August2017

Alicia Guevara Warren,KidsCountProjectDirector

2017 Right Start: Annual Report on Maternal and Child Health

Infant death rates decline in Michigan, other
trends raise concerns
INTRODUCTION
Children who are born healthy and whose mothers
receiveadequateservicesaremorelikelytoexperience
be erdevelopmentaloutcomesintheshortandlong
term. This includes both physical and mental
healthcare before, during and a er pregnancy. When
mothers have access to highquality care and receive
informa on and educa on about pregnancy and
paren ng, there is an increased likelihood for healthy
birthsincluding fewer babies
born too soon or too small and
reduced risks of infant
mortality.
69 largest ci es and townships in Michigan. The 2017
reportcompares2010(20082010threeyearaverage)
to2015(20132015threeyearaverage)andhighlights
infant mortality trends in the state. While overall
improvementhasbeenmadetoreducethenumberof
babies who die before their rst birthdays, the rates
arerisingforHispanicsandthegapbetweenWhiteand
Black infant deaths con nues to exist by a more than
21ra o.
OVERVIEW: MICHIGAN
MATERNAL AND CHILD
HEALTH

Unfortunately, some mothers Generally, Michigan has made

face challenges in receiving the
care that they need to ensure
healthier outcomes. These
include poverty, stress, food
insecurity and low levels of
educa on, along with unsafe
housing, exposure to violence, environmental toxins
and transporta on dicul es. Many factors have an
impact on the health of a mother and her baby. The
data and research also show inequi es by race, place
and income caused by historical and current
ins tu onalandsystemicbarriers.
The annual Right Start: Maternal and Child Health
report reviews eight indicators by county and for the
some gains in regards to the
health of moms and babies.
Par cularly, the share of births
to women under the age of 20
decreased by almost 37% from
2010 to 2015. Although not as
signicant of an improvement, the rate of second (or
more) births to teens who are already mothers
declined by about 6%. With high school comple on
ratesrisingacrossthestateandthereduc onofteen
births, the rate of births to mothers without a high
schooldiplomaorGEDimprovedbyover21%.Finally,
the rate of babies born too small improved slightly by
1%. S ll over 9,500 births were considered low
birthweight.

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A UNITED WAY AGENCY
 Some measures of maternal and child health improving, but more babies
born too soon, smoking and prenatal care show troubling trends

45 41.3% 42.7%

20082010 20132015
PercentofLiveBirths

30

18.1% 17.0% 18.0% 18.4%

15.9%
15 12.5% 12.2%
9.9% 8.5% 8.4% 10.1%
6.3% 4.8% 5.3%

0
Mother Teen Mother Motherno Lateorno Mother Low Preterm
under20 1519, unmarried HSdiploma prenatal smoked birthweight
yearsold alreadya orGED care during babies
mother pregnancy

However,thereareareasofconcernrelatedtomaternal neighborhood safety, poverty and educa on.1 The way

and child health outcomes in Michigan. Over 6,000 that the healthcare system is organized, nanced and
births, or 5.3%, were to mothers who either did not deliveredcanalsopresentchallengesforpeopleofcolor,
receive prenatal care or started care late in their whichimpactsaccesstohealthcare.2
pregnancy. This represents nearly a
O en hidden behind aggregate
10% rate increase from 2010. Also
rates are the dierences in
worsening over the trend period
was the rate of mothers smoking In2015,therewere outcomes for mothers and their
childrenbyraceandethnicity.For
during pregnancy, which stands at
over 18%, or close to 1 in 5 births.
nearly14,000 example, the state trends show
thattherateofprenatalsmoking
Especially concerning is the rising
rate of babies born too early. In
pretermbirths,a is on the rise. However, the rate
of smoking during pregnancy for
2015, there were nearly 14,000 rateincreaseof White women stayed the same,
preterm births, a rate increase of
buttherateforAfricanAmerican
almost20%from2010. almost20%from and La na women did worsen
overthetrendperiod.Allthreeof
MICHIGAN MATERNAL AND 2010. the states largest racial and
CHILD HEALTH BY RACE AND ethnic groups experienced
ETHNICITY improvements in the teen birth
rate and mothers with a high school diploma or GED.
Dispari es in maternal and child health by race and
Each group had worsening trends in babies born too
ethnicity exist as a result of several factors, including
early.
provider bias, language barriers, proximity to care,

Data source for all charts: Michigan Department of Health and Human Services, Division for Vital Records and Health Statistics

