Colorado’s Five-Year Needs Assessment provided a multidimensional understanding of maternal and child health across the state to leverage strengths of local communities, cross priority opportunities, and identify crucial areas of focus. Drawing from both data systems, contextual qualitative data, and community input gathered through the MCH Listening Tour, the findings reflect ongoing issues, emerging opportunities, and broad consensus on what families and communities need to thrive.

Women/Maternal Health

Colorado communities continue to experience differences in maternal health outcomes for certain populations. While prenatal care access is high statewide, maternal mental health, postpartum support, and experiences of discrepancies in care were among the most frequently cited concerns during the MCH Listening Tour.

• Strengths: Growing adoption of community doula programs; integration of perinatal mental health training for providers; attention to safe and respectful care through maternal mortality review recommendations.
• Challenges: insufficient access to postpartum follow-up.
• Needs: Access to behavioral health, relevant care, family leave protections, and better continuity between hospital and community-based care.

Population overview: There are 1,211,176 women ages 15-44 in Colorado. 89.9% live in urban counties, 8.4% in rural counties, and 1.8% in frontier counties (Department of Local Affairs, 2023).

Prenatal and postpartum care: Prenatal care utilization is high, with 96.9% of people having prenatal care, and 85.0% starting their prenatal care in the first trimester. 92% of people had a postpartum checkup, but those enrolled in Medicaid were significantly less likely to have a postpartum checkup than those without Medicaid (85.6% vs 95.9%, PRAMS 2023). Access to maternity care varies greatly across the state as 35.9% of counties in Colorado are maternity care deserts, and a further 4.7% only have low or moderate access (March of Dimes, 2024).

Mental health: Mental health has been declining in recent years, with only 66.5% of women of reproductive age reporting good mental health in the past 30 days (BRFSS, 2023). The prevalence of postpartum mood and anxiety disorders remains high, with 9.2% of postpartum women reporting postpartum depression and 21.1% reporting postpartum anxiety symptoms (PRAMS 2023). At one year postpartum, 28.6% of postpartum women report wanting or needing mental health or counseling services since their baby was born, but only 69.5% of those received the care they wanted or needed. Common barriers to accessing care include: not knowing where to go, concerns about the cost of care or not knowing if it was covered by insurance, not having anyone to watch their children, and being unable to take time off of work or school (Baby & You 2023). While 9 in 10 report being screened for anxiety, depression, and emotional health during prenatal care and in the postpartum period (PRAMS, 2023), 9.6% would not have felt comfortable talking to any healthcare worker about their emotions (Baby & You, 2023). 

Parental leave: The majority of postpartum women took leave after their child was born, with 48.7% taking paid leave and 51.7% taking unpaid leave. New parents under the age of 25 and those with Medicaid as insurance were significantly less likely to take paid leave than their counterparts. Common reasons people did not take leave included their job not offering paid leave and being unable to afford to take leave (Baby & You, 2023). 

Maternal mortality: Maternal mortality has been rising both in Colorado and nationally. From 2018-2022 there were 106 pregnancy-related deaths, with a pregnancy-related mortality ratio of 33.9 deaths per 100,000 live births. 93.4% of these deaths were determined by Colorado’s Maternal Mortality Review Committee as having “good chance” or “some chance” of being preventable. Obstetric complications, suicide, and unintentional drug overdose are the leading causes of death. Those with a high school education or less were significantly more likely to die from pregnancy-related deaths than those with more than a high school education. Geographic differences exist, with those in frontier counties, the most rural counties in Colorado, having the highest pregnancy-related mortality ratios. Either mental health or substance use contributed to more than half of all pregnancy-related deaths (Maternal Mortality Prevention Program 2018-2022). 

Perinatal/Infant Health

While Colorado maintains strong performance in newborn screening and breastfeeding initiation, outcomes may be enhanced for specific populations.

• Strengths: Strong infrastructure for early screening and immunizations; peer lactation support efforts expanding through local health departments.
• Challenges: Perceived concern of child welfare involvement, lack of trusted providers, and early disconnection from systems post-discharge.
• Needs: Trusted postpartum support systems for specific populations; improved navigation from hospital to home; bilingual care coordinators and doulas.

Population Overview: There were 64,249 resident births in Colorado in 2024, 34.8% of which were to women with Medicaid as insurance (Vital Statistics, 2024). There was a 22.5% reduction in the birth rate from 2010 (64.3) to 2023 (50.7), with an even larger reduction of 68.2% in the teen birth rate in the same time frame from 33.0 to 10.5 (Vital Statistics, 2023). 

Breastfeeding: Breastfeeding initiation is high (92.1%, PRAMS 2023), though only one-third of children ages 6 months to 5 years are exclusively breastfeeding through 6 months (NSCH 2022-2023). Those with Medicaid as insurance have significantly lower rates of breastfeeding at nine weeks compared to those without Medicaid (67.9% vs 82.9%, PRAMS 2023). While those enrolled in Medicaid or other government assistance insurance plans also have lower rates of exclusive breastfeeding at 6 months than those with other types of insurance, the difference is not statistically significant (41.7% vs 33.1%, NSCH 2022-2023). 

