The United States faces a critical maternal health crisis, characterized by the highest mortality rates among high-income nations and profound racial disparities. The University of Illinois Chicago established the Luma Center, a Maternal Health Research Center of Excellence funded by the National Institutes of Health IMPROVE initiative. This article details the center's development, implementation, and theoretical foundation. Central to the Luma Center's mission is the Biopsychosocial Ecosystem Framework, which shifts the research focus from individual-level factors to the multilevel systemic drivers of maternal morbidity and mortality. Utilizing a transdisciplinary approach involving 18 academic disciplines, the Center operates through five core areas: Leadership, Community Partnership, Research, Training, and Data. The primary objectives are to conduct robust multilevel research, cultivate a diverse research workforce, and strengthen community partnerships to ensure the translation of findings into effective postpartum interventions. By integrating community expertise with academic innovation, the Luma Center seeks to systematically address the fundamental causes of poor maternal health outcomes and advance science to promote perinatal health and wellness.

This JAMA Forum discusses the importance of the Pregnancy Risk Assessment Monitoring System (PRAMS) for maternal and infant health, recent changes that threaten PRAMS, and implications for health professionals, the public, and policymakers.

OBJECTIVE:The American Academy of Pediatrics (AAP) publishes evidence-based infant sleep recommendations to prevent sudden unexpected infant death (SUID). We defined common patterns of infant sleep and care practices in Illinois and assessed variation in patterns across demographic characteristics. METHODS:We measured maternal report of AAP recommended practices in the 2016-2020 Illinois Pregnancy Risk Assessment Monitoring System, including breastfeeding greater than or equal to 8 weeks; no maternal smoking; and 4 aspects of the sleep environment for infant sleeping on back, on an approved surface, without items in sleep area, and without bed sharing. We applied nonhierarchical cluster analysis, coupled with knowledge of AAP recommendations, to define 6 mutually exclusive patterns of infant sleep and care practices. We produced weighted prevalence estimates for each individual practice and pattern and examined differences by maternal race and ethnicity, age, parity, education, and socioeconomic status using χ2 tests. RESULTS:Prevalence estimates for individual practices ranged from 49.6% for infants sleeping without items in sleep area to 90.8% for not smoking. When examining patterns, only 19.3% of new mothers reported all 6 recommended practices; this pattern varied significantly across all demographics examined. The prevalence of the other 5 patterns were as follows: 8.1% following all 4 sleep environment practices, 28.1% bed sharing and breastfeeding, 11.7% bed sharing and no breastfeeding, 25.1% no bed sharing and back sleep positioning, and 7.8% no bed sharing and no back sleep positioning. CONCLUSION:Examining common patterns of infant sleep and care practices provides improved understanding of how infant sleep recommendations are followed and may inform intervention strategies.

In 2019, the Health Resources and Services Administration provided funding to 9 states to implement a State Maternal Health Innovation Program, which required development of a state-level Maternal Health Task Force (MHTF) and an associated Maternal Health Strategic Plan (MHSP) in each recipient state. This case study presents perspectives of the development and implementation of MHTFs in 3 funded states: Illinois, North Carolina, and Ohio. Each state used a different approach for MHTF administration: public university staff (Illinois), contracted staff (North Carolina), and state public health department staff (Ohio). To create the MHTFs, all states leveraged existing partnerships and sought new connections to ensure a multidiscplinary membership. To construct its MHSP, each state used data and recommendations from its Maternal Mortality Review Committee, existing state-level maternal health action plans and data, other maternal health initiatives, and knowledge from MHTF members. Topics addressed by all 3 MHSPs included public education on maternal health issues, training for health care providers, expansion of the perinatal workforce, and expansion and restructuring of mental health and substance use services. Common challenges for MHTFs and MHSPs that emerged across the states included engaging membership, determining the scope of activities, and demonstrating effectiveness of the MHTF. Despite the launch of MHTFs during the COVID-19 pandemic, all 3 states successfully created MHSPs, retained mostly volunteer members, and have continued to demonstrate progress on activities identified in their MHSPs. Funding is vital for success; merging MHTFs with other state-level efforts may be prudent to reduce the time burden on members, create synergy, and ensure sustainability.

