Improving the well-being of mothers, infants, and children is an important public health goal for the United States, as well as a priority for New Jersey. Their well-being determines the health of the next generation and can help predict future public health challenges for families, communities, and the health care system.¹  With the priority of improving equity, New Jersey focuses on many aspects of maternal and child health, including prenatal, perinatal, and postpartum care and innovative resources; intraconception care; special child health; breastfeeding; and more.

2018-2023

Projects

• Healthy Women Healthy Families (HWHF) works toward improving maternal and infant health outcomes for women of childbearing age and their families, while reducing racial, ethnic, and economic disparities in those outcomes through a collaborative, coordinated, community-driven approach using case management. Community Health Workers targeted initiatives such as post-partum doula care and breastfeeding supports.
• Connecting NJ, formerly known as Central Intake, is a statewide, county-based single point of entry system for pregnant women, fathers, and families with young children, to access programs, services and supports such as HWHF; Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program; Family Connects (i.e., universal home visiting); community resources; medical care; doula programs; and social support agencies, through referrals.
• Expanded Alma Program aims to support pregnant persons who may be experiencing mental health issues and/or substance use issues through a peer mentoring model. It is in alignment with the First Lady’s Nurture NJ Initiative, which is a statewide strategic plan committed to reducing maternal and infant mortality and ensuring equitable care among women and children of all races and ethnicities.
  • Specific recommendations for maternal mental health include: “Scale successful models to provide behavioral health care to pregnant individuals and their infants, including Perinatal Mood and Anxiety Disorders.”
• Maternal Health Innovation Program:  In September of 2019, New Jersey was one of only nine states to  receive funding through the Health Resources & Services Administration (HRSA) to establish a State Maternal Health Innovation Program (SMHIP). This competitive cooperative agreement, totaling $10,000,000 over five years, was awarded to fund entities such as public health departments and universities to improve maternal health in the U.S. by:  
  • Establishing a Maternal Health Task Force.
  • Improving the collection and use of state-level data on maternal mortality and severe maternal morbidity (SMM).
  • Launching new maternal health service delivery activities (e.g., improving access to services during pregnancy and the postpartum period and equipping the maternal and child health workforce with new training and resources).
• The Maternal Health Innovation team manages a variety of Maternal Health Improvement Innovations including:
  • New Jersey Maternal Care Quality Collaborative, launched June 2021
  • Maternal Mortality Review Committee, relaunched August 2020
  • Maternal Data Center
  • Hospital Report Card (annually)
  • Reproductive Justice Project for Equitable Maternal Health (explicit and implicit bias training) launched in August 2023
  • Shared Decision-Making Hospital Pilot Program, launched 2022
  • Maternal Levels of Care
  • Perinatal Risk Assessment Enhancements (PRA) (annually)
  • Long-Acting Reversible Contraception (LARC)
  • Project ECHO (Extension for Community Health Outreach), launched 2022
• Premature Birth Prevention Program (PBPP) aims to reduce preterm birth and infant death rates among non-Hispanic Black and Hispanic mothers in select counties and municipalities. The funding that supports the PBPP is a selected portion of dollars allocated from the larger Preventative Health and Services Block Grant awarded to NJDOH Integrated Health Services.  
• Maternal Feedback Database Project to develop a robust Maternal Feedback Database Survey tool that assesses birthing persons’ perceptions of care during the full pregnancy spectrum. State appropriated funds were allocated to support the development of this feedback survey in the amount of $600,000.
• New Jersey Breastfeeding Strategic Plan was published September 22, 2022, and is currently being implemented in collaboration with the Central Jersey Family Health Consortia and led by a statewide Breastfeeding Coordinator.
• Early Hearing Detection and Intervention (EHDI) Program:  In 2022, the EHDI program updated its brochure titled “Can My Baby Hear?” and translated it into multiple languages to make it accessible to more people. The brochures are available to print from the EHDI website and contain QR codes for quick access to the site.    

