Existing law requires the State Department of Public Health, subject to an appropriation in the annual Budget Act, to establish the California Perinatal Equity Initiative to expand the scope of interventions provided under the Black Infant Health Program by fostering Community Centers of Excellence and promoting the use of interventions designed to fill gaps in current programming offered through the Black Infant Health Program. Existing law requires the department to develop a process to allocate funds to up to 15 county health departments, to work collaboratively with state and local Black Infant Health programs, for the purpose of improving Black infant birth outcomes and reducing infant mortality.

This bill would expand the program to include city health departments, as specified.

Existing law requires the State Department of Public Health, subject to an appropriation in the annual Budget Act, to establish the California Perinatal Equity Initiative to expand the scope of interventions provided under the Black Infant Health Program by fostering Community Centers of Excellence and promoting the use of interventions designed to fill gaps in current programming offered through the Black Infant Health Program. Existing law requires the department to develop a process to allocate funds to up to 15 county health departments, to work collaboratively with state and local Black Infant Health programs, for the purpose of improving Black infant birth outcomes and reducing infant mortality.

This bill would expand the program to include city health departments, as specified.

Existing law requires the State Department of Public Health, subject to an appropriation in the annual Budget Act, to establish the California Perinatal Equity Initiative to expand the scope of interventions provided under the Black Infant Health Program by fostering Community Centers of Excellence and promoting the use of interventions designed to fill gaps in current programming offered through the Black Infant Health Program. Existing law requires the department to develop a process to allocate funds to up to 15 county health departments, to work collaboratively with state and local Black Infant Health programs, for the purpose of improving Black infant birth outcomes and reducing infant mortality.

This bill would expand the program to include city health departments, as specified.

Existing law requires the State Department of Public Health, subject to an appropriation in the annual Budget Act, to establish the California Perinatal Equity Initiative to expand the scope of interventions provided under the Black Infant Health Program by fostering Community Centers of Excellence and promoting the use of interventions designed to fill gaps in current programming offered through the Black Infant Health Program. Existing law requires the department to develop a process to allocate funds to up to 15 county health departments, to work collaboratively with state and local Black Infant Health programs, for the purpose of improving Black infant birth outcomes and reducing infant mortality.

This bill would expand the program to include city health departments, as specified.

Existing law requires the State Department of Public Health, subject to an appropriation in the annual Budget Act, to establish the California Perinatal Equity Initiative to expand the scope of interventions provided under the Black Infant Health Program by fostering Community Centers of Excellence and promoting the use of interventions designed to fill gaps in current programming offered through the Black Infant Health Program. Existing law requires the department to develop a process to allocate funds to up to 15 county health departments, to work collaboratively with state and local Black Infant Health programs, for the purpose of improving Black infant birth outcomes and reducing infant mortality.

This bill would expand the program to include city health departments, as specified.

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 1701

Author:(Weber)

As Amended Ver:June 15, 2023

Majority vote

SUMMARY

Expands the definition of local health jurisdictions eligible to apply for the California Perinatal Equity Initiative (PEI) to include a city or city and county.

Senate Amendments

Conform the definition of local health jurisdiction to existing law and make other technical changes.

COMMENTS

Black Infant Health (BIH) Program and PEI. The Budget Act of 2018 established the PEI within the Department of Public Health (DPH) to expand the scope of interventions provided under the BIH program, established through the Budget Act of 1989. PEI funding is intended to enhance the efforts of existing BIH program with the goal of providing a culturally supportive environment to help women have healthy babies. Existing law specifies that DPH allocate funding to up to 15 county health departments with BIH programs.

BIH funding is currently provided to city and county health departments. However, several BIH programs are not eligible to apply for the complimentary PEI funding as existing statute limits the funding to county health departments, limiting the reach of PEI. According to the author, to provide complementary services to BIH programs, PEI funding eligibility should be expanded to local health jurisdictions which encompasses both city and county health departments with a BIH.

The 2022 Budget Act provides $12.5 million ongoing augmentation to the BIH program. Of this amount, $11.25 million will be awarded to county/city health departments and $1.25 million will be retained by DPH for state operations.

According to the Author

This bill will provide equity within the distribution of funds already allocated to DPH for the BIH program by allowing both counties and cities with their own health departments to apply for the funds. The author concludes this will result in more equitable distribution of funds and increase the opportunity for more Black mothers and babies to have access to the funding within the program.

Arguments in Support

The California Nurse-Midwives Association and Children Now write in support that this bill will help address critical gaps in maternal healthcare, especially in vulnerable communities.

