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    Document Summary
    - Report Published -

    Senate Document No. 45

    Document Title
    Ways to Create and Maintain Effective Maternal Health Services for Pregnant Women in Crisis

    Council on Maternal and Child Health

    Enabling Authority
    SJR 329 (Regular Session, 1993)

    Executive Summary
    SJR 329 Requesting the Maternal and Child Health Council to study ways to create and maintain effective maternal health services for pregnant women in crisis.


    The purpose of this report is to "study ways to create and maintain effective maternal health services for pregnant women in crisis."


    For some women a pregnancy, especially if unplanned or unwanted, creates a crisis or may contribute to an already existing crisis situation resulting from personal problems, medical conditions, or financial difficulties. Examples include homelessness, being too young, inadequate health insurance, and substance abuse.

    • In 1992, 40,000 homeless women of reproductive age requested shelter. (*24)

    • In fiscal year 1993, 279 pregnant women served by shelters were victims of domestic violence. (*35)

    • In 1991, 8% of pregnant women receiving health services in the Virginia Department of Health reported using illegal drugs. (*29)

    • In 1991, 45.4 per 1000 teens were pregnant. (*36)

    • In 1991, 15% of women in Virginia had no health insurance.

    • In 1991, 36% of female-headed, single parent households were living in poverty. (*21)

    In 1991, of the 136,000 pregnancies in Virginia, it is estimated that 68,000 were planned; 32,000 ended in induced termination of pregnancies and only 244 infant adoptions occurred. (*5, *12, *36) Of the 96,000 births annually in Virginia, it is unknown how many are to women in crisis.

    Crisis during pregnancy can have serious and long-term consequences for the woman and her child. The lack of adequate shelter and financial resources can interfere with the woman's ability to maintain a healthy pregnancy. Pregnancy occurring in the teen years usually leads to an interruption in education and, subsequently, is associated with joblessness and poverty. Substance abuse is not only detrimental to the woman's general health but contributes to the incidence of fetal anomalies, low birth weight, infant mortality, and child abuse.


    A pregnant woman in crisis may need counseling about her options including parenthood, adoption, and abortion. Counseling services are provided by private physicians, family planning clinics, maternity clinics, and some private organizations. The woman's decision about her pregnancy will depend upon her religious beliefs, culture and personal values, financial concerns, and/or health status.

    Pregnant women in crisis often require additional health services as well as supplemental resources to address identified problems. The women who choose parenthood or adoption will need a level of prenatal care based upon needs as assessed by a health care provider. Prenatal care is provided by private physicians, medical schools, clinics, and the Virginia Department of Health. Case management or care coordination is an effective method to address substance abuse and high-risk medical conditions. Support services, such as shelters for homeless and battered women, or other counseling services are also needed.

    Maldistribution and/or inadequate supply of health care providers, lack of child care, lack of perceived need for care by women, and lack of adequate reimbursement for services are barriers to health care for pregnant women in crisis.

    Although the focus of this study is on the services for pregnant women in crisis, the study acknowledges the need for prevention. Prevention programs and services that provide women and their families with the knowledge and skills to avoid unintended and unwanted pregnancies need to be broad-based within the community, culturally sensitive, family-centered and based upon behavioral principles. Preventive services in Virginia include the Family-Life Education programs in public schools, school-based/school-linked health clinics, Better Beginnings and family planning services.


    Nationally and in Virginia, several programs exist to address the needs of pregnant women at risk for or in crisis. Preconceptional Health Risk Appraisal of Kentucky and Healthy Start in Hawaii are examples of programs in other states. Healthy Start/Family Resource Center in Hampton, adopted from the Healthy Start in Hawaii, is a comprehensive system of services for pregnant women aimed at preventing child abuse and neglect. Lay-home visiting programs, such as Resource Mothers and the Elizabeth Project, target pregnant teens. Project LINK focuses on coordinating existing services for substance-abusing women. Private/public partnerships have been created in two localities to provide maternal health services for women who had limited delivery services in their geographic areas. These programs are effective but benefit a minimum number of pregnant women because of limited resources.


    The study has defined a crisis pregnancy and identified what services pregnant women need. Women at risk for a crisis in pregnancy are often poor, young, homeless, and addicted to drugs. These same women are also often at risk for not receiving services.

    Maternal health and other supportive services are not universally available across the state, sometimes leaving the needs of pregnant women in crisis unmet. A number of strategies, if initiated, would provide the support needed by women in crisis pregnancies to lead to a successful resolution of the crisis.


    1. Programs that serve pregnant women in crisis should be expanded, and should provide or assure risk-appropriate health care.

    a. Support funding to expand the three existing programs: Healthy Start, Resource Mothers and Project LINK

    b. Encourage private and volunteer organizations that provide shelter for women in crisis to increase the number of pregnant women they serve, and to develop appropriate systems to refer for prenatal care.

    c. Encourage the expansion of existing efforts of private organizations that provide support and education for all pregnant women.

    d. Expand Medicaid eligibility to 185% of poverty for maternity and family planning services.

    2. Maternity health services, including family planning, should be included in primary health care for women, and should be culturally sensitive, community based, easily accessible and family-centered.

    3. Pregnancy planning or preconceptional care should be a standard service in primary care, and be included in the training of health care professionals.

    4. Adoption should be made more accessible to a pregnant woman in crisis.

    a. Request the General Assembly to take steps to streamline the adoption process.

    b. Request the Departments of Health and Social Services to provide adoption training to local health department maternity and family planning staff.

    c. Encourage the expansion of the One Church, One Child Program, the adoption program for African-American children.

    5. There should be an increased utilization of mid-level health care providers, specifically nurse practitioners and certified nurse midwives.

    a. Request that insurers and Medicaid extend third party reimbursement to all nurse practitioners who provide primary care to women.

    b. Encourage health professional organizations and medical schools to provide programs on the utilization of nurse practitioners and nurse midwives in provision of primary care of women.

    c. Encourage the medical schools to include in their curriculum and practice the nurse midwife model for obstetric care.

    6. The Regional Perinatal Coordinating Councils should address pregnant women in crisis in their region by identifying the gaps in delivering comprehensive prenatal services, providing perinatal outreach education, and encouraging the coordination of care.
    (*5) Commonwealth Poll. April, 1993.
    (*12) Henshaw, S. K., and Forrest, J. D. 1993. Women at Risk of Unintended Pregnancy, 1990 Estimates: The Need for Family Planning Services, Each State and County. New York: The Alan Guttmacher Institute.
    (*21) State Data Center, Virginia Employment Commission.
    (*24) Virginia Coalition for the Homeless. 1992. Shelter Provider Survey. Richmond, VA.
    (*29) Virginia Department of Health, Division of Women's and Infants' Health.
    (*35) Virginia Department of Social Services.
    (*36) Virginia Vital Statistics, 1991 Annual Reports. Center for Health Statistics, Virginia Department of Health.