly Child Care and all staff completed the breastfeeding training. In addition to training and support offered by local health agencies, Supporting Families Together Association and several of their Child Care Resource and Referral (CCR&R) member agencies offered the breastfeeding training to childcare program staff, offering both in-person and virtual options in English and Spanish for 53 participants. Childcare providers continue to have independent access to the online version of the training, and 259 individual providers completed the training for continuing education hours in 2024. The Wisconsin Technical College System continued to include the training in their Early Childhood Education Program’s Infant Toddler Development Course.

 

Childcare programs continued using the Go NAPSACC Breastfeeding and Infant Feeding Self-Assessment and online database, with additional support from Child Care Resource and Referral staff and YoungStar

technical consultants. The process of completing the self-assessment is linked to YoungStar and helps providers meet Health and Well-being and/or Family Engagement rating criteria. While 186 total Go NAPSACC self-assessments were completed, only 19 sites completed both pre- and post-assessments. The lowest scoring sites were related to breastfeeding, including programs not having a written breastfeeding policy, not displaying posters, books, and other materials that support breastfeeding, and not providing sufficient staff professional development on breastfeeding support. Go NAPSACC also offers Breastfeeding and Infant Feeding provider trainings on a variety of topics. These trainings offer continuing education; and 51 childcare providers completed one or more Breastfeeding and Infant Feeding Go NAPSACC trainings in 2024.

 

Work with local and Tribal health agencies to enhance community coordination for continuity of care.

 

Thirteen local and Tribal health agencies focused on improving community coordination and continuity of care for breastfeeding support with their Title V funding. The Title V program continued partnering with Coffective to support local and Tribal health agencies to build sustainable partnerships, improve communication, and coordinate efforts. Each community developed customized goals and an action plan to build/strengthen partnerships and improve access to lactation services by addressing associated barriers. Coffective provided individual technical assistance throughout the year and fostered sharing between agencies during the quarterly learning community calls. Communities saw success through activities like geographic mapping of local lactation resources, creating lactation spaces in public buildings, and facilitating local breastfeeding coalitions.

 

Common challenges were identified through discussions with local and Tribal health agencies throughout 2024. They included:

• Barriers to family and community support for lactating families
• Resource gaps, particularly in rural areas
• Difficulty in maintaining or expanding engagement in local coalitions
• Limited comprehensive breastfeeding data, especially at the local level

 

Agencies also identified common opportunities, including:

 

• Collaboration with healthcare providers
• Resource creation and distribution in multiple languages
• Research and data collection
• Technology integration, like GIS mapping or using QR codes for community feedback
• Community engagement strategies

 

Overall, local and Tribal health agencies were motivated to increase coordination and collaboration in their community and help their organization build partnerships to increase access to care. Planning sessions for 2025 strategies further ensured a forward-looking approach to enhancing breastfeeding support across settings in each community.

 

Support hospital use of quality improvement strategies.

 

Collaboration continued with the Wisconsin Association for Perinatal Care and Coffective to support Human Milk Feeding quality improvement initiatives through the Wisconsin Perinatal Quality Collaborative. Support was offered to participating hospitals, health systems, and public health stakeholders related to strategy development and implementation, data collection and analysis, and community engagement. Implementation of the Birthing Person Survey and engagement of community members with lived experience in hospital taskforces continued to be a priority. The Human Milk Feeding Expert Group, comprised of community representatives, advised the direction of quality improvement initiatives.

 

Wisconsin Perinatal Quality Collaborative collected and analyzed data for the Human Milk Feeding quality improvement initiative. In their final report, they noted the following data summaries:

 

• Percent of infants receiving any human milk during hospitalization. The percentage of infants receiving any human milk during hospitalization appears to increase between the third quarter of 2023 and the fourth quarter of 2024 (notably, the third quarter of 2024 showed a decrease). The decrease in the third quarter of 2024 is due to decreases in the rates for the Asian/Pacific Islander, Hispanic, and White populations. Comparing rates by race and ethnicity, the fourth quarter of 2024 shows the smallest difference between the groups. (The number of people identifying as American Indian/Alaska Native is small in each quarter).

 

• Percent of infants receiving exclusive human milk during hospitalization. The percent of infants receiving human milk exclusively does not appear to have changed significantly in the aggregate or by race and ethnicity. Comparing rates by race and ethnicity shows significant disparities between White and the Asian/Pacific Islander, Black, and Hispanic groups.

 

• Percent of infants with skin-to-skin contact after vaginal delivery. From the third quarter of 2023 through the fourth quarter of 2024, the percent of infants receiving skin-to-skin contact after vaginal delivery has increased. In general, all racial and ethnic groups have experienced an increase. (In discussions, some of the increases may be due to improved charting.) There do not appear to be significant disparities between racial and ethnic groups.

 

• Percent of infants with skin-to-skin after Cesarean delivery. In the aggregate, the percent of infants with skin-to-skin after Cesarean delivery shows a small increase. Depending on the quarter, the graphs show disparities between some groups, but this may reflect the smaller numbers of infants delivered by Cesarean.