Arguments in Opposition

The Californians for Equal Rights Foundation opposes this bill and states "with an unambiguous focus on providing prenatal care and other health care services for pregnant women from certain racial groups, this bill clearly violates California's constitutional principle of equal treatment for all."

FISCAL COMMENTS

None.

VOTES:

ASM HEALTH: 15-0-0

YES: Wood, Waldron, Aguiar-Curry, Arambula, Boerner Horvath, Wendy Carrillo, Flora, Vince Fong, Maienschein, McCarty, Joe Patterson, Rodriguez, Santiago, Villapudua, Weber

ASSEMBLY FLOOR: 76-0-4

YES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner Horvath, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Cervantes, Chen, Connolly, Megan Dahle, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Friedman, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, Mathis, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Rendon

ABS, ABST OR NV: Gabriel, Gallagher, Garcia, McCarty

SENATE FLOOR: 38-0-2

YES: Allen, Alvarado-Gil, Archuleta, Ashby, Atkins, Becker, Blakespear, Bradford, Caballero, Cortese, Dahle, Dodd, Durazo, Glazer, Gonzalez, Grove, Hurtado, Jones, Limón, McGuire, Menjivar, Min, Newman, Nguyen, Niello, Ochoa Bogh, Padilla, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener, Wilk

ABS, ABST OR NV: Eggman, Laird

UPDATED

VERSION: June 15, 2023

CONSULTANT: Rosielyn Pulmano / HEALTH / (916) 319-2097 FN: 0001274

 THIRD READING  

Bill No: AB 1701

Author: Weber (D), et al.

Amended: 6/15/23 in Senate

Vote: 21

SENATE HEALTH COMMITTEE: 12-0, 6/7/23

AYES: Eggman, Nguyen, Glazer, Gonzalez, Grove, Hurtado, Limón, Menjivar, Roth, Rubio, Wahab, Wiener

ASSEMBLY FLOOR: 76-0, 4/20/23 - See last page for vote

SUBJECT: Black infant health: California Perinatal Equity Initiative

SOURCE: Author

DIGEST:

This bill expands the entities eligible to apply for funding through the California Perinatal Equity Initiative to include city health departments, in addition to county health departments.

Senate Floor Amendments of 6/15/23 make nonsubstantive amendments that add two co-authors and make a minor grammatical change.

ANALYSIS:

Existing law:

1. Establishes the California Department of Public Health (CDPH), directed by a state Public Health Officer (PHO), to be vested with all the duties, powers, purposes, functions, responsibilities, and jurisdiction as they relate to public health and licensing of health facilities, as specified. Includes the Maternal, Child, and Adolescent Health program within this jurisdiction. [HSC §131050, §131051]
2. Establishes the Maternal, Child and Adolescent Health program within CDPH to improve the health and well-being of women, infants, children and adolescents throughout the state. [HSC §123225-12360]
3. Finds and declares that the rate of mortality among black infants continues to be two to four times higher than the rates for other groups statewide. States that the social support, stress management, and empowerment model of the Black Infant Health (BIH) program is an evidence-informed intervention program designed to reduce black infant mortality. [HSC §123259]
4. Requires CDPH, subject to an appropriation in the annual Budget Act, to establish the Perinatal Equity Initiative (PEI) to expand the scope of interventions provided under the BIH program. [HSC §123260]
5. Requires the PEI to foster Community Centers of Excellence in perinatal health and promote the use of interventions designed to fill gaps in current programming offered through the BIH program. [HSC §123260]
6. Requires CDPH, as part of PEI, to develop a process to allocate funds to up to 15 county health departments, to work collaboratively with state and local BIH programs, to improve black infant birth outcomes and reducing infant mortality. [HSC §123260]

This bill:

1. Requires CDPH, as part of PEI, to allocate funds to up to 15 “local health jurisdictions,” rather than to “county health departments.”
2. Defines “local health jurisdiction” as a county, city, or city and county health department that meets the requirements to otherwise receive state financial assistance.