This study evaluated the race and ethnicity-specific association between having a personal doctor or nurse and/or a usual site for care and preventive care utilization among 15,989 insured male adolescents. The 2021-2022 National Survey of Children's Health was used to conduct bivariate and multivariable binomial regression analyses and obtain crude and adjusted prevalence differences, overall and by race and ethnicity. Seventy-nine percent of male adolescents with a personal doctor or nurse had a preventive care visit, compared with 63.0% with a usual site but no personal doctor or nurse, and 31.9% with neither. Having a personal doctor a nurse was associated with greater preventive care utilization overall and for each racial and ethnic group [aPD:43.49 (95% CI:35.24, 51.73)]. Established relationships with a personal health care provider may facilitate preventive care utilization, which could be particularly important for racial and ethnic minority adolescents given existing disparities in health care utilization and outcomes.

Purpose: This study examined receipt of a well-woman visit (WWV) and cervical cancer screening (CCS) at the intersection of sexual orientation and race/ethnicity among Illinois women aged 21-65. Methods: This study used 2016, 2018, and 2020 Illinois Behavioral Risk Factor Surveillance System (BRFSS) data for women aged 21-65 to examine rates of CCS (n = 2848) and 2016-2018, 2020, and 2021 Illinois BRFSS data to examine WWV receipt (n = 5863) by sexual orientation (heterosexual vs. lesbian, gay, and bisexual [LGB]). Self-reported race/ethnicity was tested as an effect modifier to assess intersectionality. Using binomial regression, adjusted prevalence differences (aPD) and 95% confidence intervals (CIs) were estimated. Covariates included age, education, marital status, employment, and health insurance coverage. Results: Overall, 4.6% of Illinois women aged 21-65 self-identified as LGB. Heterosexual and LGB women had a similar prevalence of receipt of both a WWV (77.1% and 71.7%, respectively; aPD = 3.22, 95% CI: -3.62 to 10.06) and CCS (85.3% and 83.4%, respectively; aPD = 2.13, 95% CI: -4.77 to 9.04). Among non-Hispanic (NH) Black women, heterosexual compared with LGB women had a higher prevalence of receiving both types of care; however, adjusted associations included the null. Hispanic women had similar prevalence estimates by sexual orientation for both outcomes, and NH White heterosexual compared with LGB women had a higher prevalence of CCS, but not WWV. Conclusion: In Illinois overall, heterosexual and LGB women received preventive care at similar rates. However, when stratified by race/ethnicity, WWV and CCS receipt rates may be higher for heterosexual compared with LGB women, indicating potential missed opportunities for preventive care.

This study explores the association between health system changes over the last decade and women's preventive care utilization in Illinois. A cross-sectional analysis using Illinois Behavioral Risk Factor Surveillance System (BRFSS) data from 2012-2020 among women aged 21-75 (n=21,258) examined well-woman visit (WWV) receipt and breast and cervical cancer screening overall and over several time periods. There was an increase in the prevalence of receiving a WWV for Illinois women overall from 2012-2020. However, the overall adjusted prevalence difference was only significant for the 2020 versus 2015-2019 comparison and not for 2015-2019 versus 2012-2014. The COVID-19 pandemic was not associated with a decrease in the prevalence of mammogram use but was manifest for cervical cancer screening, particularly for Black women. Finally, those reporting having a WWV in the past year had a significantly higher prevalence of being up to date with screening compared with those not reporting a WWV.

On December 5th, 2022, controlled fusion ignition was demonstrated for the first time at the National Ignition Facility (NIF), a major achievement in the field of Inertial Confinement Fusion (ICF) requiring a multi-decadal effort involving broad national and international collaborations. To drive the fusion ignition reaction with the compressed fuel capsule, that yielded 3.15 MJ of nuclear energy [1], the NIF laser delivered a high-precision pulse shape with 2.05 MJ of ultra-violet (UV) laser energy and a peak power of 440 TW. This laser energy was an increase of similar to 8 % compared to that delivered on the previous "threshold of ignition" record yield experiment (1.37 MJ of yield for 1.89 MJ of laser energy) on August 8th, 2021 [2]. We explain how the results of our extensive research in laser technology and UV optics damage mitigation led to major improvements in the NIF laser, enabling this energy increase along with additional accuracy, precision, and power balance enhancements. Furthermore, we will discuss on-going efforts that have enabled operations at 2.2 MJ of UV energy as well as potential new initiatives to push the laser performance -accuracy and delivered energy- to even higher levels in the future as previously demonstrated on a small subset of NIF beams [3].