MICHIGANLEAGUEFORPUBLICPOLICY|AUGUST2017 PAGE2
 Latina Mothers: Four of seven key indicators worsen, including prenatal care,
preterm births, smoking and low-birthweight babies

45
PercentofBirths(Hispanic)

MothernoHSdiploma/GED
30 Teen1519,alreadyamother
Mothersmokedduringpregnancy

Pretermbirth
15 Motherunder20yearsold
Late/noprenatalcare
Lowbirthweight
0

Hispanic mothers and their children are experiencing Over the trend period, signicant gains for African
worseningtrendsinseveralkeymeasuresofhealth.While Americans were made in both teen births (43% rate
therearefewerbirthstowomenunder20andrepeatteen decrease) and births to mothers without a high school
births and improved levels of educa on among La na diploma or GED (24.3% rate decrease). However, three
mothers, four other areas were substan ally worse in indicatorseitherstayedthesameorchangedonlyslightly:
2015thanin2010.Similarrateincreasesoccurredinlate repeatteenbirths(1.9%rateincrease);lateornoprenatal

African-American Mothers: Several key indicators stagnate, smoking and preterm births
rising while teen births and education improves

30
PercentofBirths(BlackNonHispanic)

Teen1519,alreadyamother
20 MothernoHSdiploma/GED
Pretermbirth
Mothersmokedduringpregnancy
10 Lowbirthweight
Motherunder20yearsold
Late/noprenatalcare

0

or no prenatal care (19.4% rate increase), prenatal care (no change); and babies born with low birthweights
smoking(20.2%rateincrease),pretermbirths(21.2%rate (0.7%ratedecrease).ComparedtoWhitesandHispanics,
increase) and babies with low birthweights (4.3% rate AfricanAmerican babies are more likely to be born too
increase). Compared to both Whites and African earlyandtoosmall.
Americans,Hispanicbabiesweremorelikelytobebornto
amotherwithoutahighschooldiplomaorGED.

MICHIGANLEAGUEFORPUBLICPOLICY|AUGUST2017 PAGE3
 White Mothers: Smoking and low-birthweight babies stall,
prenatal care and preterm birth rates worsen
25
PercentofBirths(WhiteNonHispanic)
20
15
10
5 Late/noprenatalcare
0
With the excep on of prenatal smoking rates, maternal
and child health outcomes for Whites were be er than
those of AfricanAmericans and La nos. Over the trend
period,therewasimprovementinteenbirths(32.9%rate
decrease); repeat teen births (9.9% rate decrease); and
mothers without a high school diploma or GED (17.4%
ratedecrease).Therewasaslightreduc onintherateof
babiesborntoosmall(1.4%ratedecreased),butthehigh
rate of prenatal smoking remained at 20.1% in 2010 and
2015. Similar to La nas, White women experienced a
worsening trend in the rate of births to mothers who
receivedeitherlateornoprenatalcare.
DELCINES IN INFANT DEATHS, SOME
CONCERNING TRENDS
While most babies in Michigan do well, all babies should
be giventheopportunity to thrive wellbeyond theirrst
birthdays.Therateofinfantdeathsisagoodmeasureof
how well a state or community is doing to ensure the
healthandwellbeingofallofitspeople.Manyfactorscan
contributetoadversehealthoutcomesthatmayincrease
the risk of infant mortality, including a mothers
preconcep on health, access to prenatal care, living in
poverty, environmental hazards, unsafe housing and
more. These social determinants of health can shape the
choices that are available to people to improve their
MICHIGANLEAGUEFORPUBLICPOLICY|AUGUST2017
Mothersmokedduringpregnancy
Teen1519,alreadyamother
Pretermbirth
MothernoHSdiploma/GED
Lowbirthweight
Motherunder20yearsold
health and must be addressed to help reduce health
inequi es.3
Since 2010, Michigans infant mortality rate has declined
6.7%. There were 864 babies who died before their rst
birthday in 2010, which is a rate of 7.3 per 1,000 births,
comparedto779infantdeathsin2015,or6.8per1,000.
High popula on centers tended to have higher infant
mortality rates (8.4 per 1,000) compared to midsize
communi es(7.1per1,000)andtherestofthestate(5.7
per1,000).
Prematurity and low birthweight and related condi ons
account for more infant deaths than any other single
cause (about 1 in 3).4 The leading cause of death for
infants over the 20132015 threeyear average me
period in Michigan was certain condi ons origina ng in
the perinatalperiod, which includes factors before birth
through the rst 28 days that may be related to
complica onsduringpregnancy,labororbirth,thelength
of gesta on and fetal growth, or other disorders or
infec ons in this me period.5 The next leading cause is
relatedtobirthdefects,whichmayberelatedtogene cs,
but can also occur due to environmental risks, such as
poverty, lack of access to healthcare or food insecurity.
Higherratesofpovertyinacommunityarealsoassociated
withmoreinfantdeaths.6
PAGE4
RACE, PLACE AND INCOME MATTER
Number of infant deaths rises as poverty increases
Infants most at risk for premature death are
dispropor onatelythoseborntooearlywithlow
birthweights, born to mothers on Medicaid,