Comments

1. Author’s statement. According to the author, this bill will provide equity within the distribution of funds already allocated to CDPH for the BIH program by allowing both counties and cities with their own health departments to apply for the funds. The author concludes this will result in more equitable distribution of funds and increase the opportunity for more Black mothers and babies to have access to the funding within the program.
2. BIH program. BIH is one of the programs within CDPH’s Division of Maternal, Child, and Adolescent Health. The goal of the BIH program is to improve African-American infant and maternal health, as well as decrease black-white health inequities and social inequities for women and infants. The BIH program serves African-American women who are 18 years or older and up to 30 weeks pregnant at the time of enrollment. According to the CDPH’s BIH website, within a culturally affirming environment and honoring the unique history of African-American women, the BIH program aims to help women have healthy babies. Participants learn proven strategies to reduce stress and develop life skills. This is accomplished through a group-based approach with complementary case management. BIH services are provided by family health advocates, group facilitators, public health nurses, and social workers. BIH participants report stronger positive connections to their heritage and the African-American community, increased empowerment to make behavior changes that lead to living a healthier life, and better understanding of effective stress-reduction strategies.
3. California Perinatal Equity Initiative. AB 1810 (Committee on Budget, Chapter 34, Statutes of 2018), the health trailer bill, established the PEI at CDPH and appropriated $8 million from the General Fund to expand the scope of interventions provided under the BIH program. The PEI is intended to foster Community Centers of Excellence in perinatal health and promote the use of interventions designed to fill gaps in current programming offered through BIH. According to the CDPH PEI website, while declines in infant mortality have been achieved, the statewide mortality rate for black infants continues to be two to four times higher than rates for other groups. The PEI aims to address the causes of persistent inequality and identify best practices to eliminate disparities in infant mortality.

Under the PEI, CDPH is required to allocate funds to up to 15 county health departments, to work collaboratively with state and local BIH programs, for the purposes of improving back infant birth outcomes and reducing infant mortality. The county health departments are required to use the funds to develop local Community Centers of Excellence at hospitals, federal qualified health centers, clinics, or community-based organizations that have demonstrated capacity to work with public health and health care systems as well as within the Black community. Recipients of local grants are required to implement or expand two of five types programs: evidence-based group prenatal care that has shown promise in reducing the incidence of adverse birth outcomes; pregnancy intentionality and preconception programs; fatherhood or partnership initiatives; evidence-based home visiting programs inclusive of case management to increase advocacy and empowerment for black women and to ensure linkages to prenatal care; or, a different strategy that is justified based on local needs and resources, if a county determines that the strategy is evidence-based in related to reducing adverse birth outcomes. Currently 11 counties receive funding under PEI. This bill adds three additional city health departments that would be eligible for the funds: Berkeley, Long Beach, and Pasadena.

Related/Prior Legislation

AB 1810 (Committee on Budget, Chapter 34, Statutes of 2018) established the PEI at CDPH and appropriated $8 million from the General Fund to expand the scope of interventions provided under the BIH program, among other things.

FISCAL EFFECT: Appropriation: No Fiscal Com.: No Local: No

SUPPORT: (Verified 6/15/23)

American College of Obstetricians and Gynecologists District IX

California Nurse Midwives Association

Children Now

City of Long Beach

City of Pasadena

County Health Executives Association of California

Junior Leagues of California State Public Affairs Committee

OPPOSITION: (Verified 6/15/23)

Californians for Equal Rights Foundation

ARGUMENTS IN SUPPORT: The City of Long Beach, one of the cities with a public health department, writes that PEI funds will enable its health department to strengthen and fortify a comprehensive perinatal system of care for pregnant and parenting Black women. The City of Pasadena and the County Health Executives Association of California also write in support of adding the three city health departments as eligible entities for this funding, as do Children Now and the California Nurse Midwives Association.

ARGUMENTS IN OPPOSITION: The Californians for Equal Rights Foundation writes in opposition to the PEI in general, stating that the racial disparities in maternal and infant are more readily explained by lifestyle choices and underlying chronic conditions, and that the overwhelming majority of women survive motherhood.

ASSEMBLY FLOOR: 76-0, 4/20/23

AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner Horvath, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Cervantes, Chen, Connolly, Megan Dahle, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Friedman, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, Mathis, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Rendon

NO VOTE RECORDED: Gabriel, Gallagher, Garcia, McCarty

Prepared by: Jen Flory / HEALTH / (916) 651-4111

6/21/23 14:29:15

**** END ****

 THIRD READING  

Bill No: AB 1701

Author: Weber (D)

Amended: 6/8/23

Vote: 21

SENATE HEALTH COMMITTEE: 12-0, 6/7/23

AYES: Eggman, Nguyen, Glazer, Gonzalez, Grove, Hurtado, Limón, Menjivar, Roth, Rubio, Wahab, Wiener

ASSEMBLY FLOOR: 76-0, 4/20/23 - See last page for vote

SUBJECT: Black infant health: California Perinatal Equity Initiative

SOURCE: Author

DIGEST:

This bill expands the entities eligible to apply for funding through the California Perinatal Equity Initiative to include city health departments, in addition to county health departments.

