The New Jersey Maternal Health Revolution: A System Catalyst Success Story

Written By JR Pershall

In 2020, New Jersey faced two devastating revelations about maternal health: 

First, the state ranked 47th nationally in maternal mortality rates, with one of the country's widest racial disparities in both maternal and infant deaths. 

Second, an even more heartbreaking discovery showed that 91% of these deaths were likely preventable. 

It was crystal clear that something had to change.

On the surface, solving for deaths around pregnancy, birth, and infancy appeared to be a medical issue to be solved within hospital walls. But with some investigation, what seemed like a simple problem revealed itself to be much more complex. The critical maternal mortality rate was a symptom of a social problem. And tackling only the most obvious symptom was not going to solve what plagued state-wide systems.

As maternal deaths were declining worldwide, but on the rise in the United States, a coalition was formed with the goal of “making New Jersey the safest and most equitable place in the nation to give birth and raise a baby” (Nurture New Jersey 2021 Strategic Plan.)

The System Catalyst Transformation: By The Numbers
(Or how to reduce Maternity Death Rates 50% in 4 years)

When a broad and dedicated coalition of Catalysts in New Jersey transformed the state from the 47th worst for maternal health to 28th in just four years, they didn't just improving statistics – they saved real lives, saved real families, and rewrote the playbook for systemic social change. The raw numbers tell part of the story:

  • Maternal deaths were cut in half, with the most dramatic improvements being made among Black women, who had been seven times more likely to die from pregnancy-related complications

  • $55 million in state funding was dedicated to finding solutions

  • Three state agencies aligned for coordinated action

  • Fifty major corporations engaged 

  • Solution implementation took place across multiple cities including Trenton and Camden

  • Hundreds of trained doulas are now receiving Medicaid reimbursement

  • Thousands of women are given critical support through weekly community groups

  • Twenty states are now learning from this systems change model

But these metrics, impressive as they are, only hint at the deeper transformation in how maternal care is seen, funded, delivered, and sustained in New Jersey. 

The real story lies in how committed local residents–system catalysts–made this possible.

The System Catalyst Approach: Starting Where Change Is Possible

The breakthrough began with a crucial insight: not every problem can be solved everywhere at once. The entire country could benefit from reducing maternal mortality rates, but it’s not possible to effectively address the problem simultaneously, at such a scale.

System catalysts Wendy McWeeny and Raquel Mazon Jeffers, Co-Directors of the Community Health Acceleration Partnership (CHAP) understood that coordinated efforts and trust-based partnerships was an essential factor in creating solutions. And their New Jersey base proved strategic:

  • State leadership was not just receptive to making change, but highly motivated because of their poor ranking

  • Multiple agencies across the state showed willingness to collaborate

  • Major corporations (and potential partners) were headquartered locally

  • Strong community organizations were already established and ready to engage

  • The governor's wife, First Lady Tammy Murphy, was prepared to use her voice and networks to champion change

  • The state had both urban and rural populations needing different approaches and different solutions.

Countless people stepped up to create change, and leaders like Wendy, Raquel, and Tammy functioned as orchestrators— they maintained focused energy on saving the lives of parents and babies.

(Below is our System Catalyst podcast episode with both Wendy and Raquel)

The Four-Year Evolution: Building From The Ground Up

The transformation didn't happen overnight. In theory, a donor could have swept in, “solutions” already in hand, prepared to support a single NGO. But they wouldn’t have come close to creating the same level of impact. 

The transformation began with deep listening and trust-building in communities, understanding that folks who are pregnant need more than just medical appointments. They needed:

  • Community support networks

  • Medical and mental health services

  • Culturally competent care

  • Transportation solutions

  • Ongoing post-birth support

  • Financial sustainability

The breakthrough came through programs like CenteringPregnancy groups: 12-15 women with similar due dates meeting weekly. These weren't typical medical appointments. In comfortable settings, women shared concerns with each other about breastfeeding, discussed birthing plans, and built lasting friendships. Medical care happened but within a broader context of peer-to-peer community support.

As these groups showed success, new needs emerged:

  • Mental health provider Alma joined to address maternal anxiety and depression

  • PTSD treatment protocols were added based on observed patterns

  • Transportation barriers were identified and addressed

  • Post-natal support networks developed organically

Building The Network: The Power of Strategic Connections

System Catalysts, including Wendy McWeeny and Raquel Mazon Jeffers recognized that sustainable change required connecting multiple stakeholders with a range of specialties and deep knowledge of their communities:

Government Engagement:

  • Worked with First Lady Tammy Murphy to prioritize maternal health at the state level

  • Brought together three state agencies for coordinated action

  • Created new Medicaid reimbursement models

  • Established quality metrics for accountability

  • Supported legislative change, like more than 65 pieces of maternal and infant health legislation signed into law since 2019 as part of the Nurture NJ initiative.

Healthcare Providers:

  • Integrated mental health services through Alma

  • Trained and certified doulas

  • Created new care protocols

  • Built referral networks

Community Organizations:

  • Partnered with GirlTrek for outreach, who identified pregnant women and connected them with available services by organizing walking teams who covered local neighborhoods. GirlTrek is organized and powered by Black women—those most disproportionately affected by preventable maternal mortality.

