During the 2025 Title V Needs assessment, Maryland elected to continue the “ensure that all babies have the best possible start and thrive in their first year” priority to support perinatal and infant health. Table 10 lists the strategies to achieve this priority, focused on key areas identified for improving perinatal and infant outcomes.

Table 10: Perinatal Health Priority

Priority: Ensure that all babies have the best possible start and thrive in their first year

Strategy 2.1: Promote safe sleep practices among newborns to reduce sleep-related infant deaths

Between 2018 and 2022, sleep-related deaths continued to be the leading cause of sudden unexplained infant deaths, with 70 percent occurring between 0-4 months of age. Maryland’s Title V will continue to review existing data about infant safe sleep to improve the state’s infant safe sleep strategy. During the 2024 Maryland legislative session, HB 177/SB 59-Hospitals-Care of Infants After Discharge (Safe Sleep Act of 2024) passed. The bill requires hospitals to provide information and resources related to a safe sleep environment and MDH to provide a list of safe sleep resources by jurisdiction.

Title V will continue to partner with Maryland local health departments and Roberta’s House to provide technical assistance to birthing hospitals and aid in the development of the resource guide to support in the implementation of this legislation. The organization will also assist with planning and implementing a statewide infant safe sleep summit in fiscal year 2026. This conference will focus on integrating evidence-based infant safe sleep strategies into practical messaging for a variety of stakeholders. The conference will gather community members with lived experience, community-based organizations, local health departments and other entities to share the strategy selected for this national performance measure. This work is to build on infant safe sleep campaigns by engaging Maryland Title V programs and community partners. This strategy involves training home visitors, Healthy Start providers and other community-based service providers to discuss safe sleep using a culturally sensitive approach that considers family needs and beliefs, while promoting American Academy of Pediatrics guidelines.

This strategy is a new approach and is supported by the “Building on Campaigns with Conversations” series of modules developed by the National Center for Education in Maternal and Child Health. The modules received extensive input from the National Action Partnership to Promote Safe Sleep, a coalition of more than 70 national organizations. Furthermore, this approach is based on Ajzen’s Theory of Planned Behavior and follows current American Academy of Pediatrics’ recommendations for safe sleep.

Strategy 2.2: Cultivate a multifaceted community of professional lactation support through education and training opportunities across health care disciplines

The strategy selected for this national performance measure is to cultivate a multifaceted community of professional lactation support through education and training opportunities across health care disciplines. This strategy entails informing pregnant women and new mothers about lactation consultant services and ensuring that lactation consultants have access to new mothers after birth. This strategy is considered to have moderate evidence, where “dedicated lactation specialists may play a role in providing education and support to pregnant women and new mothers wishing to breastfeed and to continue breastfeeding to improve breastfeeding outcomes” was shown in various systematic literature reviews.[1]

As part of this strategy, in FY26, Maryland’s Title V program will use home visitors, perinatal care coordinators and doulas or birth workers in a similar role as lactation consultants to promote breastfeeding. Maryland Title V staff, in partnership with WIC staff, will update and disseminate the virtual pre-recorded training about milk supply, mothers and infants with specific needs, supporting mothers who feed with bottles, and breast and nipple concerns. These will be available on MDH’s training website. Maryland Title V staff will partner with 211 to ensure specific lactation supports are available.

Furthermore, Maryland Title V staff, in partnership with WIC staff, will create a Lactation Support Toolkit for Home Visitors and Care Coordinators. The purpose of this toolkit is to guide home visitors, care coordinators, and program supervisors to bring quality breastfeeding education and support to their clients. This toolkit will be modeled after Oregon’s Lactation Support for Home Visitors’ Toolkit, which was created in 2024.

In FY26, the Title V manager and the perinatal health manager will be onboarded and join the WIC staff in participating in the Breastfeeding Coalition. Furthermore, Title V will partner with workplaces, childcare providers and healthcare providers to confer Breastfeeding-Friendly Awards. Maryland’s Title V will explore the barriers for hospitals receiving the baby-friendly designation. Staff will also disseminate tools about breastfeeding to hospital staff and Local Health Departments.

Maryland Women, Infants and Children (WIC) Program

The Maryland WIC program continues to be committed to helping families have positive, successful breastfeeding experiences. WIC will continue to provide resources, such as an FAQ sheet, handouts and a breastfeeding checklist which are available in both English and Spanish. They will also provide videos with information on various breastfeeding-related topics. Maryland WIC employs 31 breastfeeding peer counselors who will continue to provide ongoing one-on-one support to pregnant and breastfeeding participants. WIC staff will continue participating in the Maryland Breastfeeding Coalition.