TotalNumberofDeaths
infantsofcolorandbabiesthataretheresultof CensusTract
PovertyLevel
an unintended pregnancy.7 Like many other
healthoutcomes,dispari esexistbasedonrace 0.04.9
and ethnicity, where someone lives and their 5.09.9
levelofincome. 10.019.9
20.0100
While the states infant mortality rate has Total
declined from 2010, there remains a signicant
amount of work to close the racial and ethnic 20122014Average
gap. Most groups experienced a decline from
2010 to 2015, however, others had increases.
Middle Easterners hadthelargest decrease in the rate of
Infantdeathratesalsovarybycountytypeandregion.In
infant deaths (12.5%) followed by AfricanAmericans
urbancoun es,theinfantmortalityratedeclinedby6.5%
(8.8%) and Whites (6.1%). Both groups s ll had infant
yet the rate remained higher than the state average.
death rates higher than Whites. Plus, AfricanAmerican
Midsize coun es experienced the largest rate decrease
babies are more than twice as likely to die before their
(11.5%)andcon nuedtofallbelowthestaterate.Unlike
rst birthdays than White babies. A er several years of
the state overall and urban and midsize coun es, rural
decline beginning in 2008, Hispanics and AsianPacic
coun es had an increase in the infant death rate from
Islanders began to experience increases in infant death
2010 to 2015. The nearly 4% rate increase in these
rates star ngin 2012 and 2013, respec vely. With a 15%
coun esbringstheoverallratetojustbelowthatofurban
rate increase from 2010 to 2015, Hispanics are now
coun es (6.9 per 1,000 compared to 7.0 per 1,000). In
approachingnearlydoubletheinfantdeathrateofWhites.
Southeastern Michigan, there was a total of 359 infant

Rising infant death rate for Hispanics, more than double rates
for African-Americans compared to Whites

14.7 2010 2015

InfantDeathRatesPer1,000

13.4

9.8 9.8 9.4

7.3 8.2
6.8 6.7
5.4 5.0 5.8
3.5 4.0

MICHIGANLEAGUEFORPUBLICPOLICY|AUGUST2017 PAGE5
 deaths in 2015, or about 7.7 per 1,000
Infant death rates higher in urban and rural counties,
births, which is 7.2% lower than in 2010.
increase in rural communities
Coun esintheUpperPeninsulahadarate
decreaseofabout10%bringingtheoverall
7.3 7.5
7.0 rate in the region to a low of 4.8 infant
InfantDeathsPer1,000Births

6.6 6.8 6.9

6.1 deathsper1,000births.
5.4
Communi es with higher popula ons
tended to have higher rates of infant
deaths, but rates improved by 11.6%
comparedtomidsizeci es andtownships,
which had an increase over the trend
period of 10.3%. The rate improved for
200810 201315 other communi es not included in these
Michigan UrbanCounties MidsizeCounties RuralCounties two groups (7.3%). Approximately 59% of
the states infant deaths occurred in the

