text:
(a) As used in this article, the following definitions apply:

(1) “Abortion” has the same meaning as defined in Section 123464.

(2) “Department” means the Department of Health Care Access and Information.

(3) “Fund” means the Abortion Practical Support Fund.

(4) “Grantee” means a qualifying nonprofit organization in California that assists pregnant people with direct practical support for the purposes of obtaining an abortion.

(5) “Practical support” means financial or in-kind assistance to help a person access and obtain an abortion in California.

(b) The Abortion Practical Support Fund is hereby established in the State Treasury for the purpose of providing grants described in Section 123452. Notwithstanding Section 13340 of the Government Code, moneys in the Abortion Practical Support Fund are continuously appropriated to the department for providing grants described in Section 123452 and administrative costs as described in subdivision (d).

(c) Notwithstanding any other law, the department may receive and deposit moneys in the fund from the following entities:

(1) Nonstate entities, such as private sector or philanthropic entities.

(2) Local and federal government agencies.

(d) The department shall administer the fund. No more than 5 percent of the moneys in the fund shall be available for the department’s administrative activities related to planning and production of grants.

(e) Beginning no later than July 1, 2022, the fund shall be available to receive moneys from nonstate entities.

history: (History: Amended by Stats. 2022, Ch. 738, Sec. 2. (AB 204) Effective September 29, 2022.)

article: 2.3. Abortion Practical Support Fund

path: 106. PERSONAL HEALTH CARE (INCLUDING MATERNAL, CHILD, AND ADOLESCENT) > 2. MATERNAL, CHILD, AND ADOLESCENT HEALTH > 2. Maternal Health > 2.3. Abortion Practical Support Fund


kind: section

code: HSC

text:
(a) The department, or its contracted vendor, shall use moneys in the fund to administer grants to nonprofit organizations in California that are exempt from taxation under Section 501(c) of the Internal Revenue Code and that either specialize in assisting pregnant people who are low income, or who face other financial barriers. A grant recipient under this subdivision shall use the funds awarded to fund a new program or support an existing program that increases patient access to abortion. By way of nonlimiting examples, the program and the awarded funds may be used for any of the following:

(1) Practical support services related to seeking abortion.

(2) Abortion navigators, patient navigators, and community health workers services based in California.

(3) Case management support for patients seeking abortion.

(4) Costs associated with training volunteers and staff in the provision of practical support services to abortion patients in California.

(5) Costs associated with enabling grantees that meet the requirements of this section to assist pregnant people with practical support services, including staffing and administrative costs.

(6) Costs associated with coordinating practical support services, abortion providers, and other support services in California.

(b) (1) Unless otherwise specified by the department, grants under this article are for a period of one year and may be renewed.

(2) An application for a grant shall be made on a form to be developed by the department or its contracted vendor.

(3) Decisions regarding the grants and the funding level of the grant shall be made after consideration of all relevant factors, such as the grantee’s anticipated level of need and the availability of funds.

(c) To administer this section, the department, or its contracted vendor, shall use moneys in the fund to pay direct and indirect costs of the department, or its contracted vendor, including hiring or administrative costs.

(d) The department, or its contracted vendor, shall use moneys in the fund to maintain a system of financial reporting on all aspects of the fund. The financial reporting shall include, but is not limited to, information from the grantees on their expenditures and activities using grant funds associated with this article as the department deems necessary to ensure the use of the funds are consistent with the purposes of this article and the terms of any grant award.

(e) For purposes of this section, the department, or its contracted vendor, shall not require the submission of any identifying personal information about individuals receiving practical support services as part of an application for a grant or reporting of expenditures and activities using grant funds under this article. Information required by the department, or its contracted vendor, may only include information in summary, statistical, or other forms that do not identify particular individuals.

(f) An application for a grant under this article and financial reporting by grantees are exempt from disclosure under the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code).

(g) Contracts entered into or amended pursuant to this article are exempt from Chapter 6 (commencing with Section 14825) of Part 5.5 of Division 3 of Title 2 of the Government Code, Section 19130 of the Government Code, Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code, and the State Administrative Manual, and are exempt from the review or approval of any division of the Department of General Services.

history: (History: Amended by Stats. 2022, Ch. 738, Sec. 3. (AB 204) Effective September 29, 2022.)

division: 106. PERSONAL HEALTH CARE (INCLUDING MATERNAL, CHILD, AND ADOLESCENT)

part: 2. MATERNAL, CHILD, AND ADOLESCENT HEALTH

chapter: 2. Maternal Health

article: 2.3. Abortion Practical Support Fund


text: The department shall conduct an evaluation of the grant program implemented pursuant to Section 123452 and shall report its findings to the Legislature no later than January 1, 2025, and on an annual basis no later than each January 1 thereafter. The first annual report shall cover the period before July 1, 2024. Each subsequent annual report shall cover the previous fiscal year. The department may use moneys in the fund, upon appropriation by the Legislature, for the evaluation of the program. The report shall be submitted in compliance with Section 9795 of the Government Code.

history: (History: Added by Stats. 2022, Ch. 566, Sec. 3. (SB 1142) Effective January 1, 2023.)

article: 2.3. Abortion Practical Support Fund


text: This article shall be construed to effectuate its legislative intent to support access to abortion in California and build upon its commitment to be a reproductive freedom state. The United States Supreme Court overturned the protections to access abortion under Roe v. Wade. For decades, abortion funds, abortion providers, and other community-based organizations have provided direct and indirect support to callers and patients with logistical and practical support needs. The purpose of this article ensures that people seeking abortion care have access to the logistical and practical support resources needed, to diminish barriers to care. The purpose of this article and all of its provisions with respect to the powers granted shall be interpreted to effectuate that intent and purposes to support organizations in California who provide support and resources to people seeking abortion.

history: (History: Added by Stats. 2022, Ch. 738, Sec. 4. (AB 204) Effective September 29, 2022.)

article: 2.3. Abortion Practical Support Fund


text: This article shall be known and may be cited as the Reproductive Privacy Act.

history: (History: Added by Stats. 2002, Ch. 385, Sec. 8. Effective January 1, 2003.)

article: 2.5. Reproductive Privacy Act

path: 106. PERSONAL HEALTH CARE (INCLUDING MATERNAL, CHILD, AND ADOLESCENT) > 2. MATERNAL, CHILD, AND ADOLESCENT HEALTH > 2. Maternal Health > 2.5. Reproductive Privacy Act


text:
The Legislature finds and declares that every individual possesses a fundamental right of privacy with respect to personal reproductive decisions, which entails the right to make and effectuate decisions about all matters relating to pregnancy, including prenatal care, childbirth, postpartum care, contraception, sterilization, abortion care, miscarriage management, and infertility care. Accordingly, it is the public policy of the State of California that:

(a) Every individual has the fundamental right to choose or refuse birth control.

(b) Every pregnant individual or individual who may become pregnant has the fundamental right to choose to bear a child or to choose to have and to obtain an abortion, except as specifically limited by this article.

(c) The state shall not deny or interfere with the fundamental right of a pregnant individual or an individual who may become pregnant to choose to bear a child or to choose to have and to obtain an abortion, except as specifically permitted by this article.

history: (History: Amended by Stats. 2022, Ch. 629, Sec. 5. (AB 2223) Effective January 1, 2023.)

article: 2.5. Reproductive Privacy Act


text:
The following definitions shall apply for purposes of this chapter:

(a) “Abortion” means any medical treatment intended to induce the termination of a pregnancy except for the purpose of producing a live birth.

(b) “Pregnancy” means the human reproductive process, beginning with the implantation of an embryo.

(c) “State” means the State of California, and every county, city, town and municipal corporation, and quasi-municipal corporation in the state.

(d) “Viability” means the point in a pregnancy when, in the good faith medical judgment of a physician, on the particular facts of the case before that physician, there is a reasonable likelihood of the fetus’ sustained survival outside the uterus without the application of extraordinary medical measures.

history: (History: Amended by Stats. 2003, Ch. 62, Sec. 198. Effective January 1, 2004.)

article: 2.5. Reproductive Privacy Act


text:
(a) The state shall not deny or interfere with a woman’s or pregnant person’s right to choose or obtain an abortion prior to viability of the fetus, or when the abortion is necessary to protect the life or health of the woman or pregnant person.

(b) A person shall not be compelled in a state, county, city, or other local criminal, administrative, legislative, or other proceeding to identify or provide information that would identify or that is related to an individual who has sought or obtained an abortion if the information is being requested based on either another state’s laws that interfere with a person’s rights under subdivision (a) or a foreign penal civil action, as defined in Section 2029.200 of the Code of Civil Procedure.

history: (History: Amended by Stats. 2022, Ch. 629, Sec. 6.5. (AB 2223) Effective January 1, 2023.)

article: 2.5. Reproductive Privacy Act


text:
(a) Notwithstanding any other law, a person shall not be subject to civil or criminal liability or penalty, or otherwise deprived of their rights under this article, based on their actions or omissions with respect to their pregnancy or actual, potential, or alleged pregnancy outcome, including miscarriage, stillbirth, or abortion, or perinatal death due to causes that occurred in utero.

(b) A person who aids or assists a pregnant person in exercising their rights under this article shall not be subject to civil or criminal liability or penalty, or otherwise be deprived of their rights, based solely on their actions to aid or assist a pregnant person in exercising their rights under this article with the pregnant person’s voluntary consent.

history: (History: Added by Stats. 2022, Ch. 629, Sec. 7. (AB 2223) Effective January 1, 2023.)

article: 2.5. Reproductive Privacy Act


text:
(a) A law of another state that authorizes a person to bring a civil action against a person or entity that does any of the following is contrary to the public policy of this state:

(1) Receives or seeks an abortion.