Strategy 2.3: Coordinate robust child and infant mortality review processes to understand the drivers of deaths and develop and implement recommendations to prevent mortality and near-fatalities

Maryland Title V has made reducing infant sleep deaths a priority, supported by its fatality review efforts at local jurisdictions.

Surveillance Quality Initiatives

In FY26, Surveillance Quality Initiatives, including the Child Fatality Review and the Fetal and Infant Mortality Review, will continue to identify systemic preventive factors to prevent future infant and child deaths and near fatalities in Maryland. SQI initiatives are funded through general state funds, which are used as the Title V state match. The goal of the SQI is to provide funding to all 24 Maryland jurisdictions to support the review of unexpected infant and child deaths referred to by the Maryland Office of the Chief Medical Examiner. Local Child Fatality Review teams will use these reviews to develop and, when possible, implement recommendations aimed at reducing infant and child death rates.

Title V staff provide ongoing technical support to local CFR and FIMR teams. During FY25, the program updated the Maryland State Child Fatality Review Guidelines for Local Case Review - the first revision since 2017. In FY26, the program will develop and revise its CFR/FIMR orientation materials and resources to ensure that every new local CFR and FIMR coordinator is equipped with the information needed to succeed in their role. Additionally, program staff will continue to offer comprehensive technical support so that all local CFR and FIMR coordinators—whether new or experienced—have the knowledge and skills necessary to effectively lead their teams.

For FY26, jurisdictions will focus on implementing Senate Bill 59 (Hospitals: Care of Infants after Discharge) that requires all birthing hospitals to provide education on safe sleep and resources. The program will also prioritize increasing maternal and child health communications, particularly to communicate the recommendations from child fatality reviews with partners.

For FY26, jurisdictions will continue to address the following priorities as part of their funding:

•        Dissemination of information and education on sleep-related infant death and Safe Sleep to reduce sleep-related infant death.
•        Dissemination of durable goods for safe sleep, such as a portable bed/playpen, car seat, sleep sack and stroller.
•        Develop recommendations to reduce infant, fetal and child deaths, particularly among those who are disproportionately impacted.
•        Increase safe sleep practices, particularly among communities at highest risk of sleep-related infant death.
•        Conduct screening and provide referrals to reduce the incidence of substance use disorder and transmission of sexually transmitted infections in pregnancy.
•        Increase social support for women during the perinatal and postpartum periods.

In addition, jurisdictions will implement strategies to achieve consistent health outcomes across groups in their program efforts using one of the following priority areas:

•        Workforce development.
•        Analyzing program data by demographic group to inform program design and to measure progress.
•        Pursue a program or community policy change.
•        Making data available to the target community.
•        Engaging the community in program development and evaluation.

During FY25, Title V staff developed a data brief, Sleep-Related Infant Deaths in Maryland 2016-2020, which contains the latest published sleep-related infant death data. In FY26, Title V staff will continue to update this data brief and disseminate to partners, including Maryland local health departments. Furthermore, Title V staff will continue supporting the Maryland State CFR Team’s workgroups, including efforts to develop consistent messaging and materials on preventing infant sleep-related deaths for use by key partners like health departments, hospitals, providers, and community organizations.

Fetal Infant Mortality Review

The Maternal and Child Health Bureau, housed within the Maryland Department of Health, serves as the lead agency for Maryland’s Fetal Infant Mortality Review program. Funded by Title V, the FIMR program works with program staff in jurisdictions with the highest rates of fetal and infant mortality. Infant and child mortality are two of the most critical indicators of the overall health of a population, and Maryland has made significant strides to improve infant and child health.

There are currently seven funded FIMR projects in Maryland operating in jurisdictions identified through a perinatal period of risk analysis as having the highest rates of infant mortality in the state. They include Anne Arundel, Baltimore City, Baltimore, Charles, Montgomery, Prince George’s, and Wicomico counties. The FIMR was designed to be a community-owned, action-oriented process to improve service systems. It works to examine the medical, non-medical and systems-related factors contributing to fetal and infant death at the community level. Each local team works with its community action teams to develop program and policy recommendations to improve maternal and fetal outcomes. Leveraging the recommendations of the community action teams, health departments will now be required to implement interventions aimed at addressing factors contributing to preventable maternal and infant deaths in Maryland.

