How State Leaders Can Improve Maternal Health Outcomes 

By: Valerie Newberg 

Despite advances in technology and policy substantially decreasing the risk of deaths associated with pregnancy in the 20th century, the U.S. is one of only a few countries with significant increases in maternal mortality in the 21st century.   

The Centers for Disease Control and Prevention defines an instance of maternal mortality as a person dying during pregnancy or within 42 days of pregnancy from a cause that was not accidental or incidental. Maternal mortality is used by the World Health Organization to quantify the concept of maternal health and reflects the economic, social and public health conditions of mothers in a population. Maternal mortality also provides insight on disparities in care. The United States lags other developed nations, ranking 46th globally. Current data on maternal health, while imperfect, paints a troubling picture of inequity across American racial and ethnic groups, regions and states. The Department of Health and Human Services reports that Black and Indigenous Americans are 2-3 times more likely than white Americans to experience pregnancy-related mortality and rural mothers are increasingly likely to suffer from pregnancy-related morbidity and mortality due to decreases in rural hospital access. Maternal mortality rates are highly variable among the states. California has a rate of 10.2 maternal deaths per 100,000 live births, just half of the U.S. average. Alabama currently has a rate of 36.2. 

Despite these challenges, there is reason for hope: many instances of maternal mortality and morbidity are preventable when medical professionals have the resources to provide care before, during and after a pregnancy. Additionally, the Biden administration released its “White House Blueprint for Addressing the Maternal Health Crisis,” which includes a request for a $470 million budget to develop much-needed tools that will help states and local communities mitigate this issue. The blueprint aims at “cutting the rates of maternal mortality and morbidity, reducing the disparities in maternal health outcomes, and improving the overall experience of pregnancy, birth, and postpartum for people across the country.” The plan also makes clear that reforming the American maternal health system cannot be the burden of one person, agency or institution alone. Efforts must reflect collaboration between the federal and state governments to be truly effective and equitable. 

As outlined in the blueprint, the federal government is taking several steps to help states improve pregnancy outcomes. 

Increasing data collection efforts 

  • The Centers for Disease Control and Prevention Levels of Care Assessment Tool creates “standardized assessments” of maternal care levels for policymakers in participating states.  
  • A review of Women, Infants, and Children participation and maternal health outcomes will provide state policymakers with robust information on the risk factors for maternal mortality and extreme morbidity. 

Using equity as a guiding principle. 

  • Expansion of the Nurse Corps and Community Health Worker Training Program will bridge gaps in care for medically underserved communities, including rural areas, by providing additional resources for Health Professional Shortage Areas. 
  • Revision of guidelines will ensure rural and Indian Health Service medical facilities are prepared to care for pregnant people and mothers, even if those facilities do not have obstetric units. 
  • Utilization of self-monitored blood pressure regulation programs will assist those at risk for hypertensive disorders, which disproportionately impact pregnant people over 35 and Black and Indigenous mothers. 

Encouraging state innovation.  

  • A Maternal Health Taskforce will focus on state-level data collection on maternal mortality and morbidity. 

Potential options for state responses include expanding current programs to promote equity and implementing an all-government approach that incorporates several agencies and programs. 

  • In Arkansas, the governor proposed initiatives expanding Medicaid-eligible pregnancy benefits to include home visits for those at high-risk for pregnancy complications and coverage for mothers who earn up to 212% of the federal poverty level. 
  • In Delaware, lawmakers passed a bill requiring doula services be covered under Medicaid. At-risk populations not receiving doula care are twice as likely to suffer from pregnancy complications as those with doula care. Those receiving doula care covered by Medicaid report lower levels of C-sections and premature birth. 
  • In Nevada, lawmakers passed a bill revising the responsibilities of the Maternal Mortality Review Committee to include collaboration with the Advisory Committee of the Office of Minority Health and Equity of the Department of Health and Human Services, a practice that allows the committee to better analyze racial, age and geographic disparities in maternal care. 

