WOMEN/MATERNAL Priority Need 1: Ensure women in California are healthy before, during, and after pregnancy.

 

Surveillance:

CDPH/MCAH will monitor select quantifiable characteristics to track the health of California women and mothers as part of its routine surveillance efforts. The select indicators and measures, listed in the table above, will be continuously and systematically collected, analyzed, and interpreted to guide program planning, implementation, and evaluation of interventions. CDPH/MCAH will continue to analyze these indicators at the state and sub-state (when possible) levels to identify specific improvement opportunities.

 

 

The selected indicators and measures above serve as an early warning system to identify emerging issues, target program interventions, track progress toward specified objectives in the Five-Year Action Plan, allow priorities to be re-evaluated, and inform public health policy and strategies. CDPH/MCAH will utilize information gleaned from health surveillance data to lead, fund, partner, and support efforts at the state and local levels to improve efforts that will lead to desired outcomes.

 

To provide greater depth in understanding the health status of women and mothers and to uncover health disparities, analysis of these indicators and measures will include stratification by key demographic factors such as race/ethnicity, maternal age, or county as appropriate given the specific measure and the data constraints.

 

Women/Maternal Focus Area 1: Reduce the impact of chronic conditions related to maternal mortality.

 

Women/Maternal Objective 1:

By 2025, reduce the rate of pregnancy-related deaths (up to one year after the end of pregnancy) from 12.8 deaths per 100,000 live births (2019 CA-PMSS) to 12.2 deaths per 100,000 live births.

 

Women/Maternal Objective 1: Strategy 1:

Lead surveillance and investigations of pregnancy-related deaths (up to one year after the end of pregnancy) in California.

 

Activities:

• CDPH/MCAH will lead and fund pregnancy-related mortality surveillance and public health investigation activities.
• CDPH/MCAH will lead surveillance and reporting of pregnancy-related mortality as mandated by Health & Safety Codes 123630-123630.4), Senate Bill (SB) 464 – California Dignity in Pregnancy and Childbirth Act, and SB 65 – Maternal Care and Services.
• CDPH/MCAH will focus surveillance and reporting on disparities to inform MCAH programs and promote health equity in California.
• CDPH/MCAH will lead and fund data products associated with pregnancy-related mortality.
• CDPH/MCAH will lead the dissemination of data findings from the California Pregnancy Surveillance System (CA-PMSS) and the California Pregnancy-Associated Mortality Review (CA-PAMR) to raise awareness about trends and disparities in pregnancy-related mortality and prevention strategies.
• CDPH/MCAH will lead the investigation of COVID-19 related 2020-21 deaths in pregnant or recently pregnant people.
• CDPH/MCAH will partner with the Centers for Healthy Communities Injury and Violence Prevention Branch to identify risk for intimate partner violence related morbidity and mortality by participating on the CDPH Violent Injury Prevention Initiative.

 

Women/Maternal Objective 1: Strategy 2:

Partner to translate findings from pregnancy-related mortality investigations into recommendations for action to improve maternal health and perinatal clinical practices.

 

Activities:

• CDPH/MCAH will lead the development of data-informed recommendations for prevention of pregnancy-related deaths.
• CDPH/MCAH will partner with clinical and community stakeholders to disseminate data findings and recommendations from the California Pregnancy-Associated Mortality Review (CA-PAMR) to inform policy and prevention strategies to reduce pregnancy-related morbidity and mortality.
• CDPH/MCAH will continue to provide funding and support to the California Maternal Quality Care Collaborative at Stanford University for their role to assist providers and institutions in obstetric quality improvement efforts.

 

Women/Maternal Focus Area 2: Reduce the impact of chronic conditions related to maternal morbidity.

 

Women/Maternal Objective 2:

By 2025, reduce the rate of severe maternal morbidity from 104.4 per 10,000 delivery hospitalizations (2020 PDD) to 88.8 per 10,000 delivery hospitalizations.

 

Women/Maternal Objective 2: Strategy 1:

Lead surveillance and research related to maternal morbidity in California.