In FY26, FIMR teams continue to select cases for review based on the categories of fetal and infant death, where the largest disparities are present within their jurisdictions. Teams are expected to conduct case reviews with one or more of the following risk factors present: substance use during pregnancy, birth defects, or fetal anomalies. Teams will also look at how a lack of transportation, housing instability and food insecurity contributed to fetal or infant death. In addition, sites will have the opportunity to continue to pilot using the National Center for Fatality Review and Prevention database to log reviewed case information. Teams will work to identify various findings, recommendations and action steps for improving systems of care for pregnant women and infants.

Recent recommendations include improving infant safe sleep messaging, increasing the number of safe sleep partners, and increasing the dissemination of mental health/substance use treatment information. A significant part of the review is incorporating the voices of postpartum women who experience a fetal loss in addition to reviewing the medical aspects of the case, with maternal interviews being central to the FIMR process. In FY26, FIMR teams will continue to focus on maternal interviews as a strategy area for quality improvement. FIMR teams will implement strategies through their case review process and community action team programs to promote consistent health outcomes within their local jurisdictions.

Other Efforts to Improve Perinatal and Infant Health

Improving Perinatal Health through Perinatal Care Coordination

Perinatal care coordination programs provide support to pregnant women, their infants and their families to coordinate services for a healthy pregnancy. Each local health department in Maryland has a perinatal care coordination program that is funded by grants from Medicaid for the Administrative Care Coordination Units and from public health grants through Title V,  Babies Born Healthy (BBH), Thrive by Three, Public Health Infrastructure Grant and the Integrated Maternal Health Services funds. BBH and Thrive by Three funds are used as Title V state matches.

Patients insured by Medicaid are referred to perinatal care coordination during the prenatal period by the Maryland Prenatal Risk Assessment. This paper-based form is completed by the prenatal care provider and faxed to local health departments. On Apr. 1, 2025, the Maryland Department of Health launched a digital version of this form within the Chesapeake Regional Information System for our Patients, the State’s health information exchange. Patients who had a high-risk pregnancy are also referred to perinatal care coordination in the postpartum period by their birthing hospital using the paper-based Postpartum Infant & Maternal Referral form. A digital version of this form launched in CRISP on Jul. 1, 2025. The effort to digitize these two forms was funded by the Health Resources and Services Administration’s Integrated Maternal Health Services initiative.

Babies Born Healthy- Perinatal Care Coordination

The goal of the Babies Born Healthy Program is to improve birth outcomes, specifically to decrease disparities in infant mortality, especially between non-Hispanic Black and non-Hispanic white populations. In FY26, Babies Born Healthy will continue in Anne Arundel, Baltimore, Caroline, Charles, Montgomery, Prince George’s, and Wicomico counties and in Baltimore City. Title V staff will also implement the Health Resources and Services Administration’s Integrated Maternal Health Services Program, which will increase referrals to the local health departments for services that address social needs.

All BBH sites will continue to conduct targeted outreach to engage pregnant women residing in high-risk neighborhoods and those who are determined high-risk due to medical or social needs. Local health departments will connect clients to medical and social services programs, including establishing a medical home and access to prenatal care. Prenatal care is crucial in preventing pregnancy complications and managing pre-existing and pregnancy-related conditions that could harm both the pregnant woman and their infant.[2] Receiving none or late prenatal care can result in several adverse health outcomes for both the pregnant woman and infant, including preterm birth, low birth weight, increased risk of perinatal mood and anxiety disorders, severe maternal morbidity and maternal mortality.[3] The redesigned program elements will strengthen care coordination metrics, technical assistance, and resources for sites to standardize the sites. Sites will engage with clients who are experiencing perinatal mood and anxiety disorders and/or substance use disorder, for a minimum of 6 months postpartum.

In FY26, there will continue to be strong guidelines on how BBH care coordination programs should plan and execute their services, including guidance on screening, care planning and engagement.  Babies Born Healthy has also been brought into closer alignment with FIMR/CFR programming to synergize reports and incidents of deaths and the jurisdictional response to prevent future fatalities and address the causes of death.

Program Evaluation of BBH

During FY26, evaluation of the Babies Born Healthy Program will continue.  Since 2024, Title V has been working with Cardea Services to conduct the evaluation. The evaluation will help the department understand to what extent the BBH perinatal care coordination services reach the intended priority populations and that services meet the needs of populations. Cardea Services conducted interviews in FY25 and will present their findings in FY26. In FY26, the evaluation efforts will focus on CenteringPregnancy sites and expanding the Medicaid-enrolled doula workforce projects.

