Care During Pregnancy and Delivery

Minnesota’s five-year comprehensive needs assessment identified a significant area of need in increasing accessible, quality health care during pregnancy, making care during pregnancy and delivery the women’s health priority area for the state.

Having a healthy pregnancy and access to quality birth facilities are one of the best ways to promote a healthy birth and have a thriving newborn. Starting in the first trimester, adequate and regular prenatal care during the entire pregnancy is crucial to the health of mothers and babies. Prenatal care is more than practitioner visits and ultrasounds; it is an opportunity to improve the overall well-being and health of the pregnant person which directly affects the health of the baby.

Prenatal visits give parents a chance to ask questions, discuss concerns, identify and treat complications in a timely manner and ensure that the pregnant person and baby are safe during pregnancy and delivery. Receiving quality prenatal care can have positive effects long after birth for both individuals. Babies of mothers who do not get prenatal care are three times more likely to be born low birth weight and five times more likely to die than those born to mothers who do get care.[1]

In 2020 in Minnesota, 79.2% of pregnant people received prenatal care within their first trimester of pregnancy. Approximately 71.6% received adequate prenatal care (based on the Kotelchuck Index). Systemic racism creates barriers to accessing quality care throughout pregnancy and delivery. This also results in unfair and unjust treatment of women and pregnant people of color and their families in the healthcare system. As a result of structural racism, disparities are seen in the adequacy of prenatal care utilization across race/ethnicity. Less than half of births to American Indian mothers receive the recommended adequate/intensive prenatal care utilization.

Figure 1. Adequacy of Prenatal Care Utilization by Race/Ethnicity, Minnesota, 2019

In Minnesota, the Pregnancy Risk Assessment Monitoring System (PRAMS) survey identifies barriers to care from the mother’s perspective. The leading causes respondents gave for not getting prenatal care as early in their pregnancy as they wanted were:

• Didn’t know I was pregnant
• Doctor/insurer wouldn’t start care earlier
• Not enough money/insurance to pay
• Couldn’t get appointment when wanted

Less common but still important barriers mentioned by PRAMS survey respondents included being unable to take off time from work, not having transportation to get to the care they needed, and not being able to find anyone to take care of their children. Though some of the barriers identified are personal, many, such as the inability to get an appointment when wanted, those noted above, and also reported from many home visitors, is that doctors, clinics, or insurer would not start care earlier. These are structural or systemic and could be modified to improve access to prenatal care.

Figure 2. Barriers to Prenatal Care in Minnesota among Women not Receiving Care as Early as They Wanted, 2016-2019

Also important is access to care during preconception (i.e., the period of time in a birthing person’s life prior to getting pregnant) and peri-conception (i.e., the period of time during which a birthing person is actively trying to become pregnant) to ensure optimal health for the birthing person and a future healthy pregnancy. Altering certain habits, such as tobacco cessation (commercial nicotine use), achieving a healthy weight, or managing diabetes, can help a person to become pregnant more easily and sustain a healthy pregnancy. Maintaining good health prior to getting pregnant and getting quality care for any health issues can reduce the risk of early miscarriage and birth defects through genetic counseling and daily supplementation of folic acid, management of health conditions, and avoiding substance use. People struggling with fertility issues can benefit from intensive reproductive care to improve the odds of successful conception and gestation.

COVID-19 Pandemic: Impact on Care during Pregnancy and Delivery

Pregnant individuals are at higher risk for both death and severe illness from COVID-19, and their infants may also be at increased risk for preterm birth and stillbirth.[2] Given this increased risk, the COVID-19 pandemic has significantly affected the lives of pregnant people and the care they receive throughout pregnancy and delivery.

The impact of the COVID-19 pandemic on access to care during pregnancy and delivery must be considered within a broader context. Following CDC recommendations, pregnant and post-partum people can receive the COVID-19 vaccine. Additional recommendations to reduce the risk of COVID-19 transmission during pregnancy include not taking public transportation, working from home if possible, and avoiding spaces where large numbers of people may be congregated.[3] Due to structural inequities, these recommendations are much easier and more realistic for some pregnant people to follow than for others.

