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AIM CCI is encouraging communities to come together using their Maternal Monologues Toolkit, whereby birthing people and their support systems can share their experiences related to the maternal health journey, illuminate what the national maternal health crisis looks like in their own community, and strategize about what they can do to address it. In this episode, Race for Equity's Deitre Epps is joined by Dr. Valerie Newsome Garcia to discuss how to use this toolkit and the importance of community storytelling in understanding and advocating for change in maternal health.
We are the Maternal Health Learning and Innovation Center, a network of maternal health equity experts and organizations working to make real change for women and birthing people in the U.S.
Our podcast is a series of episodes connecting around culture, lifting voices and stories, exploring innovations in maternal care and discussing ways we can center equity in the way we approach our health and wellness.
Learn more about us, explore our resource center and find support for all maternal health professionals at MaternalHealthLearning.org.
For more podcast information and content, visit MaternalHealthPodcast.org.
KRISTEN: Welcome to this special bonus episode
of the Maternal Health Innovation podcast. I'm
your host, Kristen Tully, research faculty at
the University of North Carolina at Chapel Hill,
in the Department of Obstetrics and Gynecology,
and with the UNC Collaborative for Maternal and
Infant Health. This pod is created by the Maternal
Health, Learning and Innovation Center, and these
conversations address maternal health equity and
systems change for strengthening maternal health.
In this episode, we'll be discussing Merck for
Mothers and their commitment to shifting the landscape to eliminate maternal mortality globally. I'm joined by Jackie
Caglia, director of Learning, Communications and
US programs at Merck for Mothers to learn more
about how they've been working to improve maternal
health outcomes through grant making and strategic collaborations. Thank you for joining me, Jackie.
JACQUE: Thanks so much for having me on the show,
Kristen. And really, congratulations to you and
the team on all of the engaging and thought provoking
episodes that you've had to date.
KRISTEN: It's really wonderful to get to know people behind changing the world.
So thank you for making time for this. And would
you please share a little bit about yourself and
Merck for Mothers?
JACQUE: Sure. Happy to. So my name is Jackie Caglia
and I am a director at Merck. I'm part of the
team within our company's Office of Social Business
Innovation that is leading our company's global
maternal health initiative called Merck for Mothers.
I myself am a proud public health practitioner,
and throughout my career, I've really been working
at the intersection of community and impact and
evaluation in some form always centered on improving
maternal and newborn health. And personally, I've
had the pleasure of working for a number of great
nonprofit organizations both here in the US and focused globally as well as a number of
academic institutions, before coming to the private
sector in early 2019 for my current role. And
more importantly, Kristen, I'm a wife, I'm a sister,
I'm a bonus mama to three awesome kids, I'm a
daughter, I'm not a friend. And really, all of
that is why I do this work for pregnant people
and those who care for them, because I believe
in stronger health systems and I really believe
that society as a whole is stronger when people
are healthy and supported around pregnancy and
childbirth in the months after.
KRISTEN: Thank you. I think a lot about what it
means to have humanity in health care.
JACQUE: We could use a lot more of that.
KRISTEN: Yeah, well, thank you. And a few of the
things that you mentioned were community and impact.
I wonder if you would share a little bit more
about what that means to you.
JACQUE: So, really, throughout my career and as
one of our core values within Merck for Mothers,
we're really focused on centering the communities
most impacted by the health challenge that we're
trying to address. And so what that means is taking
my knowledge and my training and allowing it to
take a backseat to the expertise that exists within
the community, within the people with lived experience
and focusing myself and my energy, really on deep
listening to those experts around what is needed in order to accomplish changes. And there's lots of different approaches for
doing that. I've worn a researcher hat in a previous
life where I was focused on community based participatory
research as a methodology and really working with
community members, community leaders, as the folks
who were co creating and then conducting the research
and evaluation of the community health programs
that we were running. And what that means in my
current role means centering our grant making
and our strategic collaborations following that
deep listening among the people most impacted
on supporting the folks at the center in the community
in order to address the issues.
KRISTEN: Thank you. I think that's why we've been
in some same spaces, I hope increasingly so, because
we share those values and I think that that is
the way for safe, quality, respectful care, which
is I see what Merck is about globally.
