Promoting Innovation in State and Territorial Maternal and Child Health Policymaking

Life Course Investments at the Maternal and Child Health Bureau.

The Relationship between Interprofessional Leadership Education and Interprofessional Practice: How Intensive Personal Leadership Education Makes a Difference

In 2003 when Dr. Halfon and I published a commentary in this journal calling for a reconceptualization of racial– ethnic disparities in birth outcomes from a life-course perspective [1], few people in maternal and child health (MCH) were talking about life course. While certainly not new, it was hailed in an accompanying editorial as ‘‘a start in a new paradigm’’ in MCH [2]. The past decade has witnessed major advancements in the development of the life course theory and its application to MCH research, practice, and policy. In this issue, Halfon et al. [3] summarized new advances in the theory of life course health development (‘‘LCHD 2.0’’), while other articles provide a sample of the many innovative applications in our field. There are now websites, toolboxes, resource guides, and a research network devoted to MCH life course, and the federal Maternal and Child Health Bureau (MCHB) of the Health Resources and Services Administration is now using the life course theory as a strategic planning framework, guiding the work of the Bureau and its grantees and partners over the next decade [4]. There has been a paradigm shift in MCH, and as proclaimed in an editorial in 2009, ‘‘[t]he life course has come of age’’ [5]. So where do we go from here? The collection of articles in this issue of the MCH Journal provides a good roadmap. In this editorial, I will offer three further suggestions for how to advance life course research, practice, and policy in MCH. In research, we need to move beyond discovery to intervention research. In practice, we need to move from isolated to collective impact. In policy, we need to move beyond paying for remediation to investing in capacity formation.

Objective As part of the Title V Maternal and Child Health (MCH) Services Block Grant, administered by the Health Resources and Services Administration's (HRSA's) Maternal and Child Health Bureau (MCHB), states are required to conduct a comprehensive needs assessment identifying MCH priorities every 5years. The most current needs assessment (2015) occurred after a transformation of the program, in which a new performance measurement framework was created. This analysis examined current patterns and trends in state MCH priorities and selected performance measures to identify changing needs and inform technical support. Methods Multiple coders categorized: (1) state priority needs from 2000 to 2015 into focus areas and subcategories for examination of current, diminishing, and emerging needs; and (2) the selection of linked national and state performance measures in 2015 for all 59 states and jurisdictions. Results Between 2000 and 2015, the proportion of states with a need around pre- and inter-conception care increased from 19% to 66%. More states had needs in the breastfeeding subcategory (42%) compared with 20% of states or less in previous years. Fewer states had needs around data capacity than in past years. Emerging needs included supporting families/relationships. The most commonly selected national performance measures (NPMs) were around breastfeeding and well-woman visits. The state performance measures (SPMs) analysis also emphasized assets, with measures around community/context and positive development. Teen births and postpartum depression were areas where multiple states had SPMs. Conclusions for practice Increasing and emerging needs may help to inform technical assistance and future national measures for the Title V program.

* Abbreviations: MCH = : Maternal and Child Health (program) • CSHCN = : Children With Special Health Care Needs (program) • DSCSHCN = : (Maternal and Child Health Bureau's) Division of Services for Children With Special Health Care Needs. Developing community systems of services for children with special health care needs represents a significant challenge for pediatricians, families, managed care organizations, and public and private agencies providing services to this population. At the state level, Maternal and Child Health (MCH) and Children With Special Health Care Needs (CSHCN) programs are vested with the responsibility for planning and developing systems of care for all children with special health care needs. Historically, these programs have been supported through Title V of the Social Security Act, with state-matching funds, to provide health services to selected groups of children with special needs, typically those with complex physical conditions. However, during the last half-century, service systems have become increasingly complex as a result of health, education, and social policy changes, as well as changes in the epidemiology of child health, including increases in the number and proportion of children with chronic conditions and disabilities and changes in their case-mix.1-4 These changes have resulted in gaps in some service areas and duplication in other areas, as well as fragmentation in the way service systems are organized.5 Recognizing these difficulties, health policy leaders at the state and federal levels, with broad input from public and private agencies, providers, and families, effected legislative changes in the federal Omnibus Budget Reconciliation Act of 1989, which expanded the mission of CSHCN programs to facilitate the development of community-based systems of services for children with special health care needs and their families. Since then, the explosive growth of managed care has presented new challenges and opportunities as well as a heightened urgency for the development of systems of care that integrate health and related services for this population.6 7 Developing systems to serve children with special health care needs requires a clear definition of the population to … Address correspondence and reprint requests to: Merle McPherson, MD, Maternal and Child Health Bureau, Room 18A27, Parklawn Bldg, 5600 Fishers Ln, Rockville, MD 20857.