Background: Given increased attention to the maternal health crisis, its heavy toll on Black birthing persons, and recognition that most pregnancy-related deaths occur in the extended postpartum period, Illinois implemented a Postpartum Medicaid Extension (PME). Objectives: The purpose of this study was to use baseline data from the pre-PME period to ascertain which groups of eligible persons can be expected to experience improved outcomes as a result of PME implementation in Illinois. Methods: We focused on the Well-Woman Visit (WWV) as it can be measured in the later postpartum period and is relevant for non-pregnant women. We provide baseline prevalence estimates for WWV receipt using PRAMS and BRFSS data within income strata and within combined income-insurance strata with particular attention to the income group most likely to be affected by the PME. Using multivariable binomial regression, we generate adjusted prevalence differences across income and insurance strata overall and by race/ethnicity. Results: The Illinois PME has the potential to improve the receipt of well-woman care in the 138-213% FPL income group, the group most likely to be affected by the PME. The analysis also suggests that Black women in Illinois may not be the group most likely to benefit from the enhanced access to care made available by the PME without additional focused attention to their particular needs and experiences. Conclusions and Implications for Practice and Policy: The PME is necessary but not sufficient for addressing racial/ethnic inequities in maternal health. Leveraging the opportunity that the PME provides to design and support delivery models that maximize the effects of such coverage will be essential to address the maternal health crisis in Illinois. Without extra attention to the needs and experiences of Black women, focused on the delivery of care as well as the structural determinants of health including institutional and interpersonal racism, the benefits of the PME for Black women may not be fully realized.### Competing Interest StatementThe authors have declared no competing interest.### Funding StatementThe Illinois Maternal and Child Health Block Grant Program of the Illinois Department of Public Health provided financial support for this project.### Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:The University of Illinois at Chicago Office for the Protection of Research Subjects provided a Not Human Research Determination on April 28, 2023.I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.YesBRFSS Data available at: Behavioral Risk Factor Surveillance System (BRFSS). Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System. Annual Survey Data. https://www.cdc.gov/brfss/annual\_data/annual\_data.htm. PRAMS data available at: PRAMS data are available as an automated research file (ARF) that can be downloaded. https://www.cdc.gov/prams/prams-data/researchers.htm

PURPOSE:Many maternal deaths occur beyond the acute birth encounter. There are opportunities for improving maternal health outcomes through facilitated quality improvement efforts in community settings, particularly in the postpartum period. We used a mixed methods approach to evaluate a collaborative quality improvement (QI) model in 6 Chicago Federally Qualified Health Centers (FQHCs) that implemented workflows optimizing care continuity in the extended postpartum period for high-risk prenatal patients. METHODS:The Quality Improvement Learning Collaborative focused on the implementation of a registry of high-risk prenatal patients to link them to primary care and was implemented in 2021; study data were collected in 2021-2022. We conducted a quantitative evaluation of FQHC-reported aggregate structure, process, and outcomes data at baseline (2020) and monthly (2021). Qualitative analysis of semistructured interviews of participating FQHC staff focused on the experience of participating in the collaborative. RESULTS:At baseline, none of the 6 participating FQHCs had integrated workflows connecting high-risk prenatal patients to primary care; by the end of implementation of the QI intervention, such workflows had been implemented at 19 sites across all 6 FQHCs, and 54 staff were trained in using these workflows. The share of high-risk patients transitioned to primary care within 6 months of delivery significantly increased from 25% at baseline to 72% by the end of implementation. Qualitative analysis of interviews with 11 key informants revealed buy-in, intervention flexibility, and collaboration as facilitators of successful engagement, and staffing and data infrastructure as participation barriers. CONCLUSIONS:Our findings show that a flexible and collaborative QI approach in the FQHC setting can help optimize care delivery. Future evaluations should incorporate the patient experience and patient-level data for comprehensive analysis.

On December 5, 2022, an indirect drive fusion implosion on the National Ignition Facility (NIF) achieved a target gain G_{target} of 1.5. This is the first laboratory demonstration of exceeding "scientific breakeven" (or G_{target}>1) where 2.05 MJ of 351 nm laser light produced 3.1 MJ of total fusion yield, a result which significantly exceeds the Lawson criterion for fusion ignition as reported in a previous NIF implosion [H. Abu-Shawareb et al. (Indirect Drive ICF Collaboration), Phys. Rev. Lett. 129, 075001 (2022)PRLTAO0031-900710.1103/PhysRevLett.129.075001]. This achievement is the culmination of more than five decades of research and gives proof that laboratory fusion, based on fundamental physics principles, is possible. This Letter reports on the target, laser, design, and experimental advancements that led to this result.

