Creation of a PA Maternal Health Collaborative

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* 1. Name

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* 2. Title

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* 3. Organization(s) or Group(s) You are Representing

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* 4. Email Address

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* 5. What part of Pennsylvania does your group represent or serve?

Northwest PA

Southwest PA

Lehigh/Capital PA

Northeastern PA

Southeastern PA

Statewide

If it is at the county or neighborhood-level, please indicate that here.

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* 6. Please briefly describe your maternal and perinatal health group, including its current work.

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* 7. What is your group's 1st recommended priority to improve maternal health and reduce racial/ethnic disparities in PA? Please describe why this is important and how you think it should be achieved within a year's time.

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* 8. What is your group's 2nd recommended priority to improve maternal health and reduce racial/ethnic disparities in PA? Please describe why this is important and how you think it should be achieved within a year's time.

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* 9. What is your group's 3rd recommended priority to improve maternal health and reduce racial/ethnic disparities in PA? Please describe why this is important and how you think it should be achieved within a year's time.

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* 10. What name would you suggest for this statewide Collaborative? Please feel free to suggest more than one name!