Infant Mortality Rates Per 1,000 Births

2010 vs Infant Mortality Rates 2015 2010 vs Infant Mortality Rates 2015
2015 (3Year Average) 2015 (3Year Average)
Rate Rate
City/Township Change Total White Black Hispanic City/Township Change Total White Black Hispanic
MICHIGAN 6.7 6.8 5.0 13.4 9.4 Midland 96.8 8.3 7.1 * *
AnnArbor 26.8 4.6 4.2 * * Muskegon 131.2 13.9 * 25.2 *
Ba leCreek 4.1 9.0 5.1 17.7 * Novi 20.9 5.0 * * *
BayCity 42.7 7.1 * * * Pon ac 0.5 13.7 * 17.9 11.1
CantonTwp. 48.9 2.3 * * * PortHuron 24.6 6.6 5.3 * *
ClintonTwp. 6.9 6.3 5.5 8.8 * Portage 40.0 5.8 4.9 * *
Dearborn 9.5 6.2 7.2 * * RedfordTwp. 12.1 7.4 * 10.1 *
DearbornHeights 65.0 6.4 7.7 * * RochesterHills 20.0 4.0 3.6 * *
Detroit 9.3 13.1 7.4 14.3 8.2 Roseville 40.5 7.7 4.8 * *
Eastpointe 39.8 14.2 11.3 15.9 * RoyalOak 22.0 4.0 3.0 * *
FarmingtonHills 10.0 6.5 5.8 17.6 * Saginaw 11.4 16.2 13.0 16.9 21.3
Flint 1.4 10.5 5.7 14.1 * St.ClairShores 39.0 5.6 5.0 * *
GrandRapids 26.2 6.4 4.8 11.8 5.6 Southeld 19.7 9.0 * 12.4 *
HighlandPark 27.4 17.0 * 17.5 * SterlingHeights 12.3 6.2 4.6 20.5 *
Holland 35.4 5.8 6.6 * * Taylor 2.6 7.0 6.5 10.2 *
HollandTwp. 19.4 8.1 10.1 * * Troy 33.1 4.1 4.1 * *
Inkster 39.6 7.5 * * * Warren 25.0 5.6 5.8 5.7 *
Jackson 40.0 9.4 7.3 13.2 * WaterfordTwp. 2.1 4.2 3.2 * *
Kalamazoo 0.8 7.5 * 16.0 * W.BloomeldTwp. 36.1 5.1 * * *
Kentwood 84.4 6.0 6.2 * * Westland 7.3 7.4 8.4 6.6 *
Lansing 7.3 8.8 6.9 13.3 9.4 Wyando e 21.2 7.4 * * *
Livonia 0.8 4.8 4.4 * * Wyoming 26.9 6.0 6.1 * *
MacombTwp. 9.3 6.0 5.6 * * Ypsilan Twp. 22.2 7.3 7.8 9.3 *
MadisonHeights 18.6 9.1 7.1 * *
*Datanotavailable

MICHIGANLEAGUEFORPUBLICPOLICY|AUGUST2017 PAGE6

improvements in its rate
amongtheci esandtownships
reviewed. With the more than
26%rateimprovement,thecity
placedinthetophalfofthe56
ci eswithratesin2015.

Out of the states 83 coun es,

onlyvecoun eshadnoinfant
deaths in 2015 (threeyear
average),while,onaverage,32
Infant mortality rates in urban coun estotalhadoneorfewer
areas are improving, but still infant deaths. The coun es
above state average; rural com withnoinfantmortali eswere:
munities experience increases Alger, Huron, Keweenaw,
Montmorency and Schoolcra .
Infant Mortality 2013-2015 Average
(Rate per 1,000 live births) Onethirdofcoun es(15outof
0 16 45) with calculated rates for
2015 had higher infant
mortality rates than the state
MICHIGAN RATE: 6.8 Per 1,000 average. County infant death
rates ranged from the best
Note:Incidencestoolowtocalculatearateincountieswithnocolor. (lowest) rate in Marque e
County of 4.3 per 1,000
comparedtotheworst(highest)rateinArenacCountyof
largest 69 ci es and townships in Michigan. A review of
16infantdeathsper1,000births.Justoverhalfofthe40
thelargestci esandtownshipsshowsthatofthe56with
coun eswithratechangesfrom2010to2015experienced
measurableratesin2015,therewere29communi eswith
an improvement with 19 coun es worsening. St. Joseph
higherinfantmortalityratesthanthestateaverage.These
ratesrangefromthetoprankedCantonwith2.3per1,000 County had the highest rate improvement (49.7% rate
compared to lastranked Highland Park with 17 infant decrease) followed by Lapeer County (41.5% rate
deaths per 1,000 births. About twothirds (46) of the decrease) and Calhoun County (33.1% rate decrease). On
largest ci es and townships experienced a rate change theotherhand,IoniaCountyhadthelargestrateincrease
with 23 of these communi es seeing an improvement in from 2010 of 67%. Other coun es worsening over the
theirratesfrom2010to2015. trend period included: Allegan County (66.5% rate
increase)andMidlandCounty(58.7%rateincrease).
ThecityofDetroitsinfantmortalityrateimprovedbyover
9%whiletherestofWayneCountyimprovedbylessthan
POLICY RECOMMENDATIONS: WORK STILL
1%.However,thecityshighrateof13.1infantdeathsper
1,000 births gives it one of the highest rates of the 69 NEEDED
largest ci es and townships. In Flint, the rate also The states threeyear 20162019 Infant Mortality
remainedoneofthehighestofthe69ci esandtownships Reduc on Plan was produced with broad stakeholder
at 10.5 per 1,000 and improved by 1.4% in 2015 from engagement and input, including from the Michigan
2010. Grand Rapids experienced one of the larger LeagueforPublicPolicy.Theplanisbasedonalifecourse