 

An expert group was recruited and convened to review root causes of differences in human milk feeding rates and translate those into actionable change strategies to address differences with initiation and duration rates.  When the group convened in November, they discussed the following action items for their work moving into 2025: finalize and disseminate data report, improve regional hospital engagement, enhance community involvement, expand peer support, policy alignment and training, outreach to non-hospital birth services, and monitor and adjust efforts.

 

Wisconsin Association for Perinatal Care and Coffective also planned for some adjustments in their approaches for 2025 work. Recruitment of new hospitals began, with a particular focus on geographic areas of the state where other public health initiatives were underway to improve breastfeeding continuity of care. They also planned to shift Human Milk Feeding cohort meetings to quarterly, rather than monthly, to allow for more individual technical assistance for participating hospitals. All of these efforts aim to foster a culture of continuous improvement and data-driven decision-making in hospital breastfeeding practices.

 

Support community agencies to address breastfeeding challenges.

 

The African American Breastfeeding Network provided focused support for the Breastfeeding Friendly Child Care initiative in Milwaukee. They worked closely with their regional Child Care Resource and Referral agency to offer breastfeeding training to local childcare programs and to recruit providers interested in becoming recognized as Breastfeeding Friendly. They helped providers complete the Go NAPSACC Self-Assessment and provided technical assistance to improve practices and policies. They helped six childcare programs complete the recognition process and held a completion ceremony to celebrate the breastfeeding friendly programs.

 

The African American Breastfeeding Network invited the childcare programs they worked with to participate in their annual Lift Up Every Baby event, in celebration of August Breastfeeding Month and Black Breastfeeding Week. The programs engaged with pregnant women and new parents to share information on breastfeeding support in childcare. Over 150 people typically attend the event annually.

 

Strengthen collaboration and partnerships.

 

Collaboration between the Title V program, the Family Foundations Home Visiting program, the Chronic Disease Prevention Program, and Wisconsin WIC continued to be a priority. Program staff met regularly as a DHS breastfeeding team throughout the year to discuss training opportunities, partnerships, and strategies to enhance breastfeeding support at the state level. Throughout 2024, WIC offered opportunities for home visitors and local and Tribal health agency staff to attend USDA breastfeeding trainings. Discussions are ongoing on how to continue this collaboration and how to expand it further to include other community-based programs and providers. The DHS breastfeeding team also worked together to offer a Partner Spotlight series of webinars highlighting how agencies and the maternal and child health workforce supported lactation. Sessions in 2024 highlighted the work of the Wisconsin Army National Guard, a community-based doula program, and information on lactation in the Hmong and Indigenous communities. In addition, the team collaborated to connect with both internal and external partners to explore other opportunities for outreach and support, including donor milk, Medicaid coverage of breast pumps and lactation services, emergency preparedness for families with infants and young children, and breastfeeding-related data collection and analysis.

 

The Title V program worked closely with the DHS breastfeeding team to share information and promote breastfeeding-related celebrations throughout August 2024. The Governor approved five state proclamations: Breastfeeding Month; Indigenous Milk Medicine Week; Asian American Native Hawaiian Pacific Islander Breastfeeding Week; Black Breastfeeding Week; and Semana de La Lactancia Latina. Social media messages were developed to share the proclamations and provide additional context for these celebrations’ importance. They included images, linked to web pages with current lactation resources, and lifted up messaging from the communities organizing the celebratory weeks.

 

The Title V program continued to partner with the Native Breastfeeding Coalition of Wisconsin to support their efforts, provide consultation, and collaborate on projects funded by other sources, such as the Chronic Disease Prevention Program’s CDC State Physical Activity and Nutrition funding. Title V staff attended the quarterly coalition meetings, provided consultation as requested, and participated in the Chronic Disease Prevention Program’s planning and technical assistance meetings.

 

Title V staff also continued to participate in the United States Breastfeeding Committee’s Workplace Support Constellation. The Workplace Support Constellation works to address the barriers to breastfeeding for lactating workers, with a specific focus on reducing barriers.

 

State Performance Measure 01: Rate of infant mortality in babies born to non-Hispanic Black mothers

 

Infants born to non-Hispanic Black mothers in Wisconsin are dying preventable deaths. Wisconsin’s goal is to reduce the infant mortality rate of babies born to non-Hispanic Black mothers from 14.6 to 13.0 per 1,000 live births by 2025. (Baseline is 2016-2018 infant mortality from the Office of Vital Records). Additionally, Wisconsin lacks a comprehensive, high-quality, regionalized perinatal care system that successfully engages women throughout the continuum of care from preconception through the postpartum transition to ongoing well woman care.

 

State Performance Measures

Measure	2020 Data	2021 Data	2022 Data	2023 Data	2024 Data
Infant mortality rate in babies born to non-Hispanic Black mothers per 1,000 live births	14.6 (2020 Vital Records)	12.8 (2021 Vital Records)	11.4 (2022 Vital Records)	14.3 (2023 Vital Records)	12.5 (2024 Vital Records, provisional)
Percent of women receiving care within the first trimester	76.7% (2020 Vital Records)	77.5% (2021 Vital Records)	78.0% (2022 Vital Records)	77.4% (2023 Vital Records)	76.0% 2024 Vital Records, provisional)
Percent of women receiving a quality* postpartum visit		60.7% (2019-2020 PRAMS)	58.2% (2020-2021 PRAMS)	58.0% (2021-2022 PRAMS)	Data not available**

* Quality is defined by those who report receiving these services according to the Wisconsin Pregnancy Risk Assessment Monitoring System (Question 70): postpartum depression screening, tobacco use, and EITHER contraception OR birth spacing discussion

**In 2023, Wisconsin PRAMS discontinued collecting data on postpartum visit characteristics in a way that is comparable to 2022 and prior.

