The Texas Department of State Health Services (DSHS) monitors emerging women’s and maternal health issues, integrates best practices, and incorporates community feedback into programming. In fiscal year 2026 (FY26), DSHS will improve maternal health by advancing quality care, implementing evidence-based prevention efforts, and addressing health disparities for Texas mothers. FY26 maternal and women health initiatives will address the following State Priority Needs:

• Improve cognitive and behavioral health and development of all maternal and child health (MCH) populations
• Address health disparities across MCH populations
• Improve health outcomes and reduce injury risk and mortality through enhanced health and safety efforts for MCH populations

DSHS aims to improve each women’s health status, increase the rate of women attending one or more postpartum follow up visits to receive recommended care, and reduce maternal morbidity disparities through maternal health programming.

 

Women’s Health Status: Percent of women of childbearing age who self-rate their health status as excellent, very good, or good

 

Throughout FY26, DSHS will continue to incorporate tobacco screenings and referrals into maternal health programs. By the end of FY26, the High-Risk Maternal Care Coordination Services Program (HRMCCS) Delivering Resources and Empowering All Mothers (DREAM) program within Northeast Texas Public Health District (NETHealth) will have community health workers (CHWs) screen at least 75 clients. The current CHW screening tool includes questions about tobacco and nicotine use. CHWs will develop client-centered action plans and provide health education, referrals, and support clients to quit tobacco use.

 

In FY26, DSHS will continue to distribute tobacco prevention resources to women of childbearing age, pregnant and postpartum women, health care providers, and other MCH populations impacted by someone who smokes in the same household. Resources include information about how tobacco, e-cigarettes, and other nicotine products are unsafe to use during pregnancy. Messaging will promote tobacco prevention best practices, educational resources, the DSHS Quitline, and smoking cessation as one of the most important ways to promote MCH.

 

In FY26, DSHS will continue to provide health care providers, public health partners, parents, and other infant caregivers resources through infant safe sleep website, including tobacco cessation resources such as the DSHS Quitline and health care provider resources such as the Texas Health Steps (THSteps) Infant Safe Sleep online provider education.

 

DSHS will continue to promote the THSteps online provider education infant safe sleep module to statewide health care providers and public health partners. This module highlights state tobacco cessation resources, including the DSHS Quitline, and promotes the importance of smoke-free environments. Providers can disseminate tobacco cessation information to pregnant and postpartum women, fathers, and other infant caregivers to build awareness of tobacco use and the increased risk of sudden infant death syndrome (SIDS) and other sleep related risks.

 

DSHS will promote state tobacco cessation resources through the Healthy Texas Mothers and Babies (HTMB) Community Coalitions (CC) to encourage regional tobacco cessation coalition collaboration to build women and their families community capacity support. In FY26, DSHS will share at least two tobacco cessation resources in virtual HTMB CC meetings. To improve impact knowledge of tobacco use on women and infant health outcomes, DSHS will promote state tobacco cessation resources such as the DSHS Quitline cessation program and HTMB CC materials. In FY26, DSHS will meet quarterly with HTMB CCs to coordinate efforts and identify shared cross-program collaboration goals and opportunities.

 

The TexasAIM program is DSHS’s partnership with the national Alliance for Innovation on Maternal Health (AIM). AIM uses the Institute for Healthcare Improvement’s (IHI) Breakthrough Series (BTS) model for collaborative learning, communication training, teamwork training, and other methods to implement AIM hospital maternal patient safety bundles (PSBs). TexasAIM’s IHI BTS structured framework, peer-based learning, small change tests, data-informed quality improvement (QI) methods, and data reporting to accelerate maternal PSB adoption and implementation. Each maternal PSB includes best practices to improve condition-specific maternal health outcomes.

In FY26, DSHS will support at least 193 Texas birthing hospital teams to adopt and sustain AIM maternal patient safety improvement. By August 2030, DSHS expects to see a 5% reduction in statewide severe maternal morbidity (SMM) rate (cases per 10,000 delivery hospitalizations).