ANALYSIS:

Existing law:

1. Establishes the California Department of Public Health (CDPH), directed by a state Public Health Officer (PHO), to be vested with all the duties, powers, purposes, functions, responsibilities, and jurisdiction as they relate to public health and licensing of health facilities, as specified. Includes the Maternal, Child, and Adolescent Health program within this jurisdiction. [HSC §131050, §131051]
2. Establishes the Maternal, Child and Adolescent Health program within CDPH to improve the health and well-being of women, infants, children and adolescents throughout the state. [HSC §123225-12360]
3. Finds and declares that the rate of mortality among black infants continues to be two to four times higher than the rates for other groups statewide. States that the social support, stress management, and empowerment model of the Black Infant Health (BIH) program is an evidence-informed intervention program designed to reduce black infant mortality. [HSC §123259]
4. Requires CDPH, subject to an appropriation in the annual Budget Act, to establish the Perinatal Equity Initiative (PEI) to expand the scope of interventions provided under the BIH program. [HSC §123260]
5. Requires the PEI to foster Community Centers of Excellence in perinatal health and promote the use of interventions designed to fill gaps in current programming offered through the BIH program. [HSC §123260]
6. Requires CDPH, as part of PEI, to develop a process to allocate funds to up to 15 county health departments, to work collaboratively with state and local BIH programs, to improve black infant birth outcomes and reducing infant mortality. [HSC §123260]

This bill:

1. Requires CDPH, as part of PEI, to allocate funds to up to 15 “local health jurisdictions,” rather than to “county health departments.”
2. Defines “local health jurisdiction” as a county, city, or city and county health department that meets the requirements to otherwise receive state financial assistance.

Comments

1. Author’s statement. According to the author, this bill will provide equity within the distribution of funds already allocated to CDPH for the BIH program by allowing both counties and cities with their own health departments to apply for the funds. The author concludes this will result in more equitable distribution of funds and increase the opportunity for more Black mothers and babies to have access to the funding within the program.
2. BIH program. BIH is one of the programs within CDPH’s Division of Maternal, Child, and Adolescent Health. The goal of the BIH program is to improve African-American infant and maternal health, as well as decrease black-white health inequities and social inequities for women and infants. The BIH program serves African-American women who are 18 years or older and up to 30 weeks pregnant at the time of enrollment. According to the CDPH’s BIH website, within a culturally affirming environment and honoring the unique history of African-American women, the BIH program aims to help women have healthy babies. Participants learn proven strategies to reduce stress and develop life skills. This is accomplished through a group-based approach with complementary case management. BIH services are provided by family health advocates, group facilitators, public health nurses, and social workers. BIH participants report stronger positive connections to their heritage and the African-American community, increased empowerment to make behavior changes that lead to living a healthier life, and better understanding of effective stress-reduction strategies.
3. California Perinatal Equity Initiative. AB 1810 (Committee on Budget, Chapter 34, Statutes of 2018), the health trailer bill, established the PEI at CDPH and appropriated $8 million from the General Fund to expand the scope of interventions provided under the BIH program. The PEI is intended to foster Community Centers of Excellence in perinatal health and promote the use of interventions designed to fill gaps in current programming offered through BIH. According to the CDPH PEI website, while declines in infant mortality have been achieved, the statewide mortality rate for black infants continues to be two to four times higher than rates for other groups. The PEI aims to address the causes of persistent inequality and identify best practices to eliminate disparities in infant mortality.

Under the PEI, CDPH is required to allocate funds to up to 15 county health departments, to work collaboratively with state and local BIH programs, for the purposes of improving back infant birth outcomes and reducing infant mortality. The county health departments are required to use the funds to develop local Community Centers of Excellence at hospitals, federal qualified health centers, clinics, or community-based organizations that have demonstrated capacity to work with public health and health care systems as well as within the Black community. Recipients of local grants are required to implement or expand two of five types programs: evidence-based group prenatal care that has shown promise in reducing the incidence of adverse birth outcomes; pregnancy intentionality and preconception programs; fatherhood or partnership initiatives; evidence-based home visiting programs inclusive of case management to increase advocacy and empowerment for black women and to ensure linkages to prenatal care; or, a different strategy that is justified based on local needs and resources, if a county determines that the strategy is evidence-based in related to reducing adverse birth outcomes. Currently 11 counties receive funding under PEI. This bill adds three additional city health departments that would be eligible for the funds: Berkeley, Long Beach, and Pasadena.

Related/Prior Legislation

AB 1810 (Committee on Budget, Chapter 34, Statutes of 2018) established the PEI at CDPH and appropriated $8 million from the General Fund to expand the scope of interventions provided under the BIH program, among other things.