As the Sept. 30 deadline for Congress to pass appropriations bills approaches, the Blueprint for Addressing the Maternal Health Crisis remains a valuable opportunity for Congress to prioritize state-federal partnerships. In the meantime, states have several options in place to address disparities in maternal health outcomes, including expanded Medicaid coverage, updated data collection and more comprehensive monitoring guidelines.  

Additional Resources: 

Asked & Answered with Megan Quattlebaum, director of the CSG Justice Center

By Katy Albis and Amelia Vorpahl

Serving as the second director since the inception of the CSG Justice Center 20 years ago, Megan Quattlebaum brings experience and passion to her role in advancing sound criminal justice policy and practice across the country. Hear from Megan about her experience as director of the CSG Justice Center, what she recounts as some of her most significant accomplishments and what excites her about the future of the Justice Center.

What was it like starting in your position at the CSG Justice Center, and how have you seen the organization evolve over time — both internally and in its external work?

One thing that was exciting to me was being part of a membership organization with active participation from all 50 states. For many types of policy, but especially criminal justice, the states are central to what can and will happen. I also appreciated that CSG is a three-branch organization because each branch has a vital role to play in the conversation about criminal justice policy and practice. Even if you’re talking about legislation, you need the folks who are going to implement that legislation brought in and excited, so you know it can make it over the inevitable bumps in the road that come when you’re putting an idea into practice. I was also really excited about the CSG Justice Center being a bipartisan organization. Working in a consensus-based way is key to stability and sustainability.

Particularly over the past few years, we’ve taken steps to make sure we’re centering racial equity in all we do. Racial disparities in the criminal justice system exist in every jurisdiction whose data we’ve ever analyzed and at multiple decision points. It’s really exciting to see our members not accepting that but wanting to change it. We’re working hard to be ready to support them with data analysis and policy ideas responsive to this challenge. We’ve also looked inward to make sure that we’re working in a way that’s inclusive and inviting to colleagues of color and that we have a workplace that’s diverse, equitable and inclusive. We can’t help other folks and not work on those issues within our own organization.

In the end, we always try to be responsive to what states need in the current moment. Our commitment to consensus and finding out how we can serve and support our members in the states — those are things that have not changed and will not change.

You came on as director succeeding someone who founded the organization as it exists today and had been in the position for more than 15 years. How did you make that role your own?

Founding directors are tough acts to follow, and Mike Thompson even more so than most. I think everyone who knows Mike thinks he’s brilliant. With that in mind, I figured I had two choices: self-consciously compare myself to Mike and worry about whether I was measuring up or try to release the idea that measuring up to Mike was the job. I’m proud of myself for choosing the second path — at least 95% of the time — I’m human! I try to remember that his job was to build the organization we have today, while my job is to enrich and sustain it.

Every day, I try to picture two specific people in my mind: first, a person I know who has been involved with the criminal or juvenile justice systems — including those who have been victimized by a crime or committed one or worked in the system — and second, a person who works for us.

For the former, I try to make sure that we are giving everything we have to supporting the systems they’re in to be the best they can be. Lives depend on it. For the latter, I try to make sure we all remember that the most impactful career in service is not the one that burns hot for a few years and then burns out. We need to support people to do this work for a lifetime. And that means supporting them to support themselves — to take breaks, to spend time with family and friends, to enjoy this life.

What are some of the things you are most proud of from your time at the CSG Justice Center?

One thing I’m proud of is how we’ve modernized our approach to communications through things like our newsletters and virtual Justice Briefing Live events. We’ve made ourselves accessible to new audiences.

I’ve also been excited to add new skills that allow us to take our data analysis and research to the next level. For example, I see in our field an increasing recognition of the ways in which probation and parole outcomes drive prison admissions and populations. I think our research division and their work on revocations played a key part in that.

