NJ’s maternal health outcomes and disparities are among the highest in the U.S. Approximately 50 women die from pregnancy-related (PR) complications in NJ every three years. According to America's Health Rankings, NJ’s maternal health outcomes and disparities are known to be among the highest in the U.S[1]. As of 2019, NJ ranks 4th in worst maternal mortality rates compared to other states using data from CDC WONDER[2]. Approximately 14 women die from PR complications in NJ every year (Figure 13.).  Black women experience seven times the rate of death from pregnancy-related causes compared to their white counterparts (Figure. 12). Moreover, severe maternal morbidity (SMM) rates are among the highest in the U.S. In 2019, SMM rates among black, Non-Hispanic (NH) women were nearly three times greater than those of white, NH women. Child health outcomes are equally concerning. While NJ has the 5th best overall infant mortality rate among the 50 states, the non-Hispanic black infant mortality rate in NJ is 3.5 times higher than the infant mortality rate for white, NH infants. The Hispanic infant mortality rate is 1.4 times higher than the rate among white, NH infants[3]. Findings from the most recent 5 year needs assessment include the need to address NJ’s maternal mortality crisis, especially with regard to disparities.

Child health outcomes are equally concerning. While NJ has the 5th best overall infant mortality rate among the 50 states, the non-Hispanic black infant mortality rate in NJ is 3.5 times higher than the infant mortality rate for non-Hispanic white infants (Figure 14). The Hispanic infant mortality rate is 1.4 times higher than the rate among White babies.

Figure 14. Infant Mortality by Race/Ethnicity per 1,000 Births

Several efforts to address the needs of the MCH population in NJ have continued and further been developed since last year’s 5 year needs assessment. In 2021, in partnership with Montclair State University, TVS evaluated the 3-year doula pilot program. The team examined the five types of services doulas provide to clients during pregnancy, labor, and postpartum periods. As well, the proportion of effort spent providing these services is estimated based on stakeholder interviews (Figure 15). Several actionable recommendations have emerged from the data for improving the implementation and outcomes of ongoing efforts related to the Doula Pilot Program. These recommendations are based on evaluation data collected and compiled from May through November 2021:

1. Continue to link doulas with Community Health Workers to help meet the needs of clients.

2. Continue and potentially enhance statewide training and certification opportunities for doulas to help expand the doula workforce in NJ. 

 3. Create a formalized support system for doulas to institutionalize mentoring and access to counseling or psychological support for doulas.

  4. Develop and maintain a central information hub for doulas practicing in NJ to share common information.

 5. Explore opportunities to increase doula compensation and expand the number of doula services that qualify for reimbursement in Medicaid.  

 6. Provide and share information about additional supports to increase the number of Medicaid provider applications among doulas.

 7. Create a pipeline to bring private doulas into future program efforts to better link the doula workforce.

 8. Develop and implement an awareness campaign for medical staff to improve awareness and acceptance of doulas.

  9. Clarify and share information about the specific roles, responsibilities, and expectations of stakeholders involved in the program to facilitate planning and program implementation.

The services provided through the Doula Pilot Program were reported to be meaningful and had critical value to the doulas and clients. There is a mutual appreciation of the commitment and efforts made by NJ TVP and grantee agencies. Moving forward, the Doula Learning Collaborative will build on the successes and improve the challenges of the pilot program and recommendation to establish a culturally responsive platform for current and prospective community doulas. Improving and providing quality access to maternal and infant care with an emphasis on NH black families in NJ.

Moreover, NJDOH, under the direction of and in collaboration with Governor Phil Murphy and First Lady Tammy Murphy, is working to ensure that NJ becomes the safest place in the United States to give birth. To this end, First Lady Tammy Murphy launched a statewide, public-private initiative, Nurture NJ, in 2019 to help eradicate maternal mortality and morbidity health disparities for black and Latinx birthing people, especially women, in NJ. Nurture NJ staff and DOH, including Title V, along with other state agencies, the state legislature, health systems, other clinical stakeholders, and communities are tasked with identifying additional strategies to turn the tide in maternal health outcomes and build upon work already being done to address these health disparities in NJ. By creating new public-private relationships and leveraging new resources supported by legislation and federal funding Nurture NJ aims to be a thought partner and culture shifter.

The New Jersey Maternal Care Quality Collaborative (NJ MCQC) is a multidisciplinary team of stakeholders who will oversee the transformation of maternal healthcare in NJ. The collaborative will establish a shared vision and statewide goals for key health services focused on decreasing maternal deaths, injuries, and racial and ethnic disparities under the umbrella of Nurture NJ. Nurture NJ, First Lady Tammy Murphy’s statewide awareness campaign is committed to reducing infant and maternal mortality and morbidity and ensuring equitable maternal and infant care among women and children of all races and ethnicities. The campaign, which is devoted to serving every mother, every baby, and every family, includes a multi-pronged, multi-agency approach to improve maternal and infant health among NJ women and children.

