HARRISBURG — Problem-solving at the laundromat. Prenatal nutrition advice at the pharmacy. Mental health screenings through an app.
The Shapiro administration recently unveiled a five-year strategy to improve health outcomes for pregnant and postpartum women. Already, the group helming the effort has awarded nearly $600,000 to fund initiatives targeted at year-one goals, like supporting moms with substance use disorder.
After it collects data on how effectively care and education improved, the Shapiro administration plans to create a structure for the remaining years.
But while maternal health advocates broadly say the plan is packed with good initiatives, some are concerned about where the money will come from for goals that require consistent investment.
The administration drew on 16 roundtables and a statewide survey held over the past few years to build the strategic plan.
Pennsylvania had about 129 pregnancy-associated deaths in 2021, which is the most recent available data from the state Department of Health’s Maternal Mortality Review Committee. Nearly half those cases were linked to a mental health condition or substance use.
Black women also experience disproportionately higher rates of maternal mortality, both in the commonwealth and nationwide. According to the health department, African American or Black women were two times more likely to die of a pregnancy-associated death than white mothers.
Non-Hispanic white women died during live births at a rate of 28 per 100,000 in 2021, according to the agency, while Black or African American women died in 60 out of 100,000 live births.
Some of the plan’s first-year goals cover initiatives already in the works or ones the Shapiro administration can likely act on alone — like making it easier for mothers to access a variety of existing perinatal programs and behavioral treatments. Another goal is identifying and promoting scholarships that can help more doctors, nurses, and other providers of color enter the workforce, which officials hope will boost trust among patients of color.
There is no specific call on the General Assembly to fund any parts of the plan. In his proposed budget this year, Shapiro is asking for $7.5 million to build off the roughly $12.3 million Pennsylvania has spent since 2023 on maternal and child health programs.
Money is the biggest concern for many advocates.
“You can't ensure accessible maternal health care services across our state without new investments,” Nicole Stallings, CEO of the Hospital and Healthsystem Association of Pennsylvania, told Spotlight PA.
“This report is just the first milestone, and the hard work is ahead in really implementing the recommendations,” Stallings said.
Adrienne Griffen, executive director of the Virginia-based Maternal Mental Health Leadership Alliance, told Spotlight PA the administration deserves credit for a “terrific” and “incredibly ambitious" plan that will raise awareness and set the tone for actionable moves to address maternal mortality and morbidity rates.
However, Griffen worries about the state doing everything the plan sets out to do in such a short time frame.
“We see this awakening or this realization all across the country that states need to be doing more to address maternal mortality,” Griffen said. “The question is, what can you do given a limited number of dollars?”
Past maternal health spending has been directed toward expanding postpartum depression screenings, improving care for women with hypertension, increasing the number of people of color in the doula industry through training, and issuing grants to help establish four Regional Maternal Health Coalitions across the commonwealth. The administration’s new plan reemphasizes many of those initiatives.
During a news conference announcing the plan, Department of Human Services Secretary Val Arkoosh also pointed to a shift in 2024 that allowed some expenses related to certified doula services to be covered by Medicaid.
“These are really important accomplishments,” Arkoosh said. “But we’ve got to keep this momentum going.”
Inside the plan
Pregnancy-related deaths nationally have spiked over the past two decades, sending health officials scrambling to grapple with the issue. States like California, Colorado, and New York have each adopted their own maternal health plans in recent years.
In Pennsylvania, the Departments of Health, Human Services, Drug and Alcohol Programs, and Insurance collaborated to construct the administration’s effort.
“New parents deserve care that allows them to focus on what matters most: welcoming their new family member,” Shapiro and his wife, Lori, write in the foreword of the document. “This plan sets a path forward to help give our Commonwealth a better future.”
Jaimey Pauli, who heads maternal fetal medicine at Penn State Health, specializes in caring for patients who have high-risk conditions. She told Spotlight PA there is “a huge range” in how much her patients know about the resources available to them.
“We have a number of patients who are incredibly well-informed and have gone to the appropriate resources, and then come to us and ask the very important questions,” Pauli said. “There's another group of patients who may just not have a very high health literacy, or may depend on information from friends, social media, things like that.”
One goal of the plan is to increase access and collaborations among preexisting care systems — including doulas and peer support services, like meeting groups and hotlines — to “allow for greater cultural competency in providing care.” The plan calls for considering whether to create a Pennsylvania-specific “Birthing-Friendly Hospital” framework similar to an existing federal one, in which people comparing hospitals using a Centers for Medicare & Medicaid Services tool can see which facilities are considered especially committed to maternal health.
The Perinatal Action Collaborative (PAC), which is implementing the plan and has already created “actionable strategies,” awarded two grants earlier this year specifically targeted at access.
The money came from federal Maternal Health Innovation Program grants provided by the state Department of Health. PAC plans to distribute another round of funding sometime this spring, with more than $2 million total to work with through 2027.
Franklin Pediatrics in Venango County received $150,000 to provide services to postpartum women, intending to close a potential gap in care. Those services, aimed at women who bring their children to pediatrician appointments, will include lactation support and postpartum mental health resources, along with screening and references toward food and housing assistance programs.