In terms of initiatives, I’m very excited about our new Reentry 2030 campaign. We’ve increasingly seen how important it is that states focus on building reentry systems and supports that are equitable. Having folks who have experienced reentry firsthand in this conversation from the beginning has been very important to help us remember that each person has unique needs and challenges.

Through the Justice Reinvestment Initiative and other programs, we can provide jurisdictions with data analysis in a really deep way. Justice Counts and other initiatives we’ve started recently, like Lantern, recognize that states need that up-to-date data about their systems not just over the course of a project with us, but every day.

How does the CSG Justice Center fit into the criminal justice policy landscape? What is its unique role?

One thing that is not as known about us is how much we partner with other organizations. We bring partner organizations into our projects to make sure they’re as rich and effective as they should be.

Another thing that makes us unique is tied into our 20th anniversary. If you look at our first publication — the “Criminal Justice/Mental Health Consensus Project” report — at the time it was issued, it was cutting-edge. While the conversation about the connections between the criminal justice system and folks with mental health needs is happening on a broader scale now, we were very early to that conversation.

From its earliest days, the CSG Justice Center was keyed into the message that you cannot and should not rely on the criminal justice system to solve all social problems. You need cross-systems partners at the table. We’ve invested in having a staff with interdisciplinary knowledge and skills from the beginning.

Tell us about your vision for the next chapter of the CSG Justice Center. What do you hope the next 20 years will bring?

Twenty years ago, people weren’t using the word ‘reentry.’ We have had a role in making ‘reentry’ a household word. I see our next 20 years as another two decades of making new things possible.

In 20 years, if we’ve done our jobs right, states will have accurate and up-to-date data to help drive their criminal justice decision-making in a way they don’t today. People experiencing a mental or behavioral health crisis will have multiple, easy-to-find pathways into treatment and supports that will help them stay safe and out of the justice system. And we’ll have found better ways to support the 95% of kids whose involvement with the juvenile justice system starts with a nonviolent offense.

I’m hopeful the culture of community supervision agencies will continue to evolve to focus on how best to support success, and that states will set specific goals around ensuring that when people leave prison, they are safely housed, connected to work and education and getting whatever treatment they need. I’m also optimistic that state programs that support people who have been victims of crime will be better positioned to reach the people who need those supports the most.

Any closing thoughts?

On a personal note, having the privilege of working with a group that is diverse in so many ways — race, gender, politics, geography, professional training — I now believe more than ever that leaders have to surround themselves with people who are different from them. If you’re not talking honestly with people who are different from you about the challenges your organization faces and potential solutions, you are making bad decisions.

Also, after more than four years in this role, I find that my respect and admiration for the CSG Justice Center’s staff, advisory board and partners somehow continue to grow. Even when I think I couldn’t possibly be more impressed, our team makes something seemingly impossible possible, and I’m in awe all over again. I am very lucky to be where I am.

Editor’s note: responses have been edited for length and clarity.

This article appeared in the CSG Capitol Ideas magazine (2022, Issue 4). View current and past issues at csg.org/publications/capitol-ideas.

Finding a Path to Consensus: The CSG Justice Center Celebrates 20 Years

By Amelia Vorpahl

The U.S. criminal justice system can evoke complicated emotions.

If you asked people what the ultimate goals of the system should be, most answers would likely include things like reducing crime and recidivism, using public resources effectively, keeping people safe and allowing for a humane system that upholds accountability. However, how we achieve these goals is where much of the difficulty arises. Political realities, competing priorities and incomplete or contradictory data can make it incredibly hard for policymakers to fully grasp what’s needed. For decades, state leaders on both sides of the aisle have called for a way to talk about what’s working and what’s not without politics getting in the way.

“In the mid-1990s, it became very clear that if you had a meeting of legislators from different states, or of prosecutors, public defenders, or victims — that people agreed on a vast majority of the things that needed to be done to make the criminal justice system work better. And that was the genesis of what has grown into the [CSG] Justice Center,” said Mike Lawlor, a founding member of the CSG Justice Center advisory board.

