MOM­MA’s Act

II 117TH CONGRESS 1ST SESSION S. 411 To improve Federal efforts with respect to the prevention of maternal mortality, and for other purposes. IN THE SENATE OF THE UNITED STATES FEBRUARY 24, 2021 Mr. DURBIN (for himself, Ms. DUCKWORTH, Mrs. SHAHEEN, Mr. BROWN, Ms. STABENOW, Mr. BLUMENTHAL, Ms. KLOBUCHAR, Ms. SMITH, Mr. VAN HOLLEN, and Mr. SANDERS) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To improve Federal efforts with respect to the prevention of maternal mortality, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Mothers and Offspring 4 Mortality and Morbidity Awareness Act’’ or the ‘‘MOM- 5 MA’s Act’’. 6 SEC. 2. FINDINGS. 7 Congress finds the following: 8 VerDate Sep 11 2014 00:50 Mar 17, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S411.IS S411 pbinns on DSKJLVW7X2PROD with BILLS 2 •S 411 IS (1) Every year, across the United States, nearly 1 4,000,000 women give birth, about 700 women suf- 2 fer fatal complications during pregnancy, while giv- 3 ing birth or during the postpartum period, and 4 about 70,000 women suffer near-fatal, partum-re- 5 lated complications. 6 (2) The maternal mortality rate is often used as 7 a proxy to measure the overall health of a popu- 8 lation. While the infant mortality rate in the United 9 States has reached its lowest point, the risk of death 10 for women in the United States during pregnancy, 11 childbirth, or the postpartum period is higher than 12 such risk in many other high-income countries. The 13 estimated maternal mortality rate (deaths per 14 100,000 live births) for the 48 contiguous States 15 and Washington, DC, increased from 14.5 percent in 16 2000 to 17.3 in 2017. The United States is the only 17 industrialized nation with a rising maternal mor- 18 tality rate. 19 (3) The National Vital Statistics System of the 20 Centers for Disease Control and Prevention has 21 found that in 2018, there were 17.4 maternal deaths 22 for every 100,000 live births in the United States. 23 This ratio is more than double that of most other 24 high-income countries. 25 VerDate Sep 11 2014 00:50 Mar 17, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S411.IS S411 pbinns on DSKJLVW7X2PROD with BILLS 3 •S 411 IS (4) It is estimated that more than 60 percent 1 of maternal deaths in the United States are prevent- 2 able. 3 (5) According to the Centers for Disease Con- 4 trol and Prevention, the maternal mortality rate var- 5 ies drastically for women by race and ethnicity. 6 There are about 13 deaths per 100,000 live births 7 for White women, 40.8 deaths per 100,000 live 8 births for non-Hispanic Black women, and 29.7 9 deaths per 100,000 live births for American Indian/ 10 Alaskan Native women. While maternal mortality 11 disparately impacts Black women, this urgent public 12 health crisis traverses race, ethnicity, socioeconomic 13 status, educational background, and geography. 14 (6) In the United States, non-Hispanic Black 15 women are about 3 times more likely to die from 16 causes related to pregnancy and childbirth compared 17 to non-Hispanic White women, which is one of the 18 most disconcerting racial disparities in public health. 19 This disparity widens in certain cities and States 20 across the country. 21 (7) According to the National Center for Health 22 Statistics of the Centers for Disease Control and 23 Prevention, the maternal mortality rate heightens 24 with age, as women 40 and older die at a rate of 25 VerDate Sep 11 2014 00:50 Mar 17, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S411.IS S411 pbinns on DSKJLVW7X2PROD with BILLS 4 •S 411 IS 81.9 per 100,000 births compared to 10.6 per 1 100,000 for women under 25. This translates to 2 women over 40 being 7.7 times more likely to die 3 compared to their counterparts under 25 years of 4 age. 5 (8) The COVID–19 pandemic risks exacer- 6 bating the maternal health crisis. A recent study of 7 the Centers for Disease Control and Prevention sug- 8 gests that pregnant women are at a significantly 9 higher risk for severe outcomes, including death, 10 from COVID–19 as compared to non-pregnant 11 women. The COVID–19 pandemic has also de- 12 creased access to prenatal and postpartum care. 13 (9) The findings described in paragraphs (1) 14 through (8) are of major concern to researchers, 15 academics, members of the business community, and 16 providers across the obstetric continuum represented 17 by organizations such as— 18 (A) the American College of Nurse-Mid- 19 wives; 20 (B) the American College of Obstetricians 21 and Gynecologists; 22 (C) the American Medical Association; 23 (D) the Association of Women’s Health, 24 Obstetric and Neonatal Nurses; 25 VerDate Sep 11 2014 00:50 Mar 17, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S411.IS S411 pbinns on DSKJLVW7X2PROD with BILLS 5 •S 411 IS (E) the Black Mamas Matter Alliance; 1 (F) the Black Women’s Health Imperative; 2 (G) the California Maternal Quality Care 3 Collaborative; 4 (H) EverThrive Illinois; 5 (I) the Illinois Perinatal Quality Collabo- 6 rative; 7 (J) the March of Dimes; 8 (K) the National Association of Certified 9 Professional Midwives; 10 (L) the National Birth Equity Collabo- 11 rative; 12 (M) the National Partnership for Women 13 & Families; 14 (N) the National Polycystic Ovary Syn- 15 drome Association; 16 (O) the Preeclampsia Foundation; 17 (P) the Society for Maternal-Fetal Medi- 18 cine; and 19 (Q) the What To Expect Project. 