Vision
New Jersey will be the safest and most equitable place in the nation to deliver and raise a baby.
Mission
All women of color, particularly African-American women, should achieve maternal and infant health and survival rates on par with whites and other ethnic groups, and New Jersey will achieve a significant and sustained improvement in the overall maternal and infant morbidity and mortality rates.
Values
Achieving equity for all women requires dismantling structures that support inequitable processes and building or shoring up processes that support respectful care.
9 Action Areas & Recommendations
This plan focuses on 1) the dismantling of structural racism, community power-building and engagement to support all aspects of planning and implementation, 2) multisector collaboration to address upstream root causes that lie outside the realm of influence of public health and medicine, and 3) a commitment to systematically build the Ecosystem that makes all recommended components accessible to all women, particularly in low resource/high need communities.
The Nine Action Areas from the Nurture NJ Strategic Plan.
The following nine action areas are designed to be inclusive of all stakeholders in the state, and to reflect the Nurture NJ vision and values. It should be noted that recommendations included in the Nurture NJ Year-One Implementation Playbook can be cross walked below.
Racism finds its way into all systems affecting the health of women and children—including health, social services, criminal justice systems, housing, food systems, employment, etc. For Nurture NJ to be successful in achieving equity in maternal and infant outcomes and in making New Jersey the safest place to give birth, some hard work is needed to dismantle the systems that hold racism in place both inside and outside government. What makes Nurture NJ distinct from other strategic plans is its commitment to eliminating the role that racism plays by systematically restructuring the systems that hold racism in place. Therefore, new structures need to be built to both provide people with the capacity and skills to undo racism, and to ensure that the requisite equity-promoting actions become a part of every person’s and organization’s DNA.
New Jersey experiences profound disparities in outcomes for the state’s mothers and babies. Structural racism underlies this disparity and can only be changed by restructuring to promote— and never inhibit—the attainment of racial equity. These recommendations are designed to build new processes and accountability structures to facilitate achievement of racial equity across all sectors in New Jersey through actions, procedures, and policies. These recommendations aim to ensure that racism is addressed in all the institutions that have connection to the life experiences that affect the health of African American, Indigenous, Latina, Asian, Pacific Islander, lower income whites, LGBTQI+, rural, immigrant, and other special needs women and their babies.
Recommendations
- 1.1 All state departments and agencies should be required to implement a plan for increasing and maintaining capacity to promote racial equity in all systems and structures.
- 1.2 Declare racism a public health crisis.
- 1.3 Establish an Office for State Diversity, Equity, and Inclusion to reflect the increased priority, enable a greater level of collaboration, and address the state's equity needs.
- 1.4 Create a state-led accrediting body empowered to award a “racial equity designation” for the public and private sectors.
- 1.5 The state should convene the private sector to incentivize and engage them in action on racial equity.
- 1.6 Build upon the Nurture NJ Interdepartmental Working Group to break down internal silos and share possibilities for collaboration.
- 1.7 Explore the process and impacts of existing Truth, Racial Healing and Transformation (TRHT) processes in other states to determine potential impact in New Jersey.
During the Nurture NJ strategic planning process, the voices of women in New Jersey communicated loudly and clearly “not about us, without us”, meaning: “listen to us; do not make decisions that profoundly affect our lives without us at the decision-making table.” The Strategic Plan outlines specific actions to structure this engagement into practice.
Community engagement in decision-making is only the first step. Effective collaboration between residents and agencies requires support for communities to build their own knowledge base, conduct their own critical analyses, and enhance their leadership skills. The Strategic Plan includes recommendations to ensure a sustained, effective, and structured process of community power-building and engagement.
Recommendations
- 2.1 State departments and agencies, in partnership with the private sector, non-profits, community leaders, and funders, should develop infrastructure for community-level power- and knowledge-building in communities with high Black maternal and infant mortality.
- 2.2 All state departments and agencies should be required to issue written statements of their commitment to community engagement.
- 2.3 Develop permanent structures to integrate community partnership into state, county, and local decision-making processes.
- 2.4 Develop incentives for all public and private entities that increase multisector and cross-state collaboration and community engagement.
