Local health departments and Maternal Child Health Expenditures: How agencies are responding to “need”

Background: As a part of the Public Health Activities and Service Tracking (PHAST) study and in collaboration with partners in 2 Public Health Practice-based Research Networks (PBRN), we examined local health department (LHD) expenditure data related to maternal/child health (MCH) services in order to investigate the relationship between LHD expenditures related to specific MCH services and apparent local need.

Methods: Retrospective expenditure data from LHDs and for 3 MCH services over 6 years represented annual financial investments in WIC, Family Planning, and a composite of Maternal/Infant/Child/Adolescent service. We used a multivariate pooled-time series design to statistically estimate the ecologic associations between these MCH expenditures and related measures of local “need” over a six year period from 2005 to 2010 and while controlling for other factors.

Results: MCH, as a share of a LHD's total expenditures, decreased over the study period in our sample, even as Medicaid births and numbers of children in poverty had increased in the same areas. Findings indicate that the MCH expenditures examined were strongly associated with local “need” in these LHD jurisdictions from 2005-2010 but that these associations are sometimes negative. WIC expenditures appear to have most consistently maintained a positive association with need.

Conclusions: Findings suggest that budget cuts to MCH services may be undermining a positive association between MCH expenditures and local need—particularly in the areas of Family Planning and more general Maternal, Infant, Child, and Adolescent services. Annual expenditure data compiled through PHAST provide the potential for timely additional practice-based research.