 

Objectives

Objective	2020 Data	2021 Data	2022 Data	2023 Data	2024 Data
Reduce the infant mortality rate in babies born to non-Hispanic Black mothers from 14.6 to 13.0 per 1,000 live births by 2025.	14.6 (2020 Vital Records)	12.8 (2021 Vital Records)	11.4 (2022 Vital Records)	14.3 (2023 Vital Records)	12.5 (2024 Vital Records, provisional)
Increase the percent of non-Hispanic Black and non-Hispanic Native birthing persons receiving prenatal care in the first trimester in Wisconsin from 60% to 66% by 2025.	60% (2016-2018 Vital Records)	60% (2016-2018 Vital Records)	61% (2018-2020 Vital Records)	63% (2019-2021 Vital Records)	68% 2021-2023 Vital Records)
	2019-2020 PRAMS	2020-2021 PRAMS	2021-2022 PRAMS
Increase the percent of women receiving a quality* postpartum visit in Wisconsin from 56% to 67% by 2025 (baseline is from 2016-2018 Pregnancy Risk Assessment Monitoring System [PRAMS]).**	60.7%	58.2%	58.0%

** denominator is PRAMS respondents who indicated that they had a postpartum visit

 

OVERALL REFLECTIONS

 

Wisconsin’s work to reduce infant mortality throughout 2024 sought to address geographic differences in infant mortality, particularly focusing on non-Hispanic Black and Indigenous populations. With priorities like improving perinatal outcomes and fostering supportive community environments, the plan integrates tailored initiatives and data-driven strategies. Efforts include supporting fetal and infant mortality review teams, promoting doula and midwifery programs, and leveraging data for community-focused interventions. Collaboration with health agencies, training programs, and community organizations underscores the state’s commitment to promoting positive outcomes for infants and families.

 

Support doula and midwifery services.

 

Wisconsin’s Title V team focused on expanding access to doula and midwifery services for specific populations. Efforts included supporting traditional doula training through programs like Waking Women Healing and the Wisconsin Doula Association, which hosted its inaugural conference. Challenges such as lack of funding and access to Medicaid reimbursement were identified, prompting advocacy for sustainable program support. These services aim to address barriers, provide trauma-informed care, and promote healing through traditional practices.

 

Fetal and infant mortality review and child death review teams.

 

Wisconsin’s Title V team endeavored to enhance local and statewide efforts to review and address the root causes of infant mortality. The Children’s Health Alliance of Wisconsin provided technical assistance, hosted training sessions, and supported review teams in conducting data analysis and implementing safe sleep campaigns. Collaboration with local teams aimed to improve care continuity. Challenges such as staff turnover and barriers to accessing medical records were addressed through continuous technical support and resource development.

 

Promote infant mortality awareness and education.

 

Efforts included community engagement through educational campaigns like "Count the Kicks" and virtual baby showers. Trainings targeted healthcare providers, public health professionals, and community organizations to raise awareness about perinatal health, safe sleep practices, and maternal mental health challenges. These initiatives integrated topic and population specific approaches, focusing on improving provider knowledge and community trust to ensure access to care.

 

Leverage data for Black infant mortality prevention.

 

The Wisconsin team supported partners in utilizing data resources, such as PRAMS and maternal mortality review reports, to inform prevention efforts. Outreach to schools, churches, and community organizations fostered awareness and collaboration. However, challenges included limited capacity within partner organizations and barriers to prioritizing infant mortality prevention. The initiative emphasized the importance of centering the voice of impacted communities and leveraging data to guide actionable solutions.

 

Develop an infant mortality-focused project for title V funding.

 

The team explored options for local and Tribal health agencies to address infant mortality through Title V funding. While implementation was delayed until 2025, early efforts included strategy development and discussions with maternal and child health consultants to align objectives with community needs. This foundational work aimed to position agencies for impactful, data-driven interventions in the coming years.

 

Support incarcerated pregnant and postpartum individuals.

 

This strategy highlighted the Wisconsin Prison Doula Project, which provides birthing support, lactation assistance, and reunification planning for incarcerated individuals. Data from similar programs in Minnesota and Alabama demonstrated reduced cesarean rates and improved breastfeeding outcomes, highlighting the program’s potential impact. Advocacy focused on expanding access, increasing funding, and promoting mental health interventions to improve outcomes for incarcerated parents and their children.

 

State Performance Measure 02: Percent of women receiving care within the first trimester; percent of women receiving a quality* postpartum visit

*Quality is defined by those who report receiving these services according to the Wisconsin Pregnancy Risk Assessment Monitoring System (Question 70): postpartum depression screening, tobacco use, and either contraception OR birth spacing discussion.