To achieve the vision of Nurture NJ, private sector participation is as critical as public sector participation for the needed values-based transformation for the state. All sectors must be engaged—education, housing, health, business, government, policy, justice, service providers, and each of these sectors needs to work with racial equity awareness, practices, and processes.
The Strategic Plan makes a series of recommendations to ensure that all sectors play a role in achieving improved outcomes, and that they work collaboratively to achieve outcomes no single stakeholder or sector could achieve alone. This Plan also recommends implementation of a place-based model that the highest need communities can embrace to demonstrate the positive impacts of building a supportive community environment and institution for health.
Recommendations
- 3.1 Develop public-private partnerships to implement place-based, community partnered change models in areas with the highest Black maternal and infant morbidity and mortality and then expand to every community across New Jersey.
- 3.2 The funders collaborative in support of Nurture NJ should support a Nurture NJ Coordinator to oversee implementation of the Nurture NJ Strategic Plan.
- 3.3 Establish a Center in the state capital that focuses on innovation and research in maternal and infant health through partnerships with the state’s academic, funder, business, and faith communities.
Mindset shifts are important first steps because they allow redefinition of the range of possibilities available to apply as solutions in health and public health design, policy, research, and implementation. Several mindsets pervading the practice of maternal and infant health that are in need of transformation are addressed in this Plan.
There are implicit and explicit beliefs in a de facto hierarchy of human value, with Black and brown people valued less than others. Racial equity is fundamental to dismantling the structures based on a hierarchy of human value contributing to actions that maintain or create inequities.
Recommendations
- 4.1 State, county and local leaders should leverage the declaration of racism as a public health crisis to generate media coverage and facilitate community dialogues.
- 4.2 Through a statewide communications campaign, shift ideology around the role of life course experiences, environmental and social exposures on women and infant health.
- 4.3 Develop a communications plan to promote benefits of midwifery and community doula models of care.
- 4.4 Develop a communications plan to encourage mindset shifts regarding the connection of behavioral and physical health services.
- 4.5 Actively shift public and private sector mindsets on benefits of shared decision-making with community.
- 4.6 Ensure understanding of the importance of human-centered and trauma-informed care practices and expand use among all program planners and providers.
- 4.7 Private sector businesses and/or their associations should fund, conduct and disseminate a business case for racial equity analysis specific to New Jersey.
- 4.8 Reframe the statewide targets in Healthy NJ 2030 to eliminate disparities in Black versus white rates.
To understand the unique policy dynamics affecting women in New Jersey, the Nurture NJ strategic planning team conducted nearly 30 interviews with policymakers operating at the state level, asking which current policies most influenced maternal health, and which policies could influence maternal health in the future. The policy recommendations reflect expansion of the extraordinary work currently undertaken by public servants, as well as a desire to broaden and strengthen policies to create a supportive environment for health.
Recommendations
Recommendations to Achieve Healthy Women:
- 5.1 The State should continue to invest in opportunities for safe, decent, toxin-free affordable housing.
- 5.2 The Secretary of Higher Education should expand successful programs that improve access to high quality education.
- 5.3 The Department of Treasury should increase uptake of the Earned Income Tax Credit.
- 5.4 The Department of Labor should continue their efforts with employees and employers to expand utilization of the paid family leave benefits.
- 5.5 The Department of Health should increase the utilization of the Women, Infants and Children (WIC) Program through policy changes and program modernization.
- 5.6 The Department of Human Services should continue to expand flexibility in the Supplemental Nutrition Assistance Program (SNAP) to ensure the maximum number of eligible families are enrolled and utilizing the benefit.
Recommendations to Achieve Equitable Service and Care:
- 5.7 New Jersey should affirmatively provide for comprehensive family planning services and reproductive autonomy through policy and in funding.
- 5.8 The Department of Human Services should strengthen efforts to make the health system accountable to women of color through reliable coverage and evidence-based care.
- 5.9 The Division of Consumer Affairs should examine standards of care related to maternal and infant health.
- 5.10 The Department of Health should implement a system of community-designed, real-time maternal feedback on quality of care.
- 5.11 The Department of Health, the Office of the Secretary of Higher Education, and the Department of Labor should promote workforce development and retention in communities of color.
- 5.12 The Office of the Attorney General, through the Division of Community Affairs, should develop pre and post licensure education for New Jersey’s health professions.