20 (10) Hemorrhage, cardiovascular and coronary 21 conditions, cardiomyopathy, infection or sepsis, em- 22 bolism, mental health conditions (including sub- 23 stance use disorder), hypertensive disorders, stroke 24 and cerebrovascular accidents, and anesthesia com- 25 VerDate Sep 11 2014 00:50 Mar 17, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S411.IS S411 pbinns on DSKJLVW7X2PROD with BILLS 6 •S 411 IS plications are the predominant medical causes of 1 maternal-related deaths and complications. Most of 2 these conditions are largely preventable or manage- 3 able. Even when these conditions are not prevent- 4 able, mortality and morbidity may be prevented 5 when conditions are diagnosed and treated in a 6 timely manner. 7 (11) According to a study published by the 8 Journal of Perinatal Education, doula-assisted 9 mothers are 4 times less likely to have a low-birth- 10 weight baby, 2 times less likely to experience a birth 11 complication involving themselves or their baby, and 12 significantly more likely to initiate breastfeeding. 13 Doula care has also been shown to produce cost sav- 14 ings resulting in part from reduced rates of cesarean 15 and pre-term births. 16 (12) Intimate partner violence is one of the 17 leading causes of maternal death, and women are 18 more likely to experience intimate partner violence 19 during pregnancy than at any other time in their 20 lives. It is also more dangerous than pregnancy. In- 21 timate partner violence during pregnancy and 22 postpartum crosses every demographic and has been 23 exacerbated by the COVID–19 pandemic. 24 VerDate Sep 11 2014 00:50 Mar 17, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S411.IS S411 pbinns on DSKJLVW7X2PROD with BILLS 7 •S 411 IS (13) Oral health is an important part of 1 perinatal health. Reducing bacteria in a woman’s 2 mouth during pregnancy can significantly reduce her 3 risk of developing oral diseases and spreading decay- 4 causing bacteria to her baby. Moreover, some evi- 5 dence suggests that women with periodontal disease 6 during pregnancy could be at greater risk for poor 7 birth outcomes, such as preeclampsia, pre-term 8 birth, and low-birth weight. Furthermore, a woman’s 9 oral health during pregnancy is a good predictor of 10 her newborn’s oral health, and since mothers can 11 unintentionally spread oral bacteria to their babies, 12 putting their children at higher risk for tooth decay, 13 prevention efforts should happen even before chil- 14 dren are born, as a matter of pre-pregnancy health 15 and prenatal care during pregnancy. 16 (14) In the United States, death reporting and 17 analysis is a State function rather than a Federal 18 process. States report all deaths—including mater- 19 nal deaths—on a semi-voluntary basis, without 20 standardization across States. While the Centers for 21 Disease Control and Prevention has the capacity and 22 system for collecting death-related data based on 23 death certificates, these data are not sufficiently re- 24 ported by States in an organized and standard for- 25 VerDate Sep 11 2014 00:50 Mar 17, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S411.IS S411 pbinns on DSKJLVW7X2PROD with BILLS 8 •S 411 IS mat across States such that the Centers for Disease 1 Control and Prevention is able to identify causes of 2 maternal death and best practices for the prevention 3 of such death. 4 (15) Vital statistics systems often underesti- 5 mate maternal mortality and are insufficient data 6 sources from which to derive a full scope of medical 7 and social determinant factors contributing to ma- 8 ternal deaths, such as intimate partner violence. 9 While the addition of pregnancy checkboxes on death 10 certificates since 2003 have likely improved States’ 11 abilities to identify pregnancy-related deaths, they 12 are not generally completed by obstetric providers or 13 persons trained to recognize pregnancy-related mor- 14 tality. Thus, these vital forms may be missing infor- 15 mation or may capture inconsistent data. Due to 16 varying maternal mortality-related analyses, lack of 17 reliability, and granularity in data, current maternal 18 mortality informatics do not fully encapsulate the 19 myriad medical and socially determinant factors that 20 contribute to such high maternal mortality rates 21 within the United States compared to other devel- 22 oped nations. Lack of standardization of data and 23 data sharing across States and between Federal en- 24 tities, health networks, and research institutions 25 VerDate Sep 11 2014 00:50 Mar 17, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S411.IS S411 pbinns on DSKJLVW7X2PROD with BILLS 9 •S 411 IS keep the Nation in the dark about ways to prevent 1 maternal deaths. 