Lawmakers Build on Murphy Initiatives to Improve Maternal Health

Lilo H. Stainton | April 4, 2019 | Health Care
State officials say new focus, extra resources for maternal and infant healthcare paying off; legislators propose more

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Mother and baby
New Jersey has made a dedicated effort over the past year to improve maternal and infant healthcare, hiring and training dozens of additional community-focused health workers and connecting thousands of women with support services. Officials say the effort is paying off.

Additional efforts are taking shape under Nurture NJ, a multi-pronged campaign launched in January by First Lady Tammy Murphy to reduce the number of mothers and babies that die in the baby’s first year. Maternal mortality in particular has more than doubled in the past 25 years nationwide, records show, and in New Jersey, black women die at nearly four times the rate of white women.

The state Legislature has also dug into the problem. The issue was flagged by a handful of Democrats in late 2017 and several committees held hearings late last year in which lawmakers and members of the public shared their birth stories. This work led to a diverse package of maternal-mortality proposals, five of which were adopted by both the Senate and Assembly at their last session in March. Nearly a dozen other maternal-care bills are also in the pipeline.

Gov. Phil Murphy, who has made women’s healthcare a priority since he campaigned for office, is expected to sign the bills soon, although he may request minor language changes. As a package, the measures seek to elevate women’s voices, expand insurance coverage for aspects of maternal care, and provide better clinical guidance and training protocols for hospitals in an effort to reduce complications.

Infant mortality has declined in the Garden State and remains below the national average. But deaths among mothers — in labor, delivery and within the first year after childbirth — are on the rise and exceed the national average. According to the latest state report, for each 100,000 live births in New Jersey, 12.8 white women die and 46.5 black women lose their lives. (The racial disparities reflect a healthcare system that is inherently biased against minorities, experts agree, in addition to social factors that can contribute to poor health.)

Renewed attention to racial gap

While the racial gap in outcomes is not news to the black community, questions concerning this disparity — and the nation’s high rates of maternal mortality overall, which exceed those of all other developed nations and many with fewer resources — has received growing attention. On January 23, 2018 advocates celebrated what may have been the nation’s first Maternal Health Awareness Day thanks to efforts by leaders at Rutgers University and the Tara Hansen Foundation, which honors a 29-year-old woman who died from a massive infection six days after giving birth, despite her pleas for help.

Under Murphy and Department of Health Commissioner Dr. Shereef Elnahal, who has also made this a priority, New Jersey has made changes to improve birth outcomes. Last year the DOH invested $4.7 million in the “Healthy Women, Healthy Families” program, which enabled local organizations to hire nearly 80 healthcare providers, half of which are doulas, or trained birth coaches who can help women with nonmedical aspects of maternity, and have been shown to improve the clinical outcomes and the patient’s experience.

The funding, which is focused on underserved communities, also enabled healthcare providers to screen some 11,000 women regarding their maternal health needs; more than three-quarters of these patients were then connected with programs designed to support their pregnancies, deliveries or post-partum experiences. In addition, the DOH provided funding for eight community-based organizations to develop regional doula pilot programs, designed to train local women to become birth coaches.

Tammy Murphy has made maternal health her top public priority and has visited a number of urban centers — including Camden, Paterson and Trenton — to highlight the services available and help individuals connect with programs they need. “Every mother deserves an equal chance at having a healthy child,” the first lady said, adding that Nurture NJ is designed to “reduce shameful disparities that have persisted in our state for too long. Our goal is to make New Jersey the safest place to give birth in the country.”

Leaders at New Jersey’s 49 hospital birthing centers have already collaborated to develop protocols designed to reduce unnecessary cesarean-section deliveries, which can cause longtime health issues for mothers and babies. They are also working to standardize birthing practices.

Several of the legislative proposals would take this further, codifying the requirements in law and requiring the DOH to oversee the development of these protocols. Others require the state to expand Medicaid coverage for maternal risk assessments, maternal health home visits, and for women’s health services between pregnancies.

What legislators want

The five measures approved by both houses on March 25:

  • A-4936/S-3375, sponsored by Assembly members Linda Carter (D-Union), Annette Chaparro (D-Hudson) and Valerie Vainieri Huttle (D-Bergen), and Sens. Teresa Ruiz (D-Essex) and Linda Greenstein (D-Middlesex), would require the DOH to establish a shared decision-making tool for hospitals — to help them respond to problems that come up in labor and delivery — and a pilot program to evaluate its impact.
  • A-4993/S-3406, sponsored by Assembly members Pamela Lampitt (D-Camden), Eliana Pintor Marin (D-Essex) and Gabriela Mosquera (D-Burlington), and Sens. Tom Kean Jr. (R-Union) and Joseph Vitale (D-Middlesex), would codify how Medicaid providers must complete a perinatal risk assessment.
  • A-4932/S-3365, sponsored by Assembly members Mosquera, Adam Taliaferro (D-Salem) and Dan Benson (D-Mercer), and Sens. Nellie Pou (D-Passaic) and Joseph Cryan (D-Union), would establish a perinatal “episodes of care” program within Medicaid, which would enable the state to create bundled payments designed to encourage positive outcomes, rather than paying for doctors’ time or for procedures.
  • AR-219, an Assembly resolution sponsored by members Shanique Speight (D-Newark), Carol Murphy (D-Burlington) and Britnee Timberlake (D-Essex), does not require the governor’s signature. It calls for the DOH to develop a set of respectful standards for birth protocols and conduct a public campaign about them. (A Senate version remains in committee.)
  • AR-226, an Assembly resolution sponsored by members Angela McKnight (D-Hudson), Vainieri Huttle and Joann Downey (D-Middlesex), urges officials at the federal Centers for Disease Control and Prevention to adopt a uniform data collection system around maternal mortality. (A Senate version is also under consideration in committee.)