(2) Performs, provides, or induces an abortion.

(3) Knowingly engages in conduct that aids or abets the performance, provision, or inducement of an abortion.

(4) Attempts or intends to engage in the conduct described in paragraphs (1) to (3), inclusive.

(b) The state shall not do either of the following:

(1) Apply a law described in subdivision (a) to a case or controversy heard in state court.

(2) Enforce or satisfy a civil judgment received through an adjudication under a law described in subdivision (a).

(c) The provisions of this section are severable. If any provision of this section or its application is held invalid, that invalidity shall not affect other provisions or applications that can be given effect without the invalid provision or application.

history: (History: Amended by Stats. 2023, Ch. 261, Sec. 2. (SB 487) Effective January 1, 2024.)

article: 2.5. Reproductive Privacy Act


text:
The performance of an abortion is unauthorized if performed by someone other than the pregnant person and if either of the following is true:

(a) The person performing the abortion is not a health care provider authorized to perform an abortion pursuant to Section 2253 of the Business and Professions Code.

(b) The abortion is performed on a viable fetus, and both of the following are established:

(1) In the good faith medical judgment of the physician, the fetus was viable.

(2) In the good faith medical judgment of the physician, continuation of the pregnancy posed no risk to life or health of the pregnant person.

history: (History: Amended by Stats. 2022, Ch. 629, Sec. 8. (AB 2223) Effective January 1, 2023.)

article: 2.5. Reproductive Privacy Act


text:
(a) (1) California law governs in any action in this state, whether civil, administrative, or criminal, against any person who provides, receives, aids or abets in providing or receiving, or attempts to provide or receive, by any means, including telehealth, the health care services described in paragraph (2) if the provider was located in this state or any other state where the care was legal at the time of the challenged conduct.

(2) Reproductive health care services and gender-affirming health care services, including gender-affirming mental health care services, are subject to paragraph (1).

(b) “Reproductive health” has the same meaning as set forth in Section 1798.300 of the Health and Safety Code.

(c) “Gender-affirming health care services” and “gender-affirming mental health care services” have the same meaning as defined in paragraph (3) of subdivision (b) of Section 16010.2 of the Welfare and Institutions Code.

history: (History: Added by Stats. 2023, Ch. 260, Sec. 13. (SB 345) Effective January 1, 2024.)

article: 2.5. Reproductive Privacy Act


text:
(a) A party whose reproductive rights are protected by this article and whose reproductive rights are interfered with by conduct or by a statute, ordinance, or other state or local rule, regulation, or enactment in violation of this article may bring a civil action against an offending state actor in a state superior court.

(b) Whoever denies a right protected by this article, or aids, incites, or conspires in that denial, is liable for each and every offense for the actual damages suffered by any person denied that right and, in addition, all of the following:

(1) An amount to be determined by a jury, or a court sitting without a jury, for exemplary damages.

(2) A civil penalty of twenty-five thousand dollars ($25,000), to be awarded to the person denied the right protected by this article.

(3) Preventive relief, including permanent or temporary injunction, restraining order, or other order against the person or persons responsible for the conduct, as the complainant deems necessary to ensure the full enjoyment of the rights described in this article.

(4) Upon a motion, a court shall award reasonable attorney’s fees and costs, including expert witness fees and other litigation expenses, to a plaintiff who is a prevailing party in an action brought pursuant to this section. In awarding reasonable attorney’s fees, the court shall consider the degree to which the relief obtained relates to the relief sought.

(c) An action under subdivision (b) shall be commenced within three years of the alleged practice violation of this article.

(d) (1) A party aggrieved by conduct or regulation in violation of this article may also bring a civil action pursuant to Section 52.1 of the Civil Code. Notwithstanding Section 821.6 of the Government Code, a civil action pursuant to Section 52.1 of the Civil Code may be based upon instituting or prosecuting any judicial or administrative proceeding in violation of this article.

(2) For purpose of establishing liability pursuant to this subdivision, the criminal investigation, arrest, or prosecution, or threat of investigation, arrest, or prosecution, of a person with respect to their pregnancy or actual, potential, or alleged pregnancy outcome, constitutes “threat, intimidation, or coercion” pursuant to Section 52.1 of the Civil Code.

(e) Sections 825, 825.2, 825.4, and 825.6 of the Government Code, providing for indemnification of an employee or former employee of a public entity, apply to any cause of action brought under this section against an employee or former employee of a public entity.

history: (History: Added by Stats. 2022, Ch. 629, Sec. 9. (AB 2223) Effective January 1, 2023.)

article: 2.5. Reproductive Privacy Act


text: This article shall be known and may be cited as the Reproductive FACT (Freedom, Accountability, Comprehensive Care, and Transparency) Act or Reproductive FACT Act.

history: (History: Added by Stats. 2015, Ch. 700, Sec. 3. (AB 775) Effective January 1, 2016.)

article: 2.7. Reproductive FACT Act

path: 106. PERSONAL HEALTH CARE (INCLUDING MATERNAL, CHILD, AND ADOLESCENT) > 2. MATERNAL, CHILD, AND ADOLESCENT HEALTH > 2. Maternal Health > 2.7. Reproductive FACT Act


text:
(a) For purposes of this article, and except as provided in subdivision (c), “licensed covered facility” means a facility licensed under Section 1204 or an intermittent clinic operating under a primary care clinic pursuant to subdivision (h) of Section 1206, whose primary purpose is providing family planning or pregnancy-related services, and that satisfies two or more of the following:

(1) The facility offers obstetric ultrasounds, obstetric sonograms, or prenatal care to pregnant women.

(2) The facility provides, or offers counseling about, contraception or contraceptive methods.

(3) The facility offers pregnancy testing or pregnancy diagnosis.

(4) The facility advertises or solicits patrons with offers to provide prenatal sonography, pregnancy tests, or pregnancy options counseling.

(5) The facility offers abortion services.

(6) The facility has staff or volunteers who collect health information from clients.

(b) For purposes of this article, subject to subdivision (c), “unlicensed covered facility” is a facility that is not licensed by the State of California and does not have a licensed medical provider on staff or under contract who provides or directly supervises the provision of all of the services, whose primary purpose is providing pregnancy-related services, and that satisfies two or more of the following:

(1) The facility offers obstetric ultrasounds, obstetric sonograms, or prenatal care to pregnant women.

(2) The facility offers pregnancy testing or pregnancy diagnosis.

(3) The facility advertises or solicits patrons with offers to provide prenatal sonography, pregnancy tests, or pregnancy options counseling.

(4) The facility has staff or volunteers who collect health information from clients.

(c) This article shall not apply to either of the following:

(1) A clinic directly conducted, maintained, or operated by the United States or any of its departments, officers, or agencies.

(2) A licensed primary care clinic that is enrolled as a Medi-Cal provider and a provider in the Family Planning, Access, Care, and Treatment Program.

article: 2.7. Reproductive FACT Act


text:
(a) A licensed covered facility shall disseminate to clients on site the following notice in English and in the primary threshold languages for Medi-Cal beneficiaries as determined by the State Department of Health Care Services for the county in which the facility is located.

(1) The notice shall state: “California has public programs that provide immediate free or low-cost access to comprehensive family planning services (including all FDA-approved methods of contraception), prenatal care, and abortion for eligible women. To determine whether you qualify, contact the county social services office at [insert the telephone number].” (2) The information shall be disclosed in one of the following ways:

(A) A public notice posted in a conspicuous place where individuals wait that may be easily read by those seeking services from the facility. The notice shall be at least 8.5 inches by 11 inches and written in no less than 22-point type.

(B) A printed notice distributed to all clients in no less than 14-point type.

(C) A digital notice distributed to all clients that can be read at the time of check-in or arrival, in the same point type as other digital disclosures. A printed notice as described in subparagraph (B) shall be available for all clients who cannot or do not wish to receive the information in a digital format.

(3) The notice may be combined with other mandated disclosures.

(b) An unlicensed covered facility shall disseminate to clients on site and in any print and digital advertising materials including Internet Web sites, the following notice in English and in the primary threshold languages for Medi-Cal beneficiaries as determined by the State Department of Health Care Services for the county in which the facility is located.

(1) The notice shall state: “This facility is not licensed as a medical facility by the State of California and has no licensed medical provider who provides or directly supervises the provision of services.”

(2) The onsite notice shall be a sign at least 8.5 inches by 11 inches and written in no less than 48-point type, and shall be posted conspicuously in the entrance of the facility and at least one additional area where clients wait to receive services.

(3) The notice in the advertising material shall be clear and conspicuous. “Clear and conspicuous” means in larger point type than the surrounding text, or in contrasting type, font, or color to the surrounding text of the same size, or set off from the surrounding text of the same size by symbols or other marks that call attention to the language.

article: 2.7. Reproductive FACT Act


text:
(a) Covered facilities that fail to comply with the requirements of this article are liable for a civil penalty of five hundred dollars ($500) for a first offense and one thousand dollars ($1,000) for each subsequent offense. The Attorney General, city attorney, or county counsel may bring an action to impose a civil penalty pursuant to this section after doing both of the following:

(1) Providing the covered facility with reasonable notice of noncompliance, which informs the facility that it is subject to a civil penalty if it does not correct the violation within 30 days from the date the notice is sent to the facility.