The Maternal and Child Health Bureau of the Health Resources and Services Administration (HRSA) in conjunction with Schools of Public Health has sponsored a variety of graduate education and continuing education initiatives during the last 15 years aimed at enhancing the analytic capacity of the maternal and child health (MCH) workforce. These initiatives are described, with lessons learned as well as recommendations for future efforts provided.

The purpose of this commentary is to start a national conversation about the future of maternal and child health (MCH). In the coming decades, we will have unprecedented opportunities to improve MCH, but will also face unprecedented threats. This paper examines emerging opportunities and threats to MCH, and discusses strategies for leading the future of MCH. Scientific advancements will continue to drive improvements in MCH, but to unleash its full potential for improving population health future MCH research must become more transdisciplinary, translational, and precise. Technological innovations could dramatically transform our work in MCH while big data could enhance predictive analytics and precision health; our challenge will be to assure equitable access. The greatest gains in MCH will continue to come from improving social conditions, which will require advancing MCH in all policies. Climate change, infectious outbreaks and antimicrobial resistance pose increasing threats to MCH, which can be averted by reducing global warming, implementing global early warning systems, and instituting responsible antimicrobial stewardship. The growing burden of chronic diseases in children and adults need to be addressed from an ecological and life course perspective. The water crisis in Flint shined a spotlight on the growing health threats from America's decaying infrastructure. We can lead the future of MCH by starting a national conversation, improving MCH research, and preparing future MCH workforce, but the future of MCH will depend on our effectiveness in bringing aboutsocial and political changein the coming decades.

The Federal Maternal and Child Health Bureau (MCHB) of the Health Resources and Services Administration (HRSA) has been involved with newborn screening and genetic testing and services since the 1960s. Although other branches of the federal government, such as the National Institutes of Health and the Centers for Disease Control and Prevention, have played key roles in newborn screening, this report focuses on the issues from the perspective of HRSA and its collaboration with the American Academy of Pediatrics (AAP). Genetic diseases gained recognition in public health with the … Address correspondence to Peter C. van Dyck, MD, MPH, FAAP, Associate Administrator, Maternal and Child Health Bureau, 5600 Fishers Lane, Room 18-05, Rockville, MD 20857. E-mail: pvandyck{at}hrsa.gov

The remarkable progress seen in maternal and child health (MCH) in India over the past two decades has been impacted by the COVID-19 pandemic. We aimed to undertake a rapid assessment to identify key priorities for public health research in MCH in India within the context and aftermath of the COVID-19 pandemic. A web-based survey was developed to identify top research priorities in MCH. It consisted of 26 questions on six broad domains: vaccine preventable diseases, outbreak preparedness, primary healthcare integration, maternal health, neonatal health, and infectious diseases. Key stakeholders were invited to participate between September and November 2020. Participants assigned importance on a 5-point Likert scale, and assigned overall ranks to each sub-domain research priority. Descriptive statistics were used to examine Likert scale responses, and a ranking analysis was done to obtain an "average ranking score" and identify the top research priority under each domain. Amongst the 84 respondents from across 15 Indian states, 37% were public-health researchers, 25% healthcare providers, 20% academic faculty and 13% were policy makers. Most respondents considered conducting systems strengthening research as extremely important. The highest ranked research priorities were strengthening the public sector workforce (vaccine preventable diseases), enhancing public-health surveillance networks (outbreak preparedness), nutrition support through community workers (primary care integration), encouraging at least 4-8 antenatal visits (maternal health), neonatal resuscitation to reduce birth asphyxia (neonatal health) and screening and treatment of tuberculosis (infectious diseases). Common themes identified through open-ended questions primarily included systems strengthening priorities across domains. The overall focus for research priorities in MCH in India during the COVID-19 pandemic is on strengthening existing services and service delivery, rather than novel research. Our results highlight pivotal steps within the roadmap for advancing and sustaining maternal and child health gains during the ongoing COVID-19 pandemic and beyond.

