NPM: Postpartum Visit – Increase the incidence of women attending a postpartum checkup within 12 weeks after giving birth and receiving the recommended postpartum care components.

 

DHSS will promote implementation of the comprehensive postpartum care guidelines recommended by the American College of Obstetricians and Gynecologists (ACOG) “Committee Opinion No. 736: Optimizing Postpartum Care” across all efforts led and participated in to promote access to patient-centered, coordinated, and comprehensive postpartum care. As stated in the Committee Opinion, “The weeks following birth are a critical period for a woman and her infant, setting the stage for long-term health and well-being. To optimize the health of women and infants, postpartum care should become an ongoing process, rather than a single encounter, with services and support tailored to each woman’s individual needs.”

 

Pregnancy-Associated Mortality Review (PAMR)

The Office on Women’s Health (OWH) manages PAMR pursuant to 192.990 RSMo. As directed in the law, the Director of DHSS appoints members to serve on the PAMR board. The board meets regularly in a closed meeting to examine summaries put together by a trained nurse abstractor. The summaries are compilations of de-identified information abstracted from medical encounters, vital statistics, autopsy reports, newspaper articles, social media postings, and/or other relevant records. The board completes a Committee Decision Form for each maternal mortality case to assist with data entry and analysis. Documents and data collected for the maternal mortality review process are confidential; the board is prohibited from releasing any information that could identify individuals. The PAMR Board is comprised of approximately 18 members representing varied geographic regions of the state and various domains intersecting maternal health. The board identifies potential solutions to address the contributing factors for each death.

 

Maternal Mortality Prevention Plan (MMPP)

With MCH Leadership oversight, OWH manages the contracts with MHA and the University of Missouri to accomplish the deliverables of the MMPP. OWH is responsible for ensuring contractors report on their progress in a timely fashion, contract deliverables are met, challenges encountered are addressed early and swiftly, and the work is done in accordance with the overarching plan to address maternal mortality in Missouri. OWH will meet with MCH Leadership regularly to share progress reports, spending updates, and contractor feedback. MCH Leadership will provide guidance to OWH on future contract deliverables and spending plans to ensure the MMPP is implemented as intended and adapted as needed. Ongoing implementation of the MMPP will include further development and maintenance of a dashboard/public-access web portal to disseminate state MCH data; promotion of maternal quality control protocols to standardize maternal care practices; continued expansion of the perinatal health access collaborative to allow general practitioners/primary care providers and community-based service providers to consult with medical specialists; statewide rollout of evidence-based recommendations for postpartum care, including care coordination, patient education and engagement, perinatal mental health, well-woman care and transition to primary care, management of chronic conditions, infant health, and addressing community and population-level factors influencing perinatal health outcomes; and relevant training for maternal care providers, including training on the provision of respectful, person-centered care.

 

As Missouri’s recipient of HRSA’s state Maternal Health Innovation Program grant, SSM Health St. Louis - Women's Services launched the Missouri Collaboration for Clinical Community Integration in Maternal Health (MO C3) to reduce maternal mortality and severe maternal morbidity (SMM) by improving access to comprehensive, high-quality, appropriate, ongoing care throughout the preconception, prenatal, labor and delivery, and postpartum periods; enhancing state maternal health surveillance/data capacity; and identifying and implementing innovative interventions to improve outcomes for populations disproportionately impacted by maternal mortality and SMM. The MCH Director and DHSS Chief Medical Officer serve on the MO C3 Core Advisory Panel to plan, implement, and evaluate MO C3 activities. The Maternal Health Task Force, a required component of MO C3 and formed around the PQC/Maternal-Child Learning and Action Network (MC LAN) at MHA, will develop a five-year state maternal health strategic plan, aligned with PAMR findings and recommendations, the statewide MCH Needs Assessment and State Action Plan, and the MIECHV Needs Assessment, to create and implement innovative strategies to address gaps in maternal health care and social support services. Initial strategic directions will include enhancing patient experience and access to care; integrating and supporting the maternal workforce and partners; transforming care delivery and the systems that support care; and demonstrating value and driving sustainability through strategic storytelling.