Infant mortality: Infant mortality rates have remained stable in recent years, with an infant mortality rate of 4.5 per 1,000 live births in 2022 (Vital Statistics, 2022), lower than the national infant mortality rate of 5.6 (CDC, 2022). 

Vaccines: Among children born in 2020-2021, 72.1% received their combined 7-series vaccinations in the first 3 years of life. This is slightly lower than the national rate of 72.8% (USAFacts, 2024).

Home visiting: Only 1 in 10 parents participate in home visiting services in the first year since their baby was born, though the majority of those who did participate found the visits to be extremely or very helpful (82.3%, Baby & You 2023). 

Postpartum emotional support: The vast majority of postpartum women have a variety of sources of emotional support, including someone to go to if feeling lonely (81.9%), someone to talk to about their feelings (85.4%), someone to listen to their problems, worries, or fears (84.5%), and someone to show them love or affection (87.9%). However, teen parents were the least likely to have these types of support (Baby & You, 2023). Younger parents ages 15-24 were also more likely to not feel comfortable talking to any healthcare worker about their emotions compared to new parents ages 25 or older (Baby & You, 2023).

Doula support: 13.5% of people used doula support during the perinatal period: 8.7% had doula support during pregnancy, 10.3% during delivery, and 4.8% in the postpartum period (Baby & You 2023).

Child Health

Food insecurity and housing instability were top concerns based on community input obtained through the MCH Listening Tour. Families expressed frustration with navigating public systems and the stigma tied to receiving assistance, particularly in rural areas.

• Strengths: High rates of developmental screening; strong WIC infrastructure in urban centers; community-led initiatives addressing early childhood mental health.
• Challenges: Under-enrollment in nutrition programs; administrative hurdles; rural access gaps.
• Needs: Policy-level change to increase eligibility thresholds, expand WIC access, and provide non-stigmatizing, relationship-based outreach; safe and affordable housing.
   

Population overview: There are 880,079 children between the ages of 1 to 13 in Colorado (Department of Local Affairs, 2023). 

Housing stability: 12.0% of children ages 0 through 11 experienced housing instability in the last year (NSCH 2022-2023). Children and youth with special health care needs had much higher rates of housing instability (23.2%) compared to children without special health care needs (8.9%) (NSCH 2022-2023). 3 in 10 children, ages 0-17, live in households that are housing cost-burdened (pay more than 30% of income on housing costs). Among kids in low-income households, nearly 7 in 10 are in housing cost-burdened homes (KIDS Count, 2023). As of January 2023, there were an estimated 14,439 people in Colorado experiencing homelessness; 3,641 of these were persons in households with at least one adult and one child (US Department of Housing and Urban Development, 2023), and the Colorado Department of Education identified 21,089 public school students experiencing homelessness in the 2019-2020 school year (Colorado Department of Education, 2021).

Food insecurity: 27.4% of children lived in households that experienced food insufficiency, and children with special health care needs were more likely to experience food insufficiency (NSCH 2022-2023). 

SNAP and WIC: Eight in ten (84%) Coloradans who are eligible for SNAP have access to SNAP benefits. (United States Department of Agriculture, 2023). As of November 2024, the total number of WIC infant and child participants compared to the total number of WIC-eligible infant and child participants who were enrolled in Medicaid averaged 63 percent (Colorado Department of Public Health and Environment, 2024). 

Supportive neighborhood: 56.3% of parents with children in Colorado report living in a supportive neighborhood. Children in households with incomes less than 200% of the federal poverty level are significantly less likely to live in a supportive neighborhood than those with household incomes of 200% or more of the federal poverty level (42.6% vs 61.6%) (NSCH 2022-2023).

Adolescent Health

Youth from across Colorado shared a common theme of disconnection during the MCH Listening Tour. Many reported lacking a trusted adult in their lives, and a persistent feeling that “adults aren’t listening.” This aligns with elevated rates of youth mental health concerns, bullying, and social isolation.

• Strengths: Statewide investment in school-based behavioral health; increased engagement of youth voice in public health planning.
• Challenges: Mismatch between mental health provider supply and youth need; stigma; generationally irrelevant service models.
• Needs: Expanded access to trusted adults, mental health care that is tailored to specific populations, and safe spaces for peer connection.

Population overview: There are 448,981 youth in Colorado ages 12-17 years (Department of Local Affairs, 2023). 