Policies and Legislation

• P.L.2019, c.75 established the Maternal Care Quality Collaborative to annually review and report on rates and causes of maternal mortality and morbidity in New Jersey, and to recommend improvements in maternal care.
• P.L.2019, c.133 established a Maternal Health Care Pilot Program (Shared Decision-Making Hospital Pilot) to evaluate a shared decision-making tool developed by NJDOH and used by hospitals providing maternity services, and by birthing centers.
• P.L.2023, c.109 established the New Jersey Maternal and Infant Health Innovation Center Act and appropriated $2,220,000.
• On November 1, 2021, N.J. Statute 26:2H-12.108 was adopted requiring every New Jersey hospital that provides inpatient maternity services and every birthing center licensed in the State, pursuant to P.L. 1971, c.136 (C.26:2H-1 et seq.,) to implement an evidence-based explicit and implicit bias training program.
• N.J. Rev. Stat § 10:5-12 (2018) (P.L. 2017, c.263) adds “breastfeeding” as a protected class under the Law Against Discrimination and requires workplace accommodations for breastfeeding employees.
• N.J. Rev. Stat § 54:32B-8.63 (2018) exempts breast pumps, breast pump repair, and replacement parts, breast pump collection and storage supplies and certain breast-pump kits from sales tax.
  • All five NJ Family Care health insurance plans provide breast pumps to pregnant and postpartum participants at no cost.
• N.J. Rev. Stat. §§ §17:48-6ss, 17:48A-7pp, 17:48E-35.43,17B:26-2.1ll, 17B:27-46.1ss, 17B:27A7.25, 17B:27A-19.29, 26:2J-4.44, 52:14-17.29cc, 52:14-17.46.6n, 30:4D-6o (P.L.2019, c.343)(2020) requires health insurers and the State Medicaid Program to provide coverage without requiring any cost sharing, for comprehensive lactation support, counseling, and consultation, and the costs for renting or purchasing electric or manual breastfeeding equipment.
• N.J. Rev. Stat. § 26:4C-2, -3, -7 (2019) P.L.2019, c.242 requires certain public facilities and offices to provide an on-site lactation room; Department of Health to provide information about lactation room availability; and Department of Education to provide information annually on lactation policies in New Jersey schools, colleges and universities. 

Outreach

• Connecting NJ Referral Specialist assesses families for needed resources and links them to services and programs that aim to reduce maternal and infant mortality and improve health outcomes for high-risk women and infants.
• Individuals and families can also be referred to Community Health Workers to provide case management and services to women and families in the community.
• Methods of referral include:
  • Pregnancy Risk Assessments (PRA)
  • Community Health Screen (CHS)
  • Initial Referral Form (IRF)
  • Self-Referral Form (online at https://www.nj.gov/connectingnj/)  
• In 2022, NJDOH’s Early Hearing Detection and Intervention (EHDI) program collaborated with Montclair State University’s (MSU) graduate audiology program to pilot screenings for children enrolled in Head Start and Early Head Start to help the sites achieve their mandated screening of children within 45 days of enrollment. EHDI and MSU are currently planning for additional screenings to take place in the fall of 2023, with possible expansion to sites statewide (seeking to partner with other college programs in New Jersey) in 2024 and beyond.  
• Childhood lead poisoning prevention outreach is done through three regional coalitions and local health departments.

Grants given by NJDOH

• Healthy Women Healthy Families Grant awarded to The Partnership for Maternal & Child Health of Northern NJ, Central Jersey Family Health Consortium, and Southern NJ Perinatal Cooperative (Connecting NJ only grantees: The Children's Home Society of NJ and Project Self-Sufficiency of Sussex County). The goals are to implement new activities focused on the postpartum period, including community health worker funding, non-traditional group breastfeeding education (partners, grandparents, teens, etc.) and postpartum doula care.
• Shared Decision-Making (SDM) with the New Jersey Health Care Quality Collaborative (2022-2024) – Also known as TeamBirth NJ, SDM is a process in which providers partner with their patients and work together to make decisions regarding the patient’s care in order to improve birthing experiences and outcomes.
• New Jersey Postpartum Resources and Support Network (NJPRSN) provides grants to improve knowledge and access to perinatal and anxiety disorder screening, treatment, and support services.
• The Early Hearing Detection and Intervention (EHDI) program provides subgrants from its Health Resources and Services Administration (HRSA) newborn hearing screening grant, Universal Newborn Hearing Screening and Intervention Program.   The subgrants fund newborn hearing follow up, a Deaf Mentor program for families, and a community-based early intervention program.   
• NJDOH Newborn Blood Spot Screening Program provides a complement of health services grants to partially support the infrastructure for care and treatment for babies identified through the newborn blood spot program. 
• The Childhood Lead Program provides grants to local health departments for nurse case management and environmental investigation of children with elevated blood lead levels.
• The Childhood Lead Program provides grants to three regional coalitions for education and primary prevention of lead burden.

Grants received by NJDOH

• State Maternal Health Innovation Program (SMHIP) through HRSA awarded in 2019 ($10 million in funding from 2019-2024)
• CDC Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM) Expanded Authority Grant awarded in 2019 ($2,250,000 in funding from 2019-2024)
• HRSA Title V MCH Block Grant: $11.7M grant that funds various MCH programs at NJDOH, including Healthy Women Healthy Families. $100,000 of the MCH Title V Block grant provides supplementary support to the Maternal Mortality Review Committee annually.
• Four-year HRSA grant: Universal Newborn Hearing Screening and Intervention Program, HRSA-20-047
• Four-year CDC grant: Improving Timely Documentation, Reporting, and Analysis of Diagnostic and Intervention Data through Optimization of EHDI Surveillance Practices and Information Systems, CDC-RFA-DD20-2006, 2020-2024
• CDC: Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET): Zika, congenital syphilis, perinatal hepatitis C, COVID-19, congenital cytomegalovirus infection (cCMV).
• CDC: A Comprehensive Approach to Reducing Childhood Blood Lead Levels Through Evidence Based Interventions and Surveillance

Other actions

• FY24 Connecting NJ continuous funding awarded to non-competitive NJ agencies.
• Maternal Health Innovation Team drafts an annual Maternal Mortality Report for dissemination on top causes of pregnancy-related and pregnancy-associated but not related maternal deaths.

