New Jersey will tap philanthropic funding and national expertise to create a strategic state plan designed to achieve a bold public health goal by 2025: cutting in half its high maternal mortality rate and eliminating racial disparities in birth outcomes that are among the worst in the United States.
First Lady Tammy Murphy announced the five-year plan, which will be supported by the New Jersey-based Nicholson Foundation and the Community Health Acceleration Partnership, which works on community health issues worldwide, during a Maternal Health Awareness Day event Thursday at the Henry J. Austin Health Center in Trenton; the two groups have committed more than $282,000 together to the effort, through June 2020. She also introduced the leader of the planning team: Dr. Vijaya Hogan, a perinatal epidemiologist and professor at the University of North Carolina, and a national expert on the issue.
The first lady has spearheaded a coordinated effort to provide short-term solutions or “triage” maternal health problems, as she described it — including her Nurture NJ program, which has sought to connect low-income women with diverse health services — but she said a long-term strategic solution is needed. The planning will build on existing findings and programs and benefit from other state efforts to address social challenges like poor housing and inadequate transportation, including an additional $23 million investment to help low-income women access quality child care, she added.
New Jersey’s long-term strategy will depend on input from clinicians, academics, mothers themselves and other nongovernmental experts, a process Murphy said would begin in the coming months. It will also be informed by the experience of states like California, which reduced its own maternal mortality rate by 55% between 2006 and 2013. But racial inequities have remained “insidious” in the Golden State, the first lady noted.
“No state has yet to eliminate (racial) disparities when it comes to maternal health,” Murphy said, surrounded by elected leaders, Cabinet members and others who joined forces on the issue. “When we achieve this here, we will be the national leader,” she said, prompting applause, “and that kind of change requires a multipronged, measurable, holistic and innovative strategy for success.”
“With this as our target together, we will make New Jersey the safest place in the United States to deliver a baby,” the first lady added.
High maternal deaths for black women
New Jersey — which ranked 47th nationwide for maternal health outcomes — had a maternal mortality rate (or the ratio of women who die during pregnancy, childbirth or within a year of delivery, to overall births) of 37 out of 100,000, well over the national average of nearly 16 in 100,000, according to 2013 state data, the most recent available. But while the mortality rate for white women was 12.8 in the Garden State that year, it was 46.5 for black women.
“This is not an easy task to tackle, but this is the kind of leadership that’s needed to address the issues at hand,” Dr. Hogan said, stressing that expertise alone isn’t enough. “I think Mrs. Murphy has generated the political will that will really advance the work in New Jersey,” she said.
Hogan said her team of eight racially and professionally diverse members has some 125 years of collective experience in perinatal care and policy. “There’s a lot of firepower we are bringing to bear on this issue,” she said. (Department of Human Services Commissioner Carole Johnson called Hogan herself a “rock star in the field” of maternal care.)
Others agreed a plan was a good next step for New Jersey. “Many laws have been passed. But now the hard work is at hand. How do we tie all the good ideas together, pay for them in a sustainable way, and measure results?” wondered Linda Schwimmer, president and CEO of the New Jersey Health Care Quality Institute, which has long worked on maternal health issues and sponsored an NJ Spotlight roundtable on the topic in 2018.
“I think that a strategic plan will help with all of this — and hopefully it will include all of these actions and changes and align them,” Schwimmer added, noting that the Quality Institute was working on several of the components Murphy described. “We look forward to continuing to support this work to improve quality, safety and equitable care for everyone.”
Hogan’s team has already been working with leaders at the 18 state agencies already involved with Nurture NJ, Murphy said, and will collaborate with the state’s Maternal Care Quality Collaborative, an entity created through a law Gov. Phil Murphy signed last spring. The collaborative received $2.25 million through the state Department of Health, part of more than $12 million in federal funds the Garden State has dedicated to improve data collection, clinical training and other efforts related to maternal care.
Health provider training, reducing C-sections
DOH has also invested in training community-based and culturally sensitive health providers, including 31 local health workers and 79 doulas, or nonclinical pregnancy and birth coaches, to help women improve birth outcomes. The agency created a new interactive public data center and issued its first Maternal Health Report Card last year. (New Jersey hospitals are also working with colleagues in Pennsylvania and Ohio to improve maternity outcomes.)
“These are small steps in a very long journey,” said DOH Commissioner Judy Persichilli.
The human services department will also continue to play a critical role in long-term maternal health improvements, Murphy noted. DHS oversees Medicaid — which pays for roughly 40% of New Jersey births — and has tweaked the insurance plan to ensure coverage for doula care, breastfeeding support services and “centering pregnancy” programs, which use peer groups to improve outcomes.
The governor — who has signed some two dozen maternal and infant health bills passed over the past two years — also approved changes to prohibit Medicaid from paying for so-called early-elective deliveries, or cesarean section procedures done before 39 weeks, unless there is a specific medical reason. At least a third of the births in New Jersey fall into this category, and this approach has worked elsewhere to reduce unnecessary C-sections, which can cause long-term damage to both mom and baby; experts aim for less than 23%.
“It is so telling how we have so much political leadership, so much will to do the right thing,” DHS Commissioner Johnson said. “The problem is real, but our commitment is strong, and lots of our colleagues across the country are struggling to get that commitment behind their work.”