 

Wisconsin lacks a comprehensive, high-quality, regionalized perinatal care system that successfully engages women throughout the continuum of care from preconception through the postpartum transition to ongoing well woman care. Wisconsin set the following related goals:

 

•          Increase the percent of non-Hispanic Black and non-Hispanic Native birthing persons receiving prenatal care in the first trimester in Wisconsin from 60% to 66% by 2025.

 

•          Non-Hispanic Black and Non-Hispanic American Indian and Alaska Native birthing persons receiving prenatal care in the first trimester in Wisconsin:

 

2021: 60% (2016-2018 Vital Records)

2022: 61% (2018-2020 Vital Records)

2023: 63% (2019-2021 Vital Records)

2024: 68% (2021-2023 Vital Records)

 

By Race/Ethnicity:

 

	2021		2022		2023		2024
	2020 Vital Records	2019-2020 PRAMS	2021 Vital Records	2020-2021 PRAMS	2022 Vital Record	2021-2022 PRAMS	2023 Vital Records	2022-2023 PRAMS
Non-Hispanic American Indian and Alaska Native	62.5%	73.8%	64.4%	77.6%	67.7%	Not shown to protect privacy	66.8%	68.4%
Non-Hispanic Black	62.8%	75.1%	67.3%	77.8%	69.3%	76.8%	66.3%	75.6%

 

Increase the percent of women receiving a quality* postpartum visit in Wisconsin from 56% to 67% by 2025 (baseline is from 2016-2018 Pregnancy Risk Assessment Monitoring System [PRAMS]).

 

	2019-2020 PRAMS	2020-2021 PRAMS	2021-2022 PRAMS	2022-2023 PRAMS
All respondents	53.9%	52.2%	53.4%	Not available*
Respondents who indicated they had a postpartum visit	60.7%	58.2%	58.0%	Not available*

**In 2023, Wisconsin PRAMS discontinued collecting data on postpartum visit characteristics in a way that is comparable to 2022 and prior.

 

OVERALL REFLECTIONS

 

Wisconsin’s work to improve Perinatal Care in 2024 focused on improving and optimizing maternal and infant health outcomes by addressing perinatal differences, enhancing perinatal mental health practices, collaborating with partners to ensure access to quality postpartum care, and supporting community workforce development.  Partnerships included local, Tribal, and statewide agencies. The plan leveraged Medicaid programs, perinatal quality improvement projects, and technical assistance aimed to improve health outcomes, improve continuity of care, and foster positive mental health. Ongoing communication strategies, learning community calls, and collaboration with stakeholders on initiatives amplified these efforts.  The plan underscores Wisconsin’s commitment to achieve and optimize individual’s holistic health potential by addressing differences, improving maternal and infant health outcomes, and empowering the community birthing workforce in an effort to promote and support sustainable health care practices for maternal child health populations throughout Wisconsin.

 

Address diferences in maternal and infant health through Wisconsin’s Medicaid programs.  

 

This strategy aims to enhance outcomes for individuals who are low income, medically underserved, and experience limited availability to health services by enhancing coordination of care delivery and work to disrupt systemic disparities noted in Medicaid programs. ForwardHealth is a system that manages and administers various healthcare programs in Wisconsin, including Medicaid and BadgerCare Plus. ForwardHealth brings together many healthcare and nutritional assistance benefit programs with the goal of improving health outcomes for members and creating efficiencies for providers. It's the state's claims processing system and also supports various health care programs and web services all under the ForwardHealth Portal. Ongoing collaboration of the Title V maternal and child health nurse consultant and the Division of Medicaid Services policy staff brought forth key actions that included: advocacy for extension of postpartum care to twelve months, educating prenatal care coordinators, collaboration on the development of care coordination modules to support prenatal care coordination service delivery, providing improved care coordination resources, and engagement directly with community agencies to determine ongoing needs to support prenatal care coordination improvements. Collaborative efforts between the Title V maternal and child health nurse consultant and the Division of Medicaid Services lead to a presentation at the Fulfilling the Promise conference on Prenatal Care Coordination – Medicaid Benefit 101, and led to the publishing of a Prenatal Care Coordination Frequently Asked Questions to the Medicaid ForwardHealth Portal Policy and Procedure Handbook. Additional resources can be found here Resources for Prenatal Care Coordination Providers.

 

The Wisconsin Child Welfare Professional Development System in partnership with the Department of Health Services created a series of four web-based Prenatal Care Coordination (PNCC) Professional Development Modules for PNCC providers. This series is intended for both new providers and more experienced providers who are looking to improve their knowledge about comprehensive and important skills, such as client-centered interviewing, behavioral health, and the role of care coordination in Wisconsin Medicaid. These are fully asynchronous and include resources and interactive activities, including a certificate for providers who complete the module. The goal of these modules is professional development, and all Medicaid providers must follow Medicaid policy. The Prenatal Care Coordination training modules can be accessed below:

 

Module 1: Coordinating Prenatal Care for Birthing People

Module 2: Client-centered Interviewing Techniques

Module 3: Providing Support and Connecting Birthing People to Behavioral Health Services

Module 4: Teaming and Coordination Across Systems of Care

 