 

In FY26, TexasAIM will enroll at least 193 Texas birthing hospitals to participate in TexasAIM Plus Sepsis in Obstetric Care (SEP) Learning Collaborative. Through learning collaborative implementation, TexasAIM will partner with expert clinical and improvement science faculty and providing individualized coaching and mentorship to TexasAIM enrolled hospital teams, host virtual and in-person PSB implementation collaborative learning to facilitate peer networking, support, and resource sharing statewide, and support TexasAIM participating hospitals to conduct assessments and prework activities before each learning session.TexasAIM will provide resources and ongoing technical assistance to enrolled TexasAIM hospitals to increase process, structure, and outcome measure data reporting and receive progress updates related to TexasAIM participation, collectfeedback to inform current and future TexasAIM programming and guide technical support. TexasAIM will convene TexasAIM hospital teams to share best practices, change ideas, and QI methods and support teams with developing processes change ideas to test in their local settings using plan-do-study-act cycles.

 

In FY26, TexasAIM will hold nine SEP action period calls and six learning sessions to help TexasAIM hospital improvement teams conduct small change tests, implement PSB components, and scale up to full PSB implementation and sustainability and upport hospital teams through interactive web-based discussions, online-sharing platforms, coaching, and mentoring to learn from experts, other hospital improvement teams, and Texas community partners.

 

TexasAIM will engage the Preeclampsia Foundation and Maternal Mortality and Morbidity Advocates Voices patient partnership to educate TexasAIM hospital teams, hospital leadership, and stakeholders based on patients’ and their families’ lived experiences. TexasAIM will hold a SEP Harvest Meeting with high-performing TexasAIM hospitals to share learning collaborative breakthroughs, barriers, and successes. During the SEP Harvest, teams will brainstorm and learn what went well and what can be improved throughout the collaborative

 

By August 2026, 70% of Texas birthing hospitals will participate in TexasAIM sustainability and readiness initiatives to increase maternal patient safety improvement capacity. In FY26, to address sustainability and readiness, TexasAIM  will offer IHI Open School enrollment to all TexasAIM participating hospital teams, engage open school participants through quarterly discussion groups to enhance learning and provide mentorship, hold weekly office hours to provide data measurement technical assistance and reporting support to TexasAIM hospital teams, connect hospital teams with implementation mentors to share resources and assess progress and barriers, and partner with DSHS to identify and implement TexasAIM maternal levels of care alignment actives to reduce hospital burden.

TexasAIM will host four perinatal academy continuing education (CE) virtual events covering maternal safety and QI topics. The perinatal academy targets rural hospital frontline staff including labor and delivery and emergency department staff who provide direct services to women, pregnant, and postpartum moms.

 

By August 2026, at least 350 Texas health care professionals will complete one or more DSHS-provided women’s maternal health CE opportunities. DSHS will offer instructor-led and on-demand self-paced courses to include concepts and principles, concrete examples, and practical guidance training to support maternal patient safety and QI implementation. DSHS will sponsor the Texas Collaborative for Healthy Mothers and Babies’ (TCHMB) annual summit and coordinate the summit’s CE contact hours award process.

 

In FY26, DSHS will prepare new TexasAIM on-demand CE platform courses and promote existing courses by:  

• Consulting with faculty and subject matter experts to develop CE course outlines and agendas  
• Developing course content, recording presentations, and populating course content in the learning management system
• Coordinating with DSHS’s internal CE services and submitting CE course documentation
• Developing promotional communications and resources 
• Promoting courses in TexasAIM newsletters, calls, and events 

 

DSHS will also increase CE access by: 

• Developing, promoting, and providing TexasAIM hospital participants CE courses through the Texas perinatal academy and other offerings. Course education topics include:
  • Obstetric hemorrhage
  • Severe hypertension (HTN) in pregnancy
  • Obstetric care for women with substance use disorder
  • Interpersonal violence and maternal sepsis
  • Congenital syphilis
  • Maternal health disparities
  • Simulation
  • Communication and teamwork
  • Maternal patient safety
  • Health care QI  

• Promoting women and maternal health THSteps online provider education including preconception, prenatal, postpartum care, and breastfeeding CE. 