(2) Verifying that the violation was not corrected within the 30-day period described in paragraph (1).

(b) The civil penalty shall be deposited into the General Fund if the action is brought by the Attorney General. If the action is brought by a city attorney, the civil penalty shall be paid to the treasurer of the city in which the judgment is entered. If the action is brought by a county counsel, the civil penalty shall be paid to the treasurer of the county in which the judgment is entered.

article: 2.7. Reproductive FACT Act


text: The Legislature finds that a community-based system of comprehensive perinatal care, including prenatal care, delivery service, postpartum care, and neonatal and infant care are necessary services that have been demonstrated effective in preventing or reducing maternal, perinatal, and infant mortality and morbidity.

history: (History: Added by Stats. 1995, Ch. 415, Sec. 8. Effective January 1, 1996.)

article: 3. Community-Based Perinatal System

path: 106. PERSONAL HEALTH CARE (INCLUDING MATERNAL, CHILD, AND ADOLESCENT) > 2. MATERNAL, CHILD, AND ADOLESCENT HEALTH > 2. Maternal Health > 3. Community-Based Perinatal System


text:
It is the intent of the Legislature in enacting this article to maintain, to the extent resources are available, a permanent statewide community-based comprehensive perinatal system to provide care and services to low-income pregnant women and their infants who are considered underserved in terms of comprehensive perinatal care.

It is also the intent of the Legislature that the statewide, community-based, comprehensive perinatal health care program be developed by the department to conform with the guidelines set forth in this article, and be integrated and coordinated with the perinatal access program in Article 2.5 (commencing with Section 288).

It is further the intent of the Legislature that these guidelines allow each applicant the flexibility to design a system specific to the nature of the community and the needs of the clients.

It is further the intent of the Legislature that the director, in allocating funds available for programs that provide comprehensive perinatal care, follow the guidelines and principles developed in this article.

article: 3. Community-Based Perinatal System


text:
The following definitions shall govern the construction of this article:

(a) “Community-based comprehensive perinatal care” means a range of prenatal, delivery, postpartum, infant, and pediatric care services delivered in an urban community or neighborhood, rural area, city or county clinic, city or county health department, freestanding birth center, or other health care provider facility by health care practitioners trained in methods of preventing complications and problems during and after pregnancy, and in methods of educating pregnant women of these preventive measures, and who provide a continuous range of services. The health care practitioners shall, through a system of established linkages to other levels of care in the community, consult with, and, when appropriate, refer to, specialists.

(b) “Low income” means all persons of childbearing age eligible for Medi-Cal benefits under Chapter 7 (commencing with Section 14000) and all persons eligible for public social services for which federal reimbursement is available, including potential recipients. “Potential recipients” shall include the pregnant woman and her infant in a family where current social, economic and health conditions of the family indicate that the family would likely become a recipient of financial assistance within the next five years.

(c) “Prenatal care” means care received from conception until the completion of labor and delivery.

(d) “Perinatal care” means care received from the time of conception through the first year after birth.

(e) “Qualified organization” means any nonprofit, not-for-profit, or for-profit corporation with demonstrated expertise in implementing the Nurse-Family Partnership program or similar programs in different local settings.

(f) “Qualified trainer” means anyone who has been certified by the Nurse-Family Partnership to provide training.

(g) “Department” means the State Department of Public Health, unless otherwise designated.

history: (History: Amended by Stats. 2007, Ch. 483, Sec. 29. Effective January 1, 2008.)

article: 3. Community-Based Perinatal System


text:
(a) The department shall develop and maintain a statewide comprehensive community-based perinatal services program and enter into contracts, grants, or agreements with health care providers to deliver these services in a coordinated effort to the extent permitted under federal law and regulation. These contracts, grants, or agreements shall be made in medically underserved areas or areas with demonstrated need. Nothing in this section shall be construed to prevent reallocation of resources or use of new moneys for the development of new community-based comprehensive perinatal systems in underserved areas or areas with demonstrated need, and supplementation of systems already in existence.

(b) As a condition of receiving funds from the Maternal and Child Health program, contractors shall bill the Medi-Cal program for services provided to Medi-Cal recipients.

article: 3. Community-Based Perinatal System


text:
(a) There is hereby established a voluntary nurse home visiting grant program for expectant first-time mothers, their children, and their families, to be administered by the department pursuant to Section 123492. The program may be cited as the Nurse-Family Partnership program.

(b) The goals and objectives of the program shall be the same as, but shall not be limited to, those in the community-based comprehensive perinatal health care system as set forth in Section 123505.

(c) The department shall adopt regulations for the implementation of this section in accordance with Section 123516.

history: (History: Added by Stats. 2006, Ch. 878, Sec. 3. Effective January 1, 2007.)

article: 3. Community-Based Perinatal System


text:
The department shall develop a grant application and award grants on a competitive basis to counties for the startup, continuation, and expansion of the program established pursuant to Section 123491. To be eligible to receive a grant for purposes of that section, a county shall agree to all of the following:

(a) Serve through the program only pregnant, low-income women who have had no previous live births. Notwithstanding subdivision (b) of Section 123485, women who are juvenile offenders or who are clients of the juvenile system shall be deemed eligible for services under the program.

(b) Enroll women in the program while they are still pregnant, before the 28th week of gestation, and preferably before the 16th week of gestation, and continue those women in the program through the first two years of the child’s life.

(c) Use as home visitors only registered nurses who have been licensed in the state.

(d) Have nurse home visitors undergo training according to the program and follow the home visit guidelines developed by the Nurse-Family Partnership program.

(e) Have nurse home visitors specially trained in prenatal care and early child development.

(f) Have nurse home visitors follow a visit schedule keyed to the developmental stages of pregnancy and early childhood.

(g) Ensure that, to the extent possible, services shall be rendered in a culturally and linguistically competent manner.

(h) Limit a nurse home visitor’s caseload to no more than 25 active families at any given time.

(i) Provide for every eight nurse home visitors a full-time nurse supervisor who holds at least a bachelor’s degree in nursing and has substantial experience in community health nursing.

(j) Have nurse home visitors and nurse supervisors trained in effective home visitation techniques by qualified trainers.

(k) Have nurse home visitors and nurse supervisors trained in the method of assessing early infant development and parent-child interaction in a manner consistent with the program.

(l) Provide data on operations, results, and expenditures in the formats and with the frequencies specified by the department.

(m) Collaborate with other home visiting and family support programs in the community to avoid duplication of services and complement and integrate with existing services to the extent practicable.

(n) Demonstrate that adoption of the Nurse-Family Partnership program is supported by a local governmental or government-affiliated community planning board, decisionmaking board, or advisory body responsible for assuring the availability of effective, coordinated services for families and children in the community.

(o) Provide cash or in-kind matching funds in the amount of 100 percent of the grant award.

(p) Prohibit the use of moneys received for the program as a match for grants currently administered by the department.

history: (History: Added by Stats. 2006, Ch. 878, Sec. 4. Effective January 1, 2007.)

article: 3. Community-Based Perinatal System


text:
(a) The department may accept voluntary contributions, in cash or in-kind, to pay for the costs in the implementation of the program under Section 123492. These private donations shall be deposited into the California Families and Children Account, which is hereby created in the State Treasury, in which, notwithstanding Section 13340 of the Government Code, is hereby continuously appropriated to the department for purposes of implementing Section 123492. No state funds shall be used in implementing Section 123492.

(b) The department shall only distribute grants established under Section 123492 if the Director of Finance determines, in writing, that there are sufficient funds from private donations available in the account for expenditure for the purposes of the program.

(c) The department’s administration costs shall not exceed 5 percent of the moneys in the account created under subdivision (a). Any costs to the department incurred prior to the account receiving funds shall be reimbursed to the department from funds in the account.

(d) The department shall not apply for grants or solicit private funds.

(e) If, as of January 1, 2009, the Director of Finance determines pursuant to subdivision (a) that there are insufficient funds on deposit in the account to implement the voluntary nurse home visiting grant program, the account shall cease to exist.

history: (History: Added by Stats. 2006, Ch. 878, Sec. 5. Effective January 1, 2007.)

article: 3. Community-Based Perinatal System


text:
(a) The department shall seek any federal waiver or waivers that may be necessary to maximize funds from the federal government including, but not limited to, funds provided under Title 19 of the Social Security Act to provide funds for a full range of preventive perinatal services.

(b) The department shall, in preparing its budget for submission each year, coordinate all funding sources intended primarily for perinatal care made available through the Budget Act to maximize the delivery of perinatal care services and to avoid duplication of programs and funding.

(c) The department shall develop and implement a uniform sliding fee schedule for women provided perinatal care through the perinatal services program. The fee schedule shall be based on family size and income, but in no case shall the fee exceed the actual cost of the services provided. The department shall not implement any schedule developed pursuant to this section sooner than 30 days after the department has provided the chairperson of the Joint Legislative Budget Committee and the chairperson of the fiscal committee of each house with the developed schedule.

All free clinics, as defined in paragraph (2) of subdivision (a) of Section 1204 shall be exempt from this subdivision.

All organizations funded under the Public Health Service Act, Sections 254b and 254c of Title 42 of the United States Code, shall be permitted to utilize those sliding fee scales mandated by federal law or regulation in lieu of the sliding fee scale adopted by the department.

article: 3. Community-Based Perinatal System


text: The department shall monitor the delivery of services under contracts, grants, and agreements provided for in this article through a uniform health data collection system that utilizes epidemiologic methodology. The department may collect data from providers receiving funds through this program as necessary to evaluate program effectiveness.

article: 3. Community-Based Perinatal System


text:
The goals of the community-based comprehensive perinatal health care system shall be:

(a) To decrease and maintain the decreased level of perinatal, maternal, and infant mortality and morbidity in the State of California.