 

Community Health

The MCH Services Program team is comprised of a program manager and four MCH District Nurse Consultants (DNCs) located throughout Missouri. The role of the MCH DNC is to provide consultation and technical assistance, serve as a liaison between DHSS and LPHAs, participate in coalitions, taskforces, and workgroups related to MCH outcomes, and provide other supports as needed. The East/Southeast DNC supports 28 LPHAs, the West Central DNC supports 28 LPHAs, the Northern DNC supports 29 LPHAs, and the Southwest DNC supports 27 LPHAs. Through the MCH Services Program, DHSS contracts with LPHAs to support LPHA local leadership roles to build community-based systems and expand the resources those systems can use to respond to priority MCH issues; provide and assure mothers and children (in particular those with low income or limited availability of health services) access to quality MCH services; reduce health disparities for women, infants, and children, including those with special health care needs; promote the health of mothers and infants by assuring prenatal, delivery, and postpartum care for low income, at-risk pregnant women; and promote the health of children by providing preventive and primary care services for low-income children. All LPHAs are eligible to participate after completion and approval of a five-year contract work plan and annual contract budget. Currently, the MCH Services Program contracts with 112 of the 115 LPHAs in Missouri. The three LPHAs not participating in the contract cite lack of workforce capacity as the determining factor. The program manager reaches out annually to LPHAs not participating to discuss possible participation.

 

In FY 2026, all LPHA contractors will complete planned activities to achieve desired system outcomes outlined in their FY 2022-2026 contract work plans. A contract outcomes report will be completed, evaluating performance trends and system outcomes. 20 LPHAs will continue work to improve pre-conception, prenatal, and postpartum health care services for women of childbearing age.

 

• Callaway County Health Department will work with community-based organizations to increase the number of community-based organizations, including food pantries, diaper banks, and faith-based organizations, that adopt policies and practices to increase the number of women and families receiving education, resources, and support for postpartum depression.

 

• Howell County Health Department will work to increase the number of women of childbearing age who receive an annual preventive visit. The health department will use their mobile unit, staffed with a Nurse Practitioner and other clinical staff, to visit outlying rural areas that have transportation barriers and offer breast and cervical cancer screenings, lab testing, immunizations, and other wrap-around services. The mobile unit will alternate between two locations each month, using the parking lots of organizations located in the middle of each town to increase accessibility.

 

• Springfield-Greene County Health Department will use the Family Connects home visiting model to provide one to three nurse home visits after the birth of a newborn, incorporating the Mothers & Babies curriculum to support families. Mothers & Babies is an evidence-based intervention for pregnant [women] and new parents to help manage stress and prevent postpartum depression.

 

• Phelps/Maries County Health Department will work to increase knowledge among women of childbearing age and families regarding prenatal, postpartum, and newborn care using the Growing Great Kids curriculum. With courses provided both in person and online, the goal is to cultivate secure attachments and bolster child development while building parenting, family strengthening, and other essential life skills with parents who themselves have experienced childhood adversity and other traumatic events. The health department will partner with FSD (DSS). FSD has approved completion of the course as acceptable for families working with the court system.

 

All LPHA contractors will conduct a focused local MCH needs assessment, seeking input from MCH stakeholders, including families, consumers, providers, and other community partners, about local MCH issues. Based on those findings, LPHAs will select at least one priority health issue from the FY 2026-2030 MCH State Action Plan and develop a five-year work plan (FY 2027-2031) to address the selected priority health issue(s). The contract work plans will include a statement of the problem, goals for addressing the problem based on targeted national, state, and/or local outcome measures, evidence-based strategies to address the problem, activities and targeted system outcomes using the Spectrum of Prevention as a framework, and, based on the Life Course Perspective, identification of risk and protective factors that influence health disparities within families and the community. The MCH Services Program plans to provide educational and technical assistance opportunities to increase LPHA’s knowledge and skills on utilizing the MCH Evidence What Works Evidence Accelerators to develop the five-year work plans. The What Works Evidence Accelerators include evidence-based strategies to increase the percentage of women who attend a postpartum checkup within 12 weeks after giving birth and increase the percentage of women who attend a postpartum checkup and received recommended care components. Strategies include:

• Appointment intervals;
• Community Health Workers;
• Group prenatal care;
• Mobile medical clinics;
• Mother-infant dyad programs;
• Provider training and education;
• Quality improvement initiatives;
• Workplace support;
• Postpartum care plans;
• Home visiting;
• Patient navigation; and
• Telehealth and remote monitoring.

 

The TEL-LINK Program will help improve women’s and maternal health by providing health care service referrals to increase access to care for any childbearing woman, mother, community member, or provider needing assistance. The program promotes this service through search engine campaigns to reach the underserved population. Monthly usage reports by resource category will assist in finding ways to improve programmatic activities. TEL-LINK will partner with tobacco control programs, WIC clinics, and dental care providers to provide referrals to services such as smoking cessation, dental care providers, mental health treatment centers, health insurance providers, and many more.

