MOM­MA’s Act

I 117TH CONGRESS 1ST SESSION H. R. 3407 To improve Federal efforts with respect to the prevention of maternal mortality, and for other purposes. IN THE HOUSE OF REPRESENTATIVES MAY 20, 2021 Ms. KELLY of Illinois (for herself, Mrs. BEATTY, Ms. MOORE of Wisconsin, Ms. DEGETTE, Mr. BLUMENAUER, Mr. SCHNEIDER, Mrs. LAWRENCE, Ms. CASTOR of Florida, Ms. DELBENE, Ms. SEWELL, Mr. DEFAZIO, Ms. DEAN, Mr. SWALWELL, Mr. MEEKS, Mr. BUTTERFIELD, Mr. CARSON, Mr. PAYNE, Ms. KUSTER, Ms. CLARKE of New York, Mr. GRIJALVA, Ms. BARRAGA´N, Ms. MENG, Mr. LOWENTHAL, Ms. LEE of California, Ms. WILSON of Florida, and Ms. BLUNT ROCHESTER) introduced the fol- lowing bill; which was referred to the Committee on Energy and Com- merce, and in addition to the Committees on Ways and Means, and Edu- cation and Labor, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 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 VerDate Sep 11 2014 00:02 Jun 03, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3407.IH H3407 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 3407 IH SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Mothers and Offspring 2 Mortality and Morbidity Awareness Act’’ or the ‘‘MOM- 3 MA’s Act’’. 4 SEC. 2. FINDINGS. 5 Congress finds the following: 6 (1) Every year, across the United States, nearly 7 4,000,000 women give birth, about 700 women suf- 8 fer fatal complications during pregnancy, while giv- 9 ing birth or during the postpartum period, and 10 about 70,000 women suffer near-fatal, partum-re- 11 lated complications. 12 (2) The maternal mortality rate is often used as 13 a proxy to measure the overall health of a popu- 14 lation. While the infant mortality rate in the United 15 States has reached its lowest point, the risk of death 16 for women in the United States during pregnancy, 17 childbirth, or the postpartum period is higher than 18 such risk in many other high-income countries. The 19 estimated maternal mortality rate (deaths per 20 100,000 live births) for the 48 contiguous States 21 and Washington, DC, increased from 14.5 percent in 22 2000 to 17.3 in 2017. The United States is the only 23 industrialized nation with a rising maternal mor- 24 tality rate. 25 VerDate Sep 11 2014 00:02 Jun 03, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3407.IH H3407 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 3407 IH (3) The National Vital Statistics System of the 1 Centers for Disease Control and Prevention has 2 found that in 2018, there were 17.4 maternal deaths 3 for every 100,000 live births in the United States. 4 This ratio is more than double that of most other 5 high-income countries. 6 (4) It is estimated that more than 60 percent 7 of maternal deaths in the United States are prevent- 8 able. 9 (5) According to the Centers for Disease Con- 10 trol and Prevention, the maternal mortality rate var- 11 ies drastically for women by race and ethnicity. 12 There are about 13 deaths per 100,000 live births 13 for White women, 40.8 deaths per 100,000 live 14 births for non-Hispanic Black women, and 29.7 15 deaths per 100,000 live births for American Indian/ 16 Alaskan Native women. While maternal mortality 17 disparately impacts Black women, this urgent public 18 health crisis traverses race, ethnicity, socioeconomic 19 status, educational background, and geography. 20 (6) In the United States, non-Hispanic Black 21 women are about 3 times more likely to die from 22 causes related to pregnancy and childbirth compared 23 to non-Hispanic White women, which is one of the 24 most disconcerting racial disparities in public health. 25 VerDate Sep 11 2014 00:02 Jun 03, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3407.IH H3407 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 3407 IH This disparity widens in certain cities and States 1 across the country. 2 (7) According to the National Center for Health 3 Statistics of the Centers for Disease Control and 4 Prevention, the maternal mortality rate heightens 5 with age, as women 40 and older die at a rate of 6 81.9 per 100,000 births compared to 10.6 per 7 100,000 for women under 25. This translates to 8 women over 40 being 7.7 times more likely to die 9 compared to their counterparts under 25 years of 10 age. 11 (8) The COVID–19 pandemic risks exacer- 12 bating the maternal health crisis. A recent study of 13 the Centers for Disease Control and Prevention sug- 14 gests that pregnant women are at a significantly 15 higher risk for severe outcomes, including death, 16 from COVID–19 as compared to non-pregnant 17 women. The COVID–19 pandemic has also de- 18 creased access to prenatal and postpartum care. 19 (9) The findings described in paragraphs (1) 20 through (8) are of major concern to researchers, 21 academics, members of the business community, and 22 