Over the past 30 years, the global maternal mortality ratio—the number of maternal deaths per 100,000 live births—has notably declined by 45%. The United States’ rate, however, does not follow this same trend: maternal deaths have risen by 58% over that same period. In conjunction, the U.S. still has the highest maternal death rate of any high-income nation on the planet. What is even more surprising is that the vast majority of these deaths—87% in 2021 alone—are preventable.

In addition to the physical impact, complications during pregnancy and birth can cause deep emotional pain. The human toll of pregnancy-related complications also places a burden on the U.S. health care system, and, in turn, the economy. Annually, the U.S. spends $165.3 billion on adverse pregnancy outcomes, like high medical costs and related non-medical costs, like travel, lodging and transportation. 

This maternal health crisis, with its human and economic toll, demands coordinated policy, workforce and community-based responses. Heartland Forward’s new Maternal and Child Health Center for Policy and Practice (MCH CPP) aims to meet these demands head on by partnering with local leaders, health care providers and community organizations to build healthier communities, starting with mothers and babies.

Announced during the 2025 Heartland Summit, the MCH CPP is a health incubator within Heartland Forward, led by director Zoe Maddox and Heartland Forward senior fellow Cara Osborne. The MCH CPP is modeled on the National Governors Association’s maternal and infant health crisis playbook and supported by founding partners including the Blue and You Foundation for a Healthier Arkansas, the Walton Family Foundation and the Centene Foundation, who have come together to address maternal and child health outcomes across the heartland.

With the goal of creating lasting and sustainable solutions to improve outcomes for mothers and children, the MCH CPP will partner with state leaders and community organizations to align research, policy and practice. Central research priorities include developing a maternal and child health index to provide a clear, data-driven measure of maternal and child well-being across the heartland. The Center’s policy work focuses on creating workforce pathways for maternal health care providers, such as community health workers, doulas and midwives, to support collaborative and economically viable women’s care teams, alongside physicians. The Center will also provide implementation support through technical assistance to health systems, community organizations and lawmakers dedicated to advancing high-quality perinatal care.

In a region where maternal care deserts can be far reaching and community-based care models are needed, the heartland has a real opportunity to uncover solutions for maternal care. In the words of director Zoe Maddox, “The Center will operationalize change through pilot programs, workforce collaboration and research to bridge the maternal health gap, ensuring policies that save lives and provide compassionate care are instituted across the heartland. We know what solutions are most effective; the Center will be a driving force in bringing those solutions to heartland states.”

From Policy to Practice: Building a Full Maternal Health Team

A key policy focus of the MCH CPP is advocating for a coordinated maternal health team that brings together medical expertise, emotional support and community awareness to care for mothers and children before, during and after birth. Coordinated and community-based care, where each provider brings a unique skill set to the team, can result in shorter labor, fewer cesarean surgeries, better newborn health and higher patient satisfaction. These teams can exist within hospitals, community clinics and Federally Qualified Health Centers (FQHCs). 

The Maternal Health Team at a Glance 

• Obstetrician/Gynecologist (OB-GYN): Physicians focused on women’s reproductive health, pregnancy, child birth, postpartum and more.
• Midwife: Advanced practice nurses providing comprehensive health care to women, including primary care, labor and delivery, postpartum and newborn care. Midwives are associated with fewer interventions, cesarean deliveries, preterm births, inductions and higher patient satisfaction. Midwives often practice alongside OB-GYNs and can provide care at hospitals, birth centers, clinics or at home.
• Doula: Trained professionals providing non-medical, emotional and physical support to the mother and family before, during and after birth. Birthing mothers who received doula care had 52.9% lower odds of cesarean delivery and 57.5% lower odds of experiencing postpartum depression or anxiety.
• Community Health Worker (CHW): Localized health professionals who assist in navigating the health care system via advocacy and education on physical and social determinants of health.
• Nurse: Licensed health professionals who promote and maintain health, practicing independently or are supervised by OB-GYNs or midwives.

The Workforce Imperative: Midwives As a Missing Link

There is a critical shortage of maternal health providers in the U.S, with a higher concentration of shortages in the heartland. In geographies where OB-GYNs can be sparse, midwives can help fill the gaps needed to provide sought-after maternal health care. For women in rural areas, midwives are critical points of contact for families who need access to primary care, who have medical complications or need a referral to a specialist. Mothers and infants across the heartland, especially in the most rural counties, need access to fully staffed maternal health teams and MCH CPP is working to help bridge that gap.

“Midwifery workforce initiatives are critical to increase the number of midwives practicing in rural areas and to tackle the long-standing complexity of maternal health care deserts, improve maternal health outcomes and realize cost savings,” said Dr. Dawn Steiner, an OB-GYN in Missouri and the National Medical Director of Clinical Initiatives for Centene. “Centene is committed to advancing maternal health by supporting education and training programs that empower midwives to deliver exceptional care. Building a strong midwifery workforce is key to improving health outcomes and fostering healthier families and communities.” 

Strategies to maintain a robust midwifery workforce across the heartland include standing up regional collaborative midwifery networks, where midwives can consult with other providers such as OB-GYNs via telehealth, encouraging universities to develop courses specific to rural areas and connecting midwifery students to mentors practicing in rural areas. Investing in the facilities particular to midwives, including birth centers and private practices and arranging student loan payment plans are other factors that support the growth of the midwifery workforce. 

Cara Osborne, Heartland Forward’s senior fellow for health and wellness, paid testament to the role of midwives in maternal health care: “Midwives bring continuity of care—ongoing and comprehensive health care throughout pregnancy—and evidence-backed methods of care to heartland communities where other maternal health care options are scarce. Supporting midwives and their practice facilities is a critical way to scale maternal health options across the heartland.” 

Empowering Heartland Maternal Health Through Workforce Strength  

Strengthening the care team for maternal health, by growing and supporting the midwifery workforce, can allow the heartland to lead the nation in reducing maternal mortality, improving maternal and child health outcomes and reinvesting savings back into healthier communities. The MCH CPP is positioned to drive midwifery workforce initiatives through research that supports implementable policy, in collaboration with state leaders, providers like Centene and local communities. Prioritizing maternal and child health, before, during and after birth, with a robust and well-supported team of providers, is an investment in the long term strength of heartland communities.