National Collaborative for Infants & Toddlers

Maternal and Child Health

Use the key issues below as a guide to find related data, research or other resources in your work:

• Key Issue 1: States, hospitals and nonprofit organizations can improve access to prenatal and postnatal care in a variety of ways and through various payment or program models.
• Key Issue 2: The same people who bore the brunt of the COVID-19 pandemic and its effects are also the most harmed by our nation’s epidemic of pregnancy-related complications, including postpartum depression and mortality.
• Key Issue 3: Governments have a responsibility to make sure that all families can access pregnancy-related health care, including postpartum care and regular well-child visits.

Materials from the following partners were used in the development of the guiding message points in this chapter:

• Center for American Progress
• Centering Healthcare
• National Conference of State Legislatures

Key Issue 1: Improve access to prenatal and postnatal care

Key Issue 1: States, hospitals and nonprofit organizations can improve access to prenatal and postnatal care in a variety of ways and through various payment or program models.

Because a healthy baby starts with a healthy pregnancy, all families need access to culturally responsive pre- and postnatal care. This generally includes physical exams, laboratory screening tests, nutrition counseling and mental health services. Yet, 1 in 16 infants in the U.S. is born to a person receiving late or no prenatal care; about 7 million women live in counties with limited or no prenatal services. Over 50% of the 18 million women living in rural areas must drive more than 30 minutes to access the closest facility offering obstetric care. States, hospitals and nonprofit organizations play a critical role in improving access to prenatal care. For example, some states allow for “presumptive eligibility,” which automatically enrolls low-income pregnant women in Medicaid so they are eligible for prenatal services.

Medical practices in at least 46 states have adopted the CenteringPregnancy model, which brings women into group settings for care. So far it’s been implemented via hospital-based pilot programs. In addition to medical care, participating women receive guidance about nutrition, breastfeeding, labor and delivery. The program also builds community and peer support. When implemented, CenteringPregnancy can decrease the rate of preterm and low-weight births, reducing costly admissions to neonatal intensive care units. One study estimated more than a 4-to-1 return on investment for every dollar spent on CenteringPregnancy.

Breastfeeding is a critical tenet of postnatal care. Primary care-initiated interventions can help improve breastfeeding initiation or duration with healthy, full-term infants. In the United States, an estimated 79% of infants start off with exclusive breastfeeding; however, by six months the number drops to 19%. A parent’s ability to care for and form an attachment with their infants affects children’s long-term social, emotional, physical and cognitive development. Breastfeeding improves infant health and reduces health care costs by lowering the occurrences of infections, asthma, allergies, diabetes, childhood obesity and sudden unexpected infant death syndrome. The USDA’s WIC program promotes and supports breastfeeding as an important part of the nutrition service benefits to help safeguard the health of low-income women, infants and children. WIC’s cash-value voucher allows participants to purchase fruits and vegetables as part of their WIC food package. Under normal circumstances, the monthly cash-value voucher is $11 for pregnant, postpartum and breastfeeding women.  

Key Issue 2: Disparities in maternal morbidity and mortality

Key Issue 2: The same people who bore the brunt of the COVID-19 pandemic and its effects are also the most harmed by our nation’s epidemic of pregnancy-related complications, including postpartum depression and mortality.

The United States has the highest maternal and infant mortality rates among developed countries. For generations—and continuing today—maternal and infant death has been higher for people of color and Indigenous peoples. In large part, policies have historically denied prenatal care, early childhood supports, education, mortgages and health benefits.  Black families at the top income levels have worse infant and maternal health than White families at the lowest income levels, with Black women dying from preventable pregnancy-related complications at three to four times the rate of non-Hispanic White women. The death rate for Black infants is twice that of infants born to non-Hispanic White mothers.

It's important to note that disparities in maternal morbidity and mortality rates persist for people of color, regardless of their socioeconomic bracket and education level. Maternal mortality affects U.S. women from all backgrounds; if a person is able to become pregnant, they risk experiencing complications such as preterm labor, infections, gestational diabetes and even death due to pregnancy. Bias and racism alone can negatively determine the quality of care provided. Further, there’s emerging data that suggests that the ongoing stress caused by racism, in and of itself, poses a risk, and is an important factor in the increased risk of death in pregnancy for Black, Indigenous and Latinx people.

From postpartum Medicaid expansion to the Black Maternal Health Momnibus Act, advocates and legislators are working to fully address every aspect of the maternal health crisis in America and its uneven impacts on communities of color. This includes critical investments in social health factors that influence maternal health outcomes, like housing, transportation and nutrition, as well as funding for community-based organizations that are working to improve maternal health outcomes and promote equity.

Key Issue 3: Governments have a responsibility to make access to care more available and effective

Key Issue 3: Governments have a responsibility to make sure that all families can access pregnancy-related health care, including postpartum care and regular well-child visits.

Programs like WIC, Medicaid and SNAP have made real progress toward helping families build economic stability and meet basic needs. For example, caregivers and children who participate in SNAP have better birth outcomes, less childhood food insecurity, more health care use and improved long-term child health. Medicaid is the single largest payer for pregnancy-related care in the U.S. In 2021, it financed 41% of all U.S. births, including around 60% of births among Black, Hispanic, American Indian and Alaska Native, and Native Hawaiian and Pacific Islander mothers. 