The FHS Assistant Commissioner has been appointed as a member of the NJ MCQC. Through engagement with the  Maternal Health Innovations Team in the Office of Population Health, TVS has been actively involved,  meeting with stakeholders across the state: the Maternal Child Health Consortia, Professional Societies, NJ Hospital organizations, Regional Health Hubs, the New Jersey Health Care Quality Institute, Medical Societies, Planned Parenthood, the NJ Primary Care Association, NJ Federally Qualified Health Centers, the NJ Family Planning League, and the New Jersey Perinatal Quality Collaborative. Through these meetings, teams were able to identify areas of synergy for collaboration. Moreover, key barriers to maternal health in NJ were identified, which include funding, workforce (training and diversity) needs, working in silos, and data use, access, and connectivity needs. Stakeholders shared a focus on health equity to eliminate bias in care, increase access to equitable care, collect and share data that illustrates disparities, and advocate for underserved and minority patients and families.

Ongoing data collection and research initiatives to better assess MCH population needs have also continued. Data review from several innovative programs including Doulas and Centering is underway. NJ’s Perinatal Risk Assessment Monitoring System (PRAMS) samples one out of every 50 mothers each month when newborns are 2-6 months old. Survey questions address the feelings and experiences before, during, and after pregnancy. The PRAMS sample design oversamples smokers and minorities. Data are weighted to give representative estimates of proportions in specific categories and actual persons. More than 26,500 NJ mothers were included between 2002 and 2019 with an average response rate of 70%. Additional questions have been incorporated into the PRAMS survey to include COVID-19 and also most recently, questions concerning the COVID-19 vaccine have been added. Information from PRAMS is used to improve health programs for NJ mothers and infants, such as improving access to high-quality prenatal care, reduction of smoking during pregnancy, and encouraging breastfeeding.

NJ is voluntarily participating in the Centers for Disease Control and Prevention (CDC) Surveillance of Emerging Threats to Mothers and Babies Network, also known in NJ as “Project W.” Tracking of maternal and infant outcomes is ongoing. What is known about COVID-19 is rapidly evolving and documented outcome rates are likely to shift as the rate and distribution of infection change. Thus far, most pregnancies do not have adverse outcomes, however, continued monitoring is needed.

TVS has also been assessing workforce development needs as the workforce of Community Health Workers, Doulas, and most recently Perinatal Community Health Workers and Certified Nurse Assistants are developed and expanded. TVS met with workers in these areas to determine training needs and employment tracks and opportunities. TVS is also working with Medicaid concerning reimbursement for these services. Together, TVS and Rutgers University Project Echo offered an educational series designed for doulas, so that they could meet a portion of the Medicaid Certification requirements. These sessions provided information, peer-to-peer discussions, and resources for doula serving Medicaid-enrolled pregnant women.

Title V seeks public input on the Maternal Child Health Block grant (MCHBG) throughout the year at the quarterly Community of Care Consortium meetings spearheaded by the Statewide Parent Advocacy Network, the NJ Chapter of the American Academy of Pediatrics, and the NJDOH TVP. Every year, public input on the MCHBG is officially requested with the posting of the draft MCHBG on the NJDOH’s website. Written testimonies are being accepted through July for inclusion in the public input section of this year’s MCHBG.

NJ TVP continues to address and develop innovative ways to meet the needs of the MCH population as the COVID-19 pandemic continues to evolve. Many programs are currently in transition in terms of returning to offering in-person services and resources. We remain intentional in our approach to promoting health equity and reducing disparities. NJ remains one of the most racially and ethnically diverse states, as well as one of the most densely populated states. Many pre-COVID-19 challenges for MCH populations, such as food insecurity, mental health, and substance use issues, employment, and childcare concerns, as well as access to comprehensive culturally competent community-based health care services, have been exacerbated during the COVID-19 pandemic, especially for the most vulnerable populations, such as birthing people and families with young children. COVID-19 and vaccine confusion and myths have continued to develop since the submission of last year’s 5-year Needs Assessment.

[1] America Health Rankings. Health of Women and Children. Accessed on April 20, 2022. Explore Health Measures in New Jersey | 2019 Health of Women and Children Report | AHR (americashealthrankings.org)

[2] America Health Rankings. Thematic Map: maternal Mortality. Accessed on April 20, 2022. https://www.americashealthrankings.org/explore/health-of-women-and-children/measure/maternal_mortality_a/state/ALL?edition-year=2019

[3] New Jersey State Health Assessment Data. “Health Indicator Report on Infant Mortality Rate”. Accessed on April 20, 2022 at NJSHAD - Health Indicator Report - Infant Mortality Rate (state.nj.us).