 

Activities:

• CDPH/MCAH will lead surveillance and reporting of maternal morbidity, including measurement of trends and disparities, and review of scientific literature to remain current with respect to both scientific methods and emerging issues.
• CDPH/MCAH will lead surveillance and reporting of severe maternal morbidity as mandated by SB 464 (now Health & Safety Codes 123630-123630.4), the California Dignity in Pregnancy and Childbirth Act. Mandated reporting will occur at least once every three years and will include, but is not limited to, data on the conditions listed in the California Dignity in Pregnancy and Childbirth Act aggregated by state regions and race/ethnicity.
• CDPH/MCAH will identify and partner with subject matter experts to conduct population-based data analyses to inform decision-making for coordination, support, and possible implementation of coordinated regionalized systems of Maternal Care.
• CDPH/MCAH will support and collaborate with DHCS/Medi-Cal to reach their Bold Goals (“reduce maternity care disparity for Black and Native American persons by 50% by 2025”) through efforts such as introducing the doula benefit to improve culturally competent birth care; extending the post-partum benefit period to 12 months; and defining pregnant and post-partum individuals as populations of Focus to receive Enhanced Care Management.

 

Women/Maternal Objective 2: Strategy 2:

Lead statewide regionalization of maternal care to ensure women receive appropriate care for childbirth.

 

Activities:

• CDPH/MCAH will continue to fund the Regional Perinatal Programs of California (RPPC) Directors to focus on quality improvement in participating labor and delivery hospitals throughout the state and to coordinate and support a regionalized perinatal system.
• CDPH/MCAH will continue to partner with the Comprehensive Perinatal Services Program (CPSP), WIC Regional Breastfeeding Liaisons, and local MCAH programs to ensure a coordinated delivery system for women during and after their pregnancy.
• CDPH/MCAH will continue to coordinate the planning, collaboration, and promotion of integrated regional perinatal systems for the delivery of high quality, risk-appropriate health care and social support to pregnant women and their newborn infants.
• CDPH/MCAH will fund a contractor to partner with RPPC Directors to improve the system of care for high-risk women by encouraging the growth and maturation of transfer agreements for the provision of risk-appropriate care specific to maternal health needs.
• CDPH/MCAH will continue to support and sustain a statewide collaborative of public and private entities that combine clinical medicine and systems of care that contribute to improvements in the quality of maternity and obstetric care.

 

Women/Maternal Objective 2: Strategy 3:

Partner to strengthen knowledge and skill among health care providers and individuals about chronic conditions exacerbated during pregnancy.

 

Activities:

• CDPH/MCAH will lead the development and implementation of a work plan to reduce the rate of diabetes in pregnancy and overweight/obesity in childbearing parents.
• CDPH/MCAH will conduct public education campaigns with emphasis on building awareness on gestational diabetes, Preconception/Interconception Health, and Postpartum Care.
• CDPH/MCAH will collaborate with BIH, CHVP, AFLP, and WIC to incorporate the importance of diet, exercise, weight loss, insulin management, and referrals into their education/outreach.
• CDPH/MCAH will conduct webinars using MyPlates, especially MyPlates for People with Gestational Diabetes and the Perinatal Food Group Recall Tool for Gestational Diabetes.
• CDPH/MCAH will support referrals on its website to DHCS Diabetes Program and Diabetes Self-Management Education and Support (DSMES) Programs.
• CDPH/MCAH will continue to collaborate with other CDPH chronic disease programs to promote education to health care providers and linkage to services.
• CDPH/MCAH will continue to lead the development and dissemination of culturally appropriate materials to address chronic disease in disparate populations.
• CDPH/MCAH will lead the development of a social media campaign to disseminate information about maternal overweight, obesity, gestational diabetes, and Postpartum Care.
• CDPH/MCAH will continue to fund local Black Infant Health (BIH) sites to include information about chronic health conditions pertinent to Black women in a culturally responsive manner.

 

Women/Maternal Focus Area 3: Improve mental health for all mothers in California.