 

The Tobacco Prevention and Control Program (TPCP) will continue to offer free cessation counseling and nicotine replacement therapy for Missourians through Missouri Tobacco Quit Services. Cash incentives are provided to perinatal and postpartum enrollees. TPCP will support efforts to implement and strengthen tobacco-free worksite policies, smoke-free multi-unit housing policies, and community policies. TPCP provides free technical assistance, support, and resources for implementing and strengthening smoke-free and tobacco-free policies.

 

The Newborn Health Program will partner with a variety of community health providers to raise awareness and provide education for the MCH population on MCH resources for women of childbearing age and their families. Providers will receive free copies of the Pregnancy and Beyond book, along with a wide variety of educational materials containing information to improve pre-conception, prenatal, and postpartum care and postpartum mood disorders, for dissemination to patients. Pregnancy and Beyond includes content regarding the importance of postpartum follow-up care. The program will track the distribution of these materials and obtain feedback from partners on how they use the materials and ways to improve them. The Healthy Births and Babies Unit will work with an informal internal MCH work group to prepare comprehensive, current, and accurate outreach materials and maximize outreach opportunities at conference exhibits, webinars, virtual baby showers, and health fairs. Educational materials will also be distributed through Home Visiting programs and other service providers.

 

OWH will develop health materials for distribution digitally and at in-person events. Materials will be brief, specific, and related to the health screenings needed based on age and health history. Postpartum visits and connection to primary care after pregnancy will be included.

 

The Adolescent and School Health Program will partner with LPHAs, school districts, and community partners to provide an evidence-based curriculum, made up of 13 lessons geared towards adolescent females ages 14-24 years, on making wise choices about relationships, pregnancy, partnering, and more. In addition to each of the planned 45–60-minute lessons, an additional 30-minute education/training will be incorporated into each class to facilitate guest presentations on a variety of topics related to pregnant and parenting teen mothers. One of the sessions will cover the importance of postpartum care for both mother and child and the supportive roles fathers can take in assisting with and supporting women in participating in these visits. Information will also be provided regarding access and enrollment in MO HealthNet and WIC services.

 

The State Breastfeeding Coordinator (SBC) will revise, update, develop, and make available resources for use in promoting breastfeeding and breastfeeding education. Lactation providers at hospitals, clinics, LPHAs, and local WIC agencies use these resources to reinforce direct patient education for prenatal and breastfeeding women, which improves breastfeeding outcomes by ensuring clear and accessible information is provided.

 

The SBC will work with the Missouri Breastfeeding Coalition (MBC) to add Missouri lactation providers at all levels to the provider directory on ZipMilk. ZipMilk is a lactation provider directory developed and maintained by the Massachusetts Breastfeeding Coalition and used by 18 states and Puerto Rico to help connect parents with various levels of lactation support, including free community support, breastfeeding counselors and educators, International Board Certified Lactation Consultants (IBCLCs), medical providers, support groups, and WIC breastfeeding support. Providers can list important details, such as specialty services provided, languages spoken, or cultural care provided. The MBC has agreed to pursue adding this resource to their website and to maintaining this resource in the future to promote comprehensive access to lactation care for postpartum women. The SBC will also work with the MBC Board on the coalition’s 2026-2030 Strategic Plan to ensure continued MBC and DHSS collaboration on breastfeeding initiatives.

 

The SBC will serve as a subject matter expert on breastfeeding in Missouri, speaking to professionals and students about DHSS breastfeeding initiatives and, when available and requested, providing breastfeeding training for providers. The SBC will promote and support the delivery of high-quality perinatal care by providing technical assistance to hospitals that are trying to meet the Missouri “Show-Me 5” requirements, including virtual and on-site visits to educate hospital staff, and evaluation of hospitals that apply for recognition. (Additional information in the Perinatal/Infant Health domain.)

 

As funding permits, BCHW will offer and promote statewide trainings for health care providers throughout Missouri to increase the number of IBCLCs in the state, particularly in regions with low breastfeeding initiation rates. Collaboration will continue with statewide and regional partners to increase access to lactation support through a closed-loop referral platform to increase clinical-community integration and coordination of service delivery across the care continuum, encourage and support breastfeeding, and address low breastfeeding initiation rates.