2 (16) Having reliable and valid State data ag- 3 gregated at the Federal level are critical to the Na- 4 tion’s ability to quell surges in maternal death and 5 imperative for researchers to identify long-lasting 6 interventions. 7 (17) Leaders in maternal wellness highly rec- 8 ommend that maternal deaths and cases of maternal 9 morbidity, including complications that result in 10 chronic illness and future increased risk of death, be 11 investigated at the State level first, and that stand- 12 ardized, streamlined, de-identified data regarding 13 maternal deaths be sent annually to the Centers for 14 Disease Control and Prevention. Such data stand- 15 ardization and collection would be similar in oper- 16 ation and effect to the National Program of Cancer 17 Registries of the Centers for Disease Control and 18 Prevention and akin to the Confidential Enquiry in 19 Maternal Deaths Programme in the United King- 20 dom. Such a maternal mortalities and morbidities 21 registry and surveillance system would help pro- 22 viders, academicians, lawmakers, and the public to 23 address questions concerning the types of, causes of, 24 VerDate Sep 11 2014 00:50 Mar 17, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S411.IS S411 pbinns on DSKJLVW7X2PROD with BILLS 10 •S 411 IS and best practices to thwart, maternal mortality and 1 morbidity. 2 (18) The United Nations’ Millennium Develop- 3 ment Goal 5a aimed to reduce by 75 percent, be- 4 tween 1990 and 2015, the maternal mortality rate, 5 yet this metric has not been achieved. In fact, the 6 maternal mortality rate in the United States has 7 been estimated to have more than doubled between 8 2000 and 2014. 9 (19) Many States have struggled to establish or 10 maintain Maternal Mortality Review Committees 11 (referred to in this section as ‘‘MMRC’’). On the 12 State level, MMRCs have lagged because States have 13 not had the resources to mount local reviews. State- 14 level reviews are necessary as only the State depart- 15 ments of health have the authority to request med- 16 ical records, autopsy reports, and police reports crit- 17 ical to the function of the MMRC. 18 (20) The United States has no comparable, co- 19 ordinated Federal process by which to review cases 20 of maternal mortality, systems failures, or best prac- 21 tices. Many States have active MMRCs and leverage 22 their work to impact maternal wellness. For exam- 23 ple, the State of California has worked extensively 24 with their State health departments, health and hos- 25 VerDate Sep 11 2014 00:50 Mar 17, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S411.IS S411 pbinns on DSKJLVW7X2PROD with BILLS 11 •S 411 IS pital systems, and research collaborative organiza- 1 tions, including the California Maternal Quality Care 2 Collaborative and the Alliance for Innovation on Ma- 3 ternal Health, to establish MMRCs, wherein such 4 State has determined the most prevalent causes of 5 maternal mortality and recorded and shared data 6 with providers and researchers, who have developed 7 and implemented safety bundles and care protocols 8 related to preeclampsia, maternal hemorrhage, 9 peripartum cardiomyopathy, and the like. In this 10 way, the State of California has been able to lever- 11 age its maternal mortality review board system, gen- 12 erate data, and apply those data to effect changes 13 in maternal care-related protocol. To date, the State 14 of California has reduced its maternal mortality 15 rate, which is now comparable to the low rates of the 16 United Kingdom. 17 (21) Hospitals and health systems across the 18 United States lack standardization of emergency ob- 19 stetric protocols before, during, and after delivery. 20 Consequently, many providers are delayed in recog- 21 nizing critical signs indicating maternal distress that 22 quickly escalate into fatal or near-fatal incidences. 23 Moreover, any attempt to address an obstetric emer- 24 gency that does not consider both clinical and public 25 VerDate Sep 11 2014 00:50 Mar 17, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S411.IS S411 pbinns on DSKJLVW7X2PROD with BILLS 12 •S 411 IS health approaches falls woefully under the mark of 1 excellent care delivery. State-based perinatal quality 2 collaboratives, or entities pa [Text truncated for display. Full text available on Congress.gov.]