- 5.13 The Department of Human Services and Department of Health should support a representative, effective community workforce serving pregnant individuals and babies.
- 5.14 The Department of Human Services should continue to ensure comprehensive access to health care for women through the Medicaid program by seeking funding and federal approval to expand Medicaid to 365 days postpartum.
- 5.15 Assess models for value-based care to ensure they do not penalize health providers that disproportionately serve communities with high social needs.
- 5.16 Through the Nurture NJ Interdepartmental Working Group, state departments and agencies should conduct a community-led analysis of co-location of community-based government assets.
- 5.17 Craft and disseminate an “advised procedure” for how county prosecutors work with pregnant women, including the possibility of delaying sentencing for the period of pregnancy and three months postpartum.
Recommendations to Achieve Supportive Environments and Institutions:
- 5.18 The Department of Health should work with state leaders to provide breastfeeding support in communities for both mothers, fathers and other partners.
- 5.19 The Department of Children and Families should continue to expand and universally offer evidence-based home visiting programs with focus on those models proven to reduce maternal and infant mortality.
- 5.20 The Department of Education should continue to prioritize access to high quality childcare through Early Head Start.
- 5.21 State leaders should increase the state contribution to the childcare block grant to ensure that, at a minimum, all families within the income limits are able to receive care.
- 5.22 The New Jersey Economic Development Authority should provide targeted support to childcare providers as a critical industry in the state.
In order to ensure that New Jersey is making the best decisions, the state must have a clear understanding of the data describing conditions on the ground and across sectors. The Nurture NJ Strategic Plan envisions improvement in the collection of data on women’s experiences, use of linked state data and evidence, and improved accessibility to data for accountability purposes. The Plan also envisions improved dissemination of data to stakeholders across the state who need the information to develop better solutions.
Recommendations
- 6.1 Publish a biannual journal or magazine for maternal and infant health in New Jersey through the proposed Center for Maternal and Infant Health (recommendation 3.3) and an academic partner.
Recommendations to Achieve Equitable Service and Care:
- 6.2 Improve the process for quality and usage of state maternal mortality data through significant reinvestment in the Maternal Mortality Review Committee (MMRC).
- 6.3 The Department of Human Services and Department of Health should work together to improve accountability to women of color through data transparency.
Recommendations to Achieve Supportive Environments and Institutions:
- 6.4 The Department of Health, in collaboration with academic partners, should develop a data-based approach to racial inequity surveillance able to identify health and social disparities and focus approaches.
- 6.5 The academic community in New Jersey should commit to conducting research to monitor and evaluate changes in community engagement, perceptions (mindsets, narrative change), changes in community-supportive policy, and resultant health impacts in populations of color in New Jersey.
Recognizing that most organizational structures were not designed to accommodate innovative approaches and designs such as multisector engagement for collective impact, community engagement, racial equity, and human-centered approaches, the Strategic Plan makes a series of recommendations that can change structures to better handle transformative approaches and interventions.
Recommendations
Recommendations to Achieve Healthy Women:
- 7.1 Staff of key state departments and agencies should become familiar with Nurture NJ Ecosystem in order to use it to guide and prioritize all program development, implementation, monitoring, and evaluation.
- 7.2 The Department of Human Services and Department of Health should ensure access to affordable, equitable integrated behavioral health care at all times over the life-course.
- 7.3 Provide access to the full range of family planning services, including all safe and effective contraception methods and abortion care, through stronger provider relationships.
- 7.4 Strengthen and expand practice of the midwifery model of care in New Jersey by building a more robust workforce pipeline.
- 7.5 All 49 birthing hospitals and the birthing facilities in New Jersey should meet or attain rates lower than the national target for NTSV surgical/cesarean births.
- 7.6 The Department of Health and the Department of Human Services should expand the use and improve the utility of the Perinatal Risk Assessment.
- 7.7 New Jersey hospitals should institute systemic changes to accommodate doulas and safe birth practices.
- 7.8 To promote access to comprehensive, continuous, high-quality maternal care services, the state should design tools to promote shared decision-making with patients.
- 7.9 The New Jersey Perinatal Quality Collaborative (NJPQC), the organization responsible for improving the quality of perinatal care throughout the state, should lead implementation of prenatal and postpartum Alliance for Innovation in Maternal Health (AIM) bundles across the state.