The Best Way to Address Maternal and Child Health (MCH) Is Not to Build an MCH Focussed Health System

Maternal and child health (MCH) outcomes remain a major public health concern in Pakistan, particularly in low- and middle-income areas where access to health services is limited. Objective: To assess the effectiveness of community-based interventions in improving maternal and child health outcomes in underserved areas of Pakistan. Methods: This cross-sectional analytical study was conducted at Services Hospital, Lahore, from November 2024 to April 2025. A total of 245 participants, including pregnant women, mothers of children under five years, and primary caregivers. Data were collected using a structured questionnaire on maternal health practices, child health indicators, and exposure to community-based interventions such as lady health worker visits, counseling sessions, and health education campaigns. Results: Among participants, 77.1% reported at least one ANC visit, while 51.4% completed four or more visits. Institutional deliveries were recorded in 61.6%, and PNC within 48 hours in 43.7%. Immunization coverage was 74.7%, and exclusive breastfeeding was practiced in 59.2% of cases. Exposure to CBIs was significantly associated with better outcomes: ≥4 ANC visits (64.8% vs. 34.1%, p < 0.01), institutional delivery (71.2% vs. 46.8%, p < 0.01), full immunization (82.1% vs. 61.9%, p < 0.01), and exclusive breastfeeding (65.7% vs. 47.2%, p = 0.02). Logistic regression confirmed independent associations between CBI exposure and improved maternal and child health outcomes. Overall satisfaction with CBIs was high (72.6%), although some participants reported irregular visits and referral gaps. Conclusion: Community-based interventions significantly improve maternal and child health outcomes in low- and middle-income areas of Pakistan.

Extreme weather events (floods and heatwaves) are becoming more frequent and intense due to climate change, posing significant risks to maternal and child health (MCH). These events interact in complex ways, occurring as compounding hazards (simultaneous or overlapping events), multiple hazards (independent but co-occurring risks), or cascading hazards (where one event triggers or exacerbates another). Understanding these interactions is critical for assessing their full health impacts and improving health system resilience. To date, health-related research has primarily focused on the effects of each hazard individually. This study employs an integrated framework that combines copula models, Bayesian networks, and machine learning approaches to analyse multi-hazard interactions, focusing on Zambia as a case study. Data, including daily rainfall and temperature, MCH-related datasets, utilisation data, and health system performance metrics – such as antenatal care (ANC), postnatal care (PNC), childhood immunisation, place and mode of delivery, and health service utilisation records – were obtained from Zambia through the REACH project. Daily rainfall was merged with TAMSAT and ERA5 reanalysis data (weather station data) to identify flood and heatwave events across Zambia from 1981 to 2023. Copula models were used to capture non-linear dependencies between heatwaves and floods; Bayesian networks uncovered causal pathways linking hazards with MCH and utilisation outcomes; and machine learning models (e.g., random forests and neural networks) predicted health impacts and identified critical patterns of hazard-MCH interactions. Intermediate variables, such as demand-side factors (e.g., education, wealth, age, etc.) and supply-side factors (e.g., facility density, health worker density, and healthcare financing), were incorporated to improve causal inference and identify actionable pathways. Marginal distributions for temperature and precipitation extremes were modelled using extreme value theory, while copulas quantified the joint probabilities of simultaneous extremes. Bayesian networks provided insights into cascading effects, such as how flooding damages healthcare infrastructure and exacerbates the impact of heatwaves on MCH services. Machine learning models were then trained to predict MCH outcomes (utilisation rates and counts) based on these multi-hazard interactions, leveraging their capacity to handle complex, non-linear relationships. Key results focus on estimating the level of ANC and PNC service disruption caused by compounding hazards, such as simultaneous floods and heatwaves. There is an urgent need for climate-resilient healthcare systems and targeted interventions to mitigate the risks of interacting with climate extremes on MCH. Such disruptions are anticipated to highlight important predictive factors, including increased rates of preterm births and maternal complications. This integrated approach, combining statistical, causal, and predictive tools, offers a holistic framework for analysing multi-hazard interactions and their impact on maternal and child health outcomes. By focusing on Zambia as a case study, this research aims to generate insights that are both contextually relevant and scalable for global application.  Keywords: Multiple hazards, maternal and child health, machine learning, copula models, Bayesian networks   Acknowledgements  This work was conducted under the framework of the Economic and Social Research Council grant: Building Resilience to Floods and Heat in the Maternal and Child Health Systems in Brazil and Zambia (REACH), Grant Number: ES/Y00258X/1

