Rutgers Health's evaluation of Nurture NJ examines efforts to expand access to services provided by midwives, doulas and lactation consultants
The availability of maternity care services varies considerably throughout New Jersey hospitals with those having the fewest services are more likely to serve Hispanic patients, while those with the most services serve a larger proportion of White patients, according to Rutgers Health researchers.
These are among the key findings of a Rutgers School of Public Health report titled, "Assessing the Availability of Maternity Care Services at NJ Hospitals: Access to Midwives, Doulas and Lactation Consultants," which evaluates efforts of the statewide initiative Nurture NJ to expand access to critical maternity care services provided by midwives, doulas and lactation consultants.
The research of Rutgers School of Public Health highlights precisely why our mission remains urgent. Through Nurture NJ, we have furthered our goal of a maternal health system that serves every New Jersey family by expanding access to birth support training for doulas and midwives and providing lactation support for new mothers, but more work is needed to ensure that access is equitable across the state.
Tammy Murphy
First Lady
Launched in 2019, Nurture NJ aims to make New Jersey "the safest and most equitable place in the nation to deliver and raise a baby." Policies advancing this goal include making doula care a Medicaid-covered benefit, increasing reimbursement rates for providers (including pay equity for midwives and obstetricians), ensuring doulas have access to hospitals and investing in midwifery education and training to expand the workforce.
To assess the availability of maternity care services following these efforts, members of the Rutgers School of Public Health evaluation team collaborated with the New Jersey Health Care Quality Institute to analyze data from the 2024 Maternity Care Report by the Leapfrog Group, a national non-profit that collects and reports on hospital care metrics, combined with NJ Department of Health hospital demographic data.
The analysis focused on hospitals' reports regarding the availability of certified nurse-midwives or certified midwives for attending births, whether patients could bring their own doulas, whether the hospital employed or contracted with doulas and the availability of lactation support within the hospital, in outpatient settings and at home.
Key findings from the evaluation include:
- Doulas: Ninety-one percent of hospitals permitted patients to bring their own doulas, and 22 percent also employed or contracted with doulas.
- Lactation support: All hospitals reported providing lactation support onsite, and 64 percent offered outpatient support while 38 percent provided support at home.
- Midwives: Eighty-four percent of hospitals reported having midwives that attend births available, and only 16 percent did not.
The evaluation team categorized hospitals as having low, average or high maternity care service offerings. The evaluation found that Hispanic and Asian families are disproportionately cared for in hospitals that have fewer maternity care resources available. Researchers said addressing service gaps in these hospitals could have a significant impact on health equity.
"Our analysis provides preliminary evidence of racial and ethnic disparities in access to perinatal health care services in New Jersey, and calls into focus the need for more research to better understand these challenges and the potential of policies to address these disparities,"said Slawa Rokicki, who led the analysis and is an assistant professor in the Department of Health Behavior, Society and Policy at the Rutgers School of Public Health.
The findings suggest that barriers remain to increasing access to the full range of maternity care providers, including low reimbursement rates for doulas and lactation consultants, inequitable midwifery reimbursement rates in commercial insurance and Medicaid MCOs, and midwifery workforce shortages.
According to the researchers, given the proven benefits of midwives, doulas, and lactation consultants for maternal and infant health, strategies to address service gaps across New Jersey hospitals are critical for advancing maternal health equity.
"The research of Rutgers School of Public Health highlights precisely why our mission remains urgent," said First Lady Tammy Murphy. "Through Nurture NJ, we have furthered our goal of a maternal health system that serves every New Jersey family by expanding access to birth support training for doulas and midwives and providing lactation support for new mothers, but more work is needed to ensure that access is equitable across the state."
This analysis is part of a broader evaluation of Nurture NJ conducted by the Rutgers School of Public Health and led by Leslie M. Kantor, a professor and chair of the Department of Urban-Global Public Health.
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