JACQUE: Yeah, that's right. Merck for Mothers
is our company's global initiative to help end
preventable maternal deaths. And it was launched as an initiative in 2011 when our company was
looking for a global health challenge that was
sort of behind where it should be, where our company
would be able to lend resources along with scientific
and technical expertise in order to help that
global health challenge sort of get unstuck, if
you will. And so our company, through Mark from others, has been supporting efforts to
improve maternal health for over a decade now.
And we've been focusing those efforts in order
to improve maternal health outcomes by really,
at its core, trying to improve access to safe,
high quality, respectful care around pregnancy
and childbirth. And what that means looks different in different contexts based on what folks think that
they need around that time.
KRISTEN: Thank you. And I was browsing the Merck
for Mother site and we'll link to that and I saw
your 2022 research. Compendium where you outline key findings and I think that
is another part of access, isn't it, is to share
learning and to present that in clear and actionable
ways.
JACQUE: Yeah. Thanks for that, Kristen. And thanks
for going to our website and thanks for calling
out that report. In particular, that Evidence
for Impact report is something that we've been
publishing every two years for the last number
of years and it really is our attempt to try to
collate the learnings and the insights what is
most. Important around some of the work that we
are supporting and present it in a way where it
is highly digestible, highly actionable, sort
of ready to use because we believe and we work
with our grantees and collaborators to contribute
to the evidence base around maternal health. And
that can sometimes look like publications that are behind paywalls or even if they are open
access, they are lengthy and technical and sort
of hard to digest. And so one of the public goods
that we create coming out of our initiative is really a curation and the synthesis of that information so that folks
have it in a way where it's easily digestible,
kind of ready to act.
KRISTEN: Yeah, that's a really good model. And
I saw that one of your United States investments
was in black mama's matter alliance. I wondered
if you'd tell us a bit about that and other current
US initiatives.
JACQUE: Well, we've been longtime supporters of
the Black Mamas Matter Alliance. We have been
a supporter of Black Maternal Health Week, as
well as a supporter of their technical conference,
I think, since it began, although that team will
keep me honest to make sure that that is accurate. And the leaders at Black Mama's Matter Alliance have also been the
lead grantee on our Safer Childbirth Cities work
happening in the Atlanta area where their organization
is based. So we have been working to collaborate
and support their work, both at a national level,
at a regional level, and then at a very specific
city place based level around their connections
in Atlanta.
KRISTEN: Thank you. And could you tell us a bit
more about the Safer Childbirth Cities Initiative
and that involves community based organizations?
JACQUE: Sure, I'd be happy to. And the Safer Childbirth Cities Initiative as a whole was launched just
before I joined the Merck for Mothers team. And
so, back in the end of 2018, our company issued
an open call for proposals that went out across
the country specifically looking for solutions
that were sort of almost hyper local, based at
the city level, working to understand local data,
what was happening locally related to racial and
ethnic disparities, specifically in maternal health
outcomes, and then offered a very exciting and
generous amount of $1 million per project. Over
the course of three years, some have stretched
to four, with delays and changes that we experienced
as a society coming out of the pandemic. The grants
that we have supported through the Safer Childbirth
Cities Initiative have really focused on the coalition
based model of bringing together all of the folks
at a local geographic level who are interacting
with people who are pregnant. Or after delivery
and working to have those folks come together
and really create an action plan and understand
what's happening locally, understand how they
may be able to work together even better to better
serve the needs of the people that they were trying
to reach. We've been really fortunate, Kristen,
that we've been able to do two rounds of grant
making so far through the Safer Childbirth Cities
Initiative. So we're supporting efforts that are
happening in 20 cities across the US. All of those
cities with high maternal mortality ratios, all
of those cities with some documented challenges
around racial and ethnic disparities in maternal
health outcomes and all of those cities with political
will, energy and enthusiasm to address those issues.
And so, because it's a hyper local initiative
that's focused at the city level, what's happening
in different geographies all looks a little bit
different. So, for example, we're supporting work
in Washington, DC. That is very focused at the
nexus of understanding addressing gaps in maternal
health care, as well as addressing gaps that those same people are experiencing related to housing support or being
able to be in safe, happy, healthy housing. We
have an initiative that we're supporting here
in Philadelphia where the focus is really around
community action connected to that nexus between cardiac health and maternal health based on
some of the challenges we see here in the Philadelphia
area where I live.
KRISTEN: Thank you. And how's that been going
with community led work?