For people with low incomes, Medicaid and CHIP’s coverage of pregnancy-related services without cost-sharing is a lifeline. Many parents experience disruptions in health coverage during the 12-month postpartum period. Families of color, Indigenous families, people living at or below the poverty line, and other marginalized groups often experience the deepest impact.

We have a responsibility to make policies and programs more effective and accessible. States can provide continuous Medicaid or CHIP coverage through 12 months postpartum. Ensuring continuous health coverage for the entire 12-month postpartum period could help bridge gender, racial and economic inequities in postpartum health outcomes. Extensive information coming out of research suggests this policy change could mean more coverage and improved health care access and affordability for thousands of new mothers across the country.

Parents and caregivers want the very best for their babies and toddlers. But not everyone has access to what they need because of policies and social practices (which affect families differently, often based on race or income). These policies and systems must be built for all families, from education and health care to economy and justice. We live up to our country’s promise when we commit to all of our youngest generation, so they have what they need to grow into socially, emotionally and physically healthy children—and then into adults who are actively part of our communities and economies. 

Data/Proof Points

• American Heart Association's Fast Facts on Mothers, Infants and Toddlers: Voices for Healthy Kids, an initiative of the American Heart Association, shares scientific data along with fast facts worded in consumer-friendly language on an array of topics. This fact sheet is broken down into four parts: (1) Importance of the Prenatal-to-3 Period for Lifelong Health and Wellbeing, (2) Healthy Parents Lead to Healthy Babies, Infants and Toddlers, (3) Investing in State and Local Policies and Services for Prenatal-to-3, and (4) Investments in Prenatal-to-3 Services Lead to Short- and Long-term Benefits for Maternal and Child Health.
  • How to use + resources to boost your message: Collaborative members can use the up-to-date, vetted and science-based information in the fast fact sheet as part of running effective campaigns.

• Center for American Progress’ Eliminating Racial Disparities in Maternal and Infant Mortality Report: In this report, the Center for American Progress highlights the devastating maternal mortality rates in the U.S., especially for women of color. Citing racism as one driver of disparities in maternal and infant mortality, the report also calls out large underinvestment in family support and health care programs. Solutions outlined in this report include improving access to critical services; improving the quality of care provided to pregnant people; addressing maternal and infant mental health; enhancing support for families before and after birth; and improving data collection and oversight.
  • How to use + resources to boost your message: Collaborative members should look for ways to amplify and advocate for solutions laid out by the Center for American Progress, such as those within the U.S. health care system that improve quality of care and diversify the health care workforce. This report can also be linked with the Playbook’s Mental Health section, as it addresses the challenges to receiving maternal and child mental health services.
    
    
• How CenteringPregnancy Can Support Birth Equity: CenteringPregnancy is a specific model of group prenatal care with well-developed training and curriculum, which can reduce preterm birth, the leading cause of infant mortality, particularly for Black women. This issue brief from the Centering Healthcare Institute advocates for CenteringPregnancy as a strategy to support birth equity and relationship-centered care that meets women’s needs. It also supports health system accountability when it comes to more equitable outcomes in pregnancy.
  
  
  • How to use + resources to boost your message: Within the brief, there is an example of a successful CenteringPregnancy program in Detroit, which focused on enrolling Black women because of the differences they experience in infant mortality rates. When Collaborative members are advocating for inclusive and diverse delivery systems, this resource can be used alongside data from the CDC that supports the need for more equitable pregnancy-related health care systems.

• March of Dimes 2022 Maternal and Infant Health Report Card: The 2022 Report Card offers a full overview of the health of moms and babies across the U.S. It grades all 50 states, Puerto Rico and 100 cities on preterm birth rates. The report also includes other information such as infant death, social vulnerability, low-risk cesarean births, and state efforts on Medicaid expansion and extension, doula and midwives policies, and legislation and other factors. The report card outlines important policy solutions that can make a difference. National, state and local Collaborative members can use this report's data as proof points for the need to provide solutions to improve maternal and infant health.
  • How to use + resources to boost your message: To view state- and city-specific data, you can click on the "State" and then click on "Learn More." You can also click on "Go to Peristats to view additional data" to view all of the disaggregated data that is available. March of Dimes provided a social toolkit to engage on social media channels, including #PrematurityAwarenessMonth in November and #WorldPrematurityDay every year on November 17.

• National Academy for State Health Policy CHIP Brief: NASHP outlines different state strategies to address an increase in uninsured children, including in New Jersey, Utah, Florida, Maine, Georgia, Iowa and West Virginia.
  • How to use + resources to boost your message: The Collaborative can use this summary of effective programs as a baseline for how to advocate for initiatives that increase enrollment in children’s coverage in Medicaid and CHIP. These examples may also provide insight into which legislatures are already investing in PN-3 issues.