Another grant, targeting Allegheny County and Philadelphia and awarded to Fabric Health, will use $150,000 to connect pregnant and postpartum women with ways to address food and utility insecurity, transportation needs, and access to insurance. Fabric Health carries out this work at laundromats.
PAC is run by the Pittsburgh-based Jewish Healthcare Foundation, and its 150 members are made up of Shapiro administration officials, health care providers, local maternal and family support organizations, and people “with lived experience,” according to its website.
Robert Ferguson, chief policy officer at the foundation, said that Pennsylvania has built a network of “really important assets” that uniquely position it to address maternal health issues, including the creation of the Maternal Mortality Review Committee in 2018.
The leading cause of pregnancy-associated deaths in Pennsylvania in 2021 involved mental health conditions, overdoses, and substance use disorders — accounting for roughly 47.3% of cases — the Department of Health found. Among the other top causes are injury (14.7%), cardiac and coronary conditions (13.9%), and hemorrhage (6.2%).
To address behavioral health risks during pregnancy and postpartum, the Shapiro administration wants to expand the educational information available to new mothers about relevant behavioral health services and create a universal screening system for postpartum depression, mental health, and substance use disorder.
“This can reduce stigma, improve access to care and resources for women … experiencing peripartum mental health needs, and improve integrated care programs,” the plan says.
PAC suggested doing so by creating a website or app, and awarded artificial intelligence company Phia Health $150,000 to develop and launch that platform in unspecified urban and rural counties. The intention, according to PAC, is to expand statewide.
Shapiro also wants to improve the Perinatal Telephonic Psychiatric Consultation Service Program, or TiPS, a hotline intended to connect patients with psychiatry and addiction medicine specialists.
‘We need to be ambitious’
As chair of the state legislature’s Black Maternal Health Caucus, state Rep. Morgan Cephas (D., Philadelphia) has been working with her colleagues on maternal mortality, with a particular focus on Black women’s increased risk of death or complications. She said Shapiro’s plan was “extremely comprehensive.”
“They really were intentional on doing their due diligence with getting a lot of different diverse perspectives and a lot of different viewpoints and vantage points,” Cephas told Spotlight PA, noting the administration’s many roundtable discussions and statewide survey.
Cephas said some of the proposals included in the formal plan are already in the works or are building off of past successes, like legislation passed in 2024 to require postpartum screenings and education for new mothers about symptoms and available treatments for postpartum depression.
Shapiro’s administration seeks to grow the number of doulas, community health workers, and home visitors who are Black or people of color through targeted apprenticeships and scholarships. Officials are also weighing a “health care mentors program” to diversify leaders in maternal health fields.
The plan says it will “consider funding existing successful programs that promote health care careers and track participation and outcomes.”
Cephas said the biggest hurdle to fulfilling Shapiro’s strategy will be the number of “competing interests” seeking money from the legislature this year.
“The plan is absolutely ambitious, but we need to be ambitious,” Cephas said.
Among the least contentious proposals in Shapiro’s plan is addressing the geographical gaps in high-quality prenatal care, according to Allegheny County Democrat Dan Frankel, who chairs the state House Health Committee. He said he expects his colleagues on both sides of the aisle to support the administration’s efforts.
Republican Michele Brooks of Crawford County, who chairs the state Senate Health Committee, declined to comment on Shapiro’s maternal health plan. Neither state Senate Majority Leader Joe Pittman (R., Indiana) nor President Pro Tempore Kim Ward (R., Westmoreland) responded to a request for comment.
National advocacy group March of Dimes has identified six counties in Pennsylvania as maternity care deserts: Cameron, Forest, Fulton, Perry, Snyder, and Sullivan.
The plan calls for collaboration with state agencies and Federally Qualified Health Centers to identify weak points in care, as well as the development of emergency training in areas that lack a hospital with maternal expertise.
PAC gave nearly $150,000 to the University of Pittsburgh School of Pharmacy, which helps organize about 200 local pharmacies across 48 counties called the Pennsylvania Pharmacists Care Network. The money is intended to expand the network’s running of blood pressure screenings, social needs evaluations, guidance on safe medicines, and prenatal nutrition advice to more counties, including Greene, Mercer, Venango, Clarion, and Clearfield.
Pennsylvania received $193 million in federal funding for the first year of its five-year rural health care plan, and the Shapiro administration has said it will use a portion to improve maternal health services.
That $193 million is meant to make up for large-scale cuts to Medicaid, but it falls far short of filling the hole. Stallings of the Hospital and Healthsystem Association of Pennsylvania said many rural hospitals already face possible closures. Their situations are expected to worsen, she said, as federal cuts to Medicaid roll into effect.
State House Speaker Joanna McClinton (D., Philadelphia) said progress on maternal health legislation has been one of the “great policy successes” of her caucus since it took power in 2023.
“Our work is not done,” she said in a statement. “This session, the House has advanced legislation requiring private insurers, along with Medicaid and CHIP, to cover blood pressure monitors for expectant moms, engaging fathers in maternal health, and expanding midwifery — all await action in the Senate.”
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