• Promoting a course suite preparing CHWs to specialize in maternal high-risk care, informal counseling, and care coordination.

• Coordinating with DSHS Grand Rounds and other CE events to disseminate women’s and maternal health provider CE.

• Sponsoring the annual TCHMB summit and coordinating summit CE contact hours award process. 

 

In FY26, TCHMB will engage Texas birthing hospitals in TCHMB quality improvement projects.  DSHS funds TCHMB as the Texas perinatal quality collaborative. TCHMB’s mission is to advance health care quality and patient safety for all Texas mothers and babies through health and community stakeholder collaboration. Throughout FY26, DSHS will continue to fund, provide technical assistance, and partner with the University of Texas (UT) Health Houston School of Public Health in Austin to support TCHMB activities. TCHMB will promote maternal health by:

 

• Implementing a statewide breastfeeding QI initiative to improve breastfeeding initiation and exclusive breastfeeding while reducing formula use among breastfed newborns during delivery hospitalizations
• Supporting TexasAIM implementation partnership alignment with other state priorities, engaging Texas hospitals in QI, offering improved experiences for participating TexasAIM teams, and improving statewide capacity for large scale maternal QI patient safety

• Continuing DSHS partnership to pilot test congenital syphilis QI toolkit for physicians and other providers
• Hosting the annual TCHMB summit and engaging more than 300 participants on maternal and infant health improvement CE topics
• Providing ancillary faculty staff support for DSHS TexasAIM program

 

Throughout FY26, DSHS will implement HRMCCS to reduce maternal health care barriers for Northeast Texas high-risk pregnant and postpartum women. DSHS will work with NETHealth to promote maternal health by:

 

• Maintaining the CHW and supervisory staffing necessary to provide the HRMCCS DREAM in Smith and Cherokee Counties
• Providing assessment and screening to identify pregnant women at high risk for poor pregnancy, birth, or postpartum outcomes and provide necessary referrals to 80% of clients based on self-identified needs
• Enrolling and providing education, counseling, health care navigation support, and other high-risk maternal care coordination services to at least 60 pregnant and postpartum women

DSHS will work with UT Health Science Center Houston School of Public Health HRMCCS’ technical assistance and evaluation contractor to support the program by:

• Continuing HRMCCS evaluation including process and impact assessment
• Facilitating CHW expertise incorporation into program planning, technical assistance, and evaluation support
• Routinely collecting, analyzing, and communicating with NETHealth on program implementation assessment findings
• Identifying program needs, developing recommendations, and supporting process improvement implementation.

In FY26, DSHS will:

• Promote the high-risk maternal health course suite to CHWs, CHW supervisors, and CHW instructors statewide
• Analyze participation, learning engagement, completion rates, learning outcomes, and learner feedback
• Identify CHW high risk maternal care coordination learning gaps that may be addressed with additional education or skills training

 

In FY26, DSHS will continue coordinating with DSHS Vital Statistics Section, DSHS Center for Health Statistics, Health and Human Services Commission Medicaid and CHIP Services, and other partners to identify data QI opportunities for pregnancy-associated deaths and enhance Texas Maternal Mortality and Morbidity Review Committee (MMMRC) case reviews. From FY24 through FY25, DSHS reduced data availability timelines for vital events and hospital discharge data. Vital events data are now available immediately to DSHS and hospital discharge data is now available six months after the end of a quarter. These efficiencies allow MMMRC to review pregnancy-associated deaths within the same year the death occurred. DSHS is also able to provide death certificate QI quality assurance data.