Many families and individuals are experiencing stress and strain from the COVID-19 pandemic that has negatively affected their mental health and well-being. According to a Kaiser Family Foundation poll, 12% of U.S. adults say their alcohol consumption and substance use has increased because of pandemic-related stress.[4] Addressing substance use is a critical issue for pregnant people and their families in Minnesota, and this care should be provided alongside wellness visits, preconception, pregnancy, and postpartum care. Even before the start of the COVID-19 pandemic, maternal opioid use, and infant neonatal abstinence syndrome (NAS) diagnoses more than doubled from 2012 to 2020 according to Minnesota Medicaid claims data. Northern Minnesota has the highest rates of prenatal opiate use. Within these northern rural communities, the average rate of prenatal opiate use is 9.8%, compared to the statewide average of 1.5% for all Medicaid-covered births.

Within the eight Emergency Medical Services (EMS) regions in Minnesota the highest rate of NAS was found in the Northwest EMS region of the state (Figure 3). Although the rate of the Metro region was the fifth highest among the EMS regions, the largest portion of the total number of NAS cases occurred in the Metro region (39% or 1,312 of the total 3,354 cases).

Figure 3. Neonatal Abstinence Syndrome Rate, by Minnesota EMS Region, 2012 - 2020

Data Source: Minnesota Hospital Discharge data

For birthing people of childbearing age, having access to family focused, age and culturally appropriate, quality health care is essential for themselves and for their families. Enhancing prenatal and postnatal care for this population will elevate the chance of healthy birth outcomes for pregnant people and infants and impacts the life course trajectory for two generations. 

Five-Year Strategies and Activities Moving Forward

The Care During Pregnancy and Delivery Strategy Team was comprised of a diverse group of statewide stakeholders, care recipients and providers of women services, such as pregnancy and postpartum support, birth doula service providers, representatives from local public health (LPH) from regions across Minnesota (representing large, small, rural, and urban communities), Title V staff, professionals serving Minnesota’s American Indian populations and other communities of color and members of academia. The strategy team identified strategies to improve pregnancy outcomes for birthing people experiencing the highest rates of disparities.

A logic model has been developed to visualize our planned work and intended results. A larger version of the logic model is included with the supporting documents for this application. This logic model, along with the action plan table, provide a broad picture of Minnesota’s strategies aimed at improving care for birthing people during pregnancy and delivery. The discussion below includes Minnesota’s plans for implementing the strategies during FY2023.

Figure 3. Minnesota Care during Pregnancy and Delivery Logic Model

Strategy A. Expand Family-Focused, Community-Based Policy and Funding

Addressing care during pregnancy and delivery from a population health lens focuses on expanding the immediate support of the family’s role in care and the birthing process. This also involves the evolution of funding and policy to be reflective of the communities they are intended to serve. Statewide initiatives will focus on addressing foundational changes to delivery structure for maternal health and improving/expanding workforce to reflect our communities and their needs.

Activity 1: Collaborate across Government Agencies, including Participating on the Children’s Cabinet Healthy Beginnings Work Group

Governor Tim Walz is committed to a vision that everyone in our state has an opportunity to thrive. The governor instituted a plan to build One Minnesota, where state agencies collaborate to create a state that works for everyone. Under One Minnesota, the Children’s Cabinet is charged with implementing the One Minnesota priorities related to children and families (Refer to Overview of the State for more information).

Activities with the Children’s Cabinet will focus on the coming months and will focus the existing goals of ending preventable maternal and infant deaths in Minnesota and reducing infant and maternal deaths experienced by American Indians, African Americans, other communities of color, and in Greater Minnesota.

