Using a broader, more inclusive, and more realistic way to impact women's health and the health of the entire community, the FDOH has reassessed, updated, and realigned targeted strategies and objectives to address the state priority to improve access to health care for women and to improve preconception and interconception health, specifically women who face significant barriers to better health.

The national performance measure selected for this priority was NPM 1: Percent of women with a past year preventive medical visit. The FDOH has identified objectives and strategies to improve the health of Florida’s women.

Pregnancy provides an opportunity to promote women’s overall health and establish a strong foundation for children’s health. A child’s health during the prenatal, infancy, and early childhood periods influences his or her health later in life. The FDOH, through the state’s Healthy Start program, provides care coordination services to pregnant women at risk for preterm or low birth weight infants. This is an optimal opportunity to ensure pregnant women receive prenatal care, including screening for conditions such as gestational diabetes, monitoring for potential complications, and education to encourage healthy behaviors such as smoking cessation and healthy eating.

Preconception health provides opportunities to promote the health of women before they become pregnant through improved access to health care, whether it be through an actual well-care visit or through services offered through the FDOH’s other programs such as diabetes prevention and breast or cervical cancer screening. With half of all U.S. pregnancies unplanned, preconception health and health care are important for all people of reproductive age. Primary care for women encompasses screening and assessment, health promotion and counseling, and brief interventions or referrals for additional services when warranted.

The FDOH will continue to build and strengthen state and community partnerships to develop comprehensive systems of care for women and use data to inform program development and policy change. Partnerships between Florida’s Title V MCH program and other state and community agencies such as Florida’s Medicaid agency; providers; home visiting programs including the MIECHV program; local health departments; and community health centers are critical to developing and advancing comprehensive preconception health efforts at the state and local level as well as the overall system of care for women.

Strong state leadership and an ongoing structure such as the FDOH’s State Health Improvement Plan, the integrated county health departments, and the Florida Perinatal Quality Collaborative are core elements of sustained success and the ability to make improvements to policies, programs, and services for not only low-income women and their families but all women and families in Florida.

The FDOH will continue to use Title V funding to provide interconception care (ICC) through Florida’s Healthy Start Program. In addition, to reach women before their first pregnancy, the FDOH’s MCH Section will continue to partner with the  Adolescent and Reproductive Health Section to implement a statewide project promoting preconception health and overall wellness targeted at adolescents.

Title V funding will continue to be provided through Schedule C and a Statement of Work to all 67 county health departments to provide services to women. These services may include well-woman preventative health visits; prenatal care; education for chronic disease management and prevention for pregnant women; preconception health counseling; reproductive health services; and dental care services for pregnant women as well as children (with an emphasis on children up to age six). County health departments also engage in activities that promote access to care, health literacy, and community engagement and/or establishment of policies that positively influence social and economic conditions to address the social determinants of health.

In 2019, the stillbirth rate in Florida was 6.8 per 1,000 deliveries (FLCHARTS). Women who are black experience stillbirth at twice the rate of the general pregnant population. The FDOH will continue to use Title V funding on the Count the Kicks campaign. Count the Kicks is an evidence based stillbirth prevention campaign that teaches moms to count their babies’ movements daily during her third trimester of pregnancy and to call her obstetric provider if she notices a change in what is normal for her baby.  Count the Kicks materials are available at no cost for Florida providers.  The FDOH and Count the Kicks will be implementing a billboard campaign over the next year and offering more trainings to home visitors and health care providers.

The FDOH’s MCH Section will continue to contract with the Florida Pregnancy Care Network to implement the Florida Pregnancy Support Services Program. This program is a network of nonprofit crisis pregnancy centers that provide support and assistance to women, men, and their families who may be facing an unplanned pregnancy. Services include free pregnancy tests, peer counseling, and referrals; and most of the centers offer classes on pregnancy, childbirth, parenting, and personal finance management. The FDOH provides technical support to the program on evidence-based models and promotes services that are available from the Florida Association of Healthy Start Coalitions and county health departments as a referral source.  The program also provides wellness services including well woman exams and health screenings for non-pregnant women 18 and older and STI testing.

The FDOH will continue to use Title V funding for four regional part-time nurse abstractors, an epidemiology staff person for data analysis, and additional staff as needed to support the statewide volunteer Florida MMRC. Reduction of maternal death is a national and state priority. The Florida  MMRC is an ongoing system of surveillance that collects and analyzes information related to maternal deaths to promote system improvements through evidence-based actions aimed at preventing future untimely deaths.  The multi-disciplinary Florida MMRC meets quarterly through out the year to review cases of maternal mortality and identify issues, and make recommendations for improvements in care at the individual, provider, and community levels. Actions of the committee include reports covering multiple years of review, which are beneficial for evaluating trends and proposing recommendations for change. In addition to monitoring annual data and trends, select topics are chosen for further analysis to obtain a more complete understanding of a particular issue or condition and promote the development of targeted actions that may prevent future deaths. The FDOH’s collaboration with the FPQC and ACOG District XII allows for moving recommendations into action through quality improvement projects.

