State Legislation in 2018 to Improve Maternal and Child Health Outcomes

April 26, 2018|10:23 a.m.| ASTHO Staff

Birth outcomes in the United States for both mothers and infants lag behind the rest of the industrial world, with significant disparities in outcomes across ethnic, racial, and socio-economic groups. Public health policies may offer key tools to improve the health and health outcomes for mothers and infants. Recently, lawmakers in Florida, Indiana, and Georgia advanced legislation to improve health outcomes for women, infants, and families, including supporting maternal mental health resources and services and strengthening perinatal regionalization efforts. 

Improving Maternal Mental Health

CDC estimates that one in nine women experiences symptoms of maternal depression. Evidence shows individuals in lower socio-economic groups experience these symptoms at even higher rates. Furthermore, women are less likely to receive treatment. About 40 percent of women with postpartum depressive syndrome are clinically diagnosed, and of that, only 50 percent receive treatment. In addition, racial, ethnic, and socio-economic disparities persist in the diagnosis and treatment of maternal depression symptoms. This is a concern, as both antenatal and postpartum depression have been linked to long-term negative health outcomes for women and infants.

Appropriate screening for depression is one approach to identify and address maternal depression. The U.S. Preventative Services Task Force recommends screening women for depression during and after pregnancy, concluding that such screenings “may reduce depressive symptoms in women with depression and reduce the prevalence of depression in a given population.” In addition, the American Academy of Pediatrics encourages pediatricians to integrate maternal depression screenings into well baby visits, and states may be able to finance some of these activities with Medicaid funds. On March 23, Florida Gov. Rick Scott signed a law to improve screening and support services for perinatal mental health in the state. The new Florida Families First Act requires the Florida Department of Health to establish and operate a toll-free perinatal mental health hotline to provide “basic information on postpartum depression by January 1, 2019.” The law also requires birth centers to incorporate mental health screening as part of postpartum and follow-up care.

Strengthening Perinatal Healthcare Systems

Perinatal regionalization is a strategy to improve maternal and perinatal outcomes by establishing systems that designate where infants are born or transferred according to the level of care they need at birth. Low-birthweight and premature infants are more likely to survive when they are born at risk-appropriate facilities that have the staffing and technology to provide evidence-based care. On March 8, Indiana Gov. Eric Holcomb signed a law to establish a perinatal certification program. The law requires the Indiana State Department of Health (ISDH) to “establish a program to certify perinatal levels of care designations for every hospital and birthing center.” While the law is clear that the certification process is not part of licensure, ISDH is granted the authority to change the level of care designation if the department “determines that the hospital or birthing center failed to meet the standards necessary for the designated perinatal level of care.” The department may also investigate complaints against facilities concerning the certification program. This law builds on the work of the Indiana Perinatal Quality Improvement Collaborative to improve health outcomes for women and infants.

In Georgia, the House and Senate passed legislation to establish a voluntary perinatal regionalization system. Under the bill, the Georgia Department of Public Health is required to establish an application process and criteria for levels for both maternal and neonatal care. Maternal level of care designations are an emerging area of focus that incorporate levels of care for maternal health distinct from, but complementary to, neonatal ones. Under the system, hospitals, clinics, and birthing centers in Georgia can “request approval as a designated facility which has achieved a particular maternal or neonatal level of care.” Health facilities must demonstrate they meet the applicable criteria for the level of care they are seeking, and the department of health has authority to suspend or revoke designations if facilities fail to meet criteria. As in Indiana, this legislation builds on collaborative partnerships already underway.

Ensuring that women and infants have access to diagnosis and care is critical to improving the lives and wellbeing of individuals, communities, and families. As described above, state and territorial health agencies often play an important role in providing services and resources aimed at improving maternal and child health outcomes. ASTHO will continue to highlight and inform its members about new and continuing ways state public health works to improve maternal and child health.