 

Women/Maternal Objective 3:

By 2025, increase the receipt of mental health services among women who reported needing help for emotional well-being or mental health concerns during the perinatal period from 49.0% (2020 MIHA) to 52.1%.

 

Women/Maternal Objective 3: Strategy 1:

Partner with state and local programs to disseminate information and resources to reduce mental health conditions in the perinatal period.

 

Activities:

• CDPH/MCAH will partner and collaborate with state departments responsible for the provision of mental health services (i.e., CalMHSA, DHCS) to identify gaps and opportunities in the availability, quality, and use of mental health services for women of reproductive age, and support and promote policy that would reduce mental health conditions in the perinatal period.
• CDPH/MCAH will continue to partner at the state and local levels to identify and promote best practices to address mental health, including stigma and discrimination due to mental health diagnosis.
• CDPH/MCAH will continue to support state and local workforce development to address mental health with the population we serve.
• CDPH/MCAH will lead to translate findings from the Maternal Suicide or other PAMR report(s) into a resource for use by health care providers, individuals, and communities.

 

Women/Maternal Objective 3: Strategy 2:

Partner to strengthen knowledge and skill among health care providers, individuals, and families to identify signs of maternal mental health-related needs.

 

Activities:

• CDPH/MCAH will continue to partner with existing MCAH programs and other Title V-funded programs (local MCAH, BIH, Indian Health, AFLP, CHVP Preconception Health) in raising awareness about mental health and promoting mental health resources.
• CDPH/MCAH will continue to partner with local Perinatal Service Coordinators (PSCs) to support education to providers, local health plans, and community stakeholders on new state requirements for provider screening of mental health at least once during pregnancy and postpartum.

 

Women/Maternal Objective 3: Strategy 3:

Partner to ensure pregnant and parenting women are screened and referred to mental health services during the perinatal period.

 

Activities:

• CDPH/MCAH will continue to partner with MCAH-funded programs (BIH, CHVP, Indian Health, ALFP, local MCAH) to utilize validated mental health screening tools.
• The DHCS/AIMSS program will continue to partner with Indian Health Service, state and local MCAH, Family Spirit, and other resources to provide evidenced-based screening tools to use for mental health screening on all perinatal and postnatal American Indian women.
• CDPH/MCAH will continue to partner with PSCs to ensure PSCs educate and promote appropriate referrals to community resources for reproductive aged clients.

 

Women/Maternal Focus Area 4: Ensure optimal health before pregnancy and improve pregnancy planning and birth spacing.

 

Women/Maternal Objective 4:

By 2025, increase the percentage of women who had an optimal interpregnancy interval of at least 18 months from 74.2% (2019 CCMBF) to 76.4%.

 

Women/Maternal Objective 4: Strategy 1:

Partner to increase provider and individual knowledge and skill to improve health and health care before and between pregnancies.

 

Activities:

• CDPH/MCAH will continue to partner, communicate, collaborate, and coordinate preconception and interconception program work, best practices, resources, and education cross-sectionally and department wide.
• CDPH/MCAH will continue to support and coordinate the Preconception Health Council of California (PHCC) quarterly meetings and biweekly PHCC Executive Committee meetings.
• CDPH/MCAH will continue to support and share preconception and interconception best practices, resources, and MCAH local program updates to PHCC to guide and inform statewide preconception and interconception efforts.
• CDPH/MCAH will continue to support the use of the Every Woman California website as a platform for sharing best practices, resources, and education for preconception and interconception health, health care, sexual and reproductive health services (including links to abortion resources), and psychosocial well-being information for the public and health professionals.
• CDPH/MCAH will support disseminating and promoting best practices, resources, and education from key preconception initiatives and local MCAH programs through statewide channels of communication (i.e., newsletters, eblasts, collaborative updates, briefings, etc.)
• CDPH/MCAH will conduct webinars on the use of the newly released MyPlate for People Who May Become Pregnant to be used by MCAH programs and health paraprofessionals.
• CDPH/MCAH will support PSCs in disseminating and encouraging best practices, resources, and education to local health plans and community organizations to promote preconception and interconception care to eligible individuals.