EARLY DAYS OF THE CSG JUSTICE CENTER

The origin of the CSG Justice Center focused on the fundamental idea that leaders needed a space to help find consensus on how states could tackle complex issues of safety, health and justice. Two decades later, the organization has grown into a group of 120 researchers, practitioners, policy experts and writers with an advisory board representing a cross-section of key leaders shaping criminal justice policy across the country.“To have what’s effectively a 120-person criminal justice think tank attached to a membership organization like CSG and part of that family is very unique,” said CSG Justice Center Director Megan Quattlebaum. “We have staff going out in the field all over the country, which gives them a clear vantage point of what the needs of our members are. That is something special and important.”

To understand how the CSG Justice Center evolved from its beginnings to its current stature, you can start with one person: Mike Thompson. When 25-year-old Thompson was hired as a criminal justice policy analyst at CSG East in 1997, he was the sole staff member of the only CSG criminal justice program. While working to get the new CSG East program off the ground, Thompson targeted a handful of key justice issues that could earn consensus, including juvenile justice, support for victims of crime, improved responses to mental health needs and racial disparities in the justice system.

Although these topics sound fairly mainstream today, the late 1990s and early 2000s were challenging times for organizations in the criminal justice space. CSG East had to navigate a political atmosphere that lacked the bipartisanship and consensus on basic criminal justice policies seen today, especially regarding what drives crime and recidivism. Back then, Thompson said there were prevailing thoughts that people could fake a mental illness to get out of responsibility for committing a crime, or that people could be ordered into treatment without consent.

“I don’t care if you were a Democrat or a Republican, you didn’t want to be seen as soft on crime,” said Thompson. “But I came from corrections, and those guys weren’t ideological. They just said, ‘This is what needs to happen to run a safe prison and to reduce recidivism.’ So, I saw the mission as framing issues in a way that gets Republicans and Democrats around a table with experts to agree that these were problems we all want to solve.

”For one of its first major projects in 2002, CSG East brought together experts from behavioral health, criminal justice, law enforcement and other key fields to publish the Criminal Justice/Mental Health Consensus Project, a first-of-its-kind report with policy recommendations to help stakeholders address the needs of people with mental illness who are involved with the justice system. This report launched the type of work that the CSG Justice Center is now known for: gathering expertise from key leaders across impacted systems to promote data-driven and evidence-based policy ideas. Four years after this seminal report, the CSG Governing Board voted to establish the national CSG Justice Center, diverging the work of CSG East’s criminal justice program into a separate organization, still under Thompson’s leadership.

“A TRAIN GOING 400 MILES AN HOUR”

The staff and board members from early years describe the formation of the CSG Justice Center as having energy like that of a startup company, with the freedom, flexibility and hustle of having to build a program from the ground up. Everyone did everything, from hiring to budgets, to writing and even leading high-level meetings with federal and state leaders. There was no infrastructure and no rulebook to work from. Thompson laughed as he compared the CSG Justice Center to a “lemonade stand” in those early years. As with most startups, everyone has stories of mishaps and adventures they still love to retell.

Michael Festa, AARP Massachusetts state director and the first chair of the CSG Justice Center Advisory Board, fondly recalled an early board meeting in his Massachusetts garden enjoying a New England clambake when a torrential downpour started. The board members then spent hours on a bus, soaking wet. During the final meeting for the Consensus Project report, Thompson remembered running out of a ballroom with hundreds of top justice and health leaders to crowd around a phone because he was chosen as a friend’s “lifeline” on the television show “Who Wants to be a Millionaire?” which was taping the same day.

Renée Brackett, executive assistant to senior management and he Justice Center’s longest-serving employee, called the early days “a train going 400 miles an hour.” She spoke about being a “one-man shop” while planning a conference for 1,000 people during her first year on the job. “I can still remember the dates because I didn’t sleep the entire Christmas break,” she said.