DSHS partners with University of North Texas Health Science Center to manage timely MMMRC case preparation and enter case information including committee decisions into the case review system. DSHS supports MMMRC to comprehensively study pregnancy-related mortality cases and SMM rates and trends.

In FY26, DSHS public health regions (PHR) will provide Texas Title V materials, communications, and programmatic activities including:

• Northwest Texas PHR will promote education and awareness of health initiatives including Healthy Texas Women, Regional & National Crisis Resources for Intimate Partner Violence, National Maternal Mental Health Hotline, National Human Trafficking Hotline, Women Infant and Children Program, and the Hear Her Texas campaign. This PHR will use materials to increase women’s access to preventative care, first trimester prenatal care, and interpersonal violence or other crisis supports.
• Southeast Texas PHR will provide education, resources, and supplies from Hear Her Texas Campaign and Maternal Early Warning Signs to women at community events and baby showers and public events for expecting mothers. This PHR will provide education to pregnant women and caregivers of children up to one year old through the March of Dimes becoming a mom/ comenzando bien bilingual prenatal and gestational diabetes curriculums. Staff will educate participants on safe sleep, mental health, car seat safety, nutrition, and physical activity.

 

DSHS will encourage HTMB CCs to amplify state maternal and infant health and safety programs, initiatives, and campaigns community-wide through social media and other awareness activities. These community-based programs engage health care providers, health systems, and other DSHS partners to strengthen community capacity to build breastfeeding, safe infant sleep, SIDS reduction, interpregnancy health, and other maternal health and safety education and awareness. In FY26, DSHS will share state-based breastfeeding and maternal health and safety resources during at least two HTMB CC virtual meetings.

DSHS’ statewide infant health and safety campaign continues to raise awareness for employers, hospital staff, and community stakeholders about worksite, community, and health care breastfeeding barriers. This campaign will include sharing information about Texas Mother-Friendly Worksite (TMFW) program designation process and the Right from the Start breastfeeding awareness campaign. For more information about the campaign, visit the Infant Health Plan, NPM 5 and SPM 3.

Maternal Morbidity Disparities: Ratio of Black to White Severe Maternal Morbidity Rate 

 

Both nationally and in Texas, Black, Indigenous, and Hispanic women are disproportionately impacted by SMM and mortality. In FY26, DSHS will support Texas birthing hospitals to implement the TexasAIM SEP PSBs, and provide ongoing support for hospital data collection, analysis, reporting, and QI.

DSHS will continue supporting hospital multidisciplinary care teams engaging pregnant and postpartum women and their support maternal health conditions networks. In addition, teams will align treatment plans with patients’ health literacy, language, and accessibility needs.

DSHS will support hospitals making respectful, supportive, responsive, patient-centered care improvements, and track hospital’s self-reported progress toward:

 

• Fostering respectful, supportive, patient-centered health care cultures with reporting, response, and systems learning
• Providing referral resources, communication pathways, and a standardized discharge summary for pregnant and postpartum patients
• Using protocols for developing individualized care plans that foster trust, safety and a therapeutic environment to promote healing
• Implementing ongoing team member health disparities, patient-centered care, therapeutic care environments, shared decision-making, and cognitive biases in clinical decision-making education
• Conducting hospital patient debriefs after a severe maternal health event
• Incorporating patients’ and/or support networks’ perspective in regular clinical team formal debriefings after major complication cases
• Considering social support case review
• Disaggregating process and outcome data by race/ethnicity and other demographic factors to pinpoint disparity improvement and/or opportunities
• Incorporating lived experience patients, caregivers, and families in actively designing, delivering, and evaluating health services to improve maternal care quality
• Using patient-centered communication and shared decision-making  

 

DSHS will monitor health care disparities and improvement by disaggregating TexasAIM state collected measures data by race/ethnicity population, payor (if available), and other key demographics. DSHS will also support hospital teams with strategies for collecting and reporting disaggregated process and outcome data.