 

The MCH Director will collaborate with DCR, Harm Reduction and Cannabis Grant programs, Office of Public Information, and other programs across DHSS to provide educational information and resources regarding the dangers of using marijuana during pregnancy and while breastfeeding.

 

Behavioral Health

BCHW plans to establish and maintain a Maternal Peer-based Recovery Support Technical Assistance Center to support DHSS-funded Maternal Peer-Based Recovery Support Programs and other organizations serving the maternal population with behavioral health conditions, including substance use disorder (SUD) and/or mental health (MH) conditions. Technical assistance will be provided on peer support and recovery support program development, expansion strategies, program sustainability, and evidence-based strategies for addressing the needs of the maternal population with MH and SUD. All services promote optimal health outcomes for the maternal population impacted by SUD.

 

The Maternal Peer-Based Recovery Support Program, also referred to as the SUD Grant Program, will work with grantees to provide navigation services to refer and link individuals needing demographically congruent, evidence-based behavioral health and/or substance use treatment and resources. Grantees will assist program participants to:

• Reduce barriers to care through wrap-around services;
• Establish and implement a referral system for partner agencies to refer pregnant and postpartum women to the Maternal Peer-Based Recovery Support Program;
• Use an evidence-based screening tool to assess SUD treatment;
• Make referrals for program participants to access additional behavioral health and wrap-around services;
• Use warm referrals when possible;
• Provide maternal recovery support services for postpartum individuals;
• Ensure all program participants receive education on overdose prevention; and
• Ensure all program participants have access to overdose reversal methods and medically proven treatment.

 

OWH supports a person-centered, multi-disciplinary, coordinated, and integrated maternal care model for women with SUD. OWH leverages Title V-funded staff time to support two clinics funded by opioid settlement funds. The clinic teams include support specialists and experts in maternal-fetal medicine, psychiatry, substance use, nursing, and social work. The clinics will ensure women receive needed postpartum care and transfer to primary care, and, by bringing all these specialties together, moms and their babies will have a single point of access for support. OWH will measure the number of moms enrolled in the program each year.

 

The Prenatal Substance Use Prevention (PSUP) Program will support healthy pregnancy and childbirth by promoting the importance of prenatal substance use prevention. PSUP will partner with statewide community-based partners to house substance-exposed infant manikins to demonstrate the effects of drugs and alcohol during pregnancy and explain the importance of a healthy pregnancy and childbirth. The placement sites' biannual report will assist in finding ways to improve programmatic activities. The PSUP Program maintains 33 sets of substance-exposed infant manikins and reallocates the sets based on requests from community partners.

 

Partnerships and Collaborative Efforts

OWH contracts with multiple agencies to enrich Missouri’s programs and initiatives to promote access to patient-centered, coordinated, and comprehensive care throughout the perinatal period. OWH leverages Title V-funded staff time to support implementation and monitoring of these efforts, including the PQC, implementation of Alliance for Innovation on Maternal Health (AIM) patient safety bundles, implementation of group prenatal care in a demographically congruent setting in Kansas City, and support of doula services in Southwest Missouri. Each of these initiatives is funded by either general revenue, other federal funds, or opioid settlement funds. This opportunity to collaborate across funding streams will allow OWH to ensure activities align with the statewide MCH State Action Plan.

 

MCH Leadership, OWH, and other DHSS programs participate in and lead many cross-sector collaborations for women’s and maternal health, including the MC LAN, the PQC, the Missouri Interagency Maternal Health Consortium (IMHC), the Missouri Maternal Health Action Network (MHAN), the Women’s Health Advisory Committee (WHAC), and the PAMR Board. These groups each meet on a consistent basis to discuss how to improve maternal health within their scope and membership. Together, these groups bring their collective impact to achieve improved health for women in Missouri.

 

The MC LAN has a broad membership that provides guidance, knowledge-sharing, and peer support in developing strategic quality initiatives based on the Triple Aim principles to support best practices that make birth safer, improve maternal health outcomes, and save lives. The PQC connects community, public health, and clinical leaders to improve the care and support systems that lead to better health and health outcomes before, during, and after a pregnancy. The PQC is currently supporting the implementation of several AIM bundles in Missouri hospitals. The purpose of the IMHC is to identify and foster solutions to address limitations in maternal health care availability, capacity, trust, and utilization in Missouri. The goal is for Missouri mothers to have quality access to the entire continuum of pregnancy and postpartum care, thereby improving maternal health, mortality, and morbidity outcomes. This is accomplished by bringing together senior executives of partnering organizations to discuss how they can contribute to improving health outcomes in Missouri. MHAN comprises key stakeholders and strategic partners, including service providers, organizations, and mothers with experiential insight, from across the state. MHAN aims to develop strategic action plans and recommendations that foster effective cross-system collaborations to address barriers preventing mothers affected by perinatal substance use from accessing essential services. Ultimately, the goal is to improve behavioral health outcomes for mothers, children, and families impacted by perinatal substance use, as well as mental and behavioral health challenges. MCH Leadership, OWH, and other DHSS team members attend these meetings and provide insight based on team member subject matter expertise and insights gained from contractors and other partners.