  • Trained community health workers

  • Developed culturally competent materials

  • Built trust in underserved areas

Corporate Partners:

  • Engaged major employers like Pfizer and Johnson & Johnson

  • Improved employee healthcare benefits

  • Leveraged corporate resources for community programs

  • Created sustainable funding streams

The Corporate Strategy: Beyond Philanthropy

The corporate engagement strategy proved particularly innovative. Rather than simply seeking donations, System Catalysts helped companies recognize maternal health as a workforce issue. This led to:

  • Direct investment in community programs

  • Employee health benefit improvements

  • Resource sharing across sectors

  • Long-term funding commitments

Sustainable Funding Mechanisms: Changing the System

Understanding that grant funding alone couldn't sustain transformation, as it's often a short-term and unpredictable source of funds, and government funding tends to be slow-moving, System Catalysts worked to change fundamental funding structures:


State Investment:

  • Secured $55 million in dedicated funding

  • Created new Medicaid reimbursement codes

  • Established sustainable payment models for doulas

  • Integrated mental health coverage


Corporate Support:

  • Boosted employee health benefit modifications

  • Increased direct program investments

  • Created resource-sharing agreements

  • Solidified long-term commitments


Foundation Engagement:

The Scaling Strategy: From Local Success to National Model

Creating robust connections between local networks provides a stable platform to evaluate progress, even when more work is needed. In the case of New Jersey, once the maternal mortality rate was brought down from the 47th worst in the nation to 28th, there was a body of data to examine for interventions that worked, measures that didn’t, and strategies that could be successful in other contexts. 

When the lives of babies and parents were on the line, success in one location wasn't enough. System Catalysts and community orchestrators developed a careful scaling strategy:

The Power of Three:

  • Started with three pilot locations

  • Built evidence through multiple successes

  • Created replicable models

  • Demonstrated adaptability across contexts

Knowledge Sharing:

  • Regular interstate learning sessions

  • Documentation of best practices

  • Adaptation guides for different contexts

  • Support for peer learning

National Platform:

Geographic Expansion: Adapting to Local Contexts

The expansion strategy recognized that different locations had unique needs and required different approaches. Indigenous communities in rural Alaska have a difficult time accessing comprehensive services just like urban residents in Trenton, New Jersey. But their contexts need specific responses to have any hope of success:

State-Level Implementation:

Local Adaptations:

  • Urban vs. rural solutions

  • Cultural competency adjustments

  • Resource allocation strategies

  • Stakeholder engagement approaches







Key Success Factors: The System Catalyst Difference

When community leaders in New Jersey learned that maternal mortality rates in their state were some of the worst in the country, they went through a process of network building across a wide range of entities—from government to private sector, large organizations, and small. They came to understand that tackling only the most obvious symptom of systemic problems was not going to solve what plagued state-wide problems. 

That is even more true for reducing preventable maternal and infant mortality across the country. The issues that can be solved within hospital walls represent one aspect of solving this tragedy. But the full range of symptoms pointing to broken systems must be addressed. 

Several factors proved crucial to success:

Strategic Location Selection

  • Readiness for change, with buy-in from legislators to community health workers

  • Available resources leveraged to minimize health risks

  • Leadership support at all levels

  • Community engagement in as many sectors as possible







Network Building

  • Multi-stakeholder engagement, especially from those working directly in service delivery

  • Trust development, requiring both time and commitment

  • Resource sharing across sectors

  • Sustainable relationships, like trust development, require the investment of time and commitment

Flexible Implementation

  • Adaptable models

  • Responsive to local needs

  • Emergent strategy that can only come from deep listening

  • Continuous learning

Sustainable Systems

  • Long-term funding mechanisms, because year-long grant schemes cannot affect broad systemic impact

  • Institutional change

  • Policy and legislative reform

  • Cultural transformation







Looking Forward: Lessons for Other Challenges

The New Jersey maternal health transformation offers crucial insights for addressing other complex social challenges. It provides a model or method for approaching systems change—from within communities, across sectors, where donors and grantees sit as partners at the same table.

To carry this model of change to other contexts, consider the following:

Choose Starting Points Strategically

  • Assess readiness for change

  • Identify potential orchestrators and those who can act as ‘collaborative glue’

  • Gather stakeholders together, and share lessons already learned so they can coalesce around issues particular to their communities

  • Map available resources across sectors

  • Understand local context

Build Trust Through Results

  • Start with achievable goals

  • Document success carefully

  • Share credit generously

  • Scale thoughtfully

Create Sustainable Systems

  • Focus on institutional change

  • Build long-term funding

  • Develop leadership capacity

  • Foster ongoing learning

Share Knowledge While Encouraging Adaptation

  • Document lessons learned

  • Support peer learning

  • Encourage local innovation

  • Maintain quality standards







Conclusion: The Future of System Change

To solve systemic problems, those who come together with a stake in finding solutions will be those who are most proximate to the challenges, whether by geography, experience, or vocation. The System Catalysts needed to usher change forward will be those who are able to hold stakeholders tightly around a common problem. No wanderers here.
The New Jersey maternal health transformation demonstrates that long-standing, generational, and seemingly intractable problems can yield to system catalyst approaches that:

  • Start where change is possible

  • Build trust through results

  • Create sustainable systems

  • Share knowledge generously

The future of social change lies not in single breakthrough programs alone, but in breakthrough thinking about where and how change becomes possible. System catalysts show us how to make that future real, one strategically chosen opportunity at a time.

For those inspired to become system catalysts, this story offers both hope and practical guidance. It shows that while the path isn't simple or easy, it is possible. Success requires patience, persistence, and willingness to work across traditional boundaries—even in ourselves. 

But as New Jersey proves, the results can transform entire systems, saving lives and creating lasting change that continues to grow and evolve.

The question isn't whether this approach works – it's where it will create breakthrough change next. For those ready to take on complex social challenges, the system catalyst model offers a proven path forward.

JR Pershall
Next

What is Systems Change? A Guide to Implement Effective Systems