Increasing CenteringPregnancy in Maryland

In 2026, MDH will expand CenteringPregnancy sites from 16 to 18 to improve maternal and infant health outcomes. CenteringPregnancy is an evidence-based group prenatal care model that combines medical care, education, and peer support for individuals with similar due dates. With more than 100 published studies and peer-reviewed articles, evidence shows that CenteringPregnancy reduces costs, lowers the risk of preterm birth and closes the disparity gap in preterm birth between Black and White women[4]. In FY26, CenteringPregnancy sites will expand through the partnership with CenteringHealthCare Institute using state general funds from BBH.

Increasing Doula Support to Improve Perinatal Health Outcomes

Maryland Medicaid reimburses for Nurse Family Partnership and Healthy Families America maternal, infant and early childhood home visiting and doula provider services. Babies Born Healthy will work to increase the number of doulas who will be reimbursed by Maryland Medicaid. In 2024, Maryland Medicaid removed the requirement that community-based doulas must contract with Managed Care Organizations and instead be able to use the self-referral billing mechanism. This is anticipated to reduce the barriers for doulas to bill in Maryland. In 2024, Maryland Medicaid also expanded the list of approved doula certification organizations to 30 organizations, allowing more community-based, trained doulas to qualify for Medicaid enrollment. Community-based doula programs have been recognized by the Association of Maternal & Child Health Programs as a best practice. HRSA is currently funding community-based doula programs under the HealthyStart program as part of their efforts to improve health outcomes before, during and after pregnancy and reduce racial/ethnic differences in rates of infant death and adverse perinatal outcomes.[5],[6]

In FY25, Maryland funded 3 local health departments (Baltimore City Health Department, Frederick County Health Department, and Talbot County Health Department) to expand the doula workforce by providing scholarships for doula training, providing assistance in Medicaid enrollment, or conducting outreach to providers. In FY26, Maryland will fund four local health departments to include Charles County Health Department to continue to build local and state doula capacity. Improving access to doula services for high-risk pregnant women can address persistent disparities in health outcomes while addressing a variety of access needs within a continuum of care framework.

Thrive by Three

Separate from the Babies Born Healthy general funds, the Maryland Prenatal and Infant Care Grant Program Fund, or the Thrive by Three Fund, helps increase access to prenatal care via maternal and infant care coordination and other programs that link parent and baby to services and supports during and after pregnancy.  In FY26,  $3.3 million has been allocated to fund perinatal care coordination and prenatal care access through the Thrive by Three program. Two local health departments, Baltimore City and Harford County Health Department, and two federally qualified health centers, Greater Baden Medical Center and Mary’s Center, are receiving their last year of funding. Five local health departments, Baltimore City, Frederick County, Somerset County, St. Mary’s County, Wicomico County Health Department, and one federally qualified health center, Greater Baden Medical Center, have been awarded for FY26-FY28 to provide care coordination services.

Local Health Departments

In FY26, local health departments will continue to provide essential core public health services based on their local maternal and child health needs. Maryland distributes Title V funding to all 24 of the state’s local health departments. Local health departments have the opportunity to focus their efforts on one or any of a combination of the four Title V domains: child health, infant health, maternal health and/or children and youth with specific health care needs. Local health departments choose their domain of focus based on alignment with the Title V State Action Plan and with local needs assessments. Allowable services within the infant health services domain will continue to include Home Birth Certification and Home Visiting.

In FY26, it is expected that eight local health departments will use Title V funds to provide perinatal care coordination or perinatal home visiting services. The local health departments include Baltimore City, Baltimore County, Calvert County, Caroline County, Cecil County, Harford County, Kent County, and Montgomery County. A total of $2,025,050 will be used for these services. Half of these funds are counted towards maternal health, and half are counted towards infant health. Of note, it is expected that Garrett County will use Title V funds for home birth certification.

Local health departments will continue to provide information related to infant safe sleep, as well as provide portable cribs for families in need. 

Public Health Infrastructure Grant

Another grant funding care coordination services in Maryland is the Public Health Infrastructure grant from the Centers for Disease Control. This award intends to invest in new and transformative ways to modernize Maryland’s public health infrastructure, and reinforce and expand the public health workforce and strengthen the health department's capacity to provide foundational public health services.

In FY26 The Maternal and Child Health Bureau is awarding $1.03 million to eight local health departments, Allegany, Anne Arundel, Baltimore County, Calvert, Garrett, Montgomery, St. Mary’s, and Washington, to support efforts to provide perinatal care coordination for those who are pregnant or planning to become pregnant referred through the Maryland Prenatal Risk Assessment and Postpartum Infant Maternal Referral forms. This funding will support the following activities:

Integrating the digital MPRA and PIMR forms once available in the state health information exchange CRISP

•        Outreach to clinical partners to support their transition to the digital MPRA and PIMR.
•        Strengthening perinatal care coordination through staff time.
•        Resource distribution.
•        Transportation services.
•        Implementing the reporting requirements for the Maryland Maternal Health Act of 2024.