A recurring recommendation from the Florida MMRC is to stress the importance of a woman receiving education on preconception health and the need to have a medical home to manage chronic disease processes and to maintain optimal weight.  The Florida  MMRC data also notes that non-Hispanic black women are significantly more likely to die from pregnancy complications compared to non-Hispanic white and Hispanic women.

The Florida  MMRC will continue to promote and develop timely messages and action items, to support initiatives related to preventing maternal deaths in Florida and develop briefs on Florida  MMRC findings to distribute to professional organizations through the Florida MMRC representatives, and post the messages on the FDOH website.

The FDOH’s MCH Section will continue to work with the FPQC on the Maternal Opioid Recovery Effort (MORE) Initiative. The goal of the MORE Initiative is to improve identification, clinical care, and coordination of treatment and support for pregnant women and their infants with any exposure to opioids. 

The FPQC and the FDOH have also partnered to implement the Promoting Primary Vaginal Deliveries (PROVIDE) Initiative. The goal of the PROVIDE Initiative is to improve maternal and newborn outcomes by applying evidence-based interventions to promote primary vaginal deliveries at Florida delivery hospitals and ultimately reduce NTSV cesareans. There are currently over 70 Florida birthing hospitals participating.

The FDOH will continue our partnership with the Agency for Health Care Administration (AHCA) to recognize hospitals that achieve the Healthy People 2020 goal of low-risk, primary Cesarean section rates at or below 23.9 percent. The FDOH and AHCA were able to recognize 15 hospitals for achieving this goal for 2019 and 10 hospitals received honorable mention recognition for achieving 24.9 percent.  As the Healthy People goals are updated, the goals and recognitions for hospitals will be updated as well.

The FDOH will continue their efforts related to the perinatal mental health grant from HRSA, The Development of a Sustainable Screening and Treatment Model to Improve Maternal Mental Health Outcomes in Florida. The purpose of the project is to develop a sustainable screening and treatment model to improve maternal mental outcomes in Florida. FDOH is currently in year three of a five year grant.  Over the remaining years, focus will be on:

• Expanding capacity in Florida to fully and competently deliver all aspects of screening, referral, engagement, and health consultation trainings to all major obstetrics practices and birth hospitals in the targeted region.
• Expanding screening and treatment model for maternal mental health in all major prenatal health care practices in the targeted region.
• Engaging and training more  obstetrics providers on tool use, follow up, and the Massachusetts Child Psychiatry Access Program (MCPAP) model; develop and refine the psychiatric consultation model.
• Maintaining provider participation and engagement in the program. Expand mental health and substance abuse referral networks in the regions. Increase statewide maternal mental health resources and capacity.
• Increasing access to screening, referral, and treatment for women in rural and non-rural areas through telehealth resources.
• Training community mental health providers in evidence-based psychotherapy and management of perinatal mental health disorders.
• Developing and implement a State Data Dashboard System.
• Developing a sustainability plan that continues beyond the grant period.

The MCH Section will continue to collaborate with the Bureau of Tobacco Free Florida to look at Florida’s data more closely regarding the interaction between socioeconomic status and race on birth outcomes as they relate to smoking and preterm birth, particularly among black women. There are racial and ethnic differences in the age of onset of smoking with black women initiating smoking later than white women. Prevention interventions should continue beyond adolescence well into the adult years, especially for black women.

The Tobacco Free Florida program continues to bring awareness to the dangers of tobacco, while also providing free resources that help tens of thousands of Floridians to quit. The program has made remarkable progress in helping reduce tobacco use across the state. However, when it comes to tobacco use and exposure to secondhand smoke, there are still many geographic and demographic inequalities across our state. About 14.8 percent of adults in Florida still smoked cigarettes during 2019.

There are large populations of Floridians, including many children, for whom tobacco use and exposure to secondhand smoke is a daily fact of life. These groups are disproportionately impacted by the health burden of tobacco use, which is especially high among certain subpopulations, including racial and ethnic minorities, low-income individuals, the LGBT community, and those with mental health conditions.

For example, smoking among all racial ethnic groups adults in Florida has declined since 2012, but smoking among non-Hispanic blacks and Hispanics in Florida has not seen a substantial decline. Lower income cigarette smokers suffer more from diseases caused by smoking than smokers with higher incomes. Tobacco use is higher among Florida adults who are not heterosexual as compared to heterosexual adults. Adults reporting poor mental health have higher smoking rates than adults reporting good mental health.