JACQUE: The community led work is going incredibly
well. We have been so excited by the response,
some of it planned, some of it unintended, some of it hoped for, that the community driven work has created.
We're seeing real changes where folks are no longer
having to ask for a seat at the table in these
important conversations that are happening locally
at a city or even at a state level. We're seeing
shifts in how all of that work is done. We're
seeing the community leaders being asked, can
they convene the meeting and who should be at
the table? And what are other ways that we can
make sure that this work is informed by the community
that we're trying to support? How else can we
share this information back into the community? So I'm excited about all of those changes
that we're seeing because I think some of these
shifts are tied to what I hope will be sustainable
changes in the way we do this work. So it's really
important to us, especially as a funder in this
space, to think strategically about how our funding
can be catalytic for longer term changes, because
we never want to be the kind of funder where we're dropping in and supporting a grant
based initiative and then moving away. We're always
trying to think about how our support can be.
I like to think of it as our support being the
first catalytic knocking down of a domino in a
series of events that we hope will happen following
that. So I'm excited about the shifts that we're
starting to see around an openness and a true
engagement around community led work.
KRISTEN: That's fantastic. And it must be so exciting
to be able to actively support that paradigm shift,
which is radical, unfortunately, and so wonderful
leadership.
JACQUE: It's our hope. It's our hope.
KRISTEN: And so another success story is the Hear
Her campaign. Would you share about that?
JACQUE: Oh, sure, Kristen. The CDC's Hear Her campaign is an initiative that we're incredibly proud to be
a supporter of. And our engagement with the Hear
Her campaign, which is focused on the recognition
of maternal warning signs around pregnancy and childbirth, goes back many, many years, related
to our approach in the US. And so I'll tell you
a story. So, a number of years ago, and as I shared
our approach to grant making and sort of crafting, our strategy is very steeped in listening and
very steeped in consulting with subject matter
experts and leaders across the country. So many
years ago, back around 2012 2013, one of the first
issues that was surfaced where support from Merck
for Mothers would be able to make a distinctive
difference was around understanding challenges
related to information that people who are pregnant
receive right after delivery before they're discharged
from a hospital. And so we entered into a strategic
collaboration with Awan, the association of Women's
Health Obstetric and Neonatal Nurses, where they
started with some formative research to understand
in a couple of states across the US. What does
discharge education look like. And through that
research, they learned that in some places it
looked like one page of information, in other
places it looked like 45 pages of information
that were given to people who had just delivered
and were getting ready to head home with new baby
for the first time. They also were able to identify
differences among knowledge and skills across
nurse educators who were delivering that discharge
education encounter following delivery. And so
what that then led them to do was create the postbirth Warning Signs education course, which was
well researched, evidence based, tested, improved. It's now happening across 17 states across
the US. Which is so exciting. So regardless of
where someone delivers the information that they
receive in that discharge encounter, the piece
of paper that they walk away with, the conversation
that they have with the nurse educator should
be the same, which is all part of our approach
around standardizing quality of care, around pregnancy
and childbirth. We're really proud of that initiative.
But we also learned over time that initiatives like that also need ecosystem support, meaning they need sort of
support that's happening out in the general public
or out in other types of healthcare providers
who are interacting with people who are pregnant.
So back in 2019, when I joined the Merck for Mothers
initiative, I was given a challenge by our leader, Dr. Marianne Etsybet, to craft a health communications campaign
at a national level in the US. That would focus
on the recognition of those warning signs that
something could potentially be going wrong in the postnatal period. I quickly learned in conversations with
our lawyers that if the campaign were coming from
us, it would be limited in what we would be able
to say. Our organization, we are not healthcare
providers, we're not sending out technical information.
So we do all of our work through grant making
and strategic collaborations. And so I, through
a number of conversations, was able to land on
a solution that we were excited about through
funding that we channeled to the CDC Foundation
in order to support folks from the CDC and the division. Of reproductive health for
the creation of a national communications campaign
related to the recognition of those critical warning
signs that has become the Hear Her campaign. And
what makes me really excited about that campaign,
there's a number of things, but in particular
it created messages for people who are pregnant
or recently delivered for anyone in that person's
support system. So not only should the person
who just recently delivered be able to recognize
these warning signs, but everyone who is around
them and caring for them in that period of time
should be able to also make those connections.