Integrated Maternal Health Services

Maryland Title V will continue to work with statewide partners to enhance perinatal care coordination through increased linkages to care through expanded referral systems. Stronger care coordination can support pregnant and postpartum individuals to be connected earlier to the care they need and encourage continued engagement through the perinatal period and beyond. Maryland currently utilizes two forms to refer high-risk individuals for care: the Maryland Prenatal Referral Assessment form and the Postpartum Infant Maternal Referral Form. In 2023, the Bureau was awarded an HRSA-funded grant, Integrated Maternal Health Services Initiative, to digitize and integrate these referral forms into the state’s health information exchange, CRISP, and pilot them in select jurisdictions. As of April 2025, the electronic MPRA has been rolled out to 10 jurisdictions. In FY26, the state will roll out the digital PIMR form and will conduct assessments and technical assistance with participating jurisdictions.

Supporting RSV immunization and reducing infectious disease transmission

In FY26, Maryland Title V will continue to partner with other programs throughout the department to align perinatal health efforts, particularly for the rise in congenital syphilis and perinatal HIV transmissions. During the 2024 Maryland legislative session, the Maryland Giving Infants a Future without Transmission (GIFT Act/House Bill 119) bill was passed, which expands testing requirements for syphilis and improves HIV surveillance for pregnant women. Title V staff will continue to work closely with the Maryland Infectious Disease Prevention and Health Services Bureau to align initiatives that reduce congenital syphilis and perinatal HIV transmission and support the implementation of the GIFT Act. Title V staff will continue to share information on pregnancy care and the prevention of HIV, syphilis and hepatitis with the maternal and child health workforce—especially community health workers, public health nurses, home visiting nurses, and clinical providers. Title V staff will also partner with 211 to update perinatal resources for those who are pregnant or planning to become pregnant and providers in Maryland. Title V staff will plan to partner with IDPHSB to implement the GIFT Act, specifically by coordinating with all 32 birthing hospitals for these new testing requirements.

In preparation for the respiratory syncytial virus season for 2025-2026, Title V staff will partner with the Maryland Infectious Disease Epidemiology, Outbreak, and Response Bureau (IDEORB) to prepare and plan to decrease hospitalizations due to RSV.  RSV is a common respiratory viral illness that causes mild, cold-like symptoms in healthy adults but can cause serious illness in infants and older adults. Between 2021 and 2023, the virus caused 603 - 1129 hospitalizations per year for children younger than 2 years old in Maryland.[7] The typical RSV season begins in October and lasts through April. In 2023, two highly effective methods of prevention became available:

•        Abrysvo is a vaccine that the CDC recommends be administered to those who are 32 - 36 weeks pregnant during September through January.
•        Beyfortus (Nirsivimab) is a monoclonal antibody that the Center for Disease Control and the American Academy of Pediatrics recommend be administered to infants under 8 months old born during, or entering, their first RSV season. Some children between the ages of 8 and 19 months who are at increased risk of severe RSV disease qualify to receive Beyfortus before their second RSV season.

Beyfortus is not necessary for infants whose mother received Abrysvo during the recommended window unless they are born less than 14 days after vaccination. During 2026, Title V staff will partner with other department staff and pediatric,and prenatal partners to ensure that pregnant women have easy access to Abrysvio and that birthing hospitals, as well as pediatric providers, administer Beyfortus to newborns and infants. This includes sharing guidance developed from the Centers for Disease Control and Prevention and other professional societies and partnering with the Vaccines for Children program. The goal is to enroll as many birthing hospitals in the Vaccines for Children program so they may have Nirsivimab available. Furthermore, Title V staff will partner with IDEORB to reach out to pharmacies that also may administer Abrysvo.

[1] https://www.mchevidence.org/documents/NPM-Webinar-3-04-22-20.pdf

[2] What is prenatal care and why is it important? https://www.nichd.nih.gov/. Accessed February 7, 2022. https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/prenatal-care

[3]https://www.cms.gov/About-CMS/Agency-Information/OMH/equity-initiatives/rural-health/09032019-Maternal-Health-Care-in-Rural-Communities.pdf

[4] https://www.centeringhealthcare.org/why-centering/research-and-resources

[5] The HealthConnect One CommunityBased Doula Program

[6] Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.pub6. 

[7] Maryland Department of Health. Internal Data - Emerging Infections Program.