Maine’s Title V Maternal and Child Health (MCH) Program, in partnership with the US Department of Health and Human Services (DHHS), Health Resources and Services Administration (HRSA), is responsible for promoting the health of all mothers and children, including children with special health needs and their families.

The Role of Title V in Maine

The Maine Title V program supports a statewide system of services that is comprehensive and family-centered. The Maine Center for Disease Control and Prevention (Maine CDC) houses the Title V Program along with other MCH programs such as WIC, Maine Families Home Visiting, Tobacco and Substance Use Prevention and Control (TSUPC), Injury Prevention and Public Health Nursing (PHN). These programs work collaboratively to address the needs of the MCH population across the state.

Title V utilizes a significant portion of federal funding to support staff in the areas of PHN, CSHN and injury prevention to ensure meeting the needs of the state’s MCH population. Title V also serves as a systems builder by funding such services as the Maine Maternal, Fetal and Infant Mortality Review Panel, epidemiological surveillance, including the Maine Integrated Youth Health Survey, and program evaluation.

The Maine Title V Program does not operate in isolation. Partnerships with other organizations are essential in our ability to expand capacity and reach across the state. The Title V Program collaborates with hospitals, other state agencies, such as the Office of MaineCare Services, Office of Child and Family Services, Department of Education, Child Development Services, the Developmental Disabilities Council, universities and other stakeholders. Family involvement is encouraged in the areas of needs assessments, program planning and evaluation. To enhance capacity, the Title V Program contracts with several external agencies to ensure needed services are available to the MCH population.

Maine’s Title V Program continually emphasizes the importance of data driven decision-making. To achieve this goal, Maine’s lead MCH epidemiologist ensures use of a data-driven approach in developing Maine’s MCH performance measure activities and conveys data back to program staff to aid in program planning. Following is a summary of the status of Maine’s maternal and child health population.

Women/Maternal Health

Reproductive Health

Improving women’s health before, during and between pregnancies is an important public health goal. In 2019, 1 in every 4 (25%) low-risk first births were born via cesarean section. In 2019, Maine’s rate on this measure was 19th lowest among all U.S. states and territories, and the second lowest in New England behind Massachusetts. Maine’s rate of C-sections among low-risk first births increased gradually between 2014 and 2019.

The perinatal education and services team provided outreach, support and services to over 4,000 MCH providers across the state offering 369 unique consultation or educational support events throughout the year. Increased focus on recording and storing these efforts for provider access was also undertaken. This effort is showcased at: https://mainehealth.org/barbara-bush-childrens-hospital/services/perinatal-outreach

Birth Outcomes

Based on Maine PRAMS data, in 2019 60% of new mothers reported that their pregnancy was intended; 22% reported that they had not wanted to be pregnant at all or wanted to be pregnant later. In the U.S., 58.5% of new mothers reported that their pregnancy was intended. Between 2016-2019, 31% of Maine women 18-24 reported that their pregnancy was unintended; 19% of those aged 25-34 had an unintended pregnancy. In recent years the percent of women reporting that their pregnancy was intended has not changed significantly.

Maine Family Planning (MFP) tracks the prevalence of long acting reversible contraception (LARC) with those they serve and have seen an increase in use. During FY20, MFP providers inserted 608 LARCs, a decrease compared to 2,259, 917 and 809 in the three previous reporting cycles. MFP attributes this significant decrease to the impact of COVID on preventive health care services during this period.

Risk Factors for Chronic Disease

In 2019, about 12% of Maine women smoked during pregnancy. Maine’s rate is double the U.S. rate of 6.0%. Only seven states have a higher smoking during pregnancy rate. However, Maine’s smoking during pregnancy rates have declined since 2014 when 16.5% of Maine women reported smoking during pregnancy. Provisional data from 2020 and the first part of 2021 suggest Maine’s rate continues to decline. Starting in 2016, Maine PRAMS included questions on e-cigarette use during the last three months of pregnancy. In 2019, 3.3% of women reported using e-cigarettes or hookah in the last three months of pregnancy. This is significantly higher than the U.S. rate of 1.3%. The percent of women using e-cigarettes did not change significantly between 2016 and 2019.

The Non-Clinical Outreach initiative is an effort where tobacco public health partners work with statewide social service programs or service agencies, such as Maine Families Home Visiting, WIC or other service providers to increase the number of people, including pregnant women, referred to the Maine Tobacco HelpLine through the QuitLink.

Perinatal/Infant

Birth Outcomes

Maine has had great success in encouraging breastfeeding (BF) initiation and promoting breastfeeding duration. Among infants born in 2017 in Maine, 88% were ever breastfed (U.S. = 84%) and 28% were breastfed exclusively for at least six months (U.S.=26%). Maine’s percent of infants ever breastfed and those breastfed exclusively at six months are both the 18th highest in the U.S.

All MFHV sites have certified lactation counselor trained staff available to support BF mothers, with several sites offering BF support groups. During FY20, the MFHV program saw participant BF rates stabilize at 49% for engaged families a decrease from 52.8% in FY19.