• Prenatal-to-3 Policy Impact Center's brief on the impact of parental health on PN-3 mental health and well-being: This brief highlights the factors that may impact a young child's mental health due to a parent's circumstances or environment, such as household economic security, parental health and well-being, and nurturing child-parent interactions.
  • How to use + resources to boost your message: The Collaborative can use the solutions outlined in this brief to advocate for resources that are proven to improve the mental health and well-being of infants and toddlers and into their lives as adults. PN-3 Policy Impact Center's featured policies and strategies are cited and include early intervention services, expanded income eligibility for health insurance, group prenatal care, paid family leave and state minimum wage.

• ZERO TO THREE and NCIT's Maternal and Child Health Message Brief: This brief is a source for research-tested messaging and broad policy guidance to help members craft messages and materials to speak with policymakers and other stakeholders.
  • How to use + resources to boost your message: The language can serve as a way to (1) introduce maternal and child health within the frame of prenatal-to-three policies, (2) show why pregnant people, postpartum parents, and infants and toddlers need access to improved health policies, (3) share recommendations to make maternal and child health policies in your communities better, and (4) drive policy change by using message-tested calls to action.

• American Academy of Pediatrics' Early Childhood Campaign Toolkit: Early childhood is our greatest opportunity to improve lifelong health and well-being. Relational health, brain development, and physical and social emotional development are critical to improving future well-being. In this toolkit, the American Academy of Pediatrics provides communications materials, including social shareables, posters and graphics, to help you talk with partners and legislators.
  • How to use + resources to boost your message: When policymakers are thinking about the importance of various child care policies, the Collaborative can use the resources included in this toolkit to show the positive impacts child care investment has on the lifelong health and well-being of a child and their parents.

• Centers for Disease Control’s Maternal Mortality Rates in the United States, 2021: Released in March 2023, this report presents maternal mortality rates for 2021 based on data from the National Vital Statistics System. Maternal mortality rates—the number of maternal deaths per 100,000 live births—are shown in this report by age group, race and Hispanic origin. A key statistic to incorporate is that in 2021, the maternal mortality rate for non-Hispanic Black women was 69.9 deaths per 100,000 live births, 2.6 times the rate for non-Hispanic White women. Rates for Black women were significantly higher than rates for White and Hispanic women. There is an overall increase in deaths: 1,205 women died of maternal causes in the United States compared with 861 in 2020 and 754 in 2019.
  • How to use + resources to boost your message: This report will help the Collaborative when drafting messaging and talking points surrounding the maternal health crisis, especially within an equity lens.

• Medicaid After Pregnancy: State-Level Implications of Extending Postpartum Coverage: The postpartum period is increasingly recognized as a target for policy intervention to improve maternal health. The American Rescue Plan Act included an option for states to offer 12 months of postpartum Medicaid eligibility, a significant extension from the current requirement of 60 days. This brief gives an overview of the important role Medicaid plays in postpartum maternal health, reviews existing pregnancy-related Medicaid eligibility limits in state Medicaid programs and assesses the projected eligibility impact if all states were to extend postpartum Medicaid eligibility to 12 months.
  • How to use + resources to boost your message: Policymakers and legislators at the state and federal level are looking for tangible solutions to address the maternal health crisis. In this brief, Medicaid is analyzed through a series of proof points and case studies on how an expansion can help with postpartum coverage. This resource can be used to measure how an expansion of Medicaid will help in individual states.

• Re-Envisioning Early Childhood Policy and Practice in a World of Striking Inequality and Uncertainty: The current early childhood ecosystem is fueled by deep knowledge about child development, with a lot of data from program evaluations and continuing public fascination with the developing brain. In this brief, researchers look at the current framework for policies and programs guided by three core concepts of early childhood development: (1) the impact of early experiences on brain architecture, (2) the importance of responsive “serve and return” interactions for healthy development, and (3) the disruptive effects of toxic stress on the developing brain and early learning.
  • How to use + resources to boost your message: The science laid out in this brief helps make the case for investing in early childhood development writ large. It links early development to lifelong educational achievement, economic productivity, and physical and mental health. Legislators and policymakers often relate to messaging that shows long-term systemic improvements.

Identified Launch Points/Escalation Moments

• Black Maternal Health Week: Taking place every year in April, Black Maternal Health Week is a time to raise awareness about the disparities affecting Black mothers, including maternal mortality rates, mental health and economic inequalities.
  • How to use + resources to boost your message: The Collaborative can share the Center for American Progress' report detailing barriers faced by birthing parents of color. This includes how health policy and more funding can make a big difference. This week is also a moment to uplift the stories of Black mothers and advocate for their health and well-being as a national priority.

Social Media Toolkit to Promote Discussion of Maternal Health

NCIT has developed a social media toolkit that connects the dots between maternal and child health and lifts up the challenges facing birthing people (and Black birthing people in particular). This content can be shared as part of Black Maternal Health Week, but is relevant enough to be used at any point when you're discussing maternal health. Please share the content from the toolkit with your networks on social media and via email.

Black Maternal Health Toolkit in English 

• Black Mommas Matter Alliance’s Black Maternal Health Week 2023 Social Media Toolkit

Recursos Sobre la Salud Materna en Español