FISCAL EFFECT: Appropriation: No Fiscal Com.: No Local: No

SUPPORT: (Verified 6/8/23)

American College of Obstetricians and Gynecologists District IX

California Nurse Midwives Association

Children Now

City of Long Beach

City of Pasadena

County Health Executives Association of California

Junior Leagues of California State Public Affairs Committee

OPPOSITION: (Verified 6/8/23)

Californians for Equal Rights Foundation

ARGUMENTS IN SUPPORT: The City of Long Beach, one of the cities with a public health department, writes that PEI funds will enable its health department to strengthen and fortify a comprehensive perinatal system of care for pregnant and parenting Black women. The City of Pasadena and the County Health Executives Association of California also write in support of adding the three city health departments as eligible entities for this funding, as do Children Now and the California Nurse Midwives Association.

ARGUMENTS IN OPPOSITION: The Californians for Equal Rights Foundation writes in opposition to the PEI in general, stating that the racial disparities in maternal and infant are more readily explained by lifestyle choices and underlying chronic conditions, and that the overwhelming majority of women survive motherhood.

ASSEMBLY FLOOR: 76-0, 4/20/23

AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner Horvath, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Cervantes, Chen, Connolly, Megan Dahle, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Friedman, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, Mathis, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Rendon

NO VOTE RECORDED: Gabriel, Gallagher, Garcia, McCarty

Prepared by: Jen Flory / HEALTH / (916) 651-4111

6/9/23 9:49:13

**** END ****

SENATE COMMITTEE ON HEALTH

Senator Dr. Susan Talamantes Eggman, Chair

BILL NO: AB 1701

SUBJECT: Black infant health: California Perinatal Equity Initiative

SUMMARY:

Expands the entities eligible to apply for funding through the California Perinatal Equity Initiative to include city health departments, in addition to county health departments.

Existing law:

1. Establishes the California Department of Public Health (CDPH), directed by a state Public Health Officer (PHO), to be vested with all the duties, powers, purposes, functions, responsibilities, and jurisdiction as they relate to public health and licensing of health facilities, as specified. Includes the Maternal, Child, and Adolescent Health program within this jurisdiction. [HSC §131050, §131051]
2. Establishes the Maternal, Child and Adolescent Health program within CDPH to improve the health and well-being of women, infants, children and adolescents throughout the state. [HSC §123225-12360]
3. Finds and declares that the rate of mortality among black infants continues to be two to four times higher than the rates for other groups statewide. States that the social support, stress management, and empowerment model of the Black Infant Health (BIH) program is an evidence-informed intervention program designed to reduce black infant mortality. [HSC §123259]
4. Requires CDPH, subject to an appropriation in the annual Budget Act, to establish the Perinatal Equity Initiative (PEI) to expand the scope of interventions provided under the BIH program. [HSC §123260]
5. Requires the PEI to foster Community Centers of Excellence in perinatal health and promote the use of interventions designed to fill gaps in current programming offered through the BIH program. [HSC §123260]
6. Requires CDPH, as part of PEI, to develop a process to allocate funds to up to 15 county health departments, to work collaboratively with state and local BIH programs, to improve black infant birth outcomes and reducing infant mortality. [HSC §123260]

This bill:

1. Requires CDPH, as part of PEI, to allocate funds to up to 15 “local health jurisdictions,” rather than to “county health departments.”
2. Defines “local health jurisdiction” as a county, city, or city and county health department.

FISCAL EFFECT:

This bill is not keyed as fiscal.

COMMENTS:

1. Author’s statement. According to the author, this bill will provide equity within the distribution of funds already allocated to CDPH for the BIH program by allowing both counties and cities with their own health departments to apply for the funds. The author concludes this will result in more equitable distribution of funds and increase the opportunity for more Black mothers and babies to have access to the funding within the program.
2. BIH program. BIH is one of the programs within CDPH’s Division of Maternal, Child, and Adolescent Health. The goal of the BIH program is to improve African-American infant and maternal health, as well as decrease black-white health inequities and social inequities for women and infants. The BIH program serves African-American women who are 18 years or older and up to 30 weeks pregnant at the time of enrollment. According to the CDPH’s BIH website, within a culturally affirming environment and honoring the unique history of African-American women, the BIH program aims to help women have healthy babies. Participants learn proven strategies to reduce stress and develop life skills. This is accomplished through a group-based approach with complementary case management. BIH services are provided by family health advocates, group facilitators, public health nurses, and social workers. BIH participants report stronger positive connections to their heritage and the African-American community, increased empowerment to make behavior changes that lead to living a healthier life, and better understanding of effective stress-reduction strategies.
3. California Perinatal Equity Initiative. AB 1810 (Committee on Budget, Chapter 34, Statutes of 2018), the health trailer bill, established the PEI at CDPH and appropriated $8 million from the General Fund to expand the scope of interventions provided under the BIH program. The PEI is intended to foster Community Centers of Excellence in perinatal health and promote the use of interventions designed to fill gaps in current programming offered through BIH. According to the CDPH PEI website, while declines in infant mortality have been achieved, the statewide mortality rate for black infants continues to be two to four times higher than rates for other groups. The PEI aims to address the causes of persistent inequality and identify best practices to eliminate disparities in infant mortality.