(b) To support methods of providing comprehensive prenatal care that prevent prematurity and the incidence of low birth weight infants.

article: 3. Community-Based Perinatal System


text:
The program objectives of the community-based comprehensive perinatal health care system shall be the following:

(a) To ensure continuing availability and accessibility to early prenatal care within the areas presently served and to develop a community-based comprehensive perinatal system in other areas of the state that are medically underserved or have demonstrated need.

(b) To assure the appropriate level of maternal, newborn and pediatric care services necessary to provide the healthiest outcome for mother and infant.

(c) To ensure postpartum, family planning, and followup care through the first year of life, and referral to an ongoing primary health care provider.

(d) To include support and ancillary services such as nutrition, health education, public health nursing, and social work that have been demonstrated to decrease maternal, perinatal, and infant mortality and morbidity, as components of comprehensive perinatal care.

(e) To ensure that care shall be available regardless of the patient’s financial situation.

(f) To ensure, to the extent possible, that the same quality of care shall be available to all pregnant women.

(g) To promote program flexibility by recognizing the needs within an area and providing for unique programs to meet those needs.

(h) To emphasize preventive health care as a major component of any perinatal program, and to support outreach programs directed at low-income pregnant women that will encourage early entry into, and appropriate utilization of, the perinatal health care system.

article: 3. Community-Based Perinatal System


text:
In processing and awarding contracts, grants, or agreements pursuant to this article, the department shall evaluate the ability of applicants to meet, to the maximum extent possible, the following criteria:

(a) The applicant’s prior experience in providing community-based, comprehensive perinatal care and services to low-income women and infants.

(b) The applicant’s ability to provide comprehensive perinatal care, either directly or through subcontract. Those services comprising comprehensive perinatal care include, but are not limited to, the following:

(1) Initial and ongoing physical assessment.

(2) Psychosocial assessments and counseling, and referral when appropriate.

(3) Nutrition assessments, counseling and referral to counseling on food supplement programs, vitamins, and breastfeeding.

(4) Health educational assessments, and intervention and referral, including childbirth preparation and parenting.

(5) Outreach and community education.

(6) Laboratory, radiology, and other specialized services as indicated.

(7) Delivery, postpartum followup, and pediatric care through the first year of life.

(c) The quality of care that is being, or has been provided to low-income women and infants by health care providers.

(d) Whether the area that is, or that will be, serviced by the applicant is medically underserved or has otherwise demonstrated the need for comprehensive, community-based perinatal services.

(e) The applicant’s ability to use an appropriate multidisciplinary staff working as a team, in consultation with obstetricians, pediatricians, and family practitioners when appropriate, to provide a full range of comprehensive perinatal care services. Staffing patterns shall reflect, to the maximum extent feasible, at all levels, the cultural, linguistic, ethnic, and other social characteristics of the community served. This staff shall include at least one of those persons described in paragraphs (1) to (3), inclusive, of this subdivision, as follows, and may include, but not be limited to, a combination of those persons described in paragraphs (4) to (10), inclusive, of this subdivision, as follows:

(1) An obstetrician.

(2) A pediatrician.

(3) (A) A family physician.

(B) For purposes of this paragraph, “family physician” means a primary care physician and surgeon who renders continued comprehensive and preventative health care services to individuals and families, and who has received specialized training in an approved family medicine residency for three years after graduation from an accredited medical school.

(4) Certified nurse-midwives, public health nurses, nurse practitioners, or physician assistants.

(5) Nutritionists.

(6) Social workers.

(7) Health and childbirth educators.

(8) A family planning counselor.

(9) Community outreach peer workers.

(10) A translator.

history: (History: Amended by Stats. 2019, Ch. 632, Sec. 9. (AB 1622) Effective January 1, 2020.)

article: 3. Community-Based Perinatal System


text:
(a) The department, in consultation with the program administrators, may contract with one or more qualified organizations to assist the department in ensuring that grantees implement the program as established under Section 123491 and to conduct an annual evaluation of the implementation of the grant program on a statewide basis. The first evaluation shall be due 12 months after the award of grants pursuant to Section 123492.

(b) (1) In conducting its monitoring and evaluation activities, the department shall be guided by program performance standards developed by the department in consultation with the Nurse-Family Partnership program.

(2) The annual evaluation shall contain, but not be limited to, the extent to which each grantee participating in the program has done each of the following:

(A) Recruited a population of low-income, first-time mothers.

(B) Enrolled families early in pregnancy and followed them through the second birthday of the child.

(C) Conducted visits that are of comparable frequency, duration, and content as those delivered in the randomized clinical trials of the program.

(D) Assessed the health and well-being of the mothers and children enrolled in the program according to common indicators of maternal, child, and family health.

history: (History: Amended by Stats. 2012, Ch. 728, Sec. 109. (SB 71) Effective January 1, 2013.)

article: 3. Community-Based Perinatal System


text:
(a) In developing a comprehensive system, health care providers funded under this article may perform the following activities to ensure that a full range of program components of a comprehensive, community-based health care system are available, accessible, and utilized by pregnant women and infants:

(1) Coordinate specific linkages with one another.

(2) Subcontract the services specified in this article.

(3) Provide additional services not specifically listed in this article. These additional services shall include, but shall not be limited to the Women, Infants, and Children (WIC) food supplement program, services offered by local health departments, and public and private social welfare agencies. Nothing contained in this article shall be construed to prohibit a subcontractor from being reimbursed pursuant to a fee for service, capitation, or other payment mechanism.

(b) All services and educational materials shall be provided in the primary languages of the clients served, provided that there are at least 5 percent or 100 persons, whichever is less, of the total beneficiary population served annually by each facility, who share language other than English and who are limited-English speaking. “Limited-English speaking” means a person who uses a language other than English in order to communicate effectively.

(c) Health care providers applying for a contract, grant, or agreement under this article shall indicate the manner in which their service elements will be coordinated with existing community resources and services and with hospitals of all levels in the area to ensure each client receives the appropriate level or care at the appropriate time. The department may require written agreements between contractors and hospital or hospitals in the area regarding delivery services, and protocols for referral and transfer when special treatment services are required. The department may, when requested by the grantee or contractor, assist in achieving coordination and written agreements pertaining to the delivery of these services.

article: 3. Community-Based Perinatal System


text: The provisions contained in this article shall be subject to the normal Budget Act process and shall be operative to the extent funds are appropriated for this purpose.

article: 3. Community-Based Perinatal System


text: The Legislature finds and declares that prenatal care, delivery service, postpartum care and neonatal and infant care are essential services necessary to assure maternal and infant health. These services are not currently distributed so as to meet the minimum maternal and infant health needs of many Californians. A regionalized perinatal health system can provide these essential services; however, many underserved areas lack the staff or expertise to develop these systems.

article: 4. Perinatal Health Care

path: 106. PERSONAL HEALTH CARE (INCLUDING MATERNAL, CHILD, AND ADOLESCENT) > 2. MATERNAL, CHILD, AND ADOLESCENT HEALTH > 2. Maternal Health > 4. Perinatal Health Care


text: The department shall develop and implement a uniform sliding fee schedule, based on family size and income, for women provided perinatal care through the Perinatal Care Services Program. The department shall not implement any schedule developed pursuant to this section sooner than 30 days after the department has provided the Chairperson of the Joint Legislative Budget Committee and the chairperson of the fiscal committee of each house with the developed schedule.

article: 4. Perinatal Health Care


text:
Unless the context otherwise requires, the definitions in this section govern the construction of this article:

(a) “Perinatal health system” means all of the prenatal care, delivery care, postpartum care, and neonatal and infant care services available to a region identified by the department pursuant to this article.

(b) “Regionalized perinatal health system” means coordinated measures intended to ensure that a perinatal health system provides at least minimum services necessary to meet the maternal and infant health needs of the region and intended to ensure that it does so as efficiently and cost-effectively as possible.

(c) “High-risk pregnant woman” means a woman considered highly likely for any reason to suffer personal mortality or morbidity from her pregnancy, or to deliver a defective, disabled, high-risk, or stillborn infant.

(d) “High-risk infant” means a newborn considered highly likely for any reason to suffer personal mortality or morbidity or to suffer long-lasting defect or disability.

(e) “High-risk geographic area” means a region in this state in which the proportion of high-risk pregnant women or high-risk infants exceeds the average for the population of California as a whole.

(f) “High-risk population” means a demographic group in which the proportion of high-risk women or high-risk infants exceeds the average for the population of California as a whole.

article: 4. Perinatal Health Care


text:
The department shall maintain a program that addresses the special needs of high-risk pregnant women and infants. The program shall include the following:

(a) Identification of high-risk geographical areas and populations.

(b) Identification and evaluation of deficiencies in perinatal health systems.

(c) Assistance in the development of regionalized perinatal health systems, particularly in underserved areas, to meet unmet needs.

(d) Assistance in implementing regionalized perinatal health systems.

(e) Collection and analyses of data on perinatal health systems and needs.

(f) Monitoring of results.

(g) Assist in implementing and maintaining a high-risk infant follow-up program.

article: 4. Perinatal Health Care


text:
(a) In assisting in the development of the regionalized perinatal health systems, the department shall consult with the office, the State Department of Developmental Services, county health officials, health systems agencies, health professionals and health facilities expected to participate in the systems, and community groups.