- 7.10 All persons who give birth in New Jersey should be cared for at a birthing hospital or facility that provides the appropriate level of maternal care by the end of 2022.
- 7.11 The Department of Health and Department of Human Services and other relevant departments or agencies should collaborate on a plan to develop community-based providers, including birthing centers, in underserved areas.
- 7.12 The Department of Health should work with New Jersey health care providers to increase accountability on racial equity initiatives.
- 7.13 State leaders should assess the benefit of regulatory relief to underserved communities and providers.
- 7.14 State leaders should increase funding for prenatal and reproductive health care for undocumented women.
Recommendations to Achieve Supportive Environments and Contexts:
- 7.15 The Department of Health and Department of Human Services should continue to strengthen the community health worker workforce.
- 7.16 State departments and agencies and health care providers should incorporate community-based perinatal health workers in an interdisciplinary care approach to support pregnant women and caregivers into the postnatal period.
- 7.17 Continue to expand and strengthen Fatherhood Engagement Initiatives.
- 7.18 Continue to improve and transform Central Intake.
Women and infant health and well-being are often determined by factors outside the health system, as well as by factors that exist before a pregnancy begins. Addressing social determinants of health means ensuring that families live in conditions that are always supportive of health, ensuring protection against adverse exposures, and providing remediation against barriers to access to needed care, services, and healthy behavioral practices. The set of recommendations in this action area ensures access to resources and conditions to attain and maintain health in environments where people live, work, play, study and seek help.
Recommendations
Recommendations to Achieve Healthy Women:
- 8.1 Regional health hubs should work collaboratively with state departments and agencies, private funders, community and grassroots groups, and academic leaders on a landscape analysis in the state’s Black maternal and infant health hotspots.
- 8.2 New Jersey’s stakeholders in the nutrition sector should expand partnerships to develop multisector efforts to address the specific issue of access to healthy foods.
- 8.3 Develop multisector efforts to address the specific issue of the impact of environmental factors on maternal and infant health.
Recommendations to Achieve Equitable Service and Care:
- 8.4 Develop multisector efforts to address the specific issue of transportation access for women.
- 8.5 Recommendations to Achieve Supportive Environments and Contexts:
- 8.6 New Jersey’s housing developers, funders, advocates, and stakeholders should develop multisector efforts to increase the availability of quality, affordable housing for pregnant individuals and women with young children.
- 8.7 Develop multisector efforts to address the specific issue of women impacted by the criminal justice system.
Improving the delivery of respectful, equitable and evidence-based care is critical to achieving the Nurture NJ goals. This requires transformation in the way care and services are delivered by health and other service providers. All of the preceding action areas and the recommendations contained within them are foundational to being able to deliver equitable, effective, and evidence-based care to individuals.
The set of recommendations contained in this action area focus on the process of care and service provision and will be effective insofar as they are implemented on top of the foundational structures of racial equity, community engagement and multisector collaboration.
Recommendations
Recommendations to Achieve Healthy Women:
- 9.1 Ensure quality and respectful preconception, interconception care and women’s wellness care is available, accessible and affordable for all women, and that it conforms to CDC Guidelines.
Recommendations to Achieve Equitable Service and Care:
- 9.2 Secure a Commitment to Action from the CEOs of all health care systems and leadership of health professional societies in New Jersey, which should include action steps to reduce maternal and infant mortality and morbidity.
- 9.3 Increase access to Centering Pregnancy.
- 9.4 The Department of Human Services should ensure access to comprehensive evidence-based childbirth education for all Medicaid beneficiaries as standard practice of prenatal care.
- 9.5 Increase the number of Baby-Friendly designated hospitals in New Jersey to at least one hospital in all infant mortality hotspot areas.
- 9.6 Normalize active engagement of fathers and other partners during prenatal care, labor and delivery, and postpartum care.
- 9.7 The Department of Banking and Insurance should continue outreach to pregnant women.
Recommendations to Achieve Supportive Environments and Contexts:
- 9.8 Ensure all parents receive community -based peer support for postpartum health, breastfeeding, and social support.
- 9.9 Health care providers, social service providers, and health insurers should promote alternative models of early childhood care to expand care for the infant.