Federal Funding for Midwifery Education
Increasing the number of midwives of color in our profession is NACPM’s highest priority.
Why is federal funding for midwifery education so important?
Perinatal death and morbidity rates, preterm birth, and low birth weight in the U.S. are the highest among wealthy countries and rising, and severe perinatal morbidity has doubled in the past 20 years. Black birthing people are 3 times (Center, 2021) more likely to die of pregnancy-related causes than their white counterparts regardless of level of education and income, and their babies are 2.4 times (Ely, 2022) more likely to die in their first year of life. Indigenous people and their babies experience similar death and morbidity rates. In addition, the U.S. is facing an increasingly severe shortage of trained perinatal care providers. More than five million birthing people in the U.S. live in a rural maternity care desert, and nearly half of all counties do not have a single obstetrical provider.
Growing and diversifying the midwifery workforce is key to addressing the workforce shortage, improving outcomes, and eliminating racial disparities. Midwifery care is strongly associated with support for physiologic birth, lower interventions, and improved outcomes. States where midwives are most accessible have the best outcomes for birthing people and babies; states where access is most limited have the worst indicators of perinatal and neonatal well-being.
Federal action is urgently needed to grow the midwifery workforce through expanding funding to accredited midwifery education programs whose graduates provide high-value care and are educated in fewer years at significantly lower cost than obstetricians. Shifting the birth equity equation and eliminating racial disparities and inequities requires a workforce that reflects the racial, ethnic, and social diversity of childbearing people in our country. Prioritizing federal funding to accredited midwifery education programs whose students plan to practice in health professional shortage areas and that demonstrate a focus on increasing racial and ethnic minority representation in midwifery education is critical.
In the Spring of 2019, NACPM was invited to assist U.S. Congresswoman Lucille Roybal-Allard’s office in their efforts to alleviate the perinatal health crisis in the U.S. by helping to design legislation to grow and diversify the midwifery workforce.
Two separate pieces of legislation resulted and are described below.
Passed Congress: The Further Consolidated Appropriations Act, 2020
This legislation , signed by the President on December 20, 2019, allocated $2,500,000 to educate midwives within the Scholarships for Disadvantaged Students (SDS) Program in Title VII of the Public Health Service Act. For the first time ever, midwives enrolled in accredited programs were included in the categories of students eligible to receive SDS scholarships. This funding will increase the number of midwifery graduates working in underserved communities and those from disadvantaged backgrounds, including students who are members of racial and ethnic minority groups.
Following the passage of this Act, NACPM partnered with MEAC to fundraise to engage a DC firm, McAllister and Quinn , that specializes in supporting schools of higher education to apply for SDS grants, to work with our schools to develop competitive SDS applications. We could not be more proud of our schools. After a deep process to assess capacity, three of our schools applied for SDS grants – a true first for CPM education. Nationally, of the almost 50 midwifery schools for all the midwife credentials in the U.S., seven schools applied – and 3 of those 7 were MEAC-accredited schools. Of the 7 SDS applications, four grants for the maximum were awarded, and the Midwifery Department at Bastyr University was one of the recipients of these five-year grants.
Introduced in Congress: Midwives for Maximizing Optimal Maternity Services (MOMS) Act of 2021
On May 19, 2021, the Midwives for MOMS Act was introduced in the U.S. Congress in both the House of Representatives and the Senate with both Republican and Democratic sponsors. NACPM celebrates this historic legislation that would authorize first-ever federal funding programs specifically to support midwifery education. NACPM worked with Congress on the development of this legislation to grow the number of midwives available to families in the United States and to support the development of a midwifery workforce that reflects and represents the racial and ethnic demographics of the childbearing population.
This work on this act established two new funding streams within the Public Health Service Act to support midwifery education and training programs for all nationally-credentialled midwives (CPMs, CNMs, CMs) enrolled in schools accredited by MEAC and ACME. With a strong focus on equity, this legislation calls for prioritizing grants to schools that train students who plan to practice in health professional shortage areas and that demonstrate a focus on increasing racial and ethnic minority representation in midwifery education and the professional.
TITLE VII Scholarships for Disadvantaged Students (SDS)
This SDS set-aside has been funded since FY20. It was originally funded at $2 million in FY20 and FY21. In FY22 it was funded at $3.5 million, and in the FY23 Omnibus it received $5 million. The FY24 House Bill funded this account at $5 million. We are asking for level funding of this program at $5 million. This program is a 5-year grant cycle, and there are 4 schools currently receiving funding to support students from economically and educationally disadvantaged backgrounds. These schools are successfully promoting diversity in their student populations while aiming to increase the number of graduates working in medically underserved and rural communities.
TITLE VIII Advanced Nursing Education Workforce (ANEW)
This ANEW set-aside has been funded since FY23. The FY23 President’s budget asked for $25 million for this set aside to address the maternal mortality crisis and the shortage of maternity care providers. The House bill funded the set aside at $20 million, but this was decreased to $8 million in the final omnibus. We are not asking for new money, just level funding of this carve-out. The program will fund accredited nurse-midwifery programs to award scholarships to students and registered nurses, with a focus on practitioners working in rural and underserved communities, to cover the total cost of tuition for the duration of the nurse-midwifery program. The program will also support the planning and development of new accredited midwifery training programs. Eight midwifery programs were funded in the first cycle of this set-aside. This critical funding is helping to educate nationally certified midwives to address the shortage of maternity care providers and the lack of diversity in the maternity care workforce.
Continuation of these set asides will
Provide direct support to students in an accredited midwifery school or program (50% of awards)
Establish or expand midwifery schools or programs (25% of awards)
Secure, prepare or provide support for increasing the number of qualified preceptors for training students in accredited midwifery schools or programs (25% of awards)
NACPM looks forward to the continuation of this legislation in collaboration with our members, supporters, and our Congressional champions.
Centers for Disease Control and Prevention. (2023, March 16). Maternal mortality rates in the United States, 2021. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-2021.htm
Ely, D., & Driscoll, A. (n.d.). Infant Mortality in the United States: Provisional Data From the 2022 Period Linked Birth/Infant Death File. https://www.cdc.gov/nchs/data/vsrr/vsrr033.pdf