(b) In carrying out this article, the department shall coordinate the regionalized perinatal health systems with all other maternal and infant health programs conducted by or for the department, the office, the State Department of Developmental Services, and all other state agencies, to ensure full regional coordination.

article: 4. Perinatal Health Care


text: It is the intent of the Legislature that the program created by Sections 123550 to 123570, inclusive, be funded through the normal budgetary process beginning in the 1980–81 fiscal year.

article: 4. Perinatal Health Care


text:
(a) Subject to an appropriation of funds by the Legislature in the annual Budget Act or another statute for this purpose, the State Department of Public Health, in consultation with subject matter experts, shall do all of the following:

(1) Review available literature on adverse effects of extreme heat on perinatal health.

(2) Develop guidance for safe conditions and healthy considerations for pregnant individuals and infant children who may be exposed to extreme heat, and for pregnant individuals, during both the gestational and postpartum periods. The department shall post this guidance on its internet website and make it accessible to medical and community-based health care organizations.

(3) Provide guidance and supporting information to the Legislature by submitting a report that includes legislative or policy recommendations on best practices for connecting perinatal patients with the appropriate health and well-being information relating to extreme heat.

(b) (1) A report to be submitted pursuant to subdivision (a) shall be submitted in compliance with Section 9795 of the Government Code.

(2) Pursuant to Section 10231.5 of the Government Code, this section is repealed on January 1, 2027.

history: (History: Added by Stats. 2022, Ch. 265, Sec. 2. (AB 2420) Effective January 1, 2023. Repealed as of January 1, 2027, by its own provisions.)

article: 4. Perinatal Health Care


text: By July 1, 1991, the Health and Welfare Agency shall develop and disseminate a model needs assessment protocol for pregnant and postpartum substance abusing women in conjunction with the appropriate professional organizations in the areas of hospital administration, substance abuse prevention and treatment, social services, public health, and appropriate state agencies, including the State Department of Social Services, the department, the State Department of Developmental Services, and the State Department of Alcohol and Drug Programs. This model may be utilized by hospitals and counties pursuant to Section 123605.

article: 4. Perinatal Health Care


text:
(a) Each county shall establish protocols between county health departments, county welfare departments, and all public and private hospitals in the county, regarding the application and use of an assessment of the needs of, and a referral for, a substance exposed infant to a county welfare department pursuant to Section 11165.13 of the Penal Code.

(b) The assessment of the needs shall be performed by a health practitioner, as defined in Section 11165.8 of the Penal Code, or a medical social worker. The needs assessment shall be performed before the infant is released from the hospital.

(c) The purpose of the assessment of the needs is to do all of the following:

(1) Identify needed services for the mother, child, or family, including, where applicable, services to assist the mother caring for her child and services to assist maintaining children in their homes.

(2) Determine the level of risk to the newborn upon release to the home and the corresponding level of services and intervention, if any, necessary to protect the newborn’s health and safety, including a referral to the county welfare department for child welfare services.

(3) Gather data for information and planning purposes.

article: 4. Perinatal Health Care


text: It is the intent of the Legislature that funding for Sections 123600 and 123605 be provided in the annual Budget Act.

article: 4. Perinatal Health Care


text: This article shall be known, and may be cited, as the Maternal Mental Health Conditions Education, Early Diagnosis, and Treatment Act.

history: (History: Added by Stats. 2018, Ch. 773, Sec. 1. (AB 3032) Effective January 1, 2019.)

article: 4.2. Maternal Mental Health

path: 106. PERSONAL HEALTH CARE (INCLUDING MATERNAL, CHILD, AND ADOLESCENT) > 2. MATERNAL, CHILD, AND ADOLESCENT HEALTH > 2. Maternal Health > 4.2. Maternal Mental Health


text:
The Legislature hereby finds and declares all of the following:

(a) Maternal depression is a common complication of pregnancy. Maternal mental health disorders encompass a range of mental health conditions, such as depression, anxiety, and postpartum psychosis.

(b) Maternal mental health conditions affect one in five women during or after pregnancy, but all women are at risk of suffering from maternal mental health conditions.

(c) Untreated maternal mental health conditions significantly and negatively impact the short- and long-term health and well-being of affected women and their children.

(d) Untreated maternal mental health conditions cause adverse birth outcomes, impaired maternal-infant bonding, poor infant growth, childhood emotional and behavioral problems, and significant medical and economic costs, estimated to be $22,500 per mother.

(e) Lack of understanding and social stigma of mental health conditions prevent women and families from understanding the signs, symptoms, and risks involved with maternal mental health conditions and disproportionately affect women who lack access to social support networks.

(f) It is the intent of the Legislature to raise awareness of the risk factors, signs, symptoms, and treatment options for maternal mental health conditions among pregnant women and their families, the general public, primary health care providers, and health care providers who care for pregnant women, postpartum women, and newborn infants.

history: (History: Amended by Stats. 2019, Ch. 497, Sec. 176. (AB 991) Effective January 1, 2020.)

article: 4.2. Maternal Mental Health


text:
For the purposes of this article, the following terms have the following meanings:

(a) “Maternal mental health condition” means a mental health condition that occurs during pregnancy or during the postpartum period and includes, but is not limited to, postpartum depression.

(b) “Perinatal unit” is a maternity and newborn service of a hospital for the provision of care during pregnancy, labor, delivery, and postpartum and neonatal periods with appropriate staff, space, equipment, and supplies.

article: 4.2. Maternal Mental Health


text: A general acute care hospital or special hospital, as defined in subdivisions (a) and (f) of Section 1250, that has a perinatal unit, in collaboration with medical staff, shall, by January 1, 2020, develop and implement a program to provide education and information to appropriate health care professionals and patients about maternal mental health conditions.

article: 4.2. Maternal Mental Health


text:
The program developed pursuant to this article shall include all of the following:

(a) Education and information for postpartum women and families about maternal mental health conditions, posthospital treatment options, and community resources.

(b) Education and information for hospital employees regularly assigned to work in the perinatal unit, including, as appropriate, registered nurses and social workers, about maternal mental health conditions.

(c) Any other service the hospital determines should be included in the program to provide optimal patient care.

article: 4.2. Maternal Mental Health


text: A person or facility that offers fetal ultrasound, or a similar procedure, for keepsake or entertainment purposes, shall disclose to a client prior to performing the procedure, in writing, the following statement: “The federal Food and Drug Administration has determined that the use of medical ultrasound equipment for other than medical purposes, or without a physician’s prescription, is an unapproved use.”

history: (History: Added by Stats. 2004, Ch. 78, Sec. 2. Effective January 1, 2005.)

article: 4.5. Fetal Ultrasound

path: 106. PERSONAL HEALTH CARE (INCLUDING MATERNAL, CHILD, AND ADOLESCENT) > 2. MATERNAL, CHILD, AND ADOLESCENT HEALTH > 2. Maternal Health > 4.5. Fetal Ultrasound


text:
(a) An ultrasound, or a similar medical imaging device or procedure used for a medical, counseling, or diagnostic service or purpose, shall only be offered in the following settings:

(1) A licensed clinic, as described in Chapter 1 (commencing with Section 1200) of Division 2.

(2) An outpatient setting, as described in Chapter 1.3 (commencing with Section 1248) of Division 2.

(3) A licensed health facility, as described in Chapter 2 (commencing with Section 1250) of Division 2.

(4) A practice of a licensed physician or surgeon, a medical group practice, including a professional medical corporation, as defined in Section 2406 of the Business and Professions Code, another form of corporation controlled by physicians and surgeons, a medical partnership, a medical foundation exempt from licensure, or another lawfully organized group of physicians and surgeons that provides health care services.

(5) A practice of a licensed chiropractor, as described in Chapter 2 (commencing with Section 1000) of Division 2 of the Business and Professions Code, or a lawfully organized group of licensed chiropractors that provides health care services.

(6) A practice of a licensed physical therapist, as described in Chapter 5.7 (commencing with Section 2600) of Division 2 of the Business and Professions Code, or a lawfully organized group of licensed physical therapists that provides health care services.

(7) A facility affiliated with those settings.

(8) An exempt entity as described in Section 1206.

(b) This section does not apply to a practice of a licensed midwife providing care pursuant to Article 24 (commencing with Section 2505) of Chapter 5 of Division 2 of the Business and Professions Code, or a practice of a certified nurse-midwife providing care pursuant to Article 2.5 (commencing with Section 2746) of Chapter 6 of Division 2 of the Business and Professions Code.

history: (History: Added by Stats. 2023, Ch. 259, Sec. 1. (AB 1720) Effective January 1, 2024.)

article: 4.5. Fetal Ultrasound


text:
(a) Any person or entity that fails to comply with the requirements of Section 123621 is liable for a civil penalty of two thousand five hundred dollars ($2,500) for a first offense and five thousand dollars ($5,000) for each subsequent offense. The Attorney General, a district attorney, a city attorney, or a county counsel may bring an action to impose a civil penalty pursuant to this section. For purposes of this subdivision, an offense is each ultrasound conducted in violation of Section 123621.

(b) Any person or entity that violates this section is liable for any costs, fees, and civil penalties. Costs, fees, and civil penalties collected pursuant to this section shall be paid to the office that brought the action as follows:

(1) To the Office of the Attorney General.

(2) To the treasurer of the city for the city attorney.