Minnesota will explore and seek to develop collaborative efforts to:

1. Participate on other external work groups to listen to community concerns and member identified needs to inform strategies; and as subject matter experts providing technical assistance and education on best practices to reduce preventable infant and maternal deaths and improve pregnancy outcomes.
2. Work with local community leaders, schools, institutes of higher education, and community-based agencies to increase workforce diversity among birth workers and increase employment opportunity in the health sector.
3. Work with family home visitors, community partner organizations, health systems, and policy makers to support fourth trimester care to include assessing and addressing postpartum visits and increasing the utilization of Medicaid’s newly expanded postpartum coverage up to 12 months.
4. Develop a comprehensive cross-sector plan to prioritize initiatives to ensure a healthy beginning for all children.

Activity 2: Establish a Learning Collaborative to Build a Culture of Health Equity as a Foundation for our Work across Disciplines

In 2022-2023, Title V staff will recruit mothers, educational institutions, providers, community advocates and staff from MDH’s Office of Rural Health to participate in the Culture of Health Equity learning collaborative, which implores organizations to revisit past policies and structures to reframe the vision of population health. This process will work with stakeholders in maternal health to re-assess recruitment and group processes, allowing communities to lead community programming. MDH will work with partners to cultivate meeting spaces and learning collaborations to bring health providers, community members/advocates, and policy makers together to address and invest in evidence-based interventions for trauma informed and culturally appropriate care. The learning collaborative will include mothers with lived experience on maternal health topics to lead informed decision-making.

MDH will partner and promote programs focusing on work force development including implicit bias training, cultural competency, and trauma-informed care as a foundation for pregnancy related care. CFH division staff participated in The State Health Department Organizational Self-Assessment for Achieving Health Equity, developed by The National Center for Chronic Disease Prevention and Health Promotion (CCDPH). This assessment helps establish a baseline measure of capacity, skills, and areas for improvement to support health equity focused activities, provide information to guide strategic planning, and serve as an ongoing set of tools to measure progress towards goals developed through the assessment process.

The division will work with staff and programming to center the CFH and Title V work around a racial justice lens, using health equity as a core practice. This work will also include collaboration with educational institutions to diversify programming.

In addition, Title V staff will work to implement a new statute requiring all birthing facilities to provide staff with anti-racism and implicit bias training annually beginning in December 2022. With our partners at the U of M’s Center for Anti-Racist Research for Health Equity, MDH looks forward to partnering with health systems, birthing hospitals, and clinics to ensure that training is provided.

Furthermore, MDH strives to elevate birth workers, doulas, and community health workers as a critical role in population health infrastructure. Created by the MN Legislature in 2021, the Title V staff will take on a new program to understand barriers to midwifery and doula availability, use of services, required certification training, and workforce diversity, with the goal of improving birth outcomes in groups with the most significant disparities, which includes Black, Indigenous, and other communities of color; rural communities; and people with low incomes. 

Strategy B. Integrate Services and Optimize Cross-Sector Collaboration

The second strategy for improving care during pregnancy and delivery is to integrate health and social services and optimize cross- sector collaboration to benefit mother and infant. Care services for expectant mothers is often delivered by health specialties, not holistically or with a family centered approach. By integrating existing services, the promotion of preventative health becomes an option for mom and baby and allows families to work with a care team. Connecting families with health resources, support services and groups is part of our core work.

Family home visiting (FHV) is an effective upstream intervention that serves as a key link to other interventions and community supports. Notable benefits to Minnesota families who have received family home visiting include improved maternal and newborn health. FHV services in Minnesota are supported by several funding streams including state, federal and local resources. At the state level, MDH oversees and distributes funding for home visiting services provided under Temporary Assistance to Needy Families (TANF) funding, the federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program, Minnesota Evidence-based Home Visiting, and Minnesota's Nurse-Family Partnership legislation. Together, these funding streams provide approximately $33 million annually to support home visiting programs across the state that serves upwards of 7,200 families. Programs funding through MDH are required to implement activities to assure culturally and linguistically appropriate services to priority populations. Examples of activities that programs may implement to meet this objective could include having home visitors attend implicit bias training or other trainings that promote culturally responsive, trauma-informed care.

