State variations in maternal and child health workforce support

Area of Science:

• Public Health
• Health Policy
• Maternal and Child Health

Background:

• Maternal and child health (MCH) indices often lack measures for MCH workforce support.
• Existing indices do not fully capture the policy landscape influencing the MCH workforce.

Purpose of the Study:

• To develop and validate a composite index measuring MCH worker supportive policies at the state level.
• To assess the relationship between supportive MCH policies and workforce availability and perinatal outcomes.

Main Methods:

• Developed the MCH Worker Supportive Policy Index, a composite of 28 policy indicators across midwifery, doula, labor, and economic domains.
• Scored policies on a 100-point scale and calculated state-level averages.
• Analyzed correlations between index scores and MCH workforce/outcomes data.

Main Results:

• State scores ranged from 23 (Wyoming) to 92 (California).
• High-scoring states featured Medicaid expansion, paid family leave, LGBTQ+ worker protections, and Medicaid doula reimbursement.
• Higher Midwifery Workforce Index scores correlated with greater certified nurse midwife supply, fewer maternity care deserts, and lower cesarean delivery rates.

Conclusions:

• Supportive policies like scope-of-practice expansion and reimbursement parity can enhance MCH workforce availability and improve perinatal outcomes.
• The MCH Worker Supportive Policy Index can identify state-level assets and opportunities for policy development to sustain a thriving MCH workforce.