Maine’s WIC program provides extensive BF supports to eligible enrolled mothers, including lactation counseling and provision of breast pumps. Maine state law requires employers to provide paid or unpaid breaks to express milk and provide a clean space for lactation activities.32

Safety and well-being for infants

In 2019, 91.4% of Maine infants were most often placed to sleep on their backs only. Maine’s percentage is the highest among states that participate in the PRAMS survey. The U.S. rate in 2019 was 79.9%.

Maine’s safe sleep efforts are focused on ensuring parents have safe places for infants to sleep, as well as ensuring proper care for drug-affected infants, which can be at high risk for unsafe sleep deaths. The Maine DHHS launched a statewide Safe Sleep Campaign ABCD (ALONE in their crib, on their BACK, clean clear CRIB, DRUG-FREE home) in early FY20 to prevent infant deaths by educating the public on ABCD and the importance of safe sleep for babies.

Child Health

Access to High Quality Health Care

When a developmental delay is not recognized early it can make it difficult for children to learn when they begin school. According to the 2018-2019 National Survey of Children’s Health (NSCH), about 39% of Maine parents of children ages 9-35 month’s report that they were asked to complete a developmental screening tool for their child within the previous year. Maine ranked 18th highest on this measure.

The Women, Infants and Children (WIC) program conducts developmental surveillance using the federal CDC’s Learn the Signs Act Early tool. During 2020, all children seen at WIC were provided with materials on age appropriate developmental surveillance. WIC documents any developmental concerns found and refers parents to the child’s medical provider for further review.

Readiness to learn and succeed

Maine conducts observations of children’s dental health as part of the Maine Integrated Youth Health Survey. In 2019, 51.6% of third graders in Maine were observed to have dental sealants.

Maine promotes oral health disease prevention for children, including education through school nurses and application of sealants. Maine dental providers promote dental sealants to parents as a good preventive intervention for their children. Maine also has dental hygienists working under public health supervision status who provide sealants on-site at schools. School sealant application facilitates children receiving sealants, especially in more rural and underserved areas where regular access to preventive dental care can be challenging. In the 2019-2020 school year, 299 (274 2nd grade and 25 3rd grade) children received dental sealants through the Maine School Oral Health Program.

Risk factors for chronic disease

Based on the 2018-2019 NSCH, 16.4% of children in Maine live in a household where someone smokes; 1.4% live with someone who smokes inside the home These rates are slightly higher compared to the those at the national level;  12.4% and 1.9% respectively. https://www.childhealthdata.org/browse/survey/results?q=7903&r=1

Maine uses the Smoke-free Homes Pledge to create community recognition around the importance of preventing children’s exposure to second hand smoke. Targeted venues include; housing authorities, schools, and employer fairs.

Adolescent Health

Readiness to Learn and Succeed

Despite increased attention to the need for prevention and intervention, bullying and harassment remain common experiences for children and adolescents. According to the 2018 NSCH, 18% of adolescents, aged 12-17 years old bullied others and almost half (47.5%) were bullied in the previous 12 months. The percent of Maine children who have bullied others is about the same as the U.S. (15.7%). The percent of Maine adolescents who had been bullied is significantly higher than the U.S. percentage of 40% and only 13 states had a higher percentage of parents reporting that their child had been bullied.

The Adolescent Health and Injury Prevention Program (AHIP) partners with the Maine Youth Action Network (MYAN) to promote youth leadership and positive youth development. MYAN District Youth Coordinators support Youth Policy Boards and other youth groups across Maine’s nine public health districts.

Unmet mental health needs among teens has a significant impact on their current well-being, and a lasting effect on their future. According to the 2018-2019 NSCH, 9.6% of Maine adolescents aged 12-17 years currently have depression; this is slightly more than the national average of 7.0%. About 22% have problems with anxiety, which is significantly higher than the national average of 12.6%, and 9% have behavioral or conduct problems (vs. 6.4% nationally).

To increase access to care, Maine CDC supports 15 School Based Health Center (SBHC) clinics that offer medical and behavioral health services to middle and high school students. SBHC providers conduct health risk assessments with young people that include screening for depression and other behavioral health conditions. School closures due to COVID-19 presented an additional access challenge; however, all SBHCs successfully implemented telehealth services and were particularly effective in providing ongoing behavioral health visits during the pandemic. After schools closed for in-person learning in March SBHCs provided an additional 1719 encounters (visits), of which 94% were for mental health. In total, the SBHCs provided ongoing mental health care to 412 students in the 2019-20 school year.

Children with Special Health Needs

Systems of care for CSHN

About half (47.2%) of Maine CSHCN had a medical home in 2018-2019; 60% of non-CSHCN reported receiving care within a medical home. The MPF offer technical assistance to provider offices on engagement activities including improving the office environment, the office visit and referrals for supports for families including availability of parent navigators The MPF’s work can help improve care coordination for parents of CSHN.

In 2018-2019, parents of 30.1% of Maine CSHCN ages 12–17 reported that their adolescent received services to assist with transition; this is slightly higher than the national figure of 22.9%. To support families and youth the MPF developed a Transition Guide (High School and Beyond: A Guide to Transition Services in Maine) and makes it available to all parents.