(3) To the treasurer of the county for the district attorney.

(4) To the treasurer of the county for the county counsel.

history: (History: Added by Stats. 2023, Ch. 259, Sec. 2. (AB 1720) Effective January 1, 2024.)

article: 4.5. Fetal Ultrasound


text: This article shall be known, and may be cited, as the California Dignity in Pregnancy and Childbirth Act.

history: (History: Added by Stats. 2019, Ch. 533, Sec. 3. (SB 464) Effective January 1, 2020.)

path: 106. PERSONAL HEALTH CARE (INCLUDING MATERNAL, CHILD, AND ADOLESCENT) > 2. MATERNAL, CHILD, AND ADOLESCENT HEALTH > 2. Maternal Health > 4.6. California Dignity in Pregnancy and Childbirth Act


text:
The Legislature hereby finds and declares all of the following:

(a) Every person should be entitled to dignity and respect during and after pregnancy and childbirth. Patients should receive the best care possible regardless of their race, gender, age, class, sexual orientation, gender identity, disability, language proficiency, nationality, immigration status, gender expression, or religion.

(b) The United States has the highest maternal mortality rate in the developed world. About 700 women die each year from childbirth, and another 50,000 suffer from severe complications. In California, since 2006, the rate of maternal death has decreased 55 percent, in contrast to the steady increase in the United States as a whole.

(c) However, for women of color, particularly Black women, the maternal mortality rate remains three to four times higher than White women. Black women make up 5 percent of the pregnancy cohort in California, but 21 percent of the pregnancy-related deaths.

(d) Forty-one percent of all pregnancy-related deaths had a good to strong chance of preventability. California has a responsibility to decrease the number of preventable pregnancy-related deaths.

(e) Pregnancy-related deaths among Black women are also more likely to be miscoded. Thirty-five percent of pregnancy-related deaths among Black women in California were miscoded, misidentifying pregnancy-related deaths as other deaths.

(f) Access to prenatal care, socioeconomic status, and general physical health do not fully explain the disparity seen in Black women’s maternal mortality and morbidity rates. There is a growing body of evidence that Black women are often treated unfairly and unequally in the health care system.

(g) Implicit bias is a key cause that drives health disparities in communities of color. At present, health care providers in California are not required to undergo any implicit bias testing or training. Nor does there exist any system to track the number of incidents where implicit prejudice and implicit stereotypes have led to negative birth and maternal health outcomes.

(h) It is the intent of the Legislature to reduce the effects of implicit bias in pregnancy, childbirth, and postnatal care so that all people are treated with dignity and respect by their health care providers.

(i) The Legislature recognizes all birthing people, including nonbinary persons and persons of transgender experience.

(j) All persons who may interact with perinatal patients to gatekeep, facilitate, or coordinate access to timely, responsive, respectful, and appropriate medical care may impact Black birthing persons’ maternal mortality and morbidity outcomes, including, but not limited to, hospital or facility employees who facilitate, control, or directly or indirectly coordinate access to timely and appropriate medical treatment as well as those who provide medical and ancillary treatment.

history: (History: Amended by Stats. 2024, Ch. 621, Sec. 1. (AB 2319) Effective January 1, 2025.)

article: 4.6. California Dignity in Pregnancy and Childbirth Act


text:
For the purposes of this article, the following terms have the following meanings:

(a) “Pregnancy-related death” is the death of a person while pregnant or within 365 days of the end of a pregnancy, irrespective of the duration or site of the pregnancy, from any cause related to, or aggravated by, the pregnancy or its management, but not from accidental or incidental causes.

(b) “Implicit bias” is a bias in judgment or behavior that results from subtle cognitive processes, including implicit prejudice and implicit stereotypes that often operate at a level below conscious awareness and without intentional control.

(c) “Implicit prejudice” is prejudicial negative feelings or beliefs about a group that a person holds without being aware of them.

(d) “Implicit stereotypes” are the unconscious attributions of particular qualities to a member of a certain social group. Implicit stereotypes are influenced by experience and are based on learned associations between various qualities and social categories, including race or gender.

(e) “Perinatal care” is the provision of care during pregnancy, labor, delivery, and postpartum and neonatal periods. “Perinatal care” includes, but is not limited to, prenatal care.

history: (History: Amended by Stats. 2024, Ch. 621, Sec. 2. (AB 2319) Effective January 1, 2025.)


text:
(a) A hospital as defined in subdivision (a) or (f) of Section 1250 that provides perinatal care, and an alternative birth center or primary care clinic subject to Section 1204.3, shall implement an evidence-based implicit bias program for all health care providers involved in the perinatal care of patients within those facilities, including:

(1) All persons licensed under Division 2 of the Business and Professions Code (commencing with Section 500) who are regularly assigned to provide perinatal care, including, but not limited to, those in primary care clinics, alternative birthing centers, outpatient clinics, or emergency departments.

(2) All persons who are regularly assigned to positions where they interact with perinatal patients, including, but not limited to, physician assistants, medical assistants, licensed vocational nurses, doctors, or those who facilitate, control, or coordinate access to timely and appropriate medical treatment, as well as any others who provide medical and ancillary treatment.

(b) An implicit bias program implemented pursuant to subdivision (a) shall include all of the following:

(1) Identification of previous or current unconscious biases and misinformation.

(2) Identification of personal, interpersonal, institutional, structural, and cultural barriers to inclusion.

(3) Corrective measures to decrease implicit bias at the interpersonal and institutional levels, including ongoing policies and practices for that purpose.

(4) Information on the effects, including, but not limited to, ongoing personal effects, of historical and contemporary exclusion and oppression of minority communities.

(5) Information about cultural identity across racial or ethnic groups.

(6) Information about communicating more effectively across identities, including racial, ethnic, religious, and gender identities.

(7) Discussion on power dynamics and organizational decisionmaking.

(8) Discussion on health inequities within the perinatal care field, including information on how implicit bias impacts maternal and infant health outcomes.

(9) Perspectives of diverse, local constituency groups and experts on particular racial, identity, cultural, and provider-community relations issues in the community.

(10) Information on reproductive justice.

(11) Recognition of intersecting identities, including, but not limited to, nonbinary persons and persons of transgender experience, and the multiple layers of potential biases that could come into play, resulting in harm to patients and their infants.

(c) (1) A health care provider described in subdivision (a) shall complete initial basic training through the implicit bias program based on the components described in subdivision (b). This initial basic training must be completed by June 1, 2025, for all current health care providers. The initial basic training must be provided to new health care providers at all facilities within six months of their start at the new facility unless subdivision (d) applies.

(2) Upon completion of the initial basic training, a health care provider shall complete a refresher course under the implicit bias program every two years thereafter, or on a more frequent basis if deemed necessary by the facility, in order to keep current with changing racial, identity, and cultural trends and best practices in decreasing interpersonal and institutional implicit bias.

(3) The training shall be provided during paid work time.

(d) A facility described in subdivision (a) shall provide a certificate of training completion to another facility or a training attendee upon request. A facility may accept a certificate of completion from another facility described in subdivision (a) to satisfy the training requirement described in subdivision (c) for a health care provider who works in more than one facility.

(e) Notwithstanding subdivisions (a) to (d), inclusive, if a physician involved in the perinatal care of patients is not directly employed by a facility, the facility shall offer the training to the physician.

(f) By February 1 of each year, commencing in 2026, a facility described in subdivision (a) shall provide the Attorney General with proof of compliance. Proof of compliance shall include all of the following:

(1) A list of all of the health care providers described in paragraph (1) of subdivision (a) who completed the training requirements outlined in subdivision (c).

(2) The dates that each health care provider completed their training.

(3) The written materials used in the training.

(4) A description of the training, including substance, format, and duration.

(5) A list that outlines the categories by job title of the health care providers described in paragraph (1) of subdivision (a) who did not participate in the training, if any. Each category shall include both of the following:

(A) A delineation of the respective health care provider or providers by employee status.

(B) The number and percentage of the health care providers who failed to complete the training out of the total relevant health care providers within the respective category.

(g) A facility described in subdivision (a) that violates the requirement to implement an implicit bias program pursuant to subdivision (a) of this section, or fails to submit proof of compliance to the Attorney General pursuant to subdivision (f) of this section shall be liable for a civil penalty of five thousand dollars ($5,000) for the first violation and fifteen thousand dollars ($15,000) for the second and each subsequent violation. In the event a facility’s proof of compliance submitted to the Attorney General reveals systemic failure of providers to complete the training requirements outlined in subdivision (c), the facility shall be liable for a civil penalty of five thousand dollars ($5,000) for the first violation, and fifteen thousand dollars ($15,000) for the second and each subsequent violation. Civil penalties specified in this subdivision shall be assessed and recovered in a civil action brought in the name of the people of the State of California by the Attorney General in any court of competent jurisdiction. The Attorney General shall be awarded all attorney’s fees and costs in any civil action in which a court imposes any of the penalties described in this section. The penalties provided by this subdivision are not exclusive and do not limit other remedies available in law for such violations.

(h) (1) For purposes of subdivision (g), “systemic failure” means the lesser of the following:

(A) Ten percent or more of providers failing to complete the training, provided that if only one or two providers did not receive the training, the facility was provided a reasonable opportunity to cure before a penalty is pursued.

(B) Twenty-five providers failing to complete the required training.

(2) For purposes of the definition of “systemic failure,” failure by a physician who is not directly employed by the facility shall not be counted toward the percentage of providers failing to complete the required training where the facility demonstrates that the required training was offered to the physician, pursuant to subdivision (e).