The United States is facing a maternal health crisis with increasing rates of severe maternal morbidity and mortality. To improve maternal health and promote health equity, the authors developed a novel 2-generation model of postpartum and pediatric care. This article describes the Two-Generation Clinic (Two-Gen) and model of care. The model combines a dyadic strategy for simultaneous maternal and pediatric care with the collaborative care model in which seamless primary and behavioral health care are delivered to address the physical health, behavioral health, and social service needs of families. The transdisciplinary team includes primary care physicians, nurse practitioners, psychiatrists, obstetrician-gynecologists, social workers, care navigators, and lactation specialists. Dyad clinic visits are coscheduled (at the same time) and colocated (in the same examination room) with the same primary care provider. In the Two-Gen, the majority (89%) of the mothers self-identify as racial and ethnic minorities. More than 40% have a mental health diagnosis. Almost all mothers (97.8%) completed mental health screenings, >50.0% have received counseling from a social worker, 17.2% had a visit with a psychiatrist, and 50.0% received lactation counseling. Over 80% of the children were up to date with their well-child visits and immunizations. The Two-Gen is a promising model of care that has the potential to inform the design of postpartum care models and promote health equity in communities with the highest maternal health disparities.

Within a multi-state Collaborative Improvement and Innovation Network addressing the social determinants of health during 2017–2020, the Illinois Department of Public Health led an exploratory project to understand how the availability of child care affects maternal health care utilization. The project assessed whether lack of child care was a barrier to perinatal health care utilization and gathered information on health facility practices, resources, and policies related to child care TWe surveyed (1) birthing hospitals (n = 98), (2) federally qualified health centers (FQHCs) (n = 40), and (3) a convenience sample of postpartum persons (n = 60). Each group reported that child care concerns negatively affect health care utilization (66

While the role of the US federal government in improving Maternal and Child Health (MCH) is often seen as a history of opportunities and tensions between the federal bureaucracy and state implementation, less is known about how federal governmental policies to improve MCH have been implemented at the local level, and the nature of the dynamic between local implementation and federal adoption of locally generated strategies. By describing the emergence of the Infant Welfare Society of Evanston in the first part of the 20th century and describing its evolution until 1971, we showcase the forces that shaped the emergence of an MCH institution at the local level in the early part of the history of MCH in the US. This article highlights the interaction of a progressive maternalistic frame and the growth of local public health infrastructure as fundamental to the basis of action to address infant health during this period. However, this history also highlights the complex relationship of institutions dominated by White women and their relationship to the populations served in the development of the field of MCH and elucidates the need for more explicit attention to understanding the role of Black social institutions in the development of the field of MCH. The history of Maternal and Child Health (MCH) in the US is often seen through the lens of federal-state relations; however, less is known about how federal governmental policies to improve MCH have been implemented at the local level, and the nature of the dynamic between local implementation and federal adoption of locally generated strategies. To address this gap in our historical knowledge, we tell the story of the Infant Welfare Society of Evanston (IWSE), a community-based organization, whose activities to address infant health beginning in the second decade of the 20th century directly parallel and in some circumstances influenced federal MCH efforts. Examining this history enables us to also explore issues of racial equity in the development of the field of MCH in the US.