Evidence-based family home visiting enhances prenatal and postnatal care for the target population of families experiencing disparities and has been shown to elevate the chance of healthy birth outcomes for pregnant people and infants and impacts the life course trajectory for two generations. One key element of evidence-based family home visiting is to assure families are connected to needed community services. FHV programs promote the importance of well-women visits, prenatal and postpartum care, and strive to assure that the women served have health insurance and are connected to a primary care provider. Home visitors work closely with primary care providers to encourage cross-sector collaboration to promote a more holistic approach to caring for families during pregnancy and after the birth of their child. 

All FHV programs funded through MDH are required to screen for depression during the postpartum period using a validated tool and to make appropriate referrals. Caregivers are also screened for intimate partner violence, the parent-child interaction is assessed, and children are screened for developmental and social emotional concerns. Some programs also screen for caregiver anxiety and substance use. In addition, home visitors provide a wide variety of health information and encouragement to families including, but not limited to, the use of effective forms of contraception to create possibilities for family planning, breastfeeding and child nutrition, and child growth and development.

The Dignity in Pregnancy and Childbirth Act (144.1461) passed by the Legislature in 2021 to address inequities in maternal health care, calls on the state to increase the availability of, and access to, doula and midwifery services by removing barriers to communities disproportionately affected by maternal and infant morbidity and mortality. To help improve health equity in pregnancy and postpartum outcomes, MDH is hiring a Maternal Care Access Coordinator to develop a strategic plan and to develop and implement policies, activities, and programs aimed at expanding access to prenatal care, doula, and midwifery services by working with internal and external partners and stakeholders. In FY2023, the Maternal Care Access Coordinator will review frameworks created by community doulas involved with BECC’s policy committee that aim to improve the doula reimbursement and certification process in Minnesota. Additional community input and assessment will be developed and implemented to reflect the suggestions outlined by the community doulas and other partners for improving the process and expand organizations for required training for birth doulas.  In addition, the Maternal Care Access Coordinator will assess the access to midwife services for communities experiencing the highest rates of disparate pregnancy outcomes. This information will be used to inform cross-sector collaborations with internal and external stakeholders working to advance policies and systems changes to remove barriers to access for doula and midwife services such as trainings, certification, and reimbursement.

Activity 1: Implement the IMPLICIT Model in Well-Child Visits

For many years, the CYSHN and MCH sections have collaborated on birth defects prevention grants and continue to focus on interconception care and optimizing postpartum mothers’ point of contact with providers through well-child visits.

MDH plans to continue and expand the evidence-based IMPLICIT program in Minnesota. The IMPLICIT model utilizes time in the well-child visit to incorporate maternal risk assessments for mothers and birthing persons to improve birth outcomes. The model includes foci on four behavioral risks affecting future birth outcomes: smoking, depression, family planning and birth spacing, and multivitamin with folic acid use. Not only does this promising practice allow collaboration to integrate services, provide needed services and education to care givers, it also encourages providers to improve their understanding of quality improvement and implementing and evaluating evidenced-based practice in their role.

The IMPLICIT Network developed, assessed, and integrated this evidence-based model for the past 10 years, and are working in partnership with MDH and the March of Dimes to disseminate this interconception model. MDH contracted with ACET Inc. to recruit and implement the IMPLICIT model in clinics throughout the state. This past year ACET Inc has worked with the national IMPLICT network to develop implementation plans and education to be used. Two clinics have been chosen as the pilot sites for the IMPLICIT program. Over the next two years these sites will receive funding to implement the IMPLICIT model, measure change following implementation, increase data management and reporting, and increase capacity building of the program. ACET Inc. will recruit a total of 5-6 clinic sites during this funding period, growing the networks reach in Minnesota.