 

Women/Maternal Objective 4: Strategy 2:

Lead a population-based assessment of mothers in California, the Maternal and Infant Health Assessment Survey (MIHA), to provide data to guide programs and services.

 

Activities:

• CDPH/MCAH will continue to partner with the University of California San Francisco (UCSF) Center for Health Equity to refine the MIHA questionnaire with new topics of interest and revise the MIHA sampling plan as needed to ensure representative data at the state, regional, and county levels.
• CDPH/MCAH will support the UCSF Center for Health Equity to implement data collection activities and maximize participation among individuals selected to participate in the survey.
• CDPH/MCAH will support the UCSF Center for Health Equity to weight the study data and prepare an annual MIHA analytic dataset and codebook.
• CDPH/MCAH will partner with the UCSF Center for Health Equity to conduct analyses of CDPH/MCAH priority topics, develop surveillance products, and design and implement scientific research studies.
• CDPH/MCAH will lead the dissemination of findings in a variety of MIHA data products.

 

Women/Maternal Objective 4: Strategy 3:

Lead efforts to improve local perinatal health systems utilizing morbidity and mortality data and implement evidence-based interventions to improve the health of pregnant individuals and their infants.

 

Activities:

• CDPH/MCAH will continue to support through technical assistance those fee-for service applicants to become a California Perinatal Service Provider, review the application, and notify the applicant if their application is accepted.
• CDPH/MCAH will continue to support local Perinatal Service Coordinators (PSC) to ensure pregnant and postpartum populations have access to perinatal and postpartum care.
• CDPH/MCAH will continue to fund the PSC Annual Meeting or other opportunities to develop a competent workforce.

 

Women/Maternal Objective 4: Strategy 4:

Fund the DHCS Indian Health Program (IHP) to administer the American Indian Maternal Support Services (AIMSS) to provide case management and home visitation program services for American Indian women during and after pregnancy.

 

Activities:

• DHCS/AIMSS will continue to support and provide case management services to their programs using evidenced-based curricula, resources, and tools provided through Family Spirit, the American College of Obstetricians and Gynecologists, and other best practices.
• DHCS/AIMSS will continue to provide technical assistance to all program case managers to support home visiting -related activities.
• DHCS/AIMSS will continue to support and share resources, education materials, and training related to American Indian perinatal and postnatal health and well-being.
• DHCS/AIMSS will continue to support and provide AIMSS programs with online or in-person (when available) training opportunities to keep providers up-to-date with evidenced-based training from CDPH/MCAH, Family Spirit, and other culturally appropriate resources.
• DHCS/AIMSS program will continue to support and provide education on the importance of following up with their postpartum visits to the obstetrician partners.

 

Women/Maternal Focus Area 5: Reduce maternal substance use.

 

Women/Maternal Objective 5:

By 2025, reduce the rate of maternal substance use from 21.1 per 1,000 delivery hospitalizations (2020 PDD) to 19.7 per 1,000 delivery hospitalizations.

 

Women/Maternal Objective 5:  Strategy 1:

Lead research and surveillance on maternal substance use in California.

 

Activities:

• CDPH/MCAH will lead surveillance of maternal substance use (including measurement of trends and disparities), review of scientific literature, and dissemination of data findings to help inform programs and services.

 

Women/Maternal Objective 5: Strategy 2:

Partner at the state and local level to increase prevention and treatment of maternal opioid and other substance use.

 

Activities:

• Support Family Health Outcomes Project (FHOP) in the local dissemination of the Association of State and Territorial Health Officials (ASHTO) Public Health Perinatal Opioid Toolkit, targeting dissemination to counties of greatest need.
• CDPH/MCAH will partner with CDPH Substance and Addiction Prevention Branch to update the social media toolkit to raise awareness about opioids and pregnancy.
• CDPH/MCAH will disseminate resources to stakeholders to promote prevention of maternal opioid and substance use.
• CDPH/MCAH will disseminate consumer-facing resources and education materials via the MCAH website.