Under the PEI, CDPH is required to allocate funds to up to 15 county health departments, to work collaboratively with state and local BIH programs, for the purposes of improving back infant birth outcomes and reducing infant mortality. The county health departments are required to use the funds to develop local Community Centers of Excellence at hospitals, federal qualified health centers, clinics, or community-based organizations that have demonstrated capacity to work with public health and health care systems as well as within the Black community. Recipients of local grants are required to implement or expand two of five types programs: evidence-based group prenatal care that has shown promise in reducing the incidence of adverse birth outcomes; pregnancy intentionality and preconception programs; fatherhood or partnership initiatives; evidence-based home visiting programs inclusive of case management to increase advocacy and empowerment for black women and to ensure linkages to prenatal care; or, a different strategy that is justified based on local needs and resources, if a county determines that the strategy is evidence-based in related to reducing adverse birth outcomes. Currently 11 counties receive funding under PEI. This bill would add three additional city health departments that would be eligible for the funds: Berkeley, Long Beach, and Pasadena.

1. Prior legislation. AB 1810 (Committee on Budget, Chapter 34, Statutes of 2018) established the PEI at CDPH and appropriated $8 million from the General Fund to expand the scope of interventions provided under the BIH program, among other things.
2. Support. The City of Long Beach, one of the cities with a public health department, writes that PEI funds will enable its health department to strengthen and fortify a comprehensive perinatal system of care for pregnant and parenting Black women. The City of Pasadena and the County Health Executives Association of California also write in support of adding the three city health departments as eligible entities for this funding, as do Children Now and the California Nurse Midwives Association.
3. Opposition. The Californians for Equal Rights Foundation writes in opposition to the PEI in general, stating that the racial disparities in maternal and infant are more readily explained by lifestyle choices and underlying chronic conditions, and that the overwhelming majority of women survive motherhood.
4. Amendments. The author may want to consider modifying the codified intent language in the prior section to match the changes in this bill. The final sentence of Health & Safety Code §123259 should state “It is the further intent of the Legislature to direct funding to county health departments local health jurisdictions to ensure the leadership and coordination required for widespread and lasting change in public awareness and in public health and clinical practice.”

Additionally, CDPH has requested that a cross reference be added to the definition of local health jurisdiction in the existing language so it reads:

(e) For purposes of this section, “local health jurisdiction” means a county, city, or city and county health department that meets the requirements of Chapter 3 (commencing with Section 101175) of Part 3 of Division 101 of the Health and Safety Code.

SUPPORT AND OPPOSITION:

Support: American College of Obstetricians and Gynecologists District IX

California Nurse Midwives Association

Children Now

City of Long Beach

City of Pasadena

County Health Executives Association of California

Junior Leagues of California State Public Affairs Committee

Oppose: Californians for Equal Rights Foundation

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 1701

Author:(Weber)

As Introduced Ver:February 17, 2023

Majority vote

SUMMARY

Expands the definition of local health jurisdictions eligible to apply for the California Perinatal Equity Initiative (PEI) to include a city or city and county.

Major Provisions

COMMENTS

Black Infant Health (BIH) Program and PEI. The Budget Act of 2018 established the PEI within the Department of Public Health (DPH) to expand the scope of interventions provided under the BIH program, established through the Budget Act of 1989. PEI funding is intended to enhance the efforts of existing BIH program with the goal of providing a culturally supportive environment to help women have healthy babies. Existing law specifies that DPH allocate funding to up to 15 county health departments with BIH programs.

BIH funding is currently provided to city and county health departments. However, several BIH programs are not eligible to apply for the complimentary PEI funding as existing statute limits the funding to county health departments, limiting the reach of PEI. According to the author, to provide complementary services to BIH programs, PEI funding eligibility should be expanded to local health jurisdictions which encompasses both city and county health departments with a BIH.

The 2022 Budget Act provides $12.5 million ongoing augmentation to the BIH program. Of this amount, $11.25 million will be awarded to county/city health departments and $1.25 million will be retained by DPH for state operations.

According to the Author

This bill will provide equity within the distribution of funds already allocated to DPH for the BIH program by allowing both counties and cities with their own health departments to apply for the funds. The author concludes this will result in more equitable distribution of funds and increase the opportunity for more Black mothers and babies to have access to the funding within the program.