providers across the obstetric continuum represented 23 by organizations such as— 24 VerDate Sep 11 2014 00:02 Jun 03, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3407.IH H3407 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 3407 IH (A) the American College of Nurse-Mid- 1 wives; 2 (B) the American College of Obstetricians 3 and Gynecologists; 4 (C) the American Medical Association; 5 (D) the Association of Women’s Health, 6 Obstetric and Neonatal Nurses; 7 (E) the Black Mamas Matter Alliance; 8 (F) the Black Women’s Health Imperative; 9 (G) the California Maternal Quality Care 10 Collaborative; 11 (H) EverThrive Illinois; 12 (I) the Illinois Perinatal Quality Collabo- 13 rative; 14 (J) the March of Dimes; 15 (K) the National Association of Certified 16 Professional Midwives; 17 (L) the National Birth Equity Collabo- 18 rative; 19 (M) the National Partnership for Women 20 & Families; 21 (N) the National Polycystic Ovary Syn- 22 drome Association; 23 (O) the Preeclampsia Foundation; 24 VerDate Sep 11 2014 00:02 Jun 03, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3407.IH H3407 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 3407 IH (P) the Society for Maternal-Fetal Medi- 1 cine; and 2 (Q) the What To Expect Project. 3 (10) Hemorrhage, cardiovascular and coronary 4 conditions, cardiomyopathy, infection or sepsis, em- 5 bolism, mental health conditions (including sub- 6 stance use disorder), hypertensive disorders, stroke 7 and cerebrovascular accidents, and anesthesia com- 8 plications are the predominant medical causes of 9 maternal-related deaths and complications. Most of 10 these conditions are largely preventable or manage- 11 able. Even when these conditions are not prevent- 12 able, mortality and morbidity may be prevented 13 when conditions are diagnosed and treated in a 14 timely manner. 15 (11) According to a study published by the 16 Journal of Perinatal Education, doula-assisted 17 mothers are 4 times less likely to have a low-birth- 18 weight baby, 2 times less likely to experience a birth 19 complication involving themselves or their baby, and 20 significantly more likely to initiate breastfeeding. 21 Doula care has also been shown to produce cost sav- 22 ings resulting in part from reduced rates of cesarean 23 and pre-term births. 24 VerDate Sep 11 2014 00:02 Jun 03, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3407.IH H3407 kjohnson on DSK79L0C42PROD with BILLS 7 •HR 3407 IH (12) Intimate partner violence is one of the 1 leading causes of maternal death, and women are 2 more likely to experience intimate partner violence 3 during pregnancy than at any other time in their 4 lives. It is also more dangerous than pregnancy. In- 5 timate partner violence during pregnancy and 6 postpartum crosses every demographic and has been 7 exacerbated by the COVID–19 pandemic. 8 (13) Oral health is an important part of 9 perinatal health. Reducing bacteria in a woman’s 10 mouth during pregnancy can significantly reduce her 11 risk of developing oral diseases and spreading decay- 12 causing bacteria to her baby. Moreover, some evi- 13 dence suggests that women with periodontal disease 14 during pregnancy could be at greater risk for poor 15 birth outcomes, such as preeclampsia, pre-term 16 birth, and low-birth weight. Furthermore, a woman’s 17 oral health during pregnancy is a good predictor of 18 her newborn’s oral health, and since mothers can 19 unintentionally spread oral bacteria to their babies, 20 putting their children at higher risk for tooth decay, 21 prevention efforts should happen even before chil- 22 dren are born, as a matter of pre-pregnancy health 23 and prenatal care during pregnancy. 24 VerDate Sep 11 2014 00:02 Jun 03, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3407.IH H3407 kjohnson on DSK79L0C42PROD with BILLS 8 •HR 3407 IH (14) In the United States, death reporting and 1 analysis is a State function rather than a Federal 2 process. States report all deaths—including mater- 3 nal deaths—on a semi-voluntary basis, without 4 standardization across States. While the Centers for 5 Disease Control and Prevention has the capacity and 6 system for collecting death-related data based on 7 death certificates, these data are not sufficiently re- 8 ported by States in an organized and standard for- 9 mat across States such that the Centers for Disease 10 Control and Prevention is able to identify causes of 11 maternal death and best practices for the prevention 12 of such death. 13 (15) Vital statistics systems often underesti- 14 mate maternal mortality and are insufficient data 15 sources from which to derive a full scope of medical 16 and social determinant factors contributing to ma- 17 ternal deaths, such as intimate partner violence. 