Abstract Background: COVID-19 disrupted the healthcare system and services across the cancer continuum. Early on, breast and cervical (B & C) screenings were effectively halted, and many diagnostic and treatment procedures delayed. Emerging evidence suggests that uninsured populations and patients of color were disproportionately affected, but less is known about rural-urban differences. The Illinois Breast and Cervical Cancer Screening Program (IBCCP), administered by agencies across 102 counties, provides screening and diagnostic services for low-income, uninsured, and underinsured persons. This study assesses the impact of COVID-19 on agencies’ administrative functions and clients’ ability to receive services, and to examine rural-urban differences. Methods: IBCCP coordinators were invited to complete an online survey that asked about COVID-19’s effect on administrative functions and services at two different time periods, the height of the pandemic and in the past month (11/2021-12/2021). Chi-square and Fisher’s exact tests were used to examine differences between rural and urban agencies (classified by using the 2013 NCHS Urban-Rural Classification Scheme).Results: In total, 32 agencies (50% urban, 50% rural), responded. Concerning administrative functions, in the past month compared to at the height of the pandemic, fewer agencies overall reported that COVID-19 had a moderate to great impact (compared to occasional or no impact) on staffing (47% vs. 74%) and client enrollment (34% vs. 90%). Although not significant, more rural than urban agencies reported effects on staffing (56% vs. 38%) and enrollment (50% vs. 19%) in the past month. Concerning clients’ ability to receive services, in the past month compared to the height of the pandemic, fewer agencies overall reported COVID-19 effects on screening (31% vs. 75%), diagnostic (19% vs. 61%), and treatment (3% vs. 38%) services. Some rural-urban differences were noted; at the height of the pandemic, urban agencies were more likely to report effects on diagnostic (88% vs. 33%, p=.002) and treatment (56% vs. 19%, p=.028) services when compared to rural. Although not significant, in the past month, more urban (vs. rural) agencies reported COVID-19 related effects on screening (44% vs. 19%), diagnostic (31% vs. 6%), and treatment (7% vs. 0%) services. Conclusion: Overall, agencies implementing this safety net program are generally rebounding from the pandemic’s effect on administrative functions and clients’ ability to receive services. However, rural and urban agencies may be differentially affected by the pandemic. For example, in the past month, a greater proportion of rural agencies reported effects on administrative functions Interestingly, more urban agencies reported lingering effects on clients’ ability to receive screening and diagnostic services. These trends suggest that rural and urban agencies may be differentially affected by the pandemic and geographically tailored responses may best support recovery. Citation Format: Leslie R. Carnahan, Ananya Stoller, William Barshop, Genevieve Rizzo, Arden Handler. Assessing the impact of the COVID-19 pandemic on a statewide breast and cervical cancer safety net screening and diagnostic program: Are there differences by rural – urban geography? [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A053.

Introduction: Racial and ethnic inequities persist among birthing families in urban U.S. communities, despite public health efforts to improve outcomes. To address these inequities, in 2020, the Chicago Department of Public Health (CDPH) launched Family Connects Chicago (FCC), an evidence-based, universal, postpartum home visiting program. We examine CDPH's transition from "high risk" to universal home visiting to determine whether and how this change represent an explicit commitment to advancing maternal and child health equity.Methods: We conducted a secondary analysis of key informant interview data (n=45 interviews) collected from stakeholders involved in FCC's early implementation. Our analysis involved identifying processes used by CDPH in their planning and early implementation of FCC and examining the alignment of these processes with approaches for promoting health equity proposed by Calancie et al.Results: The processes used by CDPH to plan and implement the FCC pilot are reflected in two major themes: (1) CDPH emphasized improving outcomes for all birthing families, and (2) CDPH prioritized engaging multiple stakeholders throughout planning and implementation. Alignment of these themes and their subthemes with the approaches proposed by Calancie et al. demonstrated that CDPH's implementation of FCC represents a commitment to advancing health equity.Discussion: In their planning and implementation of FCC, CDPH appears to have exhibited a concerted effort to address Chicago's persistent health inequities. Institutional commitment, continued stakeholder engagement, ongoing data sharing, and sustainable funding will be crucial to implementing and expanding FCC.Health Equity Implications: The implementation of FCC, a new service delivery approach for maternal and infant health, marks a new beginning in tackling inequities for Chicago's birthing families.

Introduction In light of persistent health inequities, this commentary describes the critical role of maternal and child health (MCH) graduate training in schools and programs of public health (SPPH) and illustrates linkages between key components of MCH pedagogy and practice to 2021 CEPH competencies. Methods In 2018, a small working group of faculty from the HRSA/MCHB-funded Centers of Excellence (COEs) was convened to define the unique contributions of MCH to SPPH and to develop a framework using an iterative and consensus-driven process. The working group met 5 times and feedback was integrated from the broader faculty across the 13 COEs. The framework was further revised based on input from the MCHB/HRSA-funded MCH Public Health Catalyst Programs and was presented to senior MCHB leaders in October 2019. Results We developed a framework that underscores the critical value of MCH to graduate training in public health and the alignment of core MCH training components with CEPH competencies, which are required of all SPPH for accreditation. This framework illustrates MCH contributions in education, research and evaluation, and practice, and underscores their collective foundation in the life course approach. Conclusions This new framework aims to enhance training for the next generation of public health leaders. It is intended to guide new, emerging, and expanding SPPH that may currently offer little or no MCH content. The framework invites further iteration, adaptation and customization to the range of diverse and emerging public health programs across the nation.