While the founding CSG Justice Center team navigated the challenges of building a new organization, they also pioneered entirely new ways of approaching criminal justice policy. Marshall Clement, CSG Justice Center deputy director and one of the early staff members, remembers piloting the groundbreaking Justice Reinvestment Initiative. His small team traveled across the country multiple times a month to gather data, listen to stakeholders and convene working groups using the data to develop policy options that would reduce corrections costs and allow states to reinvest savings in making communities safer. In more than 30 participating states, their efforts through the years have led to a reduction — by thousands — of the number of people behind bars, as well as lower recidivism rates, prison closures and millions of dollars reinvested in community-based treatment and alternatives to incarceration.

Both Thompson and Clement are quick to commend the hard work of the early staff members and to uplift the critical role that the first advisory board members played in getting the organization started. The board’s early leadership and guidance set the stage for the incredible success of the CSG Justice Center over the next 20 years.Michael Festa says he feels blessed to have been one of the first board members and credits its focus on “bipartisanship, evidence-based policies, finding a path to consensus, and perhaps just as important, doing all of it with mutual respect and genuine affection.”

EXTERNAL AND INTERNAL EVOLUTION

By all accounts, the tireless work ethic, grit and drive of the founding CSG Justice Center staff and board members has paid off. The criminal justice policy landscape of 2022 is very different than that of 2002, and Quattlebaum attributes this to the Justice Center’s work over the last two decades along with its partners and members. For example, she argues that there is an increasing recognition of how outcomes on community supervision drive prison admissions and populations, crediting the Justice Center’s research division and its Confined and Costly 50-state revocations report for helping make that case. She’s also seen states focus more on how they can better respond to people with mental illness and behavioral health conditions by reducing justice system contact and expanding access to treatment, including through innovative ideas like co-responder teams and community responder programs.

“Twenty years ago, co-response programs in law enforcement departments were not something you’d find in jurisdictions across the country. Twenty years ago, the national recognition of a bipartisan consensus around criminal justice policies just wasn’t there,” said Quattlebaum. “We know the criminal justice system needs collaboration with the housing system, with workforce development, with mental and behavioral health systems and with education. From our earliest days, we had staff whose expertise came from the health side and not the criminal justice side.”

Clement agrees and said he’s proud of the major evolutions that he has seen take place at the CSG Justice Center over his 17-year tenure, including the growth of the organization and staff itself, the impact of its work in transforming the criminal justice and behavioral health fields and the rise in public awareness of necessary reform to our systems of safety and justice.

A DATA-DRIVEN APPROACH

Although the CSG Justice Center’s work touches on every facet of the justice system, a throughline is the focus on data and research. From the beginning, the Justice Center pioneered a bipartisan, data-driven approach to criminal justice reform in red and blue states alike that was unprecedented in the justice policy landscape. The key to this success, spanning the past 20 years, has been the Justice Center’s ability to uplift its members to speak firsthand about the needs in their communities.

“In order to build possibilities, you have to have a lot of perspectives at the table so that you’re really understanding the problem in its fullest dimension,” said Quattlebaum. “You have to have the courts and the executive and legislative branches at the table if you really want to see justice systems become more efficient and fairer. All those folks need to be in the conversation.”

While the CSG Justice Center has helped reform criminal justice policy in the United States, the organization is increasingly seeing the need to look further upstream to prevent justice system involvement altogether. This includes helping communities build more robust crisis response systems that prevent arrests and jail stays for people with behavioral health needs as well as a focus on front-end diversion in juvenile justice systems. Reentry and diversion systems also face challenges in growing to scale, and the Justice Center has prioritized ensuring that there is a baseline level of services across the country while helping states tailor supports to individual needs.