And then the third piece of the campaign that
we're really proud of is the focus on healthcare providers. But not just the healthcare
providers who care for people who are pregnant or postpartum in OBGYN visits for any healthcare provider who
may interact with a person who is pregnant or
recently delivered. So that could be someone in
a pediatric practice, that could be someone who's
working in an emergency department. It could even
be really anyone in the healthcare system who
knows to ask the critical question if someone
was recently pregnant, if they are showing a number.
KRISTEN: Of different signs and symptoms, that's fantastic. Especially, I
mean, I think a lot about autonomy and how to
actively promote that and doing that with a village,
whoever your supports are and whoever is in contact
with you. And that has a lot of implications for
offering materials like that. And as you said, for equipping people to educate the family. That means looking at
them and structuring within the inpatient encounters
for comprehension and for information and for
clarity. So thank you for that.
JACQUE: Yeah, and really thanks to the team at
the CDC. I mean, the materials have all been designed
and collaborators who have been supporting the
campaign across the country. The materials have
really focused not only on language translation,
but also on health literacy and how to get the
concepts across in a way where people will understand,
receive the information and make it their own. Which also leads me to another really important part
of that campaign, which is the cultural adaptation of the campaign and people really being able to see
themselves in the images associated with the campaign,
in the materials, in the language that has been
used in the campaign. So we're really proud of
that as well.
KRISTEN: It's been really fun being a part of
the fourth trimester project at UNC and we have
an active collaboration with the Hear Her campaign to disseminate across rural parts of North Carolina. In addition
to we have a website, newmomhealth.com, and then
it has here her, but we have billboards and radio
ads so that it's clear. It's sort of unfortunate
that the space that we're at is talking about believing women and to spread responsibility for safety and well being across.
But clearly it's foundational.
JACQUE: Absolutely. And thank you for the partnership.
And because of collaborations like that, because
of the digital billboards that have been created
because of the signage and the radio announcements
that are getting out into all sorts of communities
across the US. We know that the messages from
that campaign have reached almost 100 million
folks across the country. And there's been almost
2 million visitors to the campaign website, specifically
clicking on additional information on the website,
downloading materials, downloading things that
they can print off and discuss with their family.
So it's very exciting to see the impact of all
of that, especially, I.
KRISTEN: Would think, with the shift to recognition
of the importance of postpartum and that's a clear
part of the continuum of reproductive life, but
especially when we think about maternal mortality.
JACQUE: Absolutely.
KRISTEN: And so making sure that we continue to
see and love and actively support birthing people
as they heal and recover and take care of themselves.
JACQUE: Absolutely. And we know, not only from
looking at national trend data that shows us that
many of the complications and even some of the
unfortunate deaths happening across the US. Are
taking place in that period, which has really
helped us, I think, bring more attention to the
need to, I think, really redefine and reimagine
what postnatal care looks like in the US. And
there's been a lot of heart behind and a lot of
movement around extending particularly Medicaid
coverage and other types of care coverage for
people who are pregnant up through that twelve
month mark after labor and delivery, so that people
have access to more care during that time. But
I'm excited to see, Kristen, what's going to happen
in the coming years around working collectively across the country to help define what good looks like for care
during that time. It's great that we have the
coverage. It's great that we have the attention.
Now, what do people actually need from their health
care providers, from other support systems around
them during that period of time, so that we can
really almost, I think, shift social norms across
the US. Around how we care for people who are
pregnant in that critical time?
KRISTEN: Jumping out of my chair and I just want
a really helpful framework for us, has been learning
from Dr. Monica McLemore about a framework for
health equity to retrofit reform and reimagine.
And so when I hear the reimagine and we have to
have a vision to make it so. And then there are
lots of ways to operationalize it and words that
work. There are so many pockets of goodness and
competence and appropriate structure, and that's
what we want to do is shine a light on those and
grow and build on the strengths that are there
but too little, too late for so many and disproportionately.
JACQUE: So I totally agree and I think that taking
what I would define as an assets based or a strengths
based approach to that really important redesign and reimagination work is what is
most urgently needed because I think you're right,
we do have, to use your words, pockets of goodness.
We have examples where things are working well,
where people feel supported and cared for, where
health providers feel supported and cared for,
where sort of the system is working in a way that
is more supportive to all and particularly more
supportive to the people who are most impacted.
