State variations in maternal and child health workforce support.

Introduction: Maternal and child health (MCH) indices can identify areas of opportunity to address maternal and infant health needs but tend to lack measures specific to MCH workforce support. Methods: To address this gap, we developed the MCH Worker Supportive Policy Index, a composite index of 28 policy indicators across 4 domains: midwifery workforce, doula workforce, labor policy, and economic policy. We scored each measure on a 100-point scale, where larger values represent more supportive policies. We calculated a state-level average for each subindex and then averaged each subindex's average to produce the overall state-level MCH Worker Index. Results: Scores ranged from 23 (Wyoming) to 92 (California), with high-scoring states offering Medicaid expansion, paid family leave, protections for LGBTQ+ workers, and Medicaid reimbursement for doula services. Higher scores on the Midwifery Workforce Index were correlated with greater certified nurse midwife supply, fewer maternity care deserts, and lower cesarean delivery rates ( Conclusion: These findings underscore how supportive policies, such as scope-of-practice expansion and reimbursement parity, may support greater workforce availability and better perinatal outcomes. These findings highlight both state-level assets and opportunities for improvement and can inform planning and policy efforts targeted towards sustaining a thriving MCH workforce.