MICHIGANLEAGUEFORPUBLICPOLICY|AUGUST2017 PAGE7
model approach to address birth and other health
outcomes, including the social determinants of health
and inequi es.8 The plan is centered on nine
comprehensivegoals,including:
1. Achieve health equity and eliminate racial and
ethnic dispari es by addressing social determinants
ofhealthinallinfantmortalitygoalsandstrategies.
2. Implementaperinatalcaresystem.
3. Reduceprematurebirthsandlowbirthweight.
4. Support increasing the number of infants who are
bornhealthyandcon nuetothrive.
5. Reducesleeprelatedinfantdeathsanddispari es.
6. Expandhomevisi ngandothersupportprogramsto
promotehealthywomenandchildren.
7. Supportbe erhealthstatusofwomenandgirls.
8. Reduceunintendedpregnancies.
9. Promote behavioral health services and other
programstosupportvulnerablewomenandinfants.
The Infant Mortality Advisory Council was created to
implement the goals of the Infant Mortality Reduc on
Plan and support the ac ons necessary for statewide
involvement. The council meets quarterly and has
ongoing collabora ve learning opportuni es to increase
informa onsharingandlearning.
To help support state and local eorts like these to
reduceinfantmortali esandinequi es,theLeagueurges
policymakersto:
Focus on reducing dispari es by race and ethnicity.
Withsignicantracialandethnichealthinequi es,it
is cri cal to target resources and eorts where the
highest need exists. By addressing inequi es the
health of the broader popula on will be improved.
While infant mortali es are declining and the gap
betweenAfricanAmericaninfantdeathsandthoseof
Whites is closing, AfricanAmerican babies are s ll
more than twice as likely to die before their rst
birthday. Addi onally, the rising rates of Hispanic
infant deaths should be cause for alarm. A childs
healthisinextricablyconnectedtothehealthofhis/
her mother and a review of maternal health
outcomesinthisreportpointstoanumberofareas
of focus needed for women of color, such as
MICHIGANLEAGUEFORPUBLICPOLICY|AUGUST2017
adequate prenatal care to improve birth outcomes,
likepretermandlowbirthweightbabies.
Address the social determinants of health. A
personshealthisrelatedtohis/herlivingcondi ons
and personal experiences. A comprehensive
approach must be taken to address social,
environmental, economic, educa on and healthcare
accessallofwhichimpactoutcomes.Investmentin
communi es to ensure aordable nutri ous foods,
safe housing, clean water and low crime rates is
necessarytoimproveeverydaylivingcondi onsthat
inturnwillsupportbe ermaternalandchildhealth.
Increasingeconomicopportuni eswherepeoplelive
through policies like the Earned Income Tax Credit
andstrengthenedsafetynetandchildcareprograms
toreducestressandotheradverseeects.Educa on
hasacri calroleinapersonshealthcareaccessand
outcomes.Removingbarriersthatpreventorreduce
a persons ability to access healthcare is also crucial
to improving preconcep on health, adequate
prenatalcareandoverallpreven vecare.
Protect the Aordable Care Act. The federal
Aordable Care Act (ACA) expanded healthcare
insurance to hundreds of thousands of people in
Michigan who would not otherwise have been able
to access coverage. It guaranteed maternity health
coverage, expanded Medicaid to those who need it
and helped to provide essen al healthcare services
for women. Preconcep on health status is a
contribu ng factor to both pregnancy and birth
outcomes.Ensuringaccesstoadoctorandpreven ve
care improves the preconcep on health of women.
Addi onally,researchshowsthatwhenparentshave
access to healthcare insurance, their children are
more likely to be insured, which increases the
chancesofimprovedchildhealth.10
Expand home visi ng programs to support
vulnerable women and infants. Home visita ons
programsinMichiganprovidevoluntary,preven on
focused family support services with pregnant
womenandfamilieswithyoungchildren.11Asapart
of the states early childhood system, home visi ng
programs provide families at risk with support,
educa onand encouragementto helptheir children
thrive.Homevisitorstaarealsoabletofocusonthe
PAGE8
 mothersandbabyshealth,suchasprenatalcareand
birth outcomes. There are currently six dierent
evidencedbased models and one promising prac ce
model with various funding streams, such as state
generalfundsandSchoolAidfunds,alongwithfederal
funding from Medicaid, the Child Abuse Preven on
and Treatment Act, and the Maternal, Infant, and
EarlyChildhoodHomeVisi ng(MIECHV)program.12In
2016, nearly 35,000 families par cipated in state
funded programs.13In budget year 2015, the MIECHV
program funded about 20 local implemen ng
agencies,reachingover1,600families.14Homevisi ng
programs have been rigorously evaluated and the
investments have shown results, with par cipa ng
families experiencing improved access to prenatal
care, fewer preterm births, increased wellchild visits
and more.15 More families could benet from
par cipa ng in home visita on programs. State
policymakersshouldnotonlycon nuefundingcurrent
programs, but consider expanding funding to be er
meettheneedsofMichiganfamilies.Addi onally,the
MIECHV program is set to expire at the end of
September 2017 and must be reauthorized by
Congress. To meet the needs of families and address
health inequi es, funding should be expanded in
reauthoriza on.