(i) The Attorney General may post on their website a list of all facilities that did not timely submit proof of compliance pursuant to subdivision (f) or that were assessed penalties pursuant to subdivision (g). The Attorney General may include all of the following information when listing the facilities that were assessed penalties:

(1) The date the penalty was issued.

(2) The amount of the penalty.

(3) The reason the penalty was issued.

(4) The percentage of untrained providers.

(5) The date of facility noncompliance.

(j) The Attorney General may post on their internet website any other compliance data related to this article they deem appropriate.

(k) This section shall not be construed to limit the Attorney General from disclosing, on their internet website or otherwise, any information that they are otherwise not restricted from disclosing by any other provision of law.

history: (History: Amended by Stats. 2024, Ch. 621, Sec. 3. (AB 2319) Effective January 1, 2025.)


text:
(a) The State Department of Public Health shall track data on severe maternal morbidity, including, but not limited to, all of the following health conditions:

(1) Obstetric hemorrhage.

(2) Hypertension.

(3) Preeclampsia and eclampsia.

(4) Venous thromboembolism.

(5) Sepsis.

(6) Cerebrovascular accident.

(7) Amniotic fluid embolism.

(b) The data on severe maternal morbidity collected pursuant to subdivision (a) shall be published at least once every three years, after all of the following have occurred:

(1) The data has been aggregated by state regions, as defined by the State Department of Public Health, to ensure data reflects how regionalized care systems are or should be collaborating to improve maternal health outcomes, or other smaller regional sorting based on standard statistical methods for accurate dissemination of public health data without risking a confidentiality or other disclosure breach.

(2) The data has been disaggregated by racial and ethnic identity.

(c) The State Department of Public Health shall track data on pregnancy-related deaths, including, but not limited to, all of the conditions listed in subdivision (a), indirect obstetric deaths, and other maternal disorders predominantly related to pregnancy and complications predominantly related to the puerperium.

(d) The data on pregnancy-related deaths collected pursuant to subdivisions (a) and (c) shall be published, at least once every three years, after all of the following have occurred:

(1) The data has been aggregated by state regions, as defined by the State Department of Public Health, to ensure data reflects how regionalized care systems are or should be collaborating to improve maternal health outcomes, or other smaller regional sorting based on standard statistical methods for accurate dissemination of public health data without risking a confidentiality or other disclosure breach.

(2) The data has been disaggregated by racial and ethnic identity.


text:
(a) A hospital, as defined in subdivision (a) of Section 1250, shall implement an evidence-based implicit bias program, as described in subdivision (b) of Section 123630.3, as part of its new graduate training program that hires and trains new nursing program graduates.

(b) If the hospital hires and trains new nursing program graduates who are subject to subdivision (c) of Section 123630.3, compliance by the hospital with Section 123630.3 shall meet the requirements of subdivision (a) only with respect to those new nursing program graduates subject to subdivision (c) of Section 123630.3.

history: (History: Added by Stats. 2021, Ch. 445, Sec. 3. (AB 1407) Effective January 1, 2022.)


text: The Attorney General may publish a report outlining compliance data related to this article on a biennial basis. The report may be posted on the Attorney General’s internet website.

history: (History: Added by Stats. 2024, Ch. 621, Sec. 4. (AB 2319) Effective January 1, 2025.)


text: If any provision of the California Dignity in Pregnancy and Childbirth Act, or the application of any such provision to any person or circumstances, shall be held invalid, the remainder of the California Dignity in Pregnancy and Childbirth Act, to the extent it can be given effect, or the application of such provision to persons or circumstances other than those as to which it is held invalid, shall not be affected thereby, and to this end the provisions of the California Dignity in Pregnancy and Childbirth Act are severable.

history: (History: Added by Stats. 2024, Ch. 621, Sec. 5. (AB 2319) Effective January 1, 2025.)


text:
For the purposes of this section, the following terms apply:

(a) “Maternal mortality” or “maternal death” means the death of a person during pregnancy or within a year from the end of pregnancy, and related to, or aggravated by, the pregnancy or birth, including, but not limited to, death by suicide.

(b) “Pregnancy-associated death” means a death of a person while pregnant or within one year of the end of a pregnancy, regardless of the cause.

(c) “Pregnancy-related death” means a death that occurs while pregnant or up to a year postpartum from any cause related to, or aggravated by, the pregnancy or its management, irrespective of the duration of the pregnancy.

(d) “Severe maternal morbidity” means unexpected outcomes of pregnancy, labor, or delivery that result in significant short- or long-term consequences to the pregnant person’s mental or physical health.

history: (History: Added by Stats. 2021, Ch. 449, Sec. 3. (SB 65) Effective January 1, 2022. Operative August 1, 2022, pursuant to Section 123637.)

path: 106. PERSONAL HEALTH CARE (INCLUDING MATERNAL, CHILD, AND ADOLESCENT) > 2. MATERNAL, CHILD, AND ADOLESCENT HEALTH > 2. Maternal Health > 4.7. California Pregnancy-Associated Review Committee


text:
(a) The California Pregnancy-Associated Review Committee is hereby established under the State Department of Public Health to continuously engage in the comprehensive, regular, and uniform review and reporting of maternal deaths throughout the state. The department, in collaboration with the designated state perinatal quality collaborative, shall oversee the committee. The committee may incorporate the membership of the California Pregnancy-Associated Mortality Review Committee, as it existed on December 31, 2021.

(b) The purposes of the committee include, but are not limited to, all of the following:

(1) Identifying and reviewing all pregnancy-related deaths, including the cause, contributing factors, and disseminating findings.

(2) Analyzing common indicators of severe maternal morbidity to identify prevention opportunities and reduce near-miss experiences.

(3) Making recommendations on best practices to prevent maternal mortality and morbidity, including, but not limited to, addressing socioeconomic impacts, as well as various environmental impacts, including global warming, on pregnancy outcomes.

(4) Examining racial disparities and making recommendations on the prevention of racial disparities.

(5) Tracking and examining disparities experienced by lesbian, bisexual, transgender, intersex, and gender-nonconforming individuals and reporting findings, to the extent possible.

(6) Collecting and reviewing data from maternal death investigations and making recommendations about how to improve or streamline data collection and investigatory processes.

(c) (1) In addition to reviewing medical records, death certificates, and other pertinent reports, committee review of maternal deaths shall include, to the degree practicable, for populations experiencing disparity, voluntary interview with the following individuals:

(A) Pertinent surviving family members or support people present with direct knowledge of, or involvement in, the event, including the patient in cases of severe maternal morbidity. The committee shall transcribe or summarize in writing any oral statements received pursuant to this paragraph.

(B) Members of the medical team who were present or involved in the deceased individual’s direct care.

(2) In determining the practicality of the interviews pursuant to subparagraphs (A) and (B), the committee may prioritize interviews with populations that have a documented higher rate of maternal death.

(d) The committee shall publish its findings to the public every three years as part of the publication of data on severe maternal morbidity, as required pursuant to Section 123630.4. The committee’s findings shall also include recommendations on how to prevent severe maternal morbidity and maternal mortality and how to reduce racial disparities.

(e) (1) The committee shall be composed of a minimum of 13 members. The members shall be comprised of multidisciplinary personnel and experts in the field of maternal mortality and morbidity, data analysis in maternal and fetal health, women’s health, clinicians in maternal health, anesthesiology, pathology, and perinatology, and representatives from various public health entities, and shall include all of the following:

(A) At least one obstetrician.

(B) At least one certified nurse-midwife.

(C) At least one certified professional midwife.

(D) At least one hospital-based registered nurse or advanced practice nurse experienced in perinatal health.

(E) A clinician or patient advocate from a birthing center, if not already represented by a member otherwise listed.

(F) At least one public member with relevant personal experience related to maternal morbidity or maternal mortality who has experienced birth and does not fit in another classification.

(G) At least one doula.

(H) At least one person from a community-based organization that works in perinatal health.

(I) At least one person from an organization that works with populations that have disproportionately high occurrences of maternal mortality and morbidity.

(J) At least one person who is an expert on mental and behavioral health, preferably with experience in perinatal health.

(K) At least one person from a native tribe, preferably with experience in perinatal health.

(L) At least one representative of the Maternal, Child, and Adolescent Health Division of the department.

(M) At least one family physician.

(N) At least one emergency room physician familiar with perinatal health.

(2) The committee shall prioritize for membership members who are representative of the diversity and geographic locations of the pregnant people in populations with disproportionately high occurrences of maternal mortality and morbidity.

(3) The State Public Health Officer shall appoint a maternal mortality expert to be a member of the committee as the chair of the committee. The chair shall appoint the other members of the committee in accordance with the criteria specified in paragraph (1).

(4) The committee may create subcommittees, as needed, to carry out its duties.

(f) The committee may request from any state department, division, commission, local health department, or other agency of the state or political subdivision thereof, or any public authority, as well as hospitals, birthing facilities, medical examiners, coroners, coroner physicians, and any other facility or individual providing services associated with maternal mortality, and those individuals and entities shall provide information, including, but not limited to, death records, medical records, autopsy reports, toxicology reports, hospital discharge records, birth records, and any other information that will help the committee to properly carry out its functions, powers, and duties. The committee shall not request, and health care providers shall not provide, reports, testimony, or other information produced as a result of activities undertaken by organized committees of a hospital medical staff or peer review body, as defined in Section 805 of the Business and Professions Code, that has the responsibility to evaluate or improve the quality of care rendered in a hospital.