This is a follow-up to a 1984 study that analyzed the relationship between areal variation in the contraceptive prevalence time series and in the intensity of maternal and child health (MCH) services of the Matlab Family Planning Health Services Project. Results based on 69 months of observation suggested that the addition of MCH components to a program with basic MCH and comprehensive family planning services had no incremental impact on family planning efficacy. However, basic MCH services, involving clinical back-up to family planning and child care since the beginning of the program in Matlab, may have contributed to clients' faith in the clinic staff and the overall efficacy of the Matlab program. In the 18 months that followed the cut-off date for this analysis, contraceptive prevalence increased markedly in the study areas. The present analysis repeats the earlier one for the extended time series to determine if the intensification of health services in Matlab contributed to this secondary increase in prevalence, and to ascertain whether the MCH service regimes have long-run differential impacts. Results for the 87-month time series are similar to those of the previous analysis, suggesting that the introduction of additional MCH inputs in the Matlab service area over the 1982-83 period had no incremental impact on the contraceptive prevalence rate time trend.

OPTN/SRTR 2020 Annual Data Report: COVID

BackgroundThe burden of maternal and child mortality is high in the Democratic Republic of the Congo (DRC). While health workers (HWs) with adequate knowledge and practice of maternal and child health (MCH) are crucial to reduce this burden, the skill level of HWs in charge of MCH in the DRC is currently insufficient. This study aimed to assess the knowledge and practice of HWs towards MCH in Kasai and Maniema, two DRC provinces with very high maternal mortality ratios and under-5 mortality rates.MethodsThis cross-sectional study was conducted in 96 health facilities of Kasai and Maniema provinces in 2019. All HWs in charge of MCH were eligible for the study. Data were collected using a structured questionnaire containing 76 questions on knowledge and practice of MCH. Analyses were performed using the Wilcoxon-Mann-Whitney test, Kendall’s correlation test, and a multivariate linear mixed regression model.ResultsAmong participating HWs, 42.6% were A2 nurses (lowest qualification), 81.9% had no up-to-date training in MCH, and 48.4% had only 1-5 years of experience in MCH. In the two provinces combined, about half of HWs had poor knowledge (50.6%) and poor practice (53.3%) of MCH. Knowledge and practice scores were higher in Maniema than in Kasai (P < 0.001). Good knowledge and practice scores were significantly associated with high qualification (P = 0.001), continuing up-to-date training in MCH (P = 0.009), and 6 years of experience or more in MCH (P = 0.01).ConclusionIn Maniema and Kasai provinces, about half of HWs had poor knowledge and poor practice of MCH. The conversion of A1 nurses into midwives as well as the provision of up-to-date training in MCH, supervision, and mentorship could improve the skill level of HWs and could thus reduce the burden of MCH in the DRC.