“The work of the CSG Justice Center over the last 20 years has been the work of a lot of people. You’d have to fill up the entire magazine with names if you really want to do it justice,” said Quattlebaum. “So many people’s ideas and effort have gone into making us what we are today. I can’t say enough how grateful we are to everybody who has been a part of this incredible project.”

LOOKING AHEAD

So, where does the CSG Justice Center go from here? Quattlebaum says that the organization’s commitment to consensus-based work won’t change, but one example of its new direction is found in its prioritization of racial equity. Internally, staff are having candid conversations about policies and practices that will ensure that the Justice Center is a transparent, fair and welcoming workplace. In its external work, there is increased focus on helping states directly tackle racially disproportionate outcomes in their justice systems. This focus has come directly from member requests.

“I think a lot about how policy and practice changes can be sustained over time. We assist policymakers to build a wide and deep base of support so that the reforms states enact are deeply embedded and sustainable moving forward. It’s important to think about how it lasts.” Quattlebaum said. “At some basic level, you have to be playing the long game.”

Looking ahead, the CSG Justice Center is focused on three big areas in which it sees broad bipartisan support, including breaking cycles of incarceration; advancing health, opportunity and equity; and using data to improve safety and justice. State and local leaders are focused on the shortcomings of safety and justice systems and are interested in ways to transform these systems to increase public safety at less cost. By ensuring its work is grounded in the present-day challenges of leaders on the ground, the Justice Center is moving the field forward with ground-breaking research and building capacity to develop innovative and practical tools while scaling up how it helps state and local leaders across all 50 states.

This article appeared in the CSG Capitol Ideas magazine (2022, Issue 4). View current and past issues at csg.org/publications/capitol-ideas.

20 in 20: 20 Significant Moments in the 20-Year History of the CSG Justice Center

Over the past 20 years, the CSG Justice Center has grown from a staff of two in one city to more than 120 employees across 23 states and Washington, D.C. In that time, the Justice Center has partnered with national and state leaders throughout the country to impact the field — whether through legislation, direct assistance, convenings or groundbreaking reports. This timeline lays out some of the most significant moments in the organization’s history.

  • 2002 – The Consensus Project report is published.
  • There are two employees based in New York City (still within the Eastern Regional Conference) — Michael Thompson and Renée Brackett.
  • 2004 – Congress authorizes the Justice and Mental Health Collaboration Program — a federal program that the CSG Justice Center has supported since its inception.
  • 2006 – CSG makes the Justice Center a national program and appoints an advisory board to help guide the center’s work.
  • 2007 – With the CSG Justice Center’s assistance, Texas and Kansas pass Justice Reinvestment legislation to avert growth in their prison population; these two pieces of legislation help spur the creation of the Justice Reinvestment Initiative, which becomes one of the CSG Justice Center’s signature initiatives.
  • 2008 – The Second Chance Act, a first-of-its-kind piece of federal legislation, is signed into law with bipartisan support to improve reentry outcomes; the CSG Justice Center was among several national organizations to back this legislation.
  • 2010 – The CSG Justice Center hosts its first national summit on Justice Reinvestment and Public Safety at the U.S. Capitol.
  • 2011 – The CSG Justice Center hosts its first 50-state convening on reentry and recidivism.
  • 2012 – There are 73 employees across 11 states.
  • 2014 – By this year, 20 states have used a Justice Reinvestment approach with the CSG Justice Center’s assistance.
  • 2015 – Collaborating with two national partners, the CSG Justice Center launches the Stepping Up initiative, its first campaign, to reduce the number of people with mental illnesses in jails across the country.
  • By this year, the organization has provided technical assistance to 1,000 grantees through the federal Justice and Mental Health Collaboration Program and Second Chance Act programs.
  • 2016 – The CSG Justice Center launches the initiative now known as Improving Outcomes for Youth (IOYouth).
  • 2017 – The CSG Justice Center convenes a 50-State Summit on Public Safety in Washington, D.C., leading to its first web-based data analysis covering all 50 states.
  • The CSG Justice Center launches the Face to Face initiative, its first project designed to directly connect policymakers to the people impacted by the criminal justice system.
  • 2018 – CSG Executive Director David Adkins names Megan Quattlebaum the second director in the organization’s history.
  • 2021 – In response to the COVID-19 pandemic, the CSG Justice Center hosts a virtual conference exploring innovative first response options, with the U.S. attorney general as a featured speaker.
  • 2022 – The CSG Justice Center and the Bureau of Justice Assistance launch Justice Counts, a first-of-its-kind national coalition to provide policymakers with accurate, accessible and actionable data.
  • The CSG Justice Center and several national partners launch Reentry 2030, a 50-state campaign to transform successful reentry across the country.
  • There are 120 employees across 23 states and Washington, D.C.

