Lawmakers Drill Down on Policies to Improve Maternal, Child Health

Lilo H. Stainton | February 21, 2018 | Health Care
Murphy slated to sign off today on bill restoring funding to family planning services, but many other measures are under consideration

baby birth delivery
So far, 2018 could be considered the “Year of Maternal and Child Health in New Jersey,” with the topic the focus of legislative hearings and a public awareness campaign, and the new governor set to commit millions of dollars more to family planning services.

New Jersey lawmakers are also working quietly on a half-dozen policy proposals designed to improve access to family planning and pregnancy care, provide consumers more information about birthing options, and increase state oversight of hospital labor and delivery departments.

One measure, to extend Medicaid benefits to cover birth control and other family-planning services for more working-poor women in the Garden State, has passed both legislative branches and now awaits signature from Gov. Phil Murphy, a Democrat who took office last month. Murphy has made women’s health a priority and is scheduled to sign his first bill today, allocating an additional $7.45 million for family-planning services.

Other proposals, including a plan to require Medicaid to cover care provided by doulas, or trained birthing professionals, and a call for an expert committee to review and make recommendations on maternal deaths, have been approved by a Senate committee and face several more steps in the legislative process. Another bill, to provide additional legal protections to surrogate mothers and the families that use their services, has passed committees in both houses.

Encouraging doulas

Jill Wodnick, a doula and childbirth educator, told lawmakers that while the Garden State has had a few community doula programs, it has not embraced these providers in the way other states have done. “Studies of the effectiveness of doula care tell us that one of the most effective and far-reaching steps New Jersey could take to reduce disparities for both mothers and infants would be to follow the example of so many other states and scale up the training and use of birth doulas,” Wodnick wrote in an op-ed published in NJ Spotlight.

Infant mortality has declined in the Garden State — to 4.8 deaths per 1,000 live births, as of 2015 — and is below the national average. But pregnant women and those in childbirth continue to die at a higher rate — 3.6 deaths per 1,000 deliveries — than in many other states. Each year, more than 500 infants die before their first birthday, most of preventable causes.

A deadly gap

There is also a significant gap in the clinical results between black and white families, with African-American babies more than three times as likely to die as white infants and black mothers facing a death rate nearly four times that of white women.

These figures have prompted a growing concern among policymakers in New Jersey, and the topic was the focus of a hearing held earlier this month by state Sen. Joseph Vitale (D-Middlesex), who chairs the health committee. The acting commissioner of the Department of Human Services, Carole Johnson, also joined a meeting last week led by U.S. Rep. Bonnie Watson Coleman (D-NJ) to explore how the Garden State can better address these problems.

Experts agree it is essential to better educate the public on the importance of prenatal care — to both mother and baby — and ensure that healthcare providers have clear protocols for assessing and treating moms and infants throughout the pregnancy and delivery. New Jersey hosted what is believed to be the nation’s first Maternal Health Awareness Day on January 23 in an effort to reduce avoidable deaths.

In addition to the family planning funding Murphy will sign today (A-2134/S-120), which cleared its last legislative hurdle with an Assembly vote Thursday that split partially along party lines, the measures under legislative consideration include:

  • A-1656/S-105, which dates back to the 2012 legislative session and has a long list of dozens of Democratic sponsors. The measure would use Medicaid to cover family-planning services, including abortion, for individuals who earn up to 200 percent of the federal poverty level, or more than $30,000 a year. Currently, these services are available to those earning up to 138 percent (less than $21,000 annually.) Medicaid currently pays for all healthcare services for pregnant women who earn up to 200 percent FPL. While the change would involve some state cost, the vast majority — 90 percent — of these expenses would fall to the federal government. The bill cleared its final legislative hurdle in the Assembly with a party-line vote Thursday.
  • A-1704/S-482 — sponsored by Assemblywomen Valerie Vainieri Huttle, Annette Quijano, and Mila Jasey, Sen. Teresa Ruiz, and Vitale, provides a mechanism to create legal agreements regarding gestational carriers, or females who serve as a surrogate to incubate another woman’s fertilized egg. The proposal spells out who could participate as a carrier (women over age 21, who have had at least one child, and pass medical and psychological exams, among other things) and the basic responsibilities of all parties involved. Committees in both houses have approved the measure.
  • A-1662/S-1784 — sponsored by Sen. Loretta Weinberg and Assemblywoman Elaina Pintor Marin would require Medicaid pay for doula care, or trained professionals who can provide physical and emotional support for mothers before, during, and after childbirth, a treatment routine that has been shown to improve outcomes. The measure has passed the Senate health committee and will now face a hearing in the budget committee; an Assembly version awaits action.
  • A-1862/S-495 — sponsored by Vitale and Ruiz in the Senate and Assemblywomen Vainieri Huttle and Pamela Lampitt and Assemblyman Raj Mukherji, would establish a Maternal Mortality Review Commission to examine and report on childbearing-related deaths each year. Unlike the existing review panel, which has been at work for decades, this body would be required by state statute, armed with subpoena power and able to accept federal funds, the sponsors note. The measure, which Vitale and Ruiz also pressed last session, passed the Senate health committee last week and is now pending in the budget committee; an Assembly version awaits action.
  • A-2366/S-1786 — championed by Weinberg and Sen. Brian Stack, Vainieri Huttle, and Mukherji, the measure would require the state Department of Health to develop a hospital-based maternal healthcare report to enable the public to easily compare birth outcomes at facilities across the state. Information would include vaginal versus surgical deliveries, complications, and other details, much of which are already collected, but not necessarily compiled in one accessible format.