And I'm really grateful for the opportunity to
support some of that work. Back to the Safer Childbirth
Cities initiative that we were speaking about
earlier. There's examples coming out of work that
we're supporting in Camden, New Jersey, around
getting people access to prenatal care sooner
once they have a pregnancy diagnosis in a supportive
way that is connecting them to care that is welcoming
and open and ready to receive them. We have examples
coming out of Norfolk, Virginia, or Baltimore,
Maryland around fully integrating in a supportive
way not only health screenings around pregnancy
and childbirth, but really important screening
tools around other social needs. That a person
who is pregnant. And the family that they're caring for may also be experiencing so that they can have those
needs met all at the same time, all during the
same encounter in a way that feels supportive
and in a way that feels welcoming, which is so
important.
KRISTEN: Yeah, that's exciting, especially with
addressing social needs because we are all whole
people. And it's interesting because I was in
a space and the phrasing was that in cases of STH positive, like as if it were
a disease, to be a real human in the world and
to have complexity in our lives. And so I think
that strength based programs, research and also
recognizing that in people and building on what
is working well and I think we have been asking
that you can structure that in. And then if our
goal and I think that that's why it's great that
we sort of opened around the goal of safe, quality,
respectful care. If our goal is to connect people
with resources, then we can make sure to lead
with that. I think we can critically assess the
role of screening in that story so that we can
be transparent with what's available and really try to get to that normalization and connecting people. So
I will be looking to lessons learned in your accessible
formats for that pioneering work. Because like
you, I'm so excited about shifting the norm in
the standard, having structures for accountability
around that see what.
JACQUE: We can accomplish.
KRISTEN: Especially when you're mentioning these
examples of coming out in very diverse settings.
Is there organizing framework for health equity
that Merck thinks about?
JACQUE: Yeah, thanks for that question. Our Maternal
Health Initiative through Mark for Mothers sits
within a wider office of social business innovation
at the company. And one of our main charges is
really around advancing health equity. And actually
one of our company's twelve public goals around
ESG and corporate responsibility is around reducing
unmet medical needs for underserved populations.
As part of our overall goal to advance health
equity. So we are very proud to have our initiatives sit within that frame of advancing
health equity. And it really goes back to, from
my perspective, what we were talking about earlier
around having your work and your strategy be driven
by the needs, hopes and desires of the people
most impacted by the challenge. And so what that
looks like for us across Merck, for mothers. In addition to the deep listening that I mentioned earlier,
it also shows up as working to create more sustainable
systems of accountability for that important feedback
from people who are pregnant, from people who
are being served by systems in order to get that
important feedback to those who are making decisions
about what moves forward, what is reinforced.
And so we're really proud to support work that's
happening at that level across the US. But also
in our global work as well. We're a proud supporter
of the global White Ribbon Alliance and their
global campaign around it initially started as
What Women Want. They've branched off and had
other campaigns that we've also supported around
what do midwives want from the health care system.
They're getting ready to launch broader campaigns
as well about what do folks want and need around
pregnancy and childbirth, around care. And the
number one demand that has surfaced from all of
those campaigns is really around dignity and respect.
Going back to something that you mentioned, Kristen,
around the humanity that exists within all of
us and having a health care system that recognizes that humanity and celebrates it and celebrates the
connection that we have between people in order
to create healthier, more respectful encounters
that also address health needs. So I'm really
excited to be able to continue to support that
work. And in fact, again, thinking about our work
globally, we just were able to support the launch
of a respectful maternity care training module
that is now scaling up digitally across the country,
that is focused on helping health providers recognize
sort of those key ingredients around, layering in respect and dignity into their
encounters and all of their interactions.
KRISTEN: Wow. It's human rights in regards to reproduction and that's
been so excited to use the framework of reproductive
justice, which is the merging of those because
that's what we're talking about is dignity, autonomy,
the ability to navigate and be informed. And so
when that is at the foreground, then everything else flows from that.
JACQUE: I agree. I think we're also frankly, I
also think in some ways we're talking about the
propagation of our species and the continuation
of life and sort of how we as a species sorry, as a scientist at heart, I go back to
my biology, but as a species, how we care for
each other and how we care for each other at those
critical moments in time where we are adding to
our numbers and adding sort of the next generation
into our families, into our communities. I think
the importance of that is really interrogating,
the question of not what just helps us to survive,
welcoming those new members of our species, welcoming
new members of our families and our communities. But what helps elevate everyone's health and well being in those
encounters and really gets us to a place where
we have healthier communities and healthier.
