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July 2025

Assessing the Needs of Maternal and Child Health Populations in North Dakota

Chelsey Hukriede is a research specialist with the Center for Social Research at NDSU with experience in survey research, data analysis and dissemination. Much of her work has focused on maternal and child health. Chelsey has a Master’s degree in Sociology and is currently a doctoral student in Criminal Justice at NDSU.

The North Dakota Department of Health and Human Services (HHS) and North Dakota State University Center for Social Research (CSR) conducted a statewide Needs Assessment of Maternal and Child Health (MCH) populations across North Dakota to better understand potential needs and challenges associated with the health and well-being of women and children. This needs assessment was conducted as part of the 2025-2030 Title V MCH Services Block Grant to States Program, which is a grant under which funds are awarded to states upon their submission of an acceptable plan to address the health services needs within a state for the target population of mothers, infants and children, including infants and children with special health care needs and their families. Through the MCH Block Grant, each state supports and promotes the development and coordination of systems of care for the MCH population, which are family-centered, community-based, and culturally appropriate. The needs assessment is used to guide and inform decisions for program planning and development by describing both the strengths and needs of North Dakota MCH populations; prioritizing North Dakota programs and resources; and assessing the resources and assets of North Dakota communities.

The Needs Assessment Process

A requirement of the 2025-2030 MCH Title V Block Grant 5-year Needs Assessment is the selection of a minimum of five national performance measures to set as state priority needs. National performance measures (NPMs) are widely accepted indicators used to track conditions, gauge trends, and measure health outcomes. These NPMs are specific to each MCH population domain with six to nine performance measures aligning with each population domain. There are five MCH population domains: women and mothers, infants, children, adolescents, and children with special health care needs. North Dakota’s selection of priority needs was guided by a survey of stakeholders and Well-Being Profiles.

The 2025 North Dakota Title V MCH Survey to Stakeholders was sent to North Dakota residents with an interest or concern in the health and well-being of women and children in January 2025. Stakeholders included health care providers, police, EMS, child care providers, community advocates, academic researchers and educators, social service providers, and hospital, county and school administrators. The purpose of the survey was to get stakeholder input and assistance in determining the MCH priority needs for the next five years, for North Dakota’s Title V MCH Services Block Grant. In addition to soliciting input on priority measures within each of the MCH population domains, the survey was designed to solicit additional input to identify unmet needs and other unique issues that may not be addressed by the defined performance measures within each MCH domain.

A total of 20 national performance measures, as defined by the MCH Title V Block Grant to address key MCH priority areas within each population domain, were used to create domain profiles with performance measure data spanning from 2018 to 2024 when available. North Dakota Well-Being Profiles were created for each of the five MCH defined population domains: perinatal and infants, children, children with special health care needs, adolescents, and women and mothers. The profiles provide a snapshot of current conditions, placed in context, by comparing each performance measure to regional and national averages, where data was available. In addition to overall averages, performance measure data were reported by various demographic characteristics as available and appropriate. Demographic characteristics included measures such as marital status or family structure, educational attainment, age, race and ethnicity, household income, poverty level, and type of health care insurance. Data for the well-being profiles was compiled from numerous data sources, all vetted and approved by the Maternal and Child Health Bureau.

CSR researchers provided the MCH team with quantitative and qualitative analysis of the stakeholder survey, performance measure analysis, and five North Dakota population domain Well-Being Profiles. The MCH Epidemiology Team reviewed these results to inform the identification and selection of North Dakota’s priority measures. MCH programmatic leaders, also considered staff capacity, feasibility, and other potential resource opportunities or constraints when identifying North Dakota’s 2025-2030 priority measures. Then, a draft of MCH priorities were determined, made available for public comment, and a press release asking for public comment was released in March 2025. Once public comments were received and reviewed, the MCH Priorities for 2025-2030 were finalized. Public comments largely reflected agreement that the correct priorities were chosen, and encouraged collaboration among stakeholders to address new priorities and health goals across the state.