Arguments in Support

The California Nurse-Midwives Association and Children Now write in support that this bill will help address critical gaps in maternal healthcare, especially in vulnerable communities.

Arguments in Opposition

There is no known opposition to this bill.

FISCAL COMMENTS

None.

VOTES

ASM HEALTH: 15-0-0

YES: Wood, Waldron, Aguiar-Curry, Arambula, Boerner Horvath, Wendy Carrillo, Flora, Vince Fong, Maienschein, McCarty, Joe Patterson, Rodriguez, Santiago, Villapudua, Weber

UPDATED

VERSION: February 17, 2023

CONSULTANT: Rosielyn Pulmano / HEALTH / (916) 319-2097 FN: 0000206

Date of Hearing: April 11, 2023

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

ABPCA Bill Id:AB 1701

Author:(Weber) – As Introduced Ver:February 17, 2023

SUBJECT: Black infant health: California Perinatal Equity Initiative.

SUMMARY: Expands the definition of local health jurisdictions eligible to apply for the California Perinatal Equity Initiative (PEI) to include a city or city and county.

EXISTING LAW:

1. Establishes the Department of Public Health (DPH), directed by a state Public Health Officer (PHO), to be vested with all the duties, powers, purposes, functions, responsibilities, and jurisdiction as they relate to public health and licensing of health facilities, as specified. Gives the PHO, broad authority to detect, monitor, and prevent the spread of communicable disease in the state. [Health & Safety Code (HSC) §131050 and §120130, et seq.]
   
2. Requires each county board of supervisors to appoint a local health officer (LHO). Requires LHOs to enforce and observe orders and ordinances of the board of supervisors, pertaining to the public health and sanitary matters, orders, including quarantine and other regulations, prescribed by DPH, and statutes relating to public health. [HSC §101000 and §101030]
   
3. Establishes the Maternal, Child and Adolescent Health program within DPH to improve the health and well-being of women, infants, children and adolescents throughout the state. [HSC §123225-12360]
4. Finds and declares that the rate of mortality among black infants continues to be two to four times higher than the rates for other groups statewide. States that the social support, stress management, and empowerment model of the Black Infant Health (BIH) program is an evidence-informed intervention program designed to reduce black infant mortality. [HSC §123259]
5. Requires DPH, subject to an appropriation in the annual Budget Act, to establish the PEI to expand the scope of interventions provided under the BIH program. [HSC §123260]
6. Requires the PEI to foster Community Centers of Excellence in perinatal health and promote the use of interventions designed to fill gaps in current programming offered through the BIH program. [Id.]
7. Requires DPH, as part of PEI, to develop a process to allocate funds to up to 15 county health departments, to work collaboratively with state and local BIH programs, to improve black infant birth outcomes and reducing infant mortality. [Id.]

FISCAL EFFECT: None.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, this bill will provide equity within the distribution of funds already allocated to DPH for the BIH program by allowing both counties and cities with their own health departments to apply for the funds. The author concludes this will result in more equitable distribution of funds and increase the opportunity for more Black mothers and babies to have access to the funding within the program.
2. BACKGROUND. According to an issue brief published by the Kaiser Family Foundation in 2022 entitled “Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Them,” Black and American Indian and Alaska Native (AIAN) women have higher rates of pregnancy-related death compared to White women. Pregnancy-related mortality rates among Black and AIAN women are over three and two times higher, respectively, compared to the rate for White women (41.4 and 26.2 vs. 13.7 per 100,000). Black, AIAN, and Native Hawaiian and Other Pacific Islander (NHOPI) women also have higher shares preterm births, low birthweight births, or births for which they received late or no prenatal care compared to White women. Infants born to Black, AIAN, and NHOPI people have markedly higher mortality rates than those born to White women. Maternal death rates increased during the COVID-19 pandemic and racial disparities widened for Black women.
   
   Maternal and infant health disparities are symptoms of broader underlying social and economic inequities that are rooted in racism and discrimination. Differences in health insurance coverage and access to care play a role in driving worse maternal and infant health outcomes for people of color. However, inequities in broader social and economic factors and structural and systemic racism and discrimination are primary drivers for maternal and infant health. Notably, disparities in maternal and infant health persist even when controlling for certain underlying social and economic factors, such as education and income, pointing to the roles racism and discrimination play in driving disparities.
   
