NPM 1 - Percent of women, ages 18 through 44, with a preventive medical visit in the past year

For the Women/Maternal Health domain, NPM 1 Well-Women Visit will continue as a priority, based on the results of the 2020 Title V five-year needs assessment. By July 2025, the state seeks to increase to 87.0% the number of women who have a preventive medical visit, including pre- and interconception care. Plans to address this objective and NPM are discussed below.

Due to significant operational and personnel changes during COVID, many of the activities planned for 2020-21 were delayed, paused, or revised. Given the recognition of maternal/women’s health in the state’s key MCH plans and collaboratives. Strategy 1 (promoting women’s wellness visits through systems building) was retired in FY 2022. Collaboration and systems building is integrated into each of specific strategy activities, including a focus on health equity to address long-standing health disparities exacerbated by COVID.

Strategy 1: Promote Pre/Interconception Healthcare Visits

The HMIHC Pre/Inter-Conception Workgroup plans will continue to focus on expanding use of OKQ and improving access to LARC.

OKQ will:

• Continue training activities with a focus on training clinical providers.

• Continue evaluation and online provision of OKQ trainings.
• Develop standardized system to track, monitor, and evaluate OKQ data across programs and agencies.

LARC activities include:

• Continue to assess and address barriers to implementation of the Medicaid LARC policy at Hawaii’s 13 birthing hospitals. The University of Hawaii John A. Burns School of Medicine, Department of Obstetrics, Gynecology and Women’s Health in partnership with Medicaid will continue leading this activity.
• Continue to assess and help meet the needs for provider training on changes to LARC coverage and codes, placement and removal of devices, and client counseling to increase provider competency.

Strategy 2: Promote Reproductive Life Planning

Title V MCHB will continue to increase access to reproductive life planning services through service contracts to community-based providers. Other activities include:

• Support telehealth use by reducing barriers to access of care through provision of telehealth technical assistance, resources, and training relating to LARC-related coding and reimbursement.
• Revise the NPM 1 ESM to align with new women’s reproductive health service contract performance measures and reporting.

Strategy 3: Promote Health Equity

Health equity is a priority for all Title V work, including women’s health. MCHB will continue to provide trainings, as needed, on the issues of implicit bias and health equity.

Work on the three women’s health publications will be completed.

• A profile of data for women of reproductive age (WRA), highlighting demographics and key health indicators, including NPM 1.
• An informational brief on maternal health, including new federal maternal health initiatives, maternal mortality and several maternal morbidity data, and Hawaii program efforts. Title V will partner with Hawaii’s Alliance for Innovation on Maternal Health (AIM) grantee at the University of Hawaii Medical School to partner on this project.
• A short infographic factsheet on Native Hawaiian MCH will also help provide some health disparities and equity-related data and information on maternal health.

Once completed, the information will be used to engage community partners/leaders to develop targeted activities to help address health disparities and the structural/systemic barriers to women’s access to care.

Title V Women’s Health Programs

Women’s Health programs administered by Hawaii Title V include:

Women, Infants, and Children (WIC): Provides Hawaii residents with nourishing supplemental foods, nutrition education, breastfeeding promotion, and health and social service referrals through the federal program, Special Supplemental Nutrition Program for Women, Infants, and Children. The participants of WIC are either pregnant, breastfeeding, or postpartum women and infants and children aged under 5 years who meet income guidelines and have a medical or nutritional risk.

Reproductive Health Care & Support Services: Reduces risk factors that contribute to infant mortality and provides an array of services to address risk factors that lead to poor birth outcomes through contractual services for uninsured and underinsured pregnant women through pregnancy and six months post-partum. Services include assistance to enroll in public/private insurance.

Adolescent Health Services: Spans across the physical, mental, and social emotional aspects including sexual health, positive youth development, and transitioning into adulthood for adolescents and young adults ages 10-24 years. The WRHS Adolescent Health Services unit is a recipient of the Personal Responsibility Education Program grant and administers the Evidence-Based Prevention Teen Outreach Program, a program directed toward reducing rates of teenage pregnancy, school failure, and school suspension.

Hawaii Home Visiting: Provides comprehensive early identification of high-risk families, including expectant families and families of newborns who may benefit in home visitation services to reduce health disparities by improving birth, health, and development outcomes through collaboration with and referral from birthing hospitals, physicians, WIC clinics, and community health centers.

Pregnancy Risk Assessment Monitoring System: Identifies and monitors maternal experiences, attitudes, and behaviors from preconception through pregnancy and into the interconception period based on a population-based surveillance system.

Maternal Mortality Review: Reviews causes of maternal deaths occurring during pregnancy up through one year of giving birth to identify public health and clinical interventions, improve systems of care and reduce preventable deaths; team comprises of a multidisciplinary disciplines and multi-agency committees.

Domestic Violence Fatality Review: Conducts multidisciplinary and multi-agency reviews of child, maternal, and domestic violence fatalities; near deaths; and suicides to reduce the incidence of preventable deaths in the community. The fatality review process analyzes systems responses to domestic violence with input from community agencies and other related organizations.