ENDNOTES

1. Artiga,SamanthaandPetryUbri.Disparities in Health and Health Care: Five Key Questions and Answers. KaiserFamilyFoundation.August12,2016:
http://www.kff.org/disparitiespolicy/issuebrief/disparitiesinhealthandhealthcarefivekeyquestionsandanswers/,accessedJuly10,2017.
2. Ibid.
3. WorldHealthOrganization.Social Determinants of Health. http://www.who.int/social_determinants/en/,accessedJuly12,2017.
4. MarchofDimes.March of Dimes 2016 Data Book. 2016:http://www.marchofdimes.org/MarchofDimes2016Databook.pdf,accessedJuly6,2017.
5. IDC10Data.com.2017 ICD10CM Diagnosis Codes: Certain conditions originating in the perinatal period. http://www.icd10data.com/ICD10CM/Codes/
P00P96,accessedJuly13,2017.
6. GuevaraWarren,AliciaS.2017 Kids Count in Michigan Data Book: A Michigan Where All Kids Thrive. MichiganLeagueforPublicPolicy.April2017:
http://www.mlpp.org/kidscount/michigan2/2017kidscountinmichigandatabook,accessedJuly13,2017.
7. MichiganCouncilforMaternalandChildHealth,AmericanAcademyofPediatricsMichiganChapterandC.S.MottChildrensHospitalUniversityof
MichiganHealthSystem.Michigan Child Health Facts: Infant Mortality. 2016.
8. MichiganDepartmentofHealthandHumanServices.20162019 Infant Mortality Reduction Plan.February2016:https://www.michigan.gov/
documents/infantmortality/Infant_Mortality_16_FINAL_515908_7.pdf,accessedJuly13,2017.
9. Ibid.
10. AnnieE.CaseyFoundation.2017 KIDS COUNT Data Book: State Trends in Child WellBeing. June2017:http://www.mlpp.org/kidscount/michigan/2017
nationalkidscountdatabook,accessedJuly13,2017.
11. MichiganDepartmentofHealthandHumanServices.Michigans Home Visiting Initiative. http://www.michigan.gov/homevisiting/,accessedJuly13,
2017.
12. MichiganDepartmentofEducationandMichiganDepartmentofHealthandHumanServices.How Home Visiting Supports Michigan Families: 2016
Home Visiting Initiative Report. May2017.
13. ibid
14. MichiganPublicHealthInstitute.Michigans Maternal Infant and Early Childhood Home Visiting Program (MIECHV) Summary Report for Fiscal Year 2015.
March2016:http://www.michigan.gov/documents/mdhhs/HV_Data_Summary_Report_FY15_FINAL_FINAL_539437_7.pdf,accessedJuly13,2017.
15. MichiganDepartmentofEducationandMichiganDepartmentofHealthandHumanServices.How Home Visiting Supports Michigan Families: 2016
Home Visiting Initiative Report. May2017.

MICHIGANLEAGUEFORPUBLICPOLICY|AUGUST2017 PAGE9