Better Management and More Resources Needed To Strengthen Federal Efforts To Improve Pregnancy Outcome

HRD-80-24: Published: Jan 21, 1980. Publicly Released: Jan 21, 1980.

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The federal government, along with state and local health agencies, has a number of health care programs directed at preventing or better timing pregnancies and improving the health and well-being of mothers and infants. However, a comprehensive national strategy for using and coordinating funds and staff involved in these numerous and fragmented programs is lacking. Federal funds have been inadequate for extending health care services to all areas and to all of those in need, while some areas have duplicate projects.

The two major federal programs targeted at improving pregnancy outcome are the Maternal and Child Health (MCH) program administered by the Department of Health, Education, and Welfare (HEW) and the Special Supplemental Food Program for Women, Infants, and Children administered by the Department of Agriculture. Family planning programs in recent years have helped to prevent unwanted or unplanned pregnancies. However, many women continue to have unwanted, unplanned, or ill-timed pregnancies and significant amounts of welfare costs can be attributed to adolescent pregnancy. The effect of the HEW programs to prevent pregnancies, especially high-risk ones, is questionable because services are not always available, accessible, or effectively used. Although progress has been made, women and infants in some locations still do not have easy access to appropriate labor and delivery services or infant care units, and many areas still do not have regionalized systems of perinatal care. Despite the problems that persist, some federal agencies and programs, such as MCH, Medicaid, National Health Service Corps (NHSC), Improved Pregnancy Outcome, and Improved Child Health, have helped to provide access to health care for many women and infants.

Matter for Congressional Consideration

  1. Status: Closed

    Comments: Please call 202/512-6100 for additional information.

    Matter: Congress should: consolidate Federal programs funding similar types of activities, or if not feasible, require coordination of activities; provide funding for an education and information campaign; designate one agency official to be responsible for coordinating Federal efforts for improving pregnancy outcome; revitalize the MCH program; direct HEW to identify those Federal programs which affect pregnancy outcome and require through legislation that the administering agencies give State MCH agencies an opportunity to participate in monitoring and evaluation; earmark funds for family life education programs; amend Title X of the Public Health Service Act to give priority to family planning services for low-income women and to designate one organization to provide family planning services in each State and local area; increase Federal training funds for nurse-midwifery; require States to extend Medicaid eligibility for prenatal and delivery care for low-income women regardless of family status; require State Medicaid programs to cover essential prenatal and delivery services; direct HEW to give higher priority to improving pregnancy outcome in project grant programs; consider making more Federal funding available for prenatal care, preventing adolescent pregnancy, and health education; and clarify section 334 of the Public Health Service Act to include State and local governments among those eligible for cost reimbursement waivers for NHSC personnel.

Recommendation for Executive Action

  1. Status: Closed

    Comments: Please call 202/512-6100 for additional information.

    Recommendation: The Secretary of HEW should direct the Assistant Secretary for Health to: formulate national goals for improving pregnancy outcome; consider the feasibility of formulating goals for alleviating infant morbidity or birth defects and providing infant care; and consider possible Federal actions to help poor persons gain access to in-hospital obstetrical or infant care. The Secretary of HEW should: designate one official to be responsible for planning, coordinating, promoting, and evaluating HEW efforts to improve pregnancy outcome; direct that State MCH agencies be able to comment during the HEW review process; require component agencies to develop a comprehensive plan for each State; develop a strategy for integrating agency resources with public health department and private organization efforts; inform public and private health care organizations and school officials at the local level of resources that can be used to improve pregnancy outcome; define what constitutes satisfactory progress in improving pregnancy outcome and monitor States' performance against this definition; specify how and to what extent States are to give priority to using MCH funds; define the essential elements and develop milestones so that State progress in developing regionalized perinatal health services can be evaluated and monitor progress; consider what incentives would be appropriate to encourage and assist States to hasten efforts to regionalize perinatal care and integrate public and private health care sectors and make recommendations to Congress; enforce requirements for Community Health Centers to provide prenatal care, perinatal care, family planning, and well baby care and provide assistance that such grantees may need to comply; consider the feasibility of additional MCH funds earmarked specifically for prenatal care until sufficient resources are available; work with professional organizations; require health planning agencies to assess the extent to which physician refusal to accept Medicaid or other low-income patients; launch a major nationwide information and education campaign; determine whether State Medicaid fee structures comply with HEW regulations requiring that they be designed to enlist the participation of a sufficient number of providers; encourage greater use of nurse-midwife/obstetrician teams; and identify what HEW will consider minimally acceptable prenatal care in Federal assistance programs. Other recommendations are listed in the report.

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