Assets/resources

• Healthy Women Healthy Families (HWHF) and Connecting NJ (CNJ) collaborate with many NJDOH programs including WIC, SNAP-Ed, Child and Adolescent Health Services, Lead, Chronic Disease, and Family Planning, as well as the New Jersey Department of Children and Families, the First Lady’s Office and the Governor’s Office through Nurture NJ, and the New Jersey Department of Human Services for the integration of the Connecting NJ system.
• Connecting NJ is a partnership between NJDOH and the New Jersey Department of Children & Families that consists of Connecting NJ hubs operated by seven community-based organizations:  Southern NJ Perinatal Cooperative, Central Jersey Family Health Consortium, Partnership for Maternal & Child Health of Northern NJ, Acenda Integrated Health, Prevent Child Abuse NJ, Children’s Home Society, and Project Self-Sufficiency.
• NJDOH partners with Family Health Initiatives to manage Connecting NJ databases and process systems and data.
• New Jersey WIC is staffed with two Lactation Consultants and local WIC agencies now offer both individual breastfeeding counseling and support groups using a variety of communication and social media platforms such as texting, telephone, and/or videoconferencing.  
• New Jersey currently has 13 maternity hospitals that are designated as Baby Friendly.
• The New Jersey EHDI Program has a legislated Hearing Evaluation Council (HEC) to advise the program on its activities.  
• The NJDOH Newborn Blood Spot Screening Program has a legislated Newborn Screening Advisory Review Committee (NSARC) to ensure the program is up to date on screening technologies, follow up processes, and keeping pace with the number of disorders screened.

Challenges

• The Maternal Mortality 2016-2018 Report identified access to services in certain geographic regions as a challenge.
• The COVID-19 pandemic placed challenges on in-person case management services and outreach events. Identification and coordination of virtual services is a challenge for some NJ residents post-COVID.
• The New Jersey Breastfeeding Coalition is run by and solely relies on volunteers.

Disparities/inequities

• Women of color experience postpartum depression at higher rates—in some studies double that of all women. Suicide and overdose are the leading causes of death among all women in the first year postpartum, with 100% of these deaths deemed preventable.  
• Black women experience almost seven times the rate of pregnancy-related mortality compared to their White counterparts in New Jersey.
• New Jersey’s Severe Maternal Morbidity (SMM) rates among Black women are among the highest in the U.S.
• In 2019, SMM rates among Black women were nearly three times greater than those of White women.
• The 2020 Black infant mortality rate in New Jersey was 3.5 times higher than the rate for White infants. The Hispanic infant mortality rate was 1.4 times higher than the rate among White babies.  
• Racial and ethnic disparities continue to persist in preterm birth rates, necessitating the need to address these disparities and reduce the preterm birth rate.
• There is a large racial disparity in breastfeeding rates. In 2019 in New Jersey,
  • the breastfeeding initiation rates were 81.0% for White women and 70.9% for Black women.
  • the exclusive breastfeeding rates (for 3-month-old infants) were 41.9% for White women and 24.4% for Black women. 
• Out-of-state providers like the Children’s Hospital of Philadelphia and Nemours Children’s Health do not accept patients with New Jersey Medicaid which negatively impacts access to pediatric specialty care, especially in South Jersey.
• Race and ethnicity data are not complete in the childhood lead poisoning database, making it difficult to draw conclusions about disparities.

Inequities That Contribute to Challenges

• In addition to safe infant sleep, antecedent risk factors such as poverty, preterm birth, poor access to care, and implicit bias represent the complex social and health issues that result in the birth of an infant more vulnerable to sudden unexpected infant death (SUID), which is the leading cause of postneonatal mortality in New Jersey.
• There is a lack of diversity among breastfeeding support providers in the state.

Final Assessment

• Healthy New Jersey targets were achieved for nine objectives.
• Improvements were made but targets were not met for seven objectives.
• There was little or no change in one objective -- alcohol use among pregnant women.

For more information, please refer to these resources:

• NJDOH Family Health Services
• Nurture NJ
• Partnership for Maternal and Child Health of Northern New Jersey
• Central Jersey Family Health Consortium
• Southern New Jersey Perinatal Cooperative
• SIDS Center of New Jersey
• CDC Division of Reproductive Health
• Healthy People 2030
  • Pregnancy and Childbirth
  • Infants

Reference:

1. Maternal, Infant, and Child Health. Healthy People 2020. 5/18/21.