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 2012: The Year of National Initiatives to Improve Birth Outcomes

By Tegan Callahan
Program Manager, Women’s and Infant Health, AMCHP

Since the inception of Title V of the Social Security Act, state and territorial programs have been working hard to address the causes of poor birth outcomes throughout the United States. Recently, national momentum has been growing to coordinate efforts addressing stagnating declines in infant mortality and persistent disparities among populations within the United States. Throughout 2012, several national initiatives were launched or enhanced to promote effective models to reduce infant mortality and build on long-standing state-level efforts to improve birth outcomes across our country. We are at a truly exciting and unprecedented time for maternal and child health, where we have the opportunity to accelerate our work, draw from each of these efforts, expand our partnerships and grow our evidence base so that we can realize our shared goal of healthy birth outcomes for all women and infants in the United States.

As a resource to members and partners, AMCHP staff have developed a consolidated source of basic information on current national initiatives. This information provides members and partners an overview of the current environment and can be a starting point for internal and external discussions on coordinating activities across a state. As we look forward to 2013, AMCHP will continue to be an active partner in these initiatives, as well as continue to provide information and recourses to our members and state partners. Through coordinated and continuous information across national- and state-level initiatives and activities, Title V MCH programs can harness the current national energy on improving birth outcomes into a collective impact for improved family health outcomes within their communities.

National Initiatives

Brief Summary of Initiative

Geographic Scope


Opportunity for
MCH programs

The Secretary’s Advisory Committee on Infant Mortality (SACIM)

The role of the SACIM is to advise the HHS Secretary on HHS programs directed at reducing infant mortality and improving the health status of pregnant women and infants. In addition, the committee provides advice on how to coordinate federal, state, local and private programs and efforts designed to deal with the health and social problems impacting on infant mortality.

Suggested national recommendations on reducing infant mortality were expected to be presented to the Secretary in November 2012. Preconception emphasized throughout the recommendations.


Committee has representation from across the United States. Members include academic, state, and community-based stakeholders


Title V programs are represented on the SACIM (two seats are currently held by active Title V directors)

Healthy Babies President’s Challenge

The Association of State and Territorial Health Officials (ASTHO) and the March of Dimes (MoD) partnered to help states prevent preterm birth and infant mortality. The challenge asks state health officials to sign a pledge to:

-  Publicly announce a goal to reduce the rate of premature birth by 8 percent by 2014 (measured against 2009 data)
-  Initiating and supporting programs and policies that reduce the premature birth rate
-  Building wider awareness of prematurity rates and other related MCH indicators

50 State Health Officials (48 states, Puerto Rico and the District of Columbia) have accepted the pledge to reduce premature births by 8 percent by 2014

MoD offers support for states that sign on with media package (Prematurity Campaign)

MCH programs can promote current prematurity efforts as key mechanisms to meet the goal, as well as partner on new programs or initiatives that are developed from this pledge

National Initiative on Preconception Health and Health Care (PCHHC)

The National PCHHC is made up of a steering committee and five workgroups – public health, consumer, policy and finance, clinical, and surveillance and research. They are in the process of releasing a 3rd National Strategic Plan.

Every Woman Southeast agreed to be an "implementor" group for the February 2013 consumer social marketing campaign – Show Your Love.


CDC provides TA and leadership support

W.K. Kellogg Foundation has provided funds to three of the initiative subcommittees via the Every Women Southeast coalition

This a national group with a specific focus on preconception health working to get preconception health on the agenda of many other groups and initiatives

March of Dimes Prematurity Prevention
39+ weeks campaign/Healthy Babies are Worth the Wait (HBWW)

The HBWW initiative is both a model of collaboration among local- and state-level clinical and public health partners and a national public awareness campaign. As a collaboration model, HBWW engages the community in efforts to achieve its goals of decreasing preterm births, implementing preventable strategies against preterm births and changing the attitudes and behaviors of providers and consumers. There are five core components (the five Ps) of the HBWW model: 1) partnerships and collaborations, 2) provider initiatives, 3) patient support, 4) public engagement, and 5) measuring progress. The March of Dimes launched a pilot in 2006 in Kentucky and after very successful results, has helped disseminate the model in New Jersey and Texas.

Throughout the summer of 2011, the March of Dimes built on the HBWW initiative and opened a new public awareness campaign to curb the large and growing number of otherwise healthy pregnancies that are deliberately ended early by induced labor or
Caesarean delivery.

HBWW intervention sites include KY (pilot), NJ and TX

March of Dimes;

Johnson & Johnson Pediatric Institute

Access implementation materials through the March of Dimes Prematurity Prevention Portal (


Regional Initiatives


Brief Summary of Initiative

Geographic Scope


Opportunity for
MCH programs

Regional Infant Mortality Summits

Regional COINs, a collaborative, multi-state initiative funded by HRSA aimed at improving infant health outcomes by reducing infant mortality and prematurity across the United States, particularly among disparate populations. For IV & VI:

-  Regional summit in New Orleans in January 2012; Regional COIN meeting in Washington DC in July 2012
-  At the January meeting, states also set five goals for themselves; the COIN initiatives reflect some but not all of these state goals
-  Current IV&VI COIN strategy teams are organized around: strengthening regional perinatal care systems, Medicaid financed interconception care, safe sleep for infants, prenatal smoking cessation, and eliminating elective deliveries prior to 39 weeks

Other regions
Region V attended the COIN launch as observers and there will be a regional Mar. 21-22 in Chicago, IL; Region X and California received QI training at 2012 Block Grant Review

HHS regions IV and VI actively engaged in the COIN, region V ‘on deck’ for the next round of summit/COIN assistance

HRSA/MCHB covers travel and meeting logistics for the in-person summit and the in-person components of the COIN

Title V programs in currently involved regions are very involved in state infant mortality teams and in the IV/VI COIN strategy teams

Every Woman SouthEast (EWSW) Coalition

EWSE is a multi-state, multi-layered partnership to improve the health of women and infants in the southeast United States. The initiative aims to foster capacity building and resource sharing, stimulate new ideas, develop new partnerships and promote effective programs and networks for moving the women’s health agenda forward in this region.