Title V Maternal Child Health nurse consultant work to bridge additional knowledge gaps for agencies through ongoing connection to Prenatal Care Coordination field representatives and included specific work with an agency to support at a postpartum depression event. Engagement with community agencies provided a platform of information shared with Division of Medicaid Services to support their application and award for Center for Medicare and Medicaid Services, Transforming Maternal Health Model. Alignment and collaboration with the Wisconsin Maternal Health Innovation Program began in 2024.  Collaboration with the Maternal Health Innovation program supported the development of a Prenatal Care Coordination brochure which aimed to promote prenatal care coordination, provide available resources, and educate clients on services offered in prenatal care coordination to Medicaid eligible individuals throughout Wisconsin.  The brochure was available in Spanish, Hmong and English languages.  Postpartum coverage only being offered through 90 days remains a significant barrier to improving maternal morbidity and mortality outcomes in the postpartum period. 

 

Enhance perinatal mental health services.

 

The primary focus for the perinatal mental health strategy relates to improving screening, referrals, and follow-ups for clients experiencing perinatal mental health disorders. This initiative includes policy development, process improvements, and collaboration with healthcare providers to strengthen workforce capacity. These efforts aim to normalize mental health care, address stigma, and ensure that women experiencing perinatal mental health disorders receive timely and effective support. Thirteen local health departments and one Tribal agency representing all five Wisconsin public health regions addressed perinatal mental health with their Title V funds and developed action plans supporting community needs and impacting populations at greater risk for poor health outcomes.

 

The local and Tribal health agencies attended quarterly peer learning calls and one-on-one consultations and were provided robust resource information and many additional learning opportunity offerings throughout the year.  Technical assistance is provided by Mom’s Mental Health Initiative and participants shared the following:

 

“Our technical assistance provided great resources at the state level in regard to perinatal mental health resources and keeps us in the loop of conferences, speaking engagements, and educational materials.”

 

“Resources provided during the learning calls has helped with continuing the policy writing process by providing different screenings that are available.”

 

Learning calls covered the following topics: perinatal mental health disorders policy and procedures on screening and follow-up, perinatal anxiety and perinatal obsessive-compulsive disorder, perinatal mental health peer support, and substance use disorders/perinatal mental health. Local public health and Tribal agencies reported a variety of improvements or implementation to their policy and procedure which included: incorporating linkages to other supportive services, developing protocols to refer clients to evidence-based treatments, operationalizing assessments and response to imminent and/or suicidal risk and postpartum psychosis, utilization of the Periscope Project for psychiatric consultation, assessment for postpartum psychosis, and methods to track referrals. Most agencies supported pregnant and postpartum individuals with printed resources (90%), online resources (70%), one-on-one education (60%), social media resources or materials (40%), and community events (30%).  One agency developed a needs assessment survey in English and Spanish to further identify their community needs and another taught client's mindfulness activities. Topics covered included strategies to identify support systems, postpartum self-care strategies, proper nutrition and sleep habits, education on therapy (role and benefits), home safety, transportation resources, baby health, and support strategies for their family.

Local and Tribal health agencies sought to engage their community with varied approaches that included: translation of resource materials; using plain language approaches to materials for increased accessibility; connecting directly with clients at community events; assessing and addressing barriers (transportation issues, mental health provider access, insurance barriers, etc.); participating in trainings or professional development; analyzing data to understand community impact; partnering with community based organizations; focusing on populations experiencing limited availability of health services, utilization of a community advisory board for program planning and decision-making, hired staff that are able to communicate with clients in other languages, and performed a community perinatal mental health assessment. Local and Tribal health agencies facilitated their work within their communities in numerous ways that included: partnerships with WIC to offer clients screenings and resources, workgroups addressing mental health as a priority, direct surveys within their community to refine the need, building community public health trust through community events (e.g., community baby shower), and improving screening methods and referral process. Local and Tribal health agencies reported:

 

“Prior to this, clients were given a list of providers, and it was left to them to make the call for services. For some clients that had extreme struggles, this often resulted in the client not seeking services.  Now, the maternal child health wellness coordinator is able to provide active assistance in the referral process for mental health services and follow up to ensure the services were a good fit for the client.”

 

“The intended outcome is to contact all appropriate families who have experienced stillbirth and infant loss in 2024 to offer them an opportunity to share their stories.”

 

“It is exciting to know that we are actively screening almost all of the mothers that attend WIC’s program.”

Collaborative partnerships significantly facilitated this work by enhancing connections within their communities directly, each developing a unique approach. The local and Tribal health agency that pursued this objective for more than two years reported significant improvements in being able to address the mental health needs of perinatal clients. The local and Tribal health agency also utilized their funding to expand their perinatal mental health knowledge by attending conference presentations offered by the Wisconsin Association of Lactation Consultants, the Wisconsin Association for Perinatal Care, the Wisconsin Child Welfare Professional Development System, the Fulfilling the Promise Conference, the Wisconsin Public Health Association Conference, and the Wisconsin Association of Local Health Departments and Boards. Additionally, trainings were offered by Reproductive Health National Training Center and US 2 Behavioral Health Care Inc. The work was further facilitated by partnerships, alignment with other efforts and priorities, helpful resources from technical assistance provider or objective lead, staff interest and expertise, learning from other agencies’ work and approaches, funding resources (Title V and other funding sources), and evidence from data or data-related resources.