Needs Assessment Analysis

2025 North Dakota Title V MCH Survey to Stakeholders

The stakeholder survey was distributed to a total of 198 key stakeholders identified by North Dakota HHS, as individuals or employees who have a vested interest in maternal and child health across the state, via an email requesting participation and input through an online survey instrument using Qualtrics software. A snowball sampling technique was used for survey distribution. Stakeholders were asked to forward the survey link to colleagues and partners that could provide meaningful insight on MCH needs in North Dakota. The survey was well received with excellent participation from stakeholders. A total of 196 responses were collected. Key findings from the stakeholder survey are highlighted below:

Most Important Things Needed to Live Fullest Lives

Stakeholders were asked to rank the top three things people need to live their fullest lives among various groups that align closely with MCH population domains: women and mothers, children, children with special health care needs, and families. Stakeholders were asked to rank the top three things needed from a list of broad-based public health considerations. Across each of the domain categories, stakeholders consistently identified similar needs. ‘Family support and child care’ was ranked as the most important thing needed across all four domains; 62 to 84 percent of respondents ranked ‘family support and child care’ as one of the top three needs for each of the four domains. The only identified need that was slightly different based on the population domain was a single different need identified for children with special health care needs. Respondents identified ‘health care provider recruitment’ among the top three needs for children with special health care needs.

Respondents were also asked to list any additional important things that women and mothers, children, children with special health care needs, and families need to live their fullest lives in North Dakota in the form of an open-ended question. Below are the eight themes that emerged from this open-ended question with ‘paid family leave and workforce support’ (employer-provided childcare, workforce development and job opportunities) being the most frequent response and ‘information and resource accessibility’ noted the least.

1. Paid Family Leave and Workforce Support
2. Access to Healthcare
3. Ease of Obtaining and Using Services
4. Education and Child Development
5. Basic and Comprehensive Needs
6. Mental Health and Community Support
7. Systemic and Policy-Related Issues
8. Information and Resource Accessibility

Top Three Unmet Needs

Stakeholders were asked to identify the top three unmet needs among various groups that align closely with the MCH population domains: women and mothers, families, children, and children with special health care needs. The unmet needs identified by stakeholders again was fairly consistent across domain categories. ‘Family support and child care,’ ‘mental health and substance abuse support’ and ‘health care and insurance’ were identified as unmet needs across all population groups and were ranked as one of the top three needs in all domain categories except children. Respondents most frequently cited ‘mental health and substance abuse support’ as the top unmet need for children. ‘Family support and child care’ was ranked highest across the remaining three domains with 70 to 80 percent of respondents that ranked ‘family support and child care’ as the number one unmet need. Stakeholders also identified ‘nutrition and exercise’ among the top three unmet needs for the child population domain.

Survey respondents were also asked to list any other important measures and unmet needs of North Dakota’s MCH population through an open-ended question. Stakeholders most frequently identified ‘access to health and wellness resources’, especially in rural communities, as an important need across populations. Several key themes emerged from the responses listed below in order from most to least frequent.

1. Access to Health and Wellness Resources
2. Community and Social Support
3. Education and Awareness
4. Systemic and Policy-Related Challenges
5. Health and Well-Being

Awareness, Desire to Address, and Progress of Performance Measures

Additionally, for each of the performance measures within each MCH domain, stakeholders were asked to gauge their awareness of, desire to address, and progress made associated with each of the national performance measures. Stakeholders tended to rank performance measures consistently across their awareness of the issue, desire to address issues, and progress being made towards measures. For example, tobacco use, childhood vaccination and safe sleep practices were all ranked high for each awareness, desire, and progress. Perinatal care discrimination, health care transition, and adult mentor were all ranked low in terms of stakeholders’ awareness, desire and progress being made towards addressing issues. However, there was not always a direct correlation between concern and results. Bullying, for example, was ranked high by stakeholders in terms of desire (53 percent) and awareness (57 percent), but only 20 percent of stakeholders felt progress was being made to address bullying issues. Breastfeeding however, although showing moderate awareness (48 percent) and relatively low desire to address it (32 percent), it is perceived as an area where strong progress is being made (55 percent).

