On March 11, 2021, the American Rescue Plan Act of 2021 was signed into law, including the appropriation of more than $130 billion to the Coronavirus Local Fiscal Recovery Fund, for making payments to metropolitan cities, counties, and other units of local government to mitigate the fiscal effects stemming from the public health emergency. Hennepin County expects to receive direct payments from the U.S. Treasury totaling more than $220 million and received the first-half payment of $122.9 million in May of 2021.

The American Rescue Plan Act provides that money from the Coronavirus Local Fiscal Recovery Fund may only be used to cover certain costs incurred by December 31, 2024, including costs to respond to the public health emergency with respect to the Coronavirus Disease 2019 (COVID–19) or its negative economic impacts Under the available guidance from the U.S. Treasury, this category of eligible costs can include payroll costs, support for vulnerable populations to access medical or public health services; public communication efforts; support for prevention, mitigation, or other services in key settings; enhancement of public health data systems; and other public health responses.

Hennepin County Public Health (HCPH) is requesting support to address maternal and infant health outcomes through new partnerships and services. This work will enhance and further operationalize the department’s health and racial equity commitment in, and with, the community. Funding will expand existing maternal health services through new partnerships and will alleviate the impact of many societal challenges worsened by COVID, called “secondary” effects of COVID, including social isolation, economic instability, and access to care. HCPH is seeking resources to expand the department’s capacity to provide and assure maternal and child health surveillance (i.e., data gathering, monitoring, and assessment), health education, and promote access to healthcare in the community.

“Maternal mortality,” or death of a person from complications of pregnancy or childbirth, and “maternal morbidity, illness or injury” caused by or associated with pregnancy or childbirth, are key indicators of maternal health and foundational to the public’s health. The number of reported pregnancy-related deaths in the United States steadily increased from 7.2 deaths per 100,000 live births in 1987 to 17.3 deaths per 100,000 live births in 2017, when data was last released from the Pregnancy Mortality Surveillance System.

Available data consistently show that the rate of maternal death among black mothers is more than double that of white mothers nationally. The preterm birth rate has been rising nationwide since 2014. Additionally, racial and ethnic differences in preterm birth rates persist. For example, in 2019, the rate of preterm birth among Black women (14.4%) was about 50 percent higher than the rate of preterm birth among white or Hispanic women (9.3% and 10% respectively). National and state data on maternal mortality is limited due to inconsistencies in data collection and reporting. The definition and timeframe of what constitutes a pregnancy or childbirth related death varies across national and state agencies and therefore, the data is collected differently, if at all, represents different measures, and cannot be compared. HCPH does not currently report maternal mortality rates, for this reason.

Public health, health care providers, community resource partners, cultural leaders, and families have a role in improving maternal health outcomes. Stress, trauma, racism, poverty, and other social determinants of health, as well as access to preconception and prenatal care, and many other social supports all impact maternal health outcomes. Preconception care refers to health care that reduces a person's reproductive risks before conception through risk assessment and health promotion.

Maternal health and birth outcomes are inextricably linked to infant health outcomes. Therefore, while the focus of this request is on maternal health, it is expected that the proposed activities will also improve infant and family health.

In response to direction from the Board of Commissioners to invest in maternal and infant health outcomes - specifically for black, indigenous and people of color - staff recommend the use of Federal Pandemic Funds in four key areas, described below. 

Through new and strengthened partnerships, expand existing programs focused on improving maternal health outcomes for black, indigenous and people of color. Funds will be allocated to expand maternal and child health services, such as Obstetrics Care Coordination and supportive services offered through NorthPoint Health and Wellness Center’s Integrated Care for High-risk Pregnancies (ICHRP). Additionally, funds will be allocated to enhance implementation of culturally congruent doula services, social service supports and health education using a trauma-informed approach at Hennepin Healthcare’s East Lake Clinic and Redleaf Center.

Develop and implement a birth justice plan to improve maternal and infant health outcomes for black, indigenous, and people of color. This will build on previous community engagement and community-initiated solutions to address infant health outcomes in Hennepin County, such as the 5 year Infant Mortality Among African Americans Project and will use a community engagement model that brings together the perspectives of the community to co-create a strategic plan to address maternal health outcomes.

Invest in community-initiated solutions and culturally congruent and innovative practices to reduce disparities. This might be accomplished by working in and with community-based organizations that provide health services, augmenting and supporting their ability to implement culturally congruent services such as doula care, home visiting, or other innovative approaches to addressing social determinants of health that impact maternal health outcomes.

Increase HCPH’s capacity for data collection, reporting and analysis to support measurement strategies that will allow for accurate and timely monitoring of the social determinants of health, and health and racial equity, as they relate to maternal and infant health. For example, enumerating the number of maternal deaths, the number of infants born at low birth weight, and other maternal factors in these cases, disaggregated by race and ethnicity.

HCPH is requesting this funding to increase our capacity to meet HCPH’s responsibilities in partnership with communities most impacted by poor maternal health outcomes. The department’s expertise in data and assessment, and it’s focus on population health positions it to convene partners and provide resources to existing programs and new, innovative approaches.

Current Request:

The current request is to authorize federal funding in the amount of up to $10 million to hire up to 5 full time equivalent positions and contract for services to support critical maternal and child health public health activities, create community-initiated solutions, and evaluate initiatives to improve maternal health outcomes for people and communities experiencing poor outcomes, especially black and indigenous mothers in Hennepin County; and delegate authority to the County Administrator to negotiate agreements for services.