18 While the addition of pregnancy checkboxes on death 19 certificates since 2003 have likely improved States’ 20 abilities to identify pregnancy-related deaths, they 21 are not generally completed by obstetric providers or 22 persons trained to recognize pregnancy-related mor- 23 tality. Thus, these vital forms may be missing infor- 24 mation or may capture inconsistent data. Due to 25 VerDate Sep 11 2014 00:02 Jun 03, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H3407.IH H3407 kjohnson on DSK79L0C42PROD with BILLS 9 •HR 3407 IH varying maternal mortality-related analyses, lack of 1 reliability, and granularity in data, current maternal 2 mortality informatics do not fully encapsulate the 3 myriad medical and socially determinant factors that 4 contribute to such high maternal mortality rates 5 within the United States compared to other devel- 6 oped nations. Lack of standardization of data and 7 data sharing across States and between Federal en- 8 tities, health networks, and research institutions 9 keep the Nation in the dark about ways to prevent 10 maternal deaths. 11 (16) Having reliable and valid State data ag- 12 gregated at the Federal level are critical to the Na- 13 tion’s ability to quell surges in maternal death and 14 imperative for researchers to identify long-lasting 15 interventions. 16 (17) Leaders in maternal wellness highly rec- 17 ommend that maternal deaths and cases of maternal 18 morbidity, including complications that result in 19 chronic illness and future increased risk of death, be 20 investigated at the State level first, and that stand- 21 ardized, streamlined, de-identified data regarding 22 maternal deaths be sent annually to the Centers for 23 Disease Control and Prevention. Such data stand- 24 ardization and collection would be similar in oper- 25 VerDate Sep 11 2014 00:02 Jun 03, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3407.IH H3407 kjohnson on DSK79L0C42PROD with BILLS 10 •HR 3407 IH ation and effect to the National Program of Cancer 1 Registries of the Centers for Disease Control and 2 Prevention and akin to the Confidential Enquiry in 3 Maternal Deaths Programme in the United King- 4 dom. Such a maternal mortalities and morbidities 5 registry and surveillance system would help pro- 6 viders, academicians, lawmakers, and the public to 7 address questions concerning the types of, causes of, 8 and best practices to thwart, maternal mortality and 9 morbidity. 10 (18) The United Nations’ Millennium Develop- 11 ment Goal 5a aimed to reduce by 75 percent, be- 12 tween 1990 and 2015, the maternal mortality rate, 13 yet this metric has not been achieved. In fact, the 14 maternal mortality rate in the United States has 15 been estimated to have more than doubled between 16 2000 and 2014. 17 (19) Many States have struggled to establish or 18 maintain Maternal Mortality Review Committees 19 (referred to in this section as ‘‘MMRC’’). On the 20 State level, MMRCs have lagged because States have 21 not had the resources to mount local reviews. State- 22 level reviews are necessary as only the State depart- 23 ments of health have the authority to request med- 24 VerDate Sep 11 2014 00:02 Jun 03, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H3407.IH H3407 kjohnson on DSK79L0C42PROD with BILLS 11 •HR 3407 IH ical records, autopsy reports, and police reports crit- 1 ical to the function of the MMRC. 2 (20) The United States has no comparable, co- 3 ordinated Federal process by which to review cases 4 of maternal mortality, systems failures, or best prac- 5 tices. Many States have active MMRCs and leverage 6 their work to impact maternal wellness. For exam- 7 ple, the State of California has worked extensively 8 with their State health departments, health and hos- 9 pital systems, and research collaborative organiza- 10 tions, including the California Maternal Quality Care 11 Collaborative and the Alliance for Innovation on Ma- 12 ternal Health, to establish MMRCs, wherein such 13 State has determined the most prevalent causes of 14 maternal mortality and recorded and shared data 15 with providers and researchers, who have developed 16 and implemented safety bundles and care protocols 17 related to preeclampsia, maternal hemorrhage, 18 peripartum cardiomyopathy, and the like. In this 19 way, the State of California has been able to lever- 20 age its maternal mortality review board system, gen- 21 erate data, and apply those data to effect changes 22 in maternal care-related protocol. To date, the State 23 of California has reduced its maternal mortality 24 VerDate Sep 11 2014 00:02 Jun 03, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H3407.IH H3407 kjohnson on DSK79L0C42PROD with BILLS 12 •HR 3407 IH rate, which is now comparable to the low rates of the 1 United Kingdom [Text truncated for display. Full text available on Congress.gov.]