Mental health: Mental health issues have been on the rise, with poor mental health among children ages 11 to 18 doubling from 2017 to 2021 (8.8% vs 18.5%), and 1 in 4 high school students experiencing signs of depression (HKCS, 2023). Suicide remains the leading cause of death for adolescents (CFPS 2023). 9.3% of high school students made a plan of how they would attempt suicide and 11.1% seriously considered attempting suicide in the past 12 months (HKCS, 2023). 23% of youth reported needing behavioral health services in the next year (CHAS 2023). Among those who needed mental health treatment or counseling, 81.8% of those ages 12-17 received the care they needed (NSCH 2022-2023). Access to behavioral healthcare varies widely across the state, as 46 of the state’s 64 counties do not have any child or adolescent psychiatrists. The counties that do have adolescent psychiatrists still experience a shortage, with fewer psychiatrists than would be considered a sufficient supply (American Academy of Child and Adolescent Psychology 2024). 

74.5% of adolescents have an adult outside the home they could go to for help with a serious problem (HKCS 2023).

Trusted adult: 74.5% of adolescents report having one or more adults outside the home who they can rely on for advice or guidance. Additionally, only 54.2% would tell their parents or guardians if they were concerned about their own or someone else’s well-being or mental health (HKCS, 2023).

Belonging: 67.0% of students either agreed or strongly agreed that they belong at school, and 40.3% enjoyed being at school all or most of the time (HKCS, 2023). 

School-based health centers: School-based health centers provided primary physical and behavioral health care to 33,444 students across the state (CDPHE, 2024).

Children and Youth with Special Health Care Needs (CYSHCN)

Families of CYSHCN consistently pointed to fragmented systems, delayed referrals, and overwhelming care navigation responsibilities. Despite these challenges, peer networks emerged as a powerful and trusted resource.

• Strengths: Organic peer-to-peer support; commitment to systems integration through early intervention and Medicaid collaboration.
• Challenges: Waitlists; lack of provider continuity; and difficulty with shifting from pediatric to adult care systems.
• Needs: Warm handoffs; formalized navigation supports; youth-directed planning when shifting to adult care systems; and expanded respite and caregiver supports.

Population overview: 27% of children and youth have special health care needs, meaning there are 501,863 children and youth with special health care needs ages 0 to 25 in Colorado. 80.8% of these children and youth have complex health needs (National Survey of Children’s Health, 2022-2023).  

Medical home and subcomponents: Children and youth with special health care needs are significantly less likely to have a medical home than their peers without special health care needs (30.9% vs 51.9%). CYSHCN who have household incomes less than 200% of the federal poverty level are significantly less likely to have a medical home than CYSHCN who have household incomes at 200% or more (26.8% vs 44.1%, NSCH 2022-2023). 67.2% of children and youth with special health care needs were able to get the referrals they needed, and 52.7% received needed care coordination (NSCH 2022-2023).

Shifting to adult health care systems: 28.1% received services to prepare for the change to the adult health care system. Children and youth with more complex needs were slightly less likely to receive services to prepare for the shift from pediatric to adult health care (24.9% vs 36.5%), though the difference is not statistically significant (NSCH 2022-2023). 

Cross-Domain Insights

Several themes cut across all population domains:

• Whole-family support: Families emphasized the importance of meeting interconnected needs—housing, food, care coordination, and social connection—rather than single-issue solutions.
• Trust and relevance for community needs: Programs and services must be delivered by trusted messengers in ways that honor specific communities and their experiences.
• Youth and caregiver voice: Both youth and adult caregivers highlighted the need for deeper, more meaningful engagement in shaping services and systems.

Analysis of Current MCH Efforts

The MCH program reviewed current priorities and associated strategies to identify areas of success to continue or expand, as well as opportunities to explore new strategies to meet the gaps that emerged through the needs assessment process. 

Some examples of successes that will continue or serve as a foundation for evolving strategies in the next block grant cycle include:

• Expanding access to health care provider training to foster positive maternal patient experiences for all populations and communities.
• Strengthening local infrastructure for developmental screening and referral, as well as postpartum screening and referrals for support. 
• Elevating youth and community voices through formal structures like the Youth

Partnership for Health and the Community Advisory Board.

• Developing small-scale grant opportunities to fund community organizations (e.g., cross-priority youth-focused mini-grants, Farm to ECE programs, Community Solutions to Prevent Maternal Mortality, mini-grants to Volunteer Tax Assistance sites and community organizations to promote child tax credits, funding for lactation consultant certification).
• Increasing awareness and access to assistance with applying for tax credits.
• Promoting breastfeeding and lactation support to populations with the greatest needs.

Despite these successes, the needs assessment illuminated persistent gaps in the health and wellbeing of the MCH population that will require new and/or expanded strategies and collaborations. Some examples include:

• Housing
• Social connectedness and belonging
• Nutrition Security
• Shifting from youth to adult health care systems
• Access to maternal care

The findings from the Listening Tour have informed Colorado’s prioritization process and action planning processes, which are further described in Section C.1.c. Identifying Priority Needs and Linking to Performance Measures.