(g) Except as otherwise provided by this article, all proceedings and activities of the committee, all opinions of the members of the committee that are formed as a result of the committee’s proceedings and activities, and all records obtained, created, or maintained by the committee, including written reports and records of interviews or oral statements, shall be confidential, and in accordance with Sections 1157 and 1157.5 of the Evidence Code, shall not be subject to public inspection, discovery, subpoena, or introduction into evidence in any civil, criminal, legislative, administrative, or other proceeding.

(h) In no case shall the committee disclose any personally identifiable information to the public, or include any personally identifiable information in a case summary that is prepared pursuant to this article, or in any report that is prepared.

(i) To the extent prescribed by Sections 1157 and 1157.5 of the Evidence Code, members of the committee shall not be questioned in any civil, criminal, legislative, administrative, or other proceeding regarding information that has been presented in, or opinions that have been formed as a result of, a meeting or communication of the committee. However, nothing in this paragraph shall prohibit a committee member from being questioned, or from testifying, in relation to publicly available information or information that was obtained independently of the member’s participation on the committee, or as an expert witness in maternal death cases unrelated to their case review as a member of the committee.

(j) This section does not prohibit the committee from publishing, or from otherwise making available for public inspection, statistical compilations or reports that are based on confidential information, provided that those compilations and reports do not contain personally identifying information or other information that could be used to ultimately identify the individuals concerned, and shall utilize standard public health reporting practices for accurate dissemination of these data elements, especially with regard to the reporting of small numbers so as to inadvertently risk a breach of confidentiality or other disclosure.

(k) A health care provider, health care facility, or pharmacy providing access to medical records pursuant to this section shall not be held liable for civil damages or be subject to any criminal or disciplinary action for good faith efforts in providing the records.

article: 4.7. California Pregnancy-Associated Review Committee


text: This article is operative on August 1, 2022.

history: (History: Added by Stats. 2021, Ch. 449, Sec. 3. (SB 65) Effective January 1, 2022.)


text:
(a) A licensed health care practitioner who provides prenatal, postpartum, or interpregnancy care for a patient shall ensure that the mother is offered screening or is appropriately screened for maternal mental health conditions.

(b) This section shall not apply to a licensed health care practitioner when providing emergency services or care, as defined in Section 1317.1.

(c) This section does not preclude any licensed or certified provider acting within their scope of practice from screening for maternal mental health conditions.

(d) For purposes of this section, the following definitions apply:

(1) “Health care practitioner” means a physician and surgeon, naturopathic doctor, nurse practitioner, physician assistant, nurse midwife, or a midwife licensed pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code or an initiative act referred to in that division and who is acting within their scope of practice.

(2) “Maternal mental health condition” means a mental health condition that occurs during pregnancy, the postpartum period, or interpregnancy and includes, but is not limited to, postpartum depression.

history: (History: Amended by Stats. 2021, Ch. 535, Sec. 1. (AB 1477) Effective January 1, 2022.)

article: 6. Maternal Mental Health

path: 106. PERSONAL HEALTH CARE (INCLUDING MATERNAL, CHILD, AND ADOLESCENT) > 2. MATERNAL, CHILD, AND ADOLESCENT HEALTH > 2. Maternal Health > 6. Maternal Mental Health


text:
(a) (1) Of the amounts appropriated in Schedule (3) of Item 4260-101-0001 of the Budget Act of 2022 for this purpose, twenty million dollars ($20,000,000) is available for encumbrance and expenditure until June 30, 2028, to establish the Los Angeles County Abortion Access Safe Haven Pilot Program for the purpose of expanding and improving access to the full spectrum of sexual and reproductive health care, including abortion, in the County of Los Angeles.

(2) Up to 8 percent of funds allocated may be used by a program administrator, as designated by the County of Los Angeles, to cover administrative costs related to completing activities consistent with this section.

(b) Funds allocated to the County of Los Angeles or its program administrator for the Los Angeles County Abortion Access Safe Haven Pilot Program shall be used to administer a pilot project to support innovative approaches and patient-centered collaborations to safeguard patient access to abortions. Funds may be used for the purpose of implementing recommendations from the County of Los Angeles, including, but not limited to, any of the following:

(1) Providing medically accurate education and training tools to the community.

(2) Providing training to health care workers and abortion providers.

(3) Building secure infrastructure.

(4) Countering misinformation campaigns and providing medically accurate information to health care providers and patients.

(5) Coordinating care and patient support services.

(6) Advancing and improving access to abortion.

(c) (1) The Los Angeles County Abortion Access Safe Haven Pilot program administrator shall use funds allocated under this section to maintain a system of financial reporting on all aspects of the fund. The financial reporting shall include information on expenditures and activities using the funds associated with this provision to ensure the use of the funds are consistent with the purposes of this section.

(2) For purposes of this section, the program administrator shall not require the submission of any identifying personal information about individuals providing, participating in, or receiving any service as part of an application for a grant or reporting of expenditures and activities using grant funds under this article. Information required by the program administrator shall only include information in summary, statistical, or other forms that do not identify particular individuals.

(d) The program administrator, as designated by the County of Los Angeles, shall determine a funding framework to prioritize funding for pilot programs and projects in consultation with stakeholders, including representatives from the local departments of public health, the Los Angeles County Chief Executive Office, sexual and reproductive health providers that serve the region, and reproductive health, rights, and justice community-based organizations.

(e) The program administrator shall provide an annual report to the Legislature summarizing the projects and collaborations funded under this section. The report shall also include data on the balances of funds available under this division for expenditures in that fiscal year and future fiscal years. The first annual report shall be submitted on or before January 1, 2025, and shall cover the period of July 1, 2023, to July 1, 2024, inclusive. Each subsequent annual report shall be submitted on or before January 1, and shall cover the previous fiscal year. The report shall be submitted in compliance with Section 9795 of the Government Code.

(f) An application for a grant under this article and financial reporting by grantees are exempt from disclosure under the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code).

(g) The State Department of Health Care Services may enter into exclusive or nonexclusive contracts, or amend existing contracts, on a bid or negotiated basis for purposes of implementing this section. Contracts entered into or amended pursuant to this section are exempt from Chapter 6 (commencing with Section 14825) of Part 5.5 of Division 3 of Title 2 of the Government Code, Section 19130 of the Government Code, Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code, and the State Administrative Manual, and are exempt from the review or approval of any division of the Department of General Services.

history: (History: Added by Stats. 2022, Ch. 567, Sec. 2. (SB 1245) Effective January 1, 2023.)

path: 106. PERSONAL HEALTH CARE (INCLUDING MATERNAL, CHILD, AND ADOLESCENT) > 2. MATERNAL, CHILD, AND ADOLESCENT HEALTH > 2. Maternal Health > 7. Los Angeles County Abortion Access Safe Haven Pilot Program


text:
(a) (1) Commencing January 1, 2026, until January 1, 2029, San Diego County may establish a pilot program for pelvic floor and core conditioning group classes.

(2) The classes shall be a combination of yoga and pilates exercises that strengthen the pelvic floor muscles. The classes shall be provided to people twice a week between their 6-to-12-week postpartum window to help people rebuild their pelvic floor after pregnancy.

(b) The program shall require all postpartum providers who teach the classes to be certified.

(c) The program shall record the following information to directly assess pelvic floor changes, including, but not limited to, both of the following:

(1) The number of incontinent episodes per week before and after the exercises.

(2) Any changes with varied increases or decreases in intraabdominal pressure, including leaking with a jump, cough, or sneeze.

history: (History: Added by Stats. 2024, Ch. 202, Sec. 1. (AB 2756) Effective January 1, 2025.)

path: 106. PERSONAL HEALTH CARE (INCLUDING MATERNAL, CHILD, AND ADOLESCENT) > 2. MATERNAL, CHILD, AND ADOLESCENT HEALTH > 2. Maternal Health > 8. San Diego County Pelvic Floor and Core Conditioning Pilot Program


text:
(a) The department shall develop a plan to identify causes of infant mortality and morbidity in California and to study recommendations on the reduction of infant mortality and morbidity in California.

(b) The study plan shall be completed on or before July 1, 1988, and shall be developed in conjunction with, and reviewed by, each of the following organizations:

(1) The California Medical Association.

(2) The California Nurses Association.

(3) The California Hospital Association.

(4) The American College of Obstetrics and Gynecologists.

(5) The American College of Nurse Midwives.

(6) The California Academy of Family Physicians.

(7) The American Academy of Pediatrics.

(8) The California Association of Freestanding Birth Centers.

(9) The American Public Health Association.

(10) The Medical Board of California.

(11) The Board of Registered Nurses.

(12) The Department of Consumer Affairs.

(13) The office.

(14) The California Association of Midwives.

history: (History: Added by Stats. 1995, Ch. 415, Sec. 8. Effective January 1, 1996.)

chapter: 3. Child Health

path: 106. PERSONAL HEALTH CARE (INCLUDING MATERNAL, CHILD, AND ADOLESCENT) > 2. MATERNAL, CHILD, AND ADOLESCENT HEALTH > 3. Child Health > 1. Infant Mortality and Morbidity Prevention


text:
The study plan shall incorporate in its design the findings of MCH Title V Research Contract DHS 8689088, the “Maternal Neonatal and Fetal Mortality Study.”

The department shall issue a report to the Legislature on or before July 1, 1989, concerning causal factors in infant mortality and morbidity.

article: 1. Infant Mortality and Morbidity Prevention