 

Local and Tribal  health agencies did report barriers and systemic challenges to their work that included: limited access to perinatal clients due to programming gaps that do not follow clients throughout the full postpartum year, need for additional staff training on perinatal mental health disorders, workforce capacity due to staffing and workload demands, need for additional funding and resources to support perinatal mental health initiatives, access issues (e.g., transportation, insurance coverage, health care distrust, etc.), and scarcity of behavioral health resources within their community.

 

The Title V perinatal health nurse consultants were utilized as the primary resource for sharing their subject matter expertise and providing resources for the Family Foundations Home Visiting Program, Family Mental Health Wellness Continuous Quality Improvement Project.

 

Improve postpartum visit rates through quality improvement projects.

 

This strategy emphasized collaboration with health care agencies and providers to encourage scheduled postpartum visits. Activities included disseminating educational materials, leveraging quality improvement tools, and aligning efforts with the Wisconsin Perinatal Quality Collaborative. Progress was made in revising strategies to promote follow-ups during the postpartum period and addressing data gaps that hinder program evaluation. These initiatives aim to ensure that women receive comprehensive care after delivery, improving overall maternal health.  A key partner in this work is the Wisconsin Association of Perinatal Care whose staff regularly share learning opportunities that included WisPQC Learning Collaboratives, Wisconsin CONNECT’s podcast, the WI Rural Health and Substance Use Clinic Support (RHeSUS) program, the WISAM conference, the Periscope Project, and various national and other perinatal quality collaborative opportunities.  The Wisconsin Association of Perinatal Care staff attended and participated in five activities: (1) Wisconsin Doulas Association Conference; (2) Opioid, Stimulants, and Trauma Summit (one staff member co-presented); (3) Wisconsin Public Health Association Conference; (4) Wisconsin CONNECTS Perinatal Substance Use Certificate program; and (5) Wisconsin CONNECT’s podcast development.

 

Implement a revised perinatal care designation process.

 

This strategy focused on refining levels of perinatal care for birthing centers through leveraging the CDC’s Levels of Care Assessment ToolSM (CDC LOCATe) Toolkit which is a standardized method for evaluating hospital and birthing center maternal and infant care to identify gaps in risk appropriate care.  Forty-seven hospitals (55%) completed the self-reported LOCATe survey tool. Hospitals reported key barriers for completion of the LOCATe survey tool that included: time constraints for completion, lack of administrative support, and reports of processes that already assess levels of care within a hospital system. The utilization of the tool provided hospital insight and a foundation to inform Wisconsin Association for Perinatal Care to further develop their designation process, engage stakeholders, and create a resource hub to ensure successful implementation for a planned pilot launch in 2025. Eight hospitals have been contacted about participating in the Wisconsin Association of Perinatal Care Levels of Care Designation Process 2025 pilot; six of the eight hospitals have confirmed participation. The sites are from rural and urban areas and represent all four levels of care designation:  Aspirus Rhinelander, Children’s Wisconsin, Froedtert Hospital, Marshfield Medical Center-Eau Claire, SSM Health St. Mary’s Hospital-Madison, and Tamarack Health Hayward.

 

Strengthen collaboration and partnership with community level workforce.

 

Wisconsin’s Title V team continues interdepartmental collaboration with the Department of Children’s Family Foundations Home Visiting program. On May 1st, 2024, a Title V, Maternal Mortality Prevention nurse abstractor presented at the Home Visitation All-Grantee quarterly meeting on the Center for Disease Control and Prevention “Hear Her Campaign” spotlighting awareness of urgent maternal warning signs, listening actively when women express concerns and the importance of sharing the Center for Disease Control and Prevention “Hear Her Campaign” resources to pregnant and postpartum women, their partners, and health care professionals.

 

Shared data promoting common screening tools, resources, and community partnerships allows the Title V team to inform work addressing similar priority population outcomes:

 

Percent of primary caregivers screened for depression within 3 months of enrollment (if not enrolled prenatally) or within 3 months of delivery (if enrolled prenatally).	81% (586/722 adults)
Percent of primary caregivers who reported using tobacco at enrollment and were referred to tobacco cessation counseling/services within 3 months of enrollment.	19% (18/94 adults)
Percent of mothers enrolled prenatally or within 30 days after delivery who received a postpartum visit with a health care provider within 8 weeks of delivery.	72% (322/450 adults)
Percent of primary caregivers referred to services for a positive depression screen who received one or more service contacts.	10% (6/59 adults)
Percent of primary caregivers who had continuous health insurance coverage for at least 6 consecutive months.	85% (1164/1363 adults)

In 2023, the Family Foundations Home Visiting team established a community of practice for home visitors that established four training development topic opportunities which included: health literacy, hypertension disorders during and after pregnancy, gestational diabetes, and pharmaceuticals during pregnancy and postpartum period.  The Title V maternal and child health design team (two maternal infant health nurse consultants, a maternal mortality review team nurse abstractor, and a home visiting nurse consultant) approached 2024 with plans designed to intentionally expand professional development opportunities with these topics to all workforce members who worked directly with families of maternal child health populations. This positive impactful shift provided avenues to build trust in relationships at community level and to inform improvement in servicing of birthing families.

