MOMMA’s Act

I 116TH CONGRESS 1ST SESSION H. R. 1897 To improve Federal efforts with respect to the prevention of maternal mortality, and for other purposes. IN THE HOUSE OF REPRESENTATIVES MARCH 27, 2019 Ms. KELLY of Illinois (for herself, Ms. DEGETTE, Ms. BASS, Ms. SCHA- KOWSKY, Mr. KENNEDY, Ms. KUSTER of New Hampshire, Ms. LEE of California, Mr. RUSH, Ms. BLUNT ROCHESTER, Mrs. DAVIS of California, Mr. RASKIN, Mr. AGUILAR, Ms. WASSERMAN SCHULTZ, Mr. BLU- MENAUER, Ms. MCCOLLUM, Ms. WILSON of Florida, Mr. KHANNA, Mr. LOWENTHAL, Mr. PAYNE, Mrs. BEATTY, Ms. CLARKE of New York, Mr. QUIGLEY, Mrs. DINGELL, and Mr. DANNY K. DAVIS of Illinois) intro- duced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Labor, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall with- in 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 22:59 Apr 03, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1897.IH H1897 pamtmann on DSKBFK8HB2PROD with BILLS 2 •HR 1897 IH SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Mothers and Offspring 2 Mortality and Morbidity Awareness Act’’ or the 3 ‘‘MOMMA’s Act’’. 4 SEC. 2. FINDINGS. 5 Congress finds the following: 6 (1) Every year, across the United States, 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 70,000 women suffer near-fatal, partum-related 11 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 developed nations. The esti- 19 mated maternal mortality rate (per 100,000 live 20 births) for the 48 contiguous States and Wash- 21 ington, DC increased from 18.8 percent in 2000 to 22 23.8 percent in 2014 to 26.6 percent in 2018. This 23 estimated rate is on par with such rate for under- 24 developed nations such as Iraq and Afghanistan. 25 VerDate Sep 11 2014 22:59 Apr 03, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1897.IH H1897 pamtmann on DSKBFK8HB2PROD with BILLS 3 •HR 1897 IH (3) International studies estimate the 2015 ma- 1 ternal mortality rate in the United States as 26.4 2 per 100,000 live births, which is almost twice the 3 2015 World Health Organization estimation of 14 4 per 100,000 live births. 5 (4) It is estimated that more than 60 percent 6 of maternal deaths in the United States are prevent- 7 able. 8 (5) According to the Centers for Disease Con- 9 trol and Prevention, the maternal mortality rate var- 10 ies drastically for women by race and ethnicity. 11 There are 12.7 deaths per 100,000 live births for 12 White women, 43.5 deaths per 100,000 live births 13 for African-American women, and 14.4 deaths per 14 100,000 live births for women of other ethnicities. 15 While maternal mortality disparately impacts Afri- 16 can-American women, this urgent public health crisis 17 traverses race, ethnicity, socioeconomic status, edu- 18 cational background, and geography. 19 (6) African-American women are 3 to 4 times 20 more likely to die from causes related to pregnancy 21 and childbirth compared to non-Hispanic White 22 women. 23 (7) The findings described in paragraphs (1) 24 through (6) are of major concern to researchers, 25 VerDate Sep 11 2014 22:59 Apr 03, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1897.IH H1897 pamtmann on DSKBFK8HB2PROD with BILLS 4 •HR 1897 IH academics, members of the business community, and 1 providers across the obstetrical continuum rep- 2 resented by organizations such as March of Dimes; 3 the Preeclampsia Foundation; the American College 4 of Obstetricians and Gynecologists; the Society for 5 Maternal-Fetal Medicine; the Association of Wom- 6 en’s Health, Obstetric, and Neonatal Nurses; the 7 California Maternal Quality Care Collaborative; 8 Black Women’s Health Imperative; the National 9 Birth Equity Collaborative; Black Mamas Matter Al- 10 liance; EverThrive Illinois; the National Association 11 of Certified Professional Midwives; PCOS Challenge: 12 The National Polycystic Ovary Syndrome Associa- 13 tion; and the American College of Nurse Midwives. 14 (8) Hemorrhage, cardiovascular and coronary 15 conditions, cardiomyopathy, infection, embolism, 16 mental health conditions, preeclampsia and eclamp- 17 sia, polycystic ovary syndrome, infection and sepsis, 18 and anesthesia complications are the predominant 19 medical causes of maternal-related deaths and com- 20 plications. Most of these conditions are largely pre- 21 ventable or manageable. 