EWSE has a leadership team with representatives from each state. They have three committees: communication, evaluation and pilot projects. They also have nine state teams – one per state.

SE Region: NC, SC, LA, MS, GA, TN, AL, FL, KY

W.K. Kellogg Foundation

This regional initiative seeks to improve women’s and infant health through preconception health and a life course approach


Subset or Selection of States/Communities

Brief Summary of Initiative

Geographic Scope


Opportunity for
MCH programs

AMCHP Action Learning Collaborative:
Optimizing Opportunities within Health Reform for Preconception Health

This AMCHP program brings together state teams for directed technical assistance and capacity building on identifying and optimizing opportunities within the ACA and other national initiatives to improve preconception health and ultimately improve birth outcomes.

The 2012-2013 cycle (November 2012-July 2013) will have a particular emphasis on supporting state MCH programs coordinate a collective impact approach in the face of many national initiatives.

For 2012-2013 AMCHP will continue to work with the six states teams from Cohort one (FL, MI, MS, NM, OK, OR) and are looking forward to bringing on an additional five states teams as part of Cohort two

W.K. Kellogg Foundation

AMCHP Life Course Metrics Project

Currently, there are no standardized metrics for the life course approach. In response to this emerging issue, AMCHP launched a new project designed to identify and promote a set of indicators that can be used to measure progress using the life course approach to improve maternal and child health. The project has two main components, the convening of a national expert panel to provide input on an overall framework and on screening criteria for the indicator set and a participatory process working with state teams to develop a set of state-level life course indicators.

Seven state teams are currently developing state level measures for all states; team are FL, IA, LA, MA, MI, NC, NE

W.K. Kellogg Foundation

Final indicators will be designed for use by all state programs and MCH partners to promote life course

The National Governors Association (NGA) Initiative
Learning Network to Improve Birth Outcomes

The goal of this learning network is to assist states in developing, implementing and streamlining their key policies and initiatives related to the improvement of birth outcomes, starting with low-income populations. NGA will convene in-state sessions with each selected state to facilitate this process and convene a networking conference for that group of states to share lessons learned and to further their respective planning process.

Overall, the NGA does not intend for this to be a new initiative, but rather a facilitative effort to work with a selected group of states to meet the ASTHO President’s Challenge (‘8 by 14’) pledge. The initiative strives to ‘meet states where they are at’ through facilitate expert design teams and learning networks among a group of states. States will be selected through a competitive process.

Four states have been selected to participate in the learning network: CT, KY, LA and MI


At the conclusion of this project, NGA hopes to create best practice resources to share widely with other states to help inform

the development and implementation of key policies related to the improvement of birth outcomes in additional states

March of Dimes The ‘Big 5’

The March of Dimes Big 5 State Prematurity Collaborative is exploring data driven perinatal quality improvement through the development and adoption of evidence-based interventions and the data systems and tools required to track changes in specific perinatal issues and indicators. Recent efforts in CA, KY, NY, OH, NC, and other states have led to innovative population-based data driven approaches that provide information on potentially effective initiatives. Lessons have been learned in states that have implemented such approaches and the Big 5 have reviewed these and other efforts to identify a shared agenda focused on eliminating elective deliveries < 39 weeks.

CA, FL, IL, NY and TX

March of Dimes

Synergy exists around this data driven project that will not only establish an effective programmatic framework but also a network that can be instrumental in facilitating the rollout of future maternal and child health initiatives among the Big 5 states, and perhaps beyond

The Best Babies Zone (BBZ)

An initiative, working with designated geographic community "zones" in four pilot cities, to improve the health and well-being of women, children and families. The initiative applies a place-based systems approach to strategically align healthcare, education, economic and community systems in the designated geographic community "zones." This initiative has five key strategies for working with these geographic zones:

-  Bringing together key stakeholders
-  Providing technical assistance, establishing collaborative learning circles and developing tools
-  Implementing continuous quality improvement approaches for systematically assessing and improving impact
-  Monitoring, reporting and disseminating key findings and useful resources from across the sites
-  Developing a national and local communication network of interested individuals, organizations and agencies

Three pilot cities include: Cincinnati, New Orleans and Oakland

W.K. Kellogg Foundation

Pilot cities are intended to serve as models for other cities in the future.

Working with pilot sites, this project will document best practices and develop a playbook for a BBZ. These resources will be made available for MCH stakeholders.

CMS Strong Start for Mothers and Newborns Initiative

With an overall goal to reduce the risk of significant complications and long-term health problems for both expectant mothers and newborns, the initiative utilizes two strategies – public-private partnership to reduce early elective deliveries and funding opportunity for testing new approaches to prenatal care.

The public-private partnership to reduce early elective deliveries will examine ways to promote best practices and support providers in reducing early electives deliveries prior to 39 weeks.

The funding opportunity for testing new approaches to prenatal care will fund opportunities for providers, states and other eligible applicants to test the effectiveness of three enhanced prenatal care approaches (enhanced Prenatal Care through Centering/Group Visits, at Birth Centers or Maternity Care Homes) to reduce preterm births for Medicaid-covered women at risk for preterm births.

The public-private partnership will provide broad-based awareness building and dissemination of best practices for all MCH programs and stakeholders.

The Strong Start RFA was open to all geographic areas.

CMS Innovation Center was established through Patient Protection and Affordable Care Act funding

Partner in application to test new approaches to prenatal care