Upcoming Activities:

• Continue data collection at recruited four sites piloting the IMPLICIT model in the state, these cohort sites will additionally serve as mentor sites to new cohorts.
• Analyze and evaluate data collected in Redcap database with the assistance of IMPICIT network partners to integrate continuous quality improvement practices to tailored to the needs of each site.

• Recruit final cohort of two clinics to receive supplemental funding to implement the IMPLICIT model in diverse health care settings.
• Work in collaboration with the national IMPLICIT network to host webinars and Minnesota based meetings to create a collaborative environment for grantees to network. Additionally, attend and present opportunities for grantees to attend national IMPLICIT webinars and conferences.

Activity 2: Strengthen and Expand the Minnesota Perinatal Quality Collaborative

A new Perinatal Equity Committee (PEC) has been established to work closely with the Steering and Executive Committees of the MPQC to improve perinatal health by promoting community engagement. Members of the PEC will meet regularly with the initiative workgroups to provide guidance and support, helping to develop curriculum and education around racism, implicit bias, and accurate data collection. Further activities and membership growth of the Community Advisory Council (CAC) has been delayed, partly due to COVID-19. The goal of the CAC is to reflect our Black, Indigenous, and other People of Color communities and include rural and urban members to develop and share a menu of strategies to inform the quality improvement work and support the mission of the MNPQC. 

With the growth, expertise, and guidance provided by the MNPQC Executive Committee and Steering Committee, the implementation of two initiatives are on-going, and include Hypertension during Pregnancy and the Postpartum Period, and Mother/Infant Opioid Substance Use Treatment and Recovery Effort (MOSTaRE).

Evidence-Based Strategy Measure

Members of MNPQC recognize the importance of the issues addressed by the Alliance for Maternal Innovation (AIM), which is a national data-driven maternal safety and quality improvement initiative. AIM’s work aligns well with the MNPQC core initiatives, and MNPQC was highly advised by the CDC to become an AIM state. The issues are relevant to discussions on quality improvement in Minnesota as supported by the Minnesota Maternal Mortality Review Committee and our Steering Committee. Formal involvement in the AIM Program aligns Minnesota’s efforts with other states’ activities. The MNPQC steering committee had identified the initiative focused on opioid use disorder as a priority within the MNPQC strategic plan with intentions to model the AIM opioid / substance use disorder bundle. Additionally, this past year Minnesota legislation had the removal of mandatory reporting requirements for prenatal substance use while the pregnant person is seeking prenatal care, postpartum care, or other health care services.

MNPQC led the state’s official enrollment in AIM in the Spring of 2022. The proposed AIM bundle for this opportunity will be on Care for Pregnant and Postpartum People with Substance Use Disorder led by the MNPQC substance use disorder workgroup, MOSTaRE. The evidence-based strategy measure (ESM 1.2) will be focused on becoming an AIM state and securing hospitals participation in a MNPQC initiative that uses an AIM bundle. More information on the performance measure, data sources, and potential limitations are included on the ESM 1.2 detail sheet.  By September 2022, teams will be recruited for the first learning session to initiate the AIM bundle data collection

Activity 3: Address Maternal Opioid Misuse

The MNPQC has designed a workgroup centered on perinatal opioid use, led by key health care professionals in our health systems across the state. Members of the workgroup have multiple representatives that have addiction medicine physician specialists, maternal and fetal medicine providers, neonatologists, pediatricians, family medicine, behavioral health specialists, social workers and public health professionals. The MNPQC workgroup membership vetted available best practices, literature, data on burden, and feasibility to identify this QI project, MOSTaRE. The MOSTaRE Initiative will emphasize family-centered care that maintains the dyad and will address treatment and prevention of substance exposure during and after pregnancy for both birthing people and their infants.