This article appeared in the CSG Capitol Ideas magazine (2022, Issue 4). View current and past issues at csg.org/publications/capitol-ideas.

Called to Serve

Tennessee Commissioner of Mental Health and Substance Abuse Services Marie Williams chairs the CSG Justice Center Advisory Board.

Continue reading

How State Leaders Can Improve Maternal Health Outcomes

By: Valerie Newberg

Despite advances in technology and policy substantially decreasing the risk of pregnancy associated deaths in the 20th century, the U.S. is one of only a few countries with significant increases in maternal mortality in the 21st century

The Centers for Disease Control and Prevention defines an instance of maternal mortality as a person dying during pregnancy or within 42 days of the end of pregnancy of a cause that was not accidental or incidental. Maternal mortality is used by the World Health Organization to quantify the concept of maternal health and reflects the economic, social and public health conditions of mothers in a population. Maternal mortality can also provide insight on disparities in care. The United States lags other developed nations, ranking 46th globally. Current data on maternal health, while imperfect, paints a troubling picture of inequity across American racial and ethnic groups, regions and states. The Department of Health and Human Services reports that Black and Indigenous Americans are 2-3 times more likely than white Americans to experience pregnancy-related mortality and rural mothers are increasingly likely to suffer from pregnancy-related morbidity and mortality due to decreases in rural hospital access. Maternal mortality rates are highly variable among states. California has a rate of 10.2 maternal deaths per 100,000 live births, just half of the U.S. average. Alabama’s rate is 36.2.

Despite these challenges, there is reason for hope: many instances of maternal mortality and morbidity are preventable when medical professionals have the resources to provide care before, during and after a pregnancy. Additionally, the Biden administration released its “White House Blueprint for Addressing the Maternal Health Crisis,” which includes a request for a $470 million budget to develop much-needed tools that will help states and local communities tackle this issue. The blueprint aims at “cutting the rates of maternal mortality and morbidity, reducing the disparities in maternal health outcomes, and improving the overall experience of pregnancy, birth, and postpartum for people across the country.” The plan also makes clear, however, that reforming the American maternal health system cannot be the burden of one person, agency or institution alone. Efforts must reflect collaboration between the federal and state governments to be truly effective and equitable.

As outlined in the blueprint, the federal government is taking several steps to help states improve pregnancy outcomes.

Increasing data collection efforts

  • The Centers for Disease Control and Prevention Levels of Care Assessment Tool creates “standardized assessments” of maternal care levels for policymakers in participating states.
  • A review of Women, Infants, and Children participation and maternal health outcomes will provide state policymakers with robust information on the risk factors for maternal mortality and extreme morbidity.

Using equity as a guiding principle.

  • Expansion of the Nurse Corps and Community Health Worker Training Program will bridge gaps in care for medically underserved communities, including rural areas, by providing additional resources for Health Professional Shortage Areas.
  • Revision of guidelines will ensure rural and Indian Health Service medical facilities are prepared to care for pregnant people and mothers, even if those facilities do not have obstetric units.
  • Utilization of self-monitored blood pressure regulation programs will assist those at risk for hypertensive disorders, which disproportionately impact pregnant people over 35 and Black and Indigenous mothers.