 

The Title V team provided a platform for discussion with the leadership from several community-based organizations.  Community-based organizations included: the African American Breastfeeding Network, City of Milwaukee Health Department, Public Health Madison Dane County Health Department, The Foundation for Black Women’s Wellness, Oneida Tribal Nation, Wisconsin Doulas of Color Collective, Dr. Kara Hoppe from University of Wisconsin Prevention Research Center, Dr. Anna Platnik from the Medical College of Wisconsin, and Unite WI.  This strategic shift allowed for collaborative support and relationship building through sharing and shaping of professional development opportunities. The discussions brought in robust qualitative data, informative and innovative ideas, and feedback related to the chosen topics, toolkits, and resources; an intentional construct of bringing forth the value of topics tailored directly to the community needs while honoring the extensive roles of Wisconsin’s community birthing workforce. This strategic focus paved a path for the Title V team to share emerging practice and evidence-based information to the community birthing workforce that includes home visitors, prenatal care coordination providers, community health workers, doulas, clinic nurses and providers, local and Tribal health agencies and others. These trainings also work to elevate awareness of the critical role of the community level birthing workforce within the health care infrastructure, promote alignment with other healthcare initiatives in Wisconsin, enable consistent messaging of health information, unify the community birthing workforce, and foster the growth of smooth care transitions throughout Wisconsin. Facilitated workforce development and support also aims to reduce community workforce burn out, maintain staff retention, and foster sustainable and impactful care practices in particular for maternal child health populations with low income or limited availability of health services. This work provides important information and resources that will directly reach individuals and families, making the largest impact for those at the greatest risk for poor outcomes.

The Title V team launched the first professional development topic of Health Literacy in November 2024, through collaboration with the Wisconsin Department of Children and Families, Family Foundations Home Visiting in partnership with the Office of Head Start, Office of the U.S. Administration for Children and Families, the National Center for Health, Behavioral Health and Safety, and the Wisconsin Child Welfare Professional Development System to bring a first of its kind webinar opportunity , “Tools and Strategies for Improving Health Literacy in Early Childhood Programs”. This webinar unpacked a health literacy toolkit from the federal Office of the Administration for Children and Families, Office of Head Start, on health literacy practices providing strategies to help families and staff find, understand, and use health information more effectively by improving communication and through advancing coordination of care for individuals. The Title V team began to lay the foundation and plan for a Pregnancy and Postpartum Hypertension three-part webinar series with launch date of early 2025 in collaboration with the University of Wisconsin School of Medicine and Public Health and UW Health maternal fetal medicine specialist, Dr. Kara Hoppe.
 

Health Literacy Training Module Registration and Attendance Data from the Wisconsin Child Welfare Professional Development System
Service sector	Registered	Attended
Birth to Three	7	6
Clinic/ Nursing	10	3
Community Health Worker	24	8
Doulas	4	1
Early Head Start (home based)	12	6
Early Head Start/ HS Center	18	8
Family Resource Center	10	2
Home Visiting	71	44
Other	76	33
PNCC	25	11
Public Health	50	21
Tribal	2	0
Total	309	143

Key data collection will allow monitoring the impact of these workforce development opportunities with a focus on aspects of care coordination opportunities and the reduction of health-related barriers. Data sources to include:  the Great Lakes Inter-Tribal Epidemiology Center, Medicaid’s Prenatal Care Coordination evaluation, Wisconsin Association for Perinatal Quality Care, Perinatal Periods of Risk data, Maternal Mortality Review qualitative data, vital records data, Wisconsin Pregnancy Risk Assessment Monitoring System data, and others.

 

NEWBORN SCREENING

 

In 2024, newborn screening program staff, in partnership with Wisconsin State Laboratory of Hygiene

and the Wisconsin Screening Hearts in NEwborns (SHINE) program administered the Wisconsin Newborn Screening program which is funded through a combination of program fee revenue and Title V funds. The large majority of the newborn screening program’s costs are funded through the purchase of blood cards. The program has been in a budget deficit and worked through the rulemaking process to increase the newborn screening blood card fee in relation to the addition of newborn screening conditions to the newborn screening panel as of August 1, 2025. This blood card fee change is needed to effectively support children with special health care needs, identified through the newborn screening program. This program consists of blood screening, heart screening, and hearing screening.  

 

Blood: The Wisconsin State Laboratory of Hygiene, under contract with the Department of Health Services, screens infants born in Wisconsin for 48 blood disorders to ensure Wisconsin newborns are screened, diagnosed, and treated.

 

Heart: Screening Hearts in NEwborns, under contract with the Department of Health Services, is designed to provide information and resources for universal screening of newborns for critical congenital heart disease.
 

Hearing: Wisconsin Sound Beginnings is Wisconsin’s Early Hearing Detection and Intervention program within the Department of Health Services, that ensures all babies born in Wisconsin are screened for hearing loss, receive timely diagnosis of hearing loss, and receive quality early intervention. is Wisconsin’s Early Hearing Detection and Intervention program within the Department of Health Services, that ensures all babies born in Wisconsin are screened for hearing loss, receive timely diagnosis of hearing loss, and receive quality early intervention.