North Dakota Well-Being Profiles

A total of 20 national performance measures (NPMs), as defined by the MCH Title V Block Grant to address key MCH priority areas within each population domain, were used to create domain profiles with performance measure data spanning from 2018 to 2024 when available. Results of this analysis are presented below by MCH population domain.

Perinatal and Infant Health

The NPMs used to track perinatal and infant health outcomes are breastfeeding, housing instability, perinatal care discrimination, risk-appropriate perinatal care, and safe sleep practices. The North Dakota Well-Being Profile for perinatal and infant health provides a snapshot of health and well-being among North Dakota’s infants 24 months and younger. When North Dakota perinatal and infant indicators were compared to regional and national averages, for most indicators, behaviors were generally similar, varying plus or minus one to three percent, with two exceptions. The prevalence of infants only placed on their back to sleep (recommended practice) was greater in North Dakota than nationally, 89 percent compared to 83 percent, respectively. The percent of infants room sharing with an adult (recommended practice) was less prevalent in North Dakota, 72 percent compared to 82 percent nationally.

Children’s Health

The NPMs used to track children’s health outcomes are childhood vaccination, developmental screening, food sufficiency, housing instability, preventive dental visit and physical activity. The North Dakota Well-Being Profile for children’s health provides a snapshot of health and well-being among North Dakota’s children ages 12 and younger for most measures; preventive dental visit includes child ages 1 through 17. The prevalence of developmental screenings for toddlers 9 through 35 months (45 percent) was comparable to regional averages (44 percent) and higher than national averages (36 percent). Preventive dental visits among children ages 1 through 17 was the same as national averages (80 percent, each) but lower than regionally (85 percent). Food sufficiency (children living in food secure households) and housing instability (children living in households with housing issues) in North Dakota were also similar to regional and national averages. However, the prevalence of children (ages 6 to 11 years) physically active 60 minutes or more per day was higher in North Dakota (31 percent) than regionally or nationally (26 percent).

Children with Special Health Care Needs’ Health

The NPMs used to track children with special health care needs’ health outcomes are bullying, health care transition, medical home overall, care coordination, family centered care, personal doctor, referrals, and usual source of sick care. The North Dakota Well-Being Profile for children with special health care needs provides a snapshot of health and well-being among children, ages 0 through 17. A comparison of NPMs for children with special health care needs suggests that for most indicators, North Dakota is performing similarly or better than regionally or nationally. Indicators related to access to care and care coordination are generally better than national averages, however, the prevalence of both bullying others and being the victim of bullying, among children with special health care needs, is higher in North Dakota than both regionally and nationally.

Adolescent Health

The NPMs used to track adolescent health outcomes are adult mentor, adolescent well-visit, bullying, health care transition, medical home, mental health treatment, preventive dental visit and tobacco use. The North Dakota Well-Being Profile for adolescent health provides a snapshot of health and well-being among North Dakota’s teenagers, ages 12 through 17. When examining adolescent indicators related to access to and delivery of health services (dental care, mental health care, well-visit and medical home), North Dakota performance measures were generally slightly better than regionally or nationally with the exception of adolescent well-visits, where North Dakota averages were slightly lower than regionally and nationally. Preventive dental visits among North Dakota children and adolescents (ages 1 through 17 years) was the same as nationally but slightly lower than regionally. The prevalence of bullying or being bullied in North Dakota was slightly lower than regionally, but higher than nationally. Tobacco use for North Dakota high school students was slightly higher than the national average.

Women and Maternal Health

The NPMs used to track women and mothers’ health outcomes are housing instability, perinatal care discrimination, postpartum contraceptive use, postpartum mental health screening, postpartum visit, and preventive dental visit. The North Dakota Well-Being Profile for women and maternal health provides a snapshot of health and well-being among North Dakota’s women and mothers. North Dakota indicators related to postpartum check-up and recommended care were generally similar to regional averages and somewhat higher than national averages. Prevalence of preventive dental visits for women in North Dakota was slightly lower than regionally but higher than nationally. Contraceptive use among North Dakota mothers was lower than regionally and slightly lower than national averages.

