State variations in maternal and child health workforce support

Maternal and child health (MCH) indices can identify areas of opportunity to address maternal and infant health needs but tend to lack measures specific to MCH workforce support.

To address this gap, we developed the MCH Worker Supportive Policy Index, a composite index of 28 policy indicators across 4 domains: midwifery workforce, doula workforce, labor policy, and economic policy. We scored each measure on a 100-point scale, where larger values represent more supportive policies. We calculated a state-level average for each subindex and then averaged each subindex's average to produce the overall state-level MCH Worker Index.

Scores ranged from 23 (Wyoming) to 92 (California), with high-scoring states offering Medicaid expansion, paid family leave, protections for LGBTQ+ workers, and Medicaid reimbursement for doula services. Higher scores on the Midwifery Workforce Index were correlated with greater certified nurse midwife supply, fewer maternity care deserts, and lower cesarean delivery rates (P < .05).

These findings underscore how supportive policies, such as scope-of-practice expansion and reimbursement parity, may support greater workforce availability and better perinatal outcomes. These findings highlight both state-level assets and opportunities for improvement and can inform planning and policy efforts targeted towards sustaining a thriving MCH workforce.