The FDOH will continue researching ways to provide postpartum cessation or relapse support in addition to the SCRIPT program. The evaluation of SCRIPT found that SCRIPT efficacy has only been examined through 90 days postpartum, potentially falling short of long-term support for mothers postpartum. By incorporating a postpartum support program, women in the interconception period are reached as well.

The FDOH continues to promote Tobacco Free Florida’s Quit Your Way. The Florida Quitline is available 24 hours a day, seven days a week, offering telephone counseling in English, Spanish, and other languages through a translation service. Pregnant tobacco users who are ready to quit receive expanded services including 10 counseling sessions, and with a medical release, they may receive a two-week starter kit of nicotine replacement therapy. Self-help materials are also provided by mail.

Tobacco users may also access resources to help them quit through Florida’s Web Coach online service. Tobacco users can plan their quit date and even receive nicotine replacement therapy through the free online service. The telephone and online services also provide another feature to help tobacco users quit, Text2Quit. Text2Quit is a new digital service that texts positive messages to tobacco users before, during, and after they quit.

The MCH section will collaborate with the Bureau of Tobacco Free Florida to update the www.tobaccofreeflorida.com website with information relevant to pregnant women. This will include information on quit resources available during pregnancy and information on the effects of smoking during pregnancy and on the baby once born.

As a continuing component of Florida’s Healthy Babies Initiative, the MCH Section will continue to collaborate with the Bureau of Tobacco Free Florida to expand existing tobacco cessation activities. The Bureau of Tobacco Free Florida is providing additional funding to county health departments that may be used for staffing, education materials, and training that support cessation objectives.

Family planning providers across the state will continue to screen their clients for tobacco use and provide information on Florida’s Quit Your Way. The FDOH Bureau of Tobacco Free Florida has implemented a secondhand smoke campaign targeted toward pregnant women. will continue to encourage all health care providers to counsel women of childbearing age and all pregnant women on the dangers of tobacco use as well as the dangers of secondhand smoke. The FDOH will continue to monitor the Healthy Start Standards and Guidelines to ensure that resources and guidance are current. The FDOH is committed to helping Florida residents reach their fullest health potential by living tobacco free lives.

The FDOH MCH Section will continue our partnership with the Volusia county health department in the CityMatch Alignment for Action Learning Collaborative. This learning collaborative is designed to better align state and local MCH work and ultimately improve MCH outcomes in U.S. cities and counties. During a two-year span, each team will participate in and receive training to support the work they have selected and implement their priority area, strategies, and evaluation methods.

The MCH Section is implementing a comprehensive maternal mortality awareness and reduction campaign.  This will include promotion of the BH IMPACT program, a mother empowerment component, and a C-Section reduction and education piece.  

In addition to initiatives previously described, the FDOH will continue to support staff with Title V funding to provide oversight and monitoring of the following contracts  to address maternal and women’s health priorities:

• Contracts with 11 Fetal Infant Mortality Review (FIMR) projects to provide for the implementation of FIMR services.
• Contract with the Family Health Line, a toll-free hotline to provide information and referrals on maternal and child health topics.
• Contract with the Ounce of Prevention Fund of Florida to identify, fund, and evaluate innovative prevention programs.
• Contract with the FPQC to engage perinatal stakeholders to improve maternal and infant health outcomes at the systems level.
• Contract with A Safe Haven for Newborns to promote the safe haven law in Florida.

During the 2021 Legislative session, a Senate Bill 2518 passed that extending Medicaid coverage for pregnant women in Florida to one year postpartum.  Prior to this legislation, Medicaid coverage only extended two months postpartum.  This move will ensure better care and services for both mothers and babies.

A second bill that passed during the 2021 Legislative session is HB 1381 related to maternal health outcomes.  Part of this legislation provides for a pilot project in Duval and Orange counties that focuses on reaching underserved, rural, and indigenous populations and communities.  The pilot projects will have a focus on telehealth and providing women with tools to monitor their health and pregnancies at home.

The FDOH was awarded additional funding through the CDC’s Preventing Maternal Deaths: Supporting Maternal Mortality.  With this funding, the FDOH has plans to look more closely at pregnancy associated deaths related to substance use and mental health disorders.  There has been a rise in these types of deaths in Florida.  While it does appear that these deaths are not pregnancy related, the FDOH wants to examine this data more closely to determine what actions or programs can be implemented to prevent these deaths from occurring.

Finally, the MCH Section is working with FDOH information technology staff to update the universal prenatal risk screen to an electronic format.  Currently the prenatal screen is completed on paper.  By transitioning to an fully electronic process, the FDOH anticipates an increase in completed screens and a decrease in the time between screen completion and entry into services. In conjunction with this upgrade, the FDOH will be kicking off a prenatal screen campaign to raise awareness of the screen and provide more education and technical assistance in completing the screen.