Encouraging state innovation.

Potential options for state responses include expanding current programs to promote equity and implementing an all-government approach that incorporates several agencies and programs.

  • In Arkansas, the governor issued initiatives expanding Medicaid-eligible pregnancy benefits to include home visits for those at high-risk for pregnancy complications and coverage for mothers who earn up to 212% of the federal poverty level.
  • In Delaware, lawmakers passed a bill requiring doula services be covered under Medicaid. At-risk populations not receiving doula care are twice as likely to suffer from pregnancy complications as those with doula care. Those receiving doula care covered by Medicaid report lower levels of C-sections and premature birth.
  • In Nevada, lawmakers passed a bill revising the responsibilities of the Maternal Mortality Review Committee to include collaboration with the Advisory Committee of the Office of Minority Health and Equity of the Department of Health and Human Services, a practice that allows the committee to better analyze racial, age and geographic disparities in maternal care.

As the Sept. 30 deadline for Congress to pass appropriations bills approaches, the Blueprint for Addressing the Maternal Health Crisis remains a valuable opportunity for Congress to prioritize state-federal partnerships. In the meantime, states have several options in place to address disparities in maternal health outcomes, including expanded Medicaid coverage, updated data collection and more comprehensive monitoring guidelines.

Additional Resources:

Behind the Ballot Sec. Toulouse-Oliver

Maggie Toulouse-Oliver – New Mexico’s Secretary of State

Working in public office since 2007, Secretary Maggie Toulouse Oliver has experienced her fair share of elections. From her first position as county clerk to her current role as secretary of state, Toulouse Oliver has years of expertise in the formation and preparation of election administration. This year, as she and her staff prepare for election season, they face a changed political landscape as New Mexico comes off one of the nation’s most extreme instances of election disinformation. 

Earlier this year, Secretary Toulouse Oliver enlisted the help of the New Mexico state Supreme Court to order a county commission to certify the results of primary election in Otero County after members of the commission refused to do so citing concerns with the vote-tallying process. 

“I think it is indicative of the types of things that are happening in other states,” she said. “So, as we prepare for November, not only are we doing all the other things that we always have to do in the lead up to an election, but now we’re also having to actively combat myths and disinformation among citizens and elected officials.” 

New Mexico has been at the forefront of election accuracy, enacting a post-election audit law in 2005 and working year-round to vamp up cybersecurity collaboratively through The New Mexico Election Security Program Office and the New Mexico Secretary of State’s Information Technology Division. However, this year Toulouse Oliver is focused on three main components to help mitigate disinformation surrounding elections: an extensive, documented review of the election process; outreach to the public; and a nonpartisan approach to collaborating with entities like county commissions. 

The Office of the Secretary of State has already been making attempts to communicate directly to the public while working to dispel any misconceptions about the process through a “Rumor vs. Reality” fact-checking webpage. Though Oliver wants to personally connect with people working in county commissions, who play an integral role in the democratic process, to quell any concerns they may have about the integrity of votes in New Mexico. 

While Oliver has her own partisan ties, she values the importance of a nonpartisan workplace and the oath she took before assuming office to ensure fairness and accuracy. Beyond that, she wants people to know that there is more that unites us than divides us. 

“Election officials, no matter whether they’re Democratic or Republican, take the aspect of their job to ensure fairness and accuracy very seriously. I certainly do that too. In fact, we swear an oath on that,” she said. “Election officials at all levels, from the highest levels down to the local poll worker, are experiencing threats based on our participation in our democratic process. I think it’s really important right now to talk about ourselves as humans, right? I’m a single mom and I have both a 24-year-old son and a 12-year-old son to whom I’m dedicated to more than anything else. Beyond my kids, this job of ensuring fair and accurate elections is my number two.”