 

In FY26, DSHS will assess HRMCCS’s impact in Smith and Cherokee Counties to reduce SMM. Through NETHealth, DSHS will continue implementing the DREAM model to deliver CHW-led high-risk maternal care coordination services. The model integrates person-centered concepts and systems to maintain healthy social support networks by:

• Staffing local community CHWs to address high-risk pregnant and postpartum women’s social supports
• Supporting ongoing CHW training and capacity-building in high-risk maternal care including reducing access to care barriers and disparities
• Providing high-risk pregnant and postpartum women with health education on increased maternal risk factors
• Screening each potential client to identify care delay or follow-up experiences
• Providing ongoing CHW social supports to improve health outcomes and help clients develop client-centered care plans to meet identified needs, coordinate care, and needed service referrals

By the end of FY26, NETHealth will screen at least 400 pregnant or postpartum women in Smith and Cherokee Counties using a CHW assessment tool to identify risk factors contributing to poor maternal health outcomes. CHWs will assess access barriers and educational needs to refer program beneficiaries to appropriate ongoing education and support services. CHWs will recruit women identified as having risk factors for high-risk pregnancies to participate in the DREAM program. CHWs will provide clients with counseling and support to recognize risks, seek care, and self-advocate for their health. DSHS anticipates participants who complete the DREAM program will be able to better identify and manage maternal health issues, participate in risk-appropriate prenatal care, self-report health status and ultimately lower incidence of poor pregnancy health outcomes (e.g., SMM or injury) during and in the year following pregnancy.

In FY26, DSHS will increase public awareness about urgent maternal warning signs and complications during pregnancy and up to a year postpartum. The Hear Her Texas campaign strategies promote SMM prevention, resources, and best-practice messaging among women of childbearing age, pregnant and postpartum women and their support networks, health care providers and other DSHS stakeholders. In FY26, the campaign will complete the following deliverables:

• Distribute provider informational video to aid health care professional training on urgent maternal warning signs
• Distribute provider toolkit materials and resources needed in health care settings for proper health care professional and patient education
• Develop and implement a influencer campaign second phase to expand campaign messaging reach
• Research effective strategies to incorporate messaging and maternal morbidity prevention strategies in state and local maternal health-oriented initiatives

• Launch a new campaign website and refresh social media to increase campaign engagement
• Expand stakeholder outreach and engagement plans to connect health care providers and other stakeholders working with pregnant and postpartum women

 

To measure reach, DSHS will analyze social media post engagements, impressions, webpage views, and document downloads.

By December 2026, DSHS will identify at least 95% of pregnancy-associated deaths statewide within 18 months of date of death. In FY26, MMMRC will review pregnancy-related death cases and make recommendations to decrease maternal and mortality rates, with special attention to mothers most affected by the state’s disparity ratios. MMMRC will use developed enhanced data collection tools and social supports impact analysis for better pregnancy-related deaths understanding.

By August 2029, DSHS aims to reduce the overall statewide rate of violent pregnancy-associated deaths by 5%. DSHS will achieve this through current strategic plans to reduce MCH population disparities, facilitate MCH services access, and decrease maternal mortality and morbidity.

In FY26, DSHS will study violent pregnancy-associated death (VPD) and VPD review processes. DSHS will conduct demographic and geographic disparity, rate, and trend analyses on maternal deaths due to violence using death, birth, and fetal death certificate data from 2016-2021. DSHS will continue partnering with state agencies and non-profit partners to identify integrating and aligning state programs VPD prevention strategies opportunities. By the end of FY26, DSHS will disseminate a state strategic action plan in collaboration with partners and stakeholders to improve health outcomes and reduce deaths among pregnant and postpartum women due to violence.