KRISTEN: Society survive and thrive.
JACQUE: Yeah. And beyond that, flourish.
KRISTEN: Right.
JACQUE: Let's get to that place.
KRISTEN: Dr. Alison Stubby and I recently wrote about systems of care needing
to be non harmful, accommodating. And then our goal is to be uplifting other people as a protagonist in their
own stories and to celebrate that. And it's such
an immense opportunity to do that.
JACQUE: Thank you. Thank you for that work and
thank you for framing it in that way, because
I think that really is the opportunity that we
have here, or at least that's the system that
I want to leave behind for my family and for those
behind me.
KRISTEN: And so, to wrap up, do you have and I
mean, I think you just answered it, but you have reflections on what innovation in maternal health
means to you and merck for mothers.
JACQUE: I do. And I have the benefit of some years
and some gray hairs under my belt now in thinking
about being part of the maternal health community
here in the US and globally for a couple of decades
now. And I think that the real innovation, to
my mind, Kristen, comes from shifting how we do
the work. I think we'll always need additional
evidence around what works and why and what facilitated it and what were the barriers
to that. But the issue that we are solving for
is a long standing one and the challenges that
need to be addressed in a lot of ways we have
those answers around what do people need to have
care that is clinically sound as well as care
that is safe and respectful and uplifting, to
use your word, around pregnancy and childbirth.
And where I think the true innovation is needed,
at least here in the US. Is around how we deliver
that every single visit for every single person,
every single time. And so to me, the call for
innovation is around how we get that work done
and how we do that in a way that is supportive
and inclusive and engaged and continues to be
informed by the people who are most impacted by the folks who are underserved
or maybe disconnected from those systems.
KRISTEN: The will to change and then the structure
to make it so and to equip people. And I think
it's not like do better. Right. We need to, as
you identify, model what quality looks like and
practice that and be assessed for that. Totally
great resources directed to strengthening it.
Right. Accountability, I think, is not a punitive
thing. Right. For continual action, a cycle to respectful care as carming. Colleagues.
JACQUE: Yeah, absolutely. And I think that would
be really exciting to see across the US.
KRISTEN: Right.
JACQUE: Accountability that is not powered by
punitive actions, but is powered by celebrating
what the good looks like in the places where things
are going well in honesty.
KRISTEN: Yeah.
JACQUE: And using that to sort of create a snowball
of more and more of that.
KRISTEN: Thank you. Are there other things from
Merck? And I know there are many other programs
in maternal mortality review committees, Mama's
Voices, which you talked about, and so we're not
going to walk through them all, but are there
any other things you'd like to highlight right
now?
JACQUE: We're so fortunate to have collaborations and grants now with more than
200 different organizations around the globe, and it's such a privilege and
an honor to be able to support their work and
help uplift the solutions that they are advancing.
I would just encourage folks to, if you're interested
in learning more, to visit our Initiatives website@merckformothers.com
in the US and Canada. Outside of the US and Canada,
our company is known as MSD, and so our initiative is called MSD for mothers in those locations. So
if you have any listeners outside of the US and
Canada, they should go to Msdformothers.com.
KRISTEN: Thank you very much.
JACQUE: Thank you. Thank you for having me, and
really thank you for all the work that you lead.
It's great to be in conversation with you and
as you said, hopefully the first of many more
conversations we can have together.
KRISTEN: Thank you, Jackie, for taking the time
to join us today to share your experiences. And
thank you all for listening. For more podcasts,
videos, blogs and maternal health content, visit the MATERNALHEALTH Learning and Innovation Center website at
MATERNALHEALTH learning.org. We want to hear from
you. Tell us what you want to hear more of. Review
our podcast and share. Be sure that you're subscribed
now so you're notified of season three coming
later this year. Let's keep talking. Tag us in
your post using Hashtag maternal Health Innovation.
I'm Dr. Kristen Tully, and we'll talk with you
again on the Maternal Health Innovation podcast.
SPEAKER C: This project is supported by the Health Resources and Service Administration, HRSA of the US. Department of Health
and Human Services HHS under grant number U7 CMC
33636, state Maternal Health Innovation, Support
and Implementation Program cooperative Agreement.
This information or content and conclusions are
those of the author and should not be construed as the official position or policy,
nor should any endorsements be inferred by HRSA,
HHS, or the US.
JACQUE: Government.