 

The WHAC, led by OWH, supports DHSS leadership in identifying women’s health issues and understanding policy opportunities to support women’s health. This group will meet twice annually to support DHSS leadership with community perspectives to address emerging policy concerns.

 

The PAMR Board reviews maternal mortality cases to identify contributing factors and causes to prevent future maternal deaths. This group helps provide the data needed for identifying emerging health concerns. OWH leads this group and is responsible for all major components of the meetings.

 

The SUD Grant Program will work to enhance cross-sector collaboration and promote postpartum care through grantees, who will partner with health care organizations, community-based organizations, and local agencies to ensure the behavioral and health care needs of the maternal population are met.

 

MCH Leadership leads the statewide Fetal Infant Mortality Review (FIMR) Network and interfaces with the Missouri Child (0-17 years) Fatality Review Program (CFRP) to identify any trends in fetal and infant mortality related to postpartum health. The FIMR Network will include the promotion of whole-person follow-up postpartum care as a protective strategy in response to all fetal and infant loss.

 

MCH Leadership will collaborate with partners and stakeholders to promote postpartum checkups and whole-person postpartum follow-up care across the full 12-month postpartum period. MCH Leadership will work with the MHA and the Missouri MC-LAN/PQC to provide guidance, education, and programming to improve the health care experience and outcomes for pregnant and postpartum women and their babies. The MCH Director will work with MO HealthNet Maternal/Infant Health leadership to provide technical assistance and training for LPHAs, as needed, regarding Notification of Pregnancy, MO HealthNet for Pregnant Women, prenatal risk assessments, prenatal case management, postpartum benefits, and benefits available for perinatal substance use treatment and mental health services. MCH Leadership will partner across internal programs and with the University of Missouri, LPHAs, MHAN, home visiting programs, the full scope of women/maternal health care providers, pediatricians, family practitioners, provider organizations, and other partners working and interfacing with women during the postpartum period. Partnerships with community-based organizations and providers, including community health workers, doulas, midwives, community paramedics, peer support specialists, faith-based organizations, and more, will be leveraged to promote whole-person, patient-centered, coordinated, and comprehensive postpartum follow-up care.

 

DHSS will convene key organizational leaders in the IMHC to explore and improve maternal healthcare access across Missouri through exploration of 12 priority areas of action, identified based on interagency meetings and discussions with additional health advocates, providers, and provider organizations. The Consortium will explore initiatives to address the community and population-level factors that influence MCH outcomes and promote postpartum care and outcomes, such as remote telehealth for maternal-fetal-medicine visits, postpartum home visits, a 24/7 MCH call center, and increased utilization of community-based maternal care providers, such as doulas and community health workers. Additional priorities to promote maternal health include partnerships between maternal health care providers and birthing facilities, rural hospital and obstetric payment reform, malpractice liability coverage, modernization of birth center regulation, integrated nurse midwifery with obstetric care, EMS obstetric readiness training, rural health workforce pipeline incentives, graduate medical education for obstetric providers, and a regionalized approach to assuring perinatal care and services.

 

Capacity Building

OWH supports the Cora Faith Walker Doula (CFW) Training program. OWH leverages Title V-funded staff capacity to support this state-funded training program and has sponsored training for the last three years. In state FY 2026, OWH will survey doulas to identify emerging and ongoing training needs and doula training organizations to identify training capacity, content, and needs. OWH will utilize survey findings to sponsor new training development, training provision, and continuing education for doulas in Missouri. To promote access to patient-centered, coordinated, and comprehensive postpartum care, OWH will ensure all doula trainings include information about the importance of postpartum visits and the transition to primary care after the postpartum period. OWH plans to evaluate the trainings using multiple strategies: doula training organizations will provide feedback to DHSS regarding the process of working with DHSS, promoting stronger community partnerships with community-based doula training organizations; OWH will measure the number of doulas trained; and, to learn about the economic impact of supporting doula training as an economic strengthener for Missouri, DHSS will review training logs and compare participant names to doula reimbursement information from DSS. This will show if doulas trained as a part of the CFW doula training program become employed and reimbursed as doulas through MO HealthNet.