For more than half a century, researchers around the world have been engaged in attempts to achieve fusion ignition as a proof of principle of various fusion concepts. As recently reported, a burning plasma state, where the alpha-heating in the plasma is the primary source of heating, was achieved in laboratory experiments. Following the Lawson criterion, an ignited plasma is one where the fusion heating power is high enough to overcome all the physical processes that cool the fusion plasma, creating a positive thermodynamic feedback loop with rapidly increasing temperature. In inertially confined fusion, ignition is a state where the fusion plasma can begin ``burn propagation'' into surrounding cold fuel, enabling the possibility of high energy gain. While ``scientific breakeven'' (i.e. unity target gain) has not yet been achieved, this talk reports the first controlled fusion experiment on the National Ignition Facility to produce capsule gain greater than unity (here 5.8) and reach ignition by many different formulations of the Lawson criterion. In the talk, we will discuss some key basic physics inertial confinement fusion (ICF) principles behind the burning plasma and ignition results as well as discuss future challenges.

Objective: To examine the association between subjective norms and breastfeeding behaviors and to assess whether individual characteristics modify this association. Design: Retrospective cohort study. Setting: Florida, 2004 to 2005; Louisiana, 2004; and Ohio, 2009 to 2010. Participants: Stratified systematic sample of respondents who completed the Pregnancy Risk Assessment Monitoring System (PRAMS) survey from three states (N = 5,378). Methods: We used PRAMS data to examine the associations between three independent variables (breastfeeding discouragement by others and number and type of normative referents) and three breastfeeding behaviors (breastfeeding initiation and breastfeeding duration at 4 weeks and 10 weeks after birth) using multivariable log binomial regression. We also examined whether maternal characteristics modified the association between breastfeeding discouragement by others and breastfeeding behaviors. Results: Respondents who reported that others discouraged them from breastfeeding were more likely to initiate breastfeeding (adjusted relative risk (RR) = 0.78, 95% confidence interval [CI] [0.64, 0.96]) than those who were not discouraged. Furthermore, in the total sample, breastfeeding discouragement from others was not associated with breastfeeding discontinuation by 4 weeks and 10 weeks after birth. Breastfeeding discouragement from health care providers was associated with a greater incidence of noninitiation among respondents who reported breastfeeding discouragement from others (adjusted RR = 2.82, 95% CI [1.88, 4.22]). Conclusions: Findings suggest that women may be motivated to initiate breastfeeding because of their beliefs and emotions despite being discouraged by others. However, discouragement by health care providers was associated with decreased initiation. This underscores a need for the continued implementation and scale-up of evidence-based maternity care practices and education of providers and the public to support breastfeeding. JOGNN, 50, 568-582; 2021. https://doi.org/10.1016/j.jogn.2021.04.010 Accepted April 12, 2021; Published online May 21, 2021

BACKGROUND:COVID-19 exposes major gaps in the MCH safety net and illuminates the disproportionate consequences borne by people living in low resource communities where systemic racism, community disinvestment, and social marginalization creates a perfect storm of vulnerability. METHODS:We draw eight lessons from the first 8 months of the pandemic, describing how COVID-19 has intensified pre-existing gaps in the MCH support network and created new problems. For each lesson identified, we present supporting evidence and a call for specific actions that can be taken by MCH practitioners, researchers and advocates. RESULTS:LESSON #1: COVID-19 hits communities of color hardest, exposing and exacerbating health inequities caused by systemic racism. LESSON #2: Women experience the most devastating social, economic and mental health tolls during COVID-19. LESSON #3: Virulent pathogens find and exacerbate cracks in our public health and health care systems. LESSON #4: COVID-19 has become a pretext to limit access to sexual and reproductive health care. LESSON #5: COVID-19 has exposed and deepened fault lines in maternity care: over-medicalization, discrimination, lack of workforce diversity, underutilization of collaborative team approaches, and lack of post-delivery follow-up. LESSON #6: The pandemic adds impetus to much-needed Medicaid policy reforms that can have a lasting positive effect on maternal health. LESSON #7: Social and health policy changes, heretofore deemed infeasible, ARE possible under pandemic threat. LESSON #8: Finally, an overarching COVID-19 lesson: We are all inextricably connected. CONCLUSION:COVID-19 is a loud wake up call for renewed action by MCH epidemiologists, policy-makers, and advocates.