  

The Newborn Screening program provided outreach and education for submitters, providers, and families through a variety of forums. The Education Subcommittee oversees this work, with the purpose of educating the public and medical providers about newborn screening. Newborn screening information and brochures are made available online and as printed resources for partners and parents. Families who receive a diagnosis through newborn screening are provided resources through Connecting Families, Wisconsin Wayfinder and Children’s Resource Centers throughout the state.

 

In 2024, a sub-workgroup of the Education Subcommittee was created to review and update all newborn screening publications, including a review by the Title V team’s health outcomes specialist.

 

In 2024, the Newborn Screening program established an ad-hoc research workgroup to provide the Department of Health Services’ Secretary with proposed recommendations regarding research activities. These included examining research processes, reporting of results to parents and primary care providers, and consent related to research. The goal is for guidelines and recommendations to be sent to the Department of Health Services’ Secretary by fall of 2025.

 

Work Completed in 2024

 

Blood: The Newborn Screening program, in collaboration with Wisconsin State Laboratory of Hygiene, worked closely with hospitals and out of hospital partners to ensure all babies born in Wisconsin received blood screening, appropriate follow-up testing, and treatment in a timely manner. The Newborn Screening Program Coordinator worked collaboratively with contracted agencies to provide ongoing clinical services, care coordination under the medical home model, prevention of loss to follow-up, links to services including early intervention, and transitions for youth with special health care needs to adult care.

 

Heart: Screening Hearts in NEwborns provided clinical decision support and guidance to providers while ensuring that infants suspected of or diagnosed with critical congenital heart disease received appropriate follow-up evaluation and care. The newborn screening program’s data system, WE-TRAC, continues to be refined for use in critical congenital heart disease monitoring, and the team is able to conduct meaningful analyses of outcomes and follow-up, as mentioned above. 

 

Hearing: The Wisconsin Sound Beginnings program supported hospitals and providers to increase the percentage of babies screened, percentage of babies receiving timely diagnosis of permanent hearing loss, and the percentage of babies enrolling in Early Intervention. Wisconsin Sound Beginnings also aimed to reduce the percentage of babies not receiving follow-up. The WE-TRAC data system allowed for real-time surveillance and tracking of all babies born in a Wisconsin hospital or in an out-of-hospital setting to encourage timely interventions. Children from birth to age three with developmental delays and/or disabilities are eligible for enrollment in Early Intervention in Wisconsin. 92.3% of babies born in 2024 diagnosed with permanent hearing loss have been referred to Early Intervention.

 

BIRTH DEFECTS PREVENTION AND SURVEILLANCE

 

Wisconsin’s Title V program continued to support staff who are responsible for administering the Wisconsin Birth Defects Prevention and Surveillance program. State funds are used to support surveillance and prevention initiatives. Beginning July 2024, the University of Wisconsin School of Medicine and Public Health, Department of Pediatrics was selected to establish a statewide taskforce on congenital Cytomegalovirus to research and recommend steps for implementing high-quality systemic screening in Wisconsin. The Wisconsin Screening Prevention and Early Recognition (CMV WiSPER Project) is a cross-sector collaborative with representatives from hospital departments (pediatrics, audiology, infectious disease, and others), representatives from the Wisconsin Department of Health Services, community members, and parents of children diagnosed with congenital Cytomegalovirus. Three work groups have been created (Newborn Screening/Hospital workgroup, Audiology workgroup, and the Family and Education workgroup) and currently meet monthly.

 

Staff also supported the Council on Birth Defect Prevention and Surveillance, which met quarterly. The Council members are appointed and include a diverse group of experts who make recommendations to Wisconsin regarding the registry and are responsible for coordinating with the Early Intervention Interagency Coordinating Council (Wisconsin Governor’s Birth to 3 Program Interagency Coordinating Council).

 

The Wisconsin Birth Defects Prevention and Surveillance program is required to maintain a registry of birth defects diagnosed among children from birth to age two years, who were either diagnosed and/or treated in Wisconsin. The Wisconsin Birth Defects Registry is a secure, web-based system that allows pediatric specialty clinics and physicians to submit one individual report at a time or a batch report with multiple reports included. Reporters may also submit a paper form to the Wisconsin Birth Defects Registry state administrator for inclusion in the registry. The registry is mandated by Wisconsin statute to collect demographic, diagnostic, and identifying information on children from birth to 2 years of age who are born with specified birth defects. Physicians and pediatric specialty clinics are mandated reporters, while hospitals may report. The Wisconsin Birth Defects Registry collects identifying and demographic information on the child and mother, as well as information on referral to services, risk factors, and the diagnostic information for one or more of the 64 reportable conditions included in the registry. The registry has not been functional the past four years due to a transition into a new reporting system. However, in September 2024, one of the state’s largest healthcare systems began reporting data, while three other large healthcare systems prepared to start reporting in 2025. The Wisconsin Birth Defects Prevention and Surveillance program continued to outreach with other health care systems to increase statewide reporting.