 

To promote whole-person perinatal care, all patients should be screened for tobacco use, advised to quit, and connected with Missouri Tobacco Quit Services or another evidence-based cessation service, such as counseling with a Tobacco Treatment Specialist (TTS). TPCP will promote and support system changes within health care systems to screen and treat all clients for tobacco use and refer people who use tobacco to cessation services such as Missouri Tobacco Quit Services. In addition to cessation support, health system changes include tobacco-free facilities that promote quitting and eliminate exposure to secondhand smoke. Free TTS training and a Health Systems Change Community of Practice are available to providers and health systems. TPCP will offer and promote statewide technical assistance, support, and free resources for health care providers throughout Missouri to increase the number of providers in the state who screen all patients for tobacco use and refer them to evidence-based cessation using the Ask, Advise, Refer model.

 

Newly developing collaborative efforts across DHSS, MO HealthNet, MHA, the IMHC, the Mobile Integrated Healthcare Network, and other key partners will include strategies to improve clinical readiness, recognition, and response to obstetric/perinatal emergencies.

 

NPM: Preventative Dental Visit – Pregnancy - Preventive oral health care services during pregnancy.

 

Oral health plays an essential role in supporting healthy pregnancies. A recent study published in Oral Health and Preventive Dentistry showed when a pregnant woman receives treatment for a gum infection, it can reduce her risk of going into pre-term labor by 50%. The ODH team includes a dentist, dental hygienist, and several public health professionals and leads efforts to promote and educate on the importance of oral health. ODH will educate pregnant women, medical and dental providers, and other community partners on the importance of dental visits and oral health during pregnancy. Training for dental providers will include content on providing whole-person, patient-centered, coordinated, comprehensive, and respectful care. As funding is available, ODH will continue to create and distribute Brushing for Two kits, which include educational materials on proper oral care, tobacco cessation, and lead poisoning and prevention and oral care supplies for mom and baby.

 

To increase the number of pregnant women who receive a preventive dental visit and ensure preventive oral health care services during pregnancy, ODH will partner with the MCH Services Program to deliver oral health education to pregnant women through the MCH Services contract with LPHAs. LPHAs will facilitate dental appointments for pregnant women with their local dentist, FQHC, or dental clinic that accepts Medicaid and track subsequent dental visit attendance. LPHAs will provide education to the obstetric care providers on the importance and safety of a preventive dental visit for pregnant women. The MCH Services Program will encourage LPHAs to conduct an oral health review, provide oral health education and supplies, and make dental care referrals, as indicated, for pregnant women receiving LPHA services. ODH will develop the Medical/Dental Home brochure to be provided to OB/GYNS and encourage warm hand-offs for oral care during pregnancy. To support LPHA outreach efforts, ODH will promote use of social media messages, created specifically for use by LPHA, highlighting the importance and safety of a preventive dental visit during pregnancy, with the family unit being considered in messaging.

 

In conjunction with other funding, ODH educates and provides guidance to promote the importance of oral health across the lifespan, with a focus on supporting families through education on topics such as water fluoridation, preventive oral care, access and workforce shortage challenges, and how oral health affects overall health. ODH will develop resources and provide water fluoridation education to towns and cities across Missouri, training to water operators and public and dental health professionals, and guidance on emerging water fluoridation issues. ODH will partner with dental clinics to conduct diabetes risk assessments, collect relevant data, and educate high-risk patients about ways to reduce the risk of developing diabetes.

 

ODH works with MO HealthNet to promote oral health at MHD’s annual regional meetings to doulas, LPHAs, and other maternal service providers. ODH also maintains a partnership with the Missouri Primary Care Association, participating in their quarterly Oral Health Network meetings to educate on oral health initiatives, namely the importance of partnering with LPHAs to provide care to pregnant women. As funding allows, ODH will speak and exhibit at health promotion events, health fairs, conferences, and other educational opportunities to promote the importance of oral health during pregnancy. ODH will work closely with the MCOs and other funders to identify joint opportunities for expanding oral health education and resources and, in FY 2026, aims to partner with at least two MCOs on different events and programs to promote the importance of oral health during pregnancy. ODH is scheduled to exhibit and speak at Babypalooza events, which target pregnant women in rural areas . Information will be given on proper oral hygiene techniques for the parent and baby, the safety and importance of a dental visit, and general oral health information.