DSHS will encourage HTMB CC to use state and local data to identify key drivers of poor birth outcomes and will help support development of maternal health interventions. In FY26, DSHS will provide monthly technical assistance through virtual meetings and use an online shared platform for coalition collaboration to share best practices and highlight successes. DSHS will fund at least two community-based health initiatives or events to improve pregnant and postpartum Black women’s health outcomes in communities with disparate outcomes.

DSHS will continue to focus on breastfeeding support activities to reduce breastfeeding disparities and barriers. In FY26, DSHS will promote the TMFW program in all Texas job sectors with a focus on often-overlooked sectors such as hospitality and childcare. Outreach to state agencies will continue with a goal to designate all state agencies as TMFWs. DSHS will work closely with community partners to support TMFW promotion and provide technical assistance and support whenever needed.

Postpartum Visit: A) Percent of women who attended a postpartum checkup within 12 weeks after giving birth (Postpartum Visit) B) Percent of women who attended a postpartum checkup and received recommended care components

In FY26, DSHS will continue existing efforts to promote and support postpartum care and access, examine opportunities to address universal measures, and begin new efforts. DSHS plans to assess new strategies to increase both Texas postpartum care access and participation. Strategies and activities will include using the Texas Title V needs assessment (NA) to identify gaps and opportunities for improving systems and expanding awareness about postpartum follow-up importance throughout the state, conducting qualitative assessment to supplement five-year Texas Title V NA and identify postpartum visit attendance barriers, tracking postpartum follow up visits data (such as blood pressure and other symptoms) for women experiencing HTN in pregnancy, and integrating qualitative postpartum care assessment into the Texas lactation support hotline quality assurance survey.

DSHS will develop and promote educational opportunities, materials, communications, and programmatic activities to increase Texas Title V awareness and knowledge among women and their families, health care professionals, community health workers and other stakeholders. Topics will include/be related to maternal medical and behavioral health, urgent maternal warning signs, and scheduling and attending postpartum visits importance. DSHS will educate and raise awareness through:

• Emphasizing postpartum follow-up visit importance and urgent maternal warning signs with hospitals participating in the Texas statewide QI learning collaborative (TexasAIM)
• Implementing TexasAIM CE activities such as DSHS Texas perinatal academy series and online on-demand CE modules to emphasize postpartum visit importance
• Promoting prevention, resources, and best-practice messaging among women of childbearing age, pregnant and postpartum women, health care providers and other DSHS stakeholders through the Hear Her Texas campaign
• Promoting postpartum follow up through the high-risk maternal care coordination program
• In FY26, PHR staff will develop and pilot an improved prenatal education train the trainer model including postpartum care importance information
• Educating on postpartum care importance during one-on-one appointments including immunizations events, car seat inspections, and community events (such as health fairs and festivals) to connect individuals with PHR referrals and resources
• Communicating with pregnant and postpartum women and their support networks on maternal health conditions
• Aligning treatment plans with patients’ health literacy, culture, language, and accessibility needs
• Distributing the DSHS Information for Parents of Newborn brochure to promote postpartum visit attendance state-mandated infant and maternal health information awareness
• Developing or using DSHS social media messaging to encourage postpartum visits
• Disseminating environmental scan (circles of support) results of regional partners providing postpartum family services or support
• Promoting HHS online provider education prenatal and postpartum care modules

DSHS will foster partnerships to develop referral and counter referral systems and promote reducing risk and prevent maternal harm best practices. DSHS will support HTMB CC to:

• Identify and promote evidence-based and/or evidence-informed infant and maternal mortality and disparity reduction interventions
• Assess community-based postpartum care efforts and increase available services and resources awareness
• Scan current outreach materials to identify promoting postpartum visit attendance opportunities
• Develop an activity bundle (outreach presentations and other resources on postpartum visits) for HTMB CC to implement in FY27
• Identify key actions for community members including health care providers to support postpartum visits

DSHS will continue providing technical assistance and support for maternal health care QI to multidisciplinary hospital teams through the work of TexasAIM and TCHMB.