Maternal Health Awareness Month

The health of women and children is vital to a community and society as a whole and can serve as a measure of the overall public health of the state. In 2017, the American College of Obstetricians and Gynecologists declared January 23 as Maternal Health Awareness Day. In 2021, Governor Holcomb followed suit declaring January 23 as Maternal Health Awareness Day in Indiana. This day serves as an opportunity to:

• Increase awareness of maternal health issues that impact Hoosiers daily.
• Remember those who have lost their life.
• Assess the steps Indiana is taking to improve care and outcomes for pregnant and postpartum individuals across the state.

What is maternal health?

The World Health Organization defines maternal health as: “The health of mothers during pregnancy, at childbirth and during the postpartum period.” This period includes the 12 months following the end of a pregnancy. Child health is defined as “the health of children from birth through adolescence with the focus on the health of children under the age of five.” The special focus on young children birth to 5 years is intentional because of the rapid amount of brain development in the early years.
Experts in the field have studied the health of mother and child as couplets for decades. They have determined the two are very much connected, in terms of both risk and protective factors. Maternal and child health is essential for understanding broader public health issues. This population provides critical information and insights about overall health of a community, preventability of conditions, and the impact of the health of future generations.

Studies of maternal child health have and continue to shape healthcare systems and policies. Unmet health-related social needs such as safety, adequate nutrition, access to transportation and adverse childhood experiences lead to poorer health outcomes for pregnant and postpartum individuals and their children. Understanding the health of and relationship between maternal-child couplets can offer new strategies for addressing generational cycles of oppression, untreated mental health conditions, substance abuse, and trauma and lead to upstream solutions for healthy, thriving communities.

What is maternal mortality?

In 2018, the State of Indiana formally commenced a Maternal Mortality Review Committee, with adherence to the CDC guidance. Each year since, the multi-disciplinary statewide committee reviews all deaths of individuals that occurred during pregnancy and the subsequent 12 months postpartum. The goal is to understand causes and contributing factors to maternal mortality and ultimately determine recommendations to prevent similar deaths in the future. Annually, the Indiana Department of Health Fatality Review & Prevention Division publishes the Indiana MMRC report for the public.

The 2022 report, which reviewed the deaths from the year 2020, concludes the maternal mortality rate in Indiana has increased over recent years 2018–2020. Black mothers experienced the highest mortality rates during this time. The Indiana Department of Health: Agency Strategic Plan (2021–2025) acknowledges the existence of disparities in the state, and the number one goal in the plan is reducing health disparities and ensuring equitable outcomes. The plan includes a specific objective dedicated to reducing “Indiana’s infant and maternal mortality rates in all populations, especially in our minority populations.”

Notably, the Indiana MMRC has determined that substance-use disorder is the number one contributing factor to pregnancy-associated deaths in our state. The committee has also found that pregnancy-associated deaths occur most commonly in the later postpartum period, between 43 and 365 days postpartum. These findings are key to developing actionable steps for prevention of maternal deaths.

Comparing maternal mortality rates across states is difficult. Collecting mortality data is complex and varies across states. The mechanisms for collecting and reporting maternal mortality data have evolved over recent years. At this time, 39 other states in addition to Indiana have a formal Maternal Mortality Review Committees guided by the CDC.
In 2022, the CDC released updated data which further acknowledges the maternal mortality crisis in the United States. According to the report, each year nearly 700 individuals in the U.S. die from issues related to pregnancy and childbirth complications. In most cases, these deaths are preventable. Nationally, Black mothers experience the highest mortality rates among racial and ethnic groups.

Statewide efforts and maternal health initiatives

Preventing maternal and infant mortality takes an all-hands-on deck approach at the state, national and even international levels. Importantly, the American Rescue Plan Act allowed states to expand Medicaid coverage to specific populations. As a result, in the spring of 2022, Indiana expanded Medicaid coverage to all pregnant Medicaid beneficiaries through 12 months postpartum. Prior to this policy change, for many individuals, coverage ended at 60 days postpartum. This expansion of coverage aligns with health care data which indicates that complications resulting from pregnancy and childbirth, including mental health conditions and substance use disorder continue to occur beyond the first six weeks following labor and delivery. Several state initiatives also aim to address maternal health in Indiana including:

• The Indiana Pregnancy Promise Program is a free, voluntary program available statewide for pregnant Medicaid beneficiaries with current or past opioid use. The program connects pregnant individuals to prenatal, postpartum, physical, and mental health care as well as treatment for opioid use disorder. The program extends beyond pregnancy and offers services to mothers and infants through 12 months postpartum, with a focus on addressing the health-related social needs of families.
• My Healthy Baby is a collaboration with IDOH, FSSA, and DCS—which connects pregnant individuals to family support providers in their own community. The initiative was created to address high infant mortality rates in Indiana and offer support to mothers and babies resulting in healthier outcomes for both. These efforts intentionally targeted the communities with highest infant mortality rates. However, my Healthy Baby has been steadily expanding and will be fully rolled out across the state by mid-2023.
• The Mom’s Helpline is a resource and referral system connecting pregnant individuals with prenatal and child health care services. Anyone may call 844-MCH-MOMS.
• Indiana 211 is a free and confidential service that helps Hoosiers across Indiana (including pregnant individuals) find the local resources they need.
  Call to Action
• Advocate for maternal child health policies in your own communities. Spread awareness of available programs and resources for pregnant, postpartum individuals and their infants.
• Encourage individuals to access prenatal and postpartum care. Share healthcare insurance resources, such as Indiana Medicaid.
• Help reduce stigma around mental health conditions and substance use disorder in the perinatal period. Remember, words matter. Use of person-centered, inclusive language creates an invitation for individuals to enter treatment and other healthcare services.

Helpful links

1. Postpartum Support International
2. The American College of Obstetrics and Gynecologists
3. CDC Hear Her Campaign
4. NCSL National Conference of State Legislators Preventing Infant and Maternal Mortality
5. Maternal Mental Health Leadership Alliance Fact Sheets
6. Indiana Perinatal Quality Improvement Collaborative
7. Indiana Medicaid Pregnant Women
8. Covering Kids and Families of Indiana
9. Nurse Family Partnership of Indiana
10. CDC Social Determinants of Health
11. CDC Adverse Childhood Experiences
12. Kaiser Family Foundation Maternal Mortality Issue Brief