 

ODH works to build the oral health workforce and ensure oral care for the entire population. Recognizing the challenges of a strained oral health workforce, ODH will actively collaborate with Delta Dental of Missouri and community partners to explore strategies to develop a stronger oral health workforce. ODH will work in long-term care facilities to provide oral hygiene training to staff for providing dental services to facility residents. ODH will partner with dental education schools to expand dental assisting programs and with MPCA to enhance the dental assisting training program for high school students.

 

The MCH Services Program will work closely with ODH to increase educational and technical assistance opportunities to enhance knowledge and skills among LPHA contractors to develop five-year work plans utilizing the What Works Evidence Accelerators. Evidence-based strategies to increase the percentage of women who have a preventive dental visit during pregnancy include patient education and counseling, Quality Improvement Collaboratives, information about the use of teledentistry, and provider education, including for Early Head Start, Home Visiting, and WIC providers.

 

The Adolescent and School Health Program will partner with LPHAs, school districts, and community partners to deliver an evidence-based curriculum for adolescent females ages 14-24 focused on healthy decision-making about relationships, pregnancy, partnering, and more. Each lesson has a supplemental session to facilitate guest presentations on a variety of topics related to pregnant and parenting teen mothers. In collaboration with ODH, one featured session will cover the importance of proper oral health care for themselves and their child. Information on how to access and enroll in MO HealthNet will also be included.

 

The TEL-LINK Program will refer callers to community-based dental clinics, with the option to find low-cost or reduced dental services, to increase awareness of community resources and access to needed dental health services. The program will provide outreach to the underserved population through effective marketing strategies, such as search engine campaigns.

 

Other Activities to Promote Women and Maternal Health

 

The significant risks associated with lead exposure for women of childbearing age, developing fetuses, and breastfed infants are not generally well-known and understood. The most severe effects of high blood levels of lead during pregnancy are miscarriage and stillbirth. Other complications during pregnancy, such as gestational hypertension, low birth weight, and premature delivery, can also occur. Prenatal lead exposure impairs children’s neurodevelopment, placing them at increased risk for developmental delay, reduced ability to reason and problem-solve, hearing impairment, and learning and behavioral challenges. The Childhood Lead Poisoning Prevention Program (CLPPP) will perform the following activities to prevent or decrease blood lead poisoning in pregnant women and their babies:

• Provide community lead education via various outreach events, such as health fairs;
• Participate in updating outreach materials, such as Pregnancy and Beyond and other pamphlets and brochures, for distribution to expectant and new parents;
• Provide lead education and resource materials to health care providers, LPHAs, health plan lead case managers, and WIC staff regarding the need to discuss lead poisoning prevention and lead testing with clients; and
• Provide LeadCare Analyzers and lead test kits to LPHAs that do not have the capacity to provide accurate lead screenings, allowing them to routinely offer the service.

 

The MCH Director will actively engage in statewide collaborative efforts to promote the health of women of childbearing age, including but not limited to leading the State Health Improvement Plan (SHIP) Infant and Maternal Health priority area and continued engagement in PAMR, the MC-LAN, the Women's Health Committee, the Maternal Health Action Network, the DSS Maternal/Infant Health Efforts coordination meetings, the Uplift Connection, the ParentLink Advisory Council, and the Missouri Association for Infant and Early Childhood Mental Health. The MCH Director will continue to collaborate with the two Healthy Start grantees, Nurture KC and Missouri Bootheel Regional Consortium, and their partners to facilitate the sharing of information and resources, shared learning, and identification of opportunities for alignment and collective impact. Efforts will continue to actively engage and leverage partnerships with a broad spectrum of partners across the state, such as LPHAs, MCOs, healthcare systems, the Women and Infant Substance Help (WISH) Center at SSM Health, MPCA, Generate Health, the Bootheel Perinatal Network, Bootheel Babies and Families, Uzazi Village, Jamaa Birth Village, the Missouri Foundation for Health, Health Forward Foundation, and many others. New opportunities for collaboration will be explored with the Children’s Trust Fund, St. Louis Integrated Health Network, Mobile Integrated Health Network, Catholic Charities of Southern Missouri, and The Doula Foundation, as well as other partners yet to be identified. The MCH Director will participate in the Region 7 Maternal Health Alliance and collaborate with the Regional Public Health Analyst in the Office of the Assistant Secretary for Health (HHS) and other Region 7 states to advance maternal health initiatives across the region.