Upcoming activities to support the ongoing quality improvement project include:

• Development of a resource list of stakeholders involved with OUD/SUD. Community mapping led the Perinatal Equity Committee will expand access to available resources that are currently compiled by the following Perinatal (16 listings); Neonatal (3 listings); and Community (19 listings).
• MOSTaRE leadership team and workgroup meeting monthly to define aim and objectives.
• Hennepin Health are planning a new twice-monthly ECHO webinar series on the intersection of perinatal opioid use disorder and mental health, which will be led by Dr. Cresta Jones and Dr. Katie Thorsness (starting April 2022).
• The planning for a town hall session, led by subject matter experts to reach health care providers and health systems on possible topics such as CPS panel; Substance use screening overview; Health system response: policy and legal input is scheduled for May – July 2022.
• MOSTaRE is planning to use Project Echo as a technique for a broader reach in health systems and increase frequency to host facilitated topic trainings. The target audience will largely be health care professionals and community partners that work across the continuum of care of the perinatal population (September 2022).
• Recruitment of health systems statewide to participate in a 12 – 18-month MNPQC initiative (September 2022 – Spring 2024).

Strategy C. Strengthen and Expand Culturally Responsive, Trauma-Informed Care

The third strategy is to work with partners and decision makers to strengthen and expand culturally responsive, trauma-informed care, for women of childbearing age. In discussions with partners, it is evident that changes need to occur in training, locations of delivery services, and funding sources for this population. Increasing access to respectful care, will allow mothers to have more autonomy while seeking services with the intention to build a trusting relationship with their health provider. Using public health surveillance programs such as evaluating maternal mortality, has allowed collaboration across sectors to identify where population health can be improved to allow mothers to thrive during and after their pregnancies.

MDH will partner across sectors to encourage providers and maternal health partners to participate, complete, and continue education on implicit bias and trauma-informed care in women’s and maternal health. Building on the Maternal Mortality Review Committee (MMRC), MDH will disseminate committee findings, analyses, and recommendations to internal and external stakeholders annually.

During the pandemic, the MNPQC was instrumental in cross-sector collaboration for the COVID response in birthing hospitals throughout the state. This COVID workgroup represented all major health systems, where partners were able to share contingency planning, protocols developed, and review data in real time to address rising concerns and questions around COVID-19 in pregnancy. This work will continue over the coming year, focusing on the mental health aspects of improving care around pregnancy, and integrating trauma-informed care models to the statewide evidence-based interventions.

Activity 1: Expand and Improve the Minnesota Maternal Mortality Review Project

The Maternal Mortality Review Project’s (MMMRP) goal is to improve the health outcomes of pregnant people through maternal mortality and morbidity reviews. The MMMRP houses the Maternal Mortality Review Committee, which reviews maternal deaths cases and develops recommendations to prevent future deaths. Beginning in July 2021, the committee was formally included in statute, and the Commissioner of Health now appoints each member. As the review committee continues to review cases, translating to action will be key in improving outcomes. A necessary next step is to develop a community action team to identify strategies and resources needed for the community to implement recommendations and mitigate barriers to improved pregnancy outcomes.

The MMMRP activities for FY2023 are to:

• Analyze multi-year data, provide demographics, geographic burden, distribution of death, and cause of death, to inform change of practice or policies.
• Review all pregnancy- associated maternal deaths within 18 months of date of death, and document findings and decisions in the Maternal Mortality Review Information Application (MMRIA) to assist with ongoing analysis.
• Continue to review maternal deaths associated with COVID-19 infections.
• Expand community members and/or those with lived experience representation on the committee.
• Disseminate committee findings, analysis, and recommendations to internal and external stakeholders annually.
• Work with committee and partners to strategically develop statewide actionable interventions to reduce contributing factors identified by the case reviews.
• Develop a community action team to identify strategies and resources needed for the community to implement recommendations and mitigate barriers to improved pregnancy outcomes.
• Train and cross-train internal staff on data management and system processes to improve timely access to case information, abstraction and data entry.
• Invest in community driven interventions to address maternal mortality and build upon communities working in culturally tailored approaches in maternal health.
• Improve case identification and completion of record collection in partnership with Department of Human Services, Divisions within MDH, the Minnesota Hospital Association, State Medical Examiners and Law Enforcement entities.
• Develop feasible systems to collect and analyze maternal morbidity data to identify leading causes of morbidity in the state.
• Tailor quality improvement interventions, in conjunction with the MNPQC, to target and address maternal mortality and morbidity.