   The increased awareness and attention to maternal and infant health have contributed to a rise in efforts and resources focused on improving health outcomes in these areas and reducing disparities. These include efforts to expand access to coverage and care, increase access to a broader array of services and providers that support maternal and infant health, diversity the health care workforce, and enhance data collection and reporting. However, addressing social and economic factors that contribute to poorer health outcomes and disparities will also be important. Moreover, the persistence of disparities in maternal health across income and education levels, points to the importance of addressing the roles of racism and discrimination within the health care system as part of efforts to improve health and advance equity.
   1. California Data. According to the March of Dimes, infant mortality refers to death that occurs during the first year of life. Infant deaths can be further classified into neonatal (zero to 27 days) and postneonatal (28 days-under one year) periods. Neonatal mortality is typically associated with events surrounding the prenatal period and the delivery, whereas postneonatal deaths are more likely to be associated with conditions or events that arise after the delivery and may reflect environmental factors.
      
      In 2019, 1,889 infants died before reaching their first birthday, an infant mortality rate of 4.2 per 1,000 live births. Between 2009 and 2019, the infant mortality rate in California declined more than 14%. In 2019, 69.7% of infant deaths occurred in the neonatal period, and 30.2% occurred in the postneonal period. Some of the leading causes of infant death in the United States include: birth defects, prematurity/low birth weight, sudden infant death syndrome, maternal complications of pregnancy, and respiratory distress syndrome. The rate of perinatal mortality (fetal deaths of 28 or more weeks gestation and infant deaths in the first seven days of life) in 2019 was 4.7% live births and fetal deaths.
   2. Health Disparities. According to the BIH program, health disparities affecting Black women and babies appear to be less dependent on age, economic status or education. Poor birth outcomes persist even when Black women have a pregnancy at an optimal age, have high income or are well educated. Black women are four to six times more likely to die from pregnancy-related causes than Asian/Pacific Islander, Hispanic/Latina and White women. Black babies are twice as likely to be born with a low birth weight (less than five lbs., eight oz.) than infants of other racial or ethnic groups. 
      
      The March of Dimes states that during 2017-2019 (average), the infant mortality rate per 1,000 live births in California was highest for Black infants (8.3), followed by AIAN (6.3), Hispanics (4.4), White (3.2) and Asian/Pacific Islanders (API) (2.9). Black infants were about three times as likely as API infants to die during the first year of life during 2017-2019.
   3. BIH Program and PEI. The Budget Act of 2018 established the PEI within DPH to expand the scope of interventions provided under the BIH program, established through the Budget Act of 1989. PEI funding is intended to enhance the efforts of existing BIH program with the goal of providing a culturally supportive environment to help women have healthy babies. Existing law specifies that DPH allocate funding to up to 15 county health departments with BIH programs.
      
      BIH funding is currently provided to city and county health departments. However, several BIH programs are not eligible to apply for the complimentary PEI funding as existing statute limits the funding to county health departments, limiting the reach of PEI. According to the author, to provide complementary services to BIH programs, PEI funding eligibility should be expanded to local health jurisdictions which encompasses both city and county health departments with a BIH.
      
      The 2022 Budget Act provides $12.5 million ongoing augmentation to the BIH program. Of this amount, $11.25 million will be awarded to county/city health departments and $1.25 million will be retained by DPH for state operations.
   4. Local Health Departments. California’s local health departments, led by LHOs, play a vital role in preparing for and responding to public health emergencies. There are 58 county local health departments and three city (Berkeley, Long Beach and Pasadena) local health departments in the state. LHOs have a broad mandate to take measures necessary to preserve and protect public health. While LHOs administer many of the programs identified under DPH, LHOs have a fundamental role as the front line for delivery of public health services to California’s communities. The structure and size of LHOs vary by jurisdiction, and some include operations such as public hospitals, primary care clinics, and animal control services. Select core functions include:
      
      1. Infectious disease control. LHOs prevent and control the spread of infectious diseases through immunizations, epidemiologic surveillance, disease investigation, laboratory testing and response activities;
      2. Emergency preparedness and response. LHOs work to ensure communities are informed, supplies and medications are accessible, and that there is capacity to expand medical services in large events. In addition, LHOs utilize public health labs to investigate and identify potential bioterrorism threats. In the event of a disaster, LHOs may staff shelters and screen for infectious diseases and address the needs of medically fragile residents; and,
      3. Maternal, child, and adolescent health. LHOs work to identify, disseminate, and promote emerging and evidence-based information about early interventions in prenatal and early childhood periods that promote lifelong health, positive social-emotional development, and reduce health disparities.
3. SUPPORT. The California Nurse-Midwives Association and Children Now write in support that this bill will help address critical gaps in maternal healthcare, especially in vulnerable communities.

REGISTERED SUPPORT / OPPOSITION:

Support

California Nurse-Midwives Association

Children Now

Opposition

None on file.

Analysis Prepared by: Rosielyn Pulmano / HEALTH / (916) 319-2097