Identified Priority Measures

The final selection of North Dakota’s nine priority needs was guided by quantitative and qualitative analysis of a stakeholder survey, national performance measures and Well-Being Profiles for each MCH Title V population domain. MCH programmatic leaders also considered staff capacity, feasibility, and other potential resource opportunities or constraints in identifying North Dakota’s 2025-2030 priority measures. Nine chosen priority measures are North Dakota’s next step in their plan to address the health service’s needs and promote the health of all mothers and children, including children with special health care needs and their families.

The following were identified as North Dakota’s priority measures for each of the MCH population domains.

Perinatal and Infant Health

North Dakota Department of Health and Human Services (HHS) leadership selected safe sleep as the priority measure for the Perinatal and Infant Health domain, for the 2025-2030 cycle. Safe sleep performance metrics show that North Dakota is making progress in certain areas (e.g., slightly higher percentages of infants placed on their backs and sleeping alone) but continues to underperform in others. For example, fewer mothers reported that their infant sleeps in the same room – one of the most effective risk-reduction strategies – compared to both regional and national benchmarks. Choosing safe sleep as the domain priority reflects an urgent and actionable opportunity to address one of the state’s most preventable contributors to infant death.

Children’s Health

HHS leadership selected food sufficiency and medical home care coordination as North Dakota’s new child health priority measures for the 2025-2030 cycle. While the percent of children 11 and younger, whose households were food sufficient was the same as the national average (69 percent), food sufficiency in North Dakota (69 percent) was lower than the regional average (72 percent). The focus on food sufficiency will improve accessibility to healthy food options through community resources (schools, food banks, health units, etc.).
While only 3 percent of survey respondents indicated medical home should be the top priority within the child health domain, care coordination, a component of medical home was selected as a priority measure for North Dakota children to ensure all children are receiving necessary care coordination to link children to essential services and resources, for optimal health and well-being. Medical home is a mandatory priority measure and the care coordination subcomponent aligns with current work initiatives within North Dakota’s child health domain.

Children with Special Health Care Needs Health

HHS leadership selected medical home overall as the new domain priority measure for the 2025-2030 cycle. A majority of stakeholders (60 percent) indicated medical home should be the next priority measure for children with special health needs. North Dakota compares favorably with regional and national averages for the percentage of children with special health needs that received needed help with care coordination. Sixty-three percent of children with special health needs in North Dakota received needed help with care coordination compared to 54 percent regionally and 53 percent nationally. Focus on this measure will improve the system of care for children with special health care needs.

Adolescent Health

HHS leadership selected mental health treatment as the new domain priority measure for the 2025-2030 cycle. While North Dakota compares favorably for the percentage of adolescents that received needed mental health treatment, 50 percent of survey respondents indicated mental health treatment should be the top priority for adolescent health. Focus on this measure will help identify, reduce, or eliminate barriers preventing adolescents from receiving mental health treatment and counseling.

Women and Maternal Health

HHS leadership selected postpartum visit as the new domain priority measure for the 2025-2030 cycle. Most of survey respondents (41 percent) indicated postpartum mental health screening and 21 percent chose postpartum visits as top priorities within in the women and mothers’ population domain. The percentage of ND mothers that had a postpartum checkup is similar to regional and national averages. Ninety-three percent of ND mothers had a postpartum checkup compared to 92 percent regionally and 91 percent nationally. The focus on this measure will help identify, reduce, or eliminate barriers preventing women from receiving recommended postpartum care components, including but not limited to mental health screening, breastfeeding support, care coordination, etc.

Cross-Cutting and Systems Building

HHS leadership selected Vision Zero, implementing North Dakota state mandates, and improving access to health-related services as the domain priority measures for the 2025-2030 cycle. Vision Zero is a state initiative to eliminate fatalities and serious injuries caused by motor vehicle crashes. HHS leadership also prioritizes implementing all North Dakota state mandates delegated to the HHS Title V/MCH Programs as well as increasing awareness and utilization of statewide services and resources to improve health and well-being.

The nine identified priority measures will guide the North Dakota HHS efforts to promote the health and well-being of all mothers and children in North Dakota.