In FY2023, staff will work with MNPQC members, community partners, and clinic systems to develop protocols and processes for a maternal morbidity review team. Maternal morbidities are considered ‘near miss’ incidents related to pregnancy or childbirth that did not result in death. The protocols and processes will assist implementing case reviews to expand identification of opportunities to improve care.

Activity 2: Minnesota Maternal Death Context CUES (MMDCC) Project

Title V staff are working with MDH’s Injury and Violence Prevention Section (IVPS) on a maternal violent death project funded by the Office on Women’s Health. This five-year grant (2021-2026) is designed to reduce deaths among pregnant and postpartum women due to violence with specific interventions around suicide, homicide, and domestic violence. This project will be accomplished by 1) enhancing surveillance of violent maternal deaths and 2) expanding the evidence-based Confidentiality, Universal Education and Empowerment, Support (CUES) intervention. The project team will work closely with the MMRC, MNPQC, and other local organizations to achieve these goals.

In FY 2023, the MCH subgroup of the project team will:

• Develop an MCH-led maternal mortality surveillance improvement work group.
• Complete psychological autopsy certification. 
• Develop and share the maternal violent death review protocol with MMRC leadership. 
• Implement Minnesota National Violent Death Reporting System (MNVDRS) and MMRIA data quality assurance procedures and protocols to improve maternal death case ascertainment. 
• Partner with the MNPQC to develop resources on maternal violence in Minnesota.

Many of the activities and outputs from this project will directly support and impact the ongoing efforts at MDH that address maternal mortality in Minnesota.

National Performance Measure and Five-Year Objective

Minnesota has chosen to continue to focus on NPM 1, the percent of women, ages 18 through 44, with a well-woman visit in the past year for the next five-year cycle beginning with FY2022. It is important for women to have access to reliable preventive care throughout the life course. Well-woman visits address a range of physical and mental health concerns with their health care provider and may include healthy diet education, screening for chronic diseases, screening for sexually transmitted infections, vaccinations, and mental health screening.[5] The fragmented nature of women’s preventive care is embedded in care during pregnancy and delivery. Women often see many preventive providers during preconception, interconception, and pregnancy.

The 2018 Behavioral Risk Factor Surveillance System (BRFSS) found that 75.8% of women, ages 18 through 44, had a preventive health visit in the past year. By 2025, Minnesota aims to increase the percentage of women receiving a preventative medical visit in the past year by 10%.

[1]Wymelenberg S. (1990). Science and Babies: Private Decisions, Public Dilemmas. Washington (DC): National Academies Press (US); Chapter 5, Prenatal Care: Having Healthy Babies. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK235274/.

[2] Centers for Disease Control and Prevention. (2020). Pregnancy, Breastfeeding, and Caring for Newborns. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnancy-breastfeeding.html.

[3] UNICEF. (2020). Navigating pregnancy during the coronavirus disease (COVID-19) pandemic. Retrieved from: https://www.unicef.org/coronavirus/navigating-pregnancy-during-coronavirus-disease-covid-19-pandemic.

[4] Panchal, N., Kamal, R., Cox, C., Garfield, R. (2021). Issue Brief: The Implications of COVID-19 for Mental Health and Substance Use. Retrieved from https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/

[5] Garcia, S, Martino K, Lai Y-H, Minkovitz C, Strobino D. Strengthen the Evidence Base for Maternal and Child Health Programs. NPM 1: Well-Women Visit. Women’s and Children’s Health Policy Center Johns Hopkins University, June 2017.