 

State Health Improvement Plan

Improving Infant and Maternal Health is one of the priorities identified by the State Health Assessment and addressed by the SHIP. The goals and objectives outlined under the Infant and Maternal Health priority area are set on a five-year project scale, with work ongoing through 2027. DHSS recognizes infant and maternal health are intrinsically linked and must be addressed within the framework of the mother-infant dyad to achieve the goal of advancing optimal health during the childbearing continuum and improve health outcomes for childbearing women and their infants. MCH Leadership will collaborate with a wide-ranging group of partners to implement activities to achieve three targeted objectives.

 

• Increasing the percentage of women of childbearing age who have received selected women/maternal preventive health services will be accomplished by:
  • Engagement of community health workers, doulas, and other community-based maternal health care providers.
  • Partnering with community-based organizations to provide prenatal care.
  • Implement community-based health promotion efforts.
  • Raising awareness of the importance of reproductive life planning.
  • Educating women on the importance of immunizations.
  • Promoting comprehensive health care for pregnant women, postpartum women, and women of childbearing age.
  • Supporting activities and facilitating partnerships to create environments that support healthy eating and active living.
  • Partnering with tobacco control programs and community-based partners to assure delivery of effective tobacco cessation services.
  • Participating in maternal and women’s health partnerships by convening public health and advocacy partners for strategic thinking and action, engaging clinicians as partners, and engaging collaboratives to improve maternal health and health care outcomes.
  • Addressing underlying community and population-level factors that influence MCH outcomes.

 

• Increasing the percentage of women of childbearing age who self-report having received “respectful care” will be accomplished by:
  • Providing education to providers on the 12 domains of respectful care: being free from harm and mistreatment; maintaining privacy and confidentiality; preserving women’s dignity; prospective provision of information and seeking of informed consent; ensuring continuous access to family and community support; enhancing quality of physical environment and resources; providing responsive maternal care; engaging with effective communication; respecting women’s choices that strengthen their capabilities to give birth; availability of competent and motivated human resources; provision of efficient and effective care; and continuity of care.
  • Partner with academic institutions to include respectful care into the education curriculum for all health care professionals (physicians, nurses, social workers, APRNs, nutritionists, health care administrators) including facility related issues such as women’s perception of incompetence or disrespect of professionals attending delivery, unhygienic facilities and unavailability of basic supplies.
  • Qualitative phenomenological study with focus group discussions (FGDs) with primipara and multipara women using a semi-structured discussion guide to elicit discussion and audio recording and transcribing interviews verbatim.
  • Analyze data using thematic analysis approach to describe the prevalence of various categories of mistreatment during admission, labor and delivery, and postpartum care (losing self-control, being overlooked, being informed of bad news without proper preparation, repeated examination without being properly communicated/informed, disallow companions and left unattended during labor).

 

• Reducing the percentage of preventable maternal deaths with underlying mental health issues, including SUD will be accomplished by:
  • Establishing a Perinatal Health Access Project.
  • Promote the use of validated screenings of mental health conditions and substance use disorder to be conducted at multiple intervals during pregnancy and the postpartum period.
  • Increasing provider knowledge of how to treat mental health conditions during pregnancy.
  • Promoting changes in systems, policies, and environments; fostering positive public dialogue; countering shame, prejudice, and silence; and building public support for suicide prevention.
  • Addressing the needs of vulnerable groups, tailoring strategies to match the cultural and situational contexts in which they are offered and seeking to eliminate disparities in health outcomes.
  • Collaborating with behavioral health agencies and partners to implement the Strengthening Families Protective Factors Framework.
  • Promoting efforts to reduce access to lethal means among individuals with identified suicide risks.
  • Implementing and spreading evidence-based suicide and self-harm prevention strategies and programs.
  • Strengthening collaboration across agencies, developing new tools and capacity, and implementing evidence-based change in suicide and self-harm prevention strategies.

 

DHSS will engage community-based organizations, community partners, and community members in developing, implementing, and maintaining programs and initiatives to promote access to health care, including preventive oral health care services, during the perinatal period. The values of patient/family-centered shared care planning will be promoted across all efforts led and participated in to operationalize core values of family-centered care and ensure families are full partners in assuring patient-centered, coordinated, and comprehensive perinatal care and optimal maternal health outcomes.