22 (9) Oral health is an important part of 23 perinatal health. Reducing bacteria in a woman’s 24 mouth during pregnancy can significantly reduce her 25 VerDate Sep 11 2014 22:59 Apr 03, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1897.IH H1897 pamtmann on DSKBFK8HB2PROD with BILLS 5 •HR 1897 IH risk of developing oral diseases and spreading decay- 1 causing bacteria to her baby. Moreover, some evi- 2 dence suggests that women with periodontal disease 3 during pregnancy could be at greater risk for poor 4 birth outcomes, such as preeclampsia, pre-term 5 birth, and low-birth weight. Furthermore, a woman’s 6 oral health during pregnancy is a good predictor of 7 her newborn’s oral health, and since mothers can 8 unintentionally spread oral bacteria to their babies, 9 putting their children at higher risk for tooth decay, 10 prevention efforts should happen even before chil- 11 dren are born, as a matter of pre-pregnancy health 12 and prenatal care during pregnancy. 13 (10) The United States has not been able to 14 submit a formal maternal mortality rate to inter- 15 national data repositories since 2007. Thus, no offi- 16 cial maternal mortality rate exists for the United 17 States. There can be no maternal mortality rate 18 without streamlining maternal mortality-related data 19 from the State level and extrapolating such data to 20 the Federal level. 21 (11) In the United States, death reporting and 22 analysis is a State function rather than a Federal 23 process. States report all deaths—including mater- 24 nal deaths—on a semi-voluntary basis, without 25 VerDate Sep 11 2014 22:59 Apr 03, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1897.IH H1897 pamtmann on DSKBFK8HB2PROD with BILLS 6 •HR 1897 IH standardization across States. While the Centers for 1 Disease Control and Prevention has the capacity and 2 system for collecting death-related data based on 3 death certificates, these data are not sufficiently re- 4 ported by States in an organized and standard for- 5 mat across States such that the Centers for Disease 6 Control and Prevention is able to identify causes of 7 maternal death and best practices for the prevention 8 of such death. 9 (12) Vital statistics systems often underesti- 10 mate maternal mortality and are insufficient data 11 sources from which to derive a full scope of medical 12 and social determinant factors contributing to ma- 13 ternal deaths. While the addition of pregnancy 14 checkboxes on death certificates since 2003 have 15 likely improved States’ abilities to identify preg- 16 nancy-related deaths, they are not generally com- 17 pleted by obstetrical providers or persons trained to 18 recognize pregnancy-related mortality. Thus, these 19 vital forms may be missing information or may cap- 20 ture inconsistent data. Due to varying maternal 21 mortality-related analyses, lack of reliability, and 22 granularity in data, current maternal mortality 23 informatics do not fully encapsulate the myriad med- 24 ical and socially determinant factors that contribute 25 VerDate Sep 11 2014 22:59 Apr 03, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H1897.IH H1897 pamtmann on DSKBFK8HB2PROD with BILLS 7 •HR 1897 IH to such high maternal mortality rates within the 1 United States compared to other developed nations. 2 Lack of standardization of data and data sharing 3 across States and between Federal entities, health 4 networks, and research institutions keep the Nation 5 in the dark about ways to prevent maternal deaths. 6 (13) Having reliable and valid State data ag- 7 gregated at the Federal level are critical to the Na- 8 tion’s ability to quell surges in maternal death and 9 imperative for researchers to identify long-lasting 10 interventions. 11 (14) Leaders in maternal wellness highly rec- 12 ommend that maternal deaths be investigated at the 13 State level first, and that standardized, streamlined, 14 de-identified data regarding maternal deaths be sent 15 annually to the Centers for Disease Control and Pre- 16 vention. Such data standardization and collection 17 would be similar in operation and effect to the Na- 18 tional Program of Cancer Registries of the Centers 19 for Disease Control and Prevention and akin to the 20 Confidential Enquiry in Maternal Deaths Pro- 21 gramme in the United Kingdom. Such a maternal 22 mortalities and morbidities registry and surveillance 23 system would help providers, academicians, law- 24 makers, and the public to address questions con- 25 VerDate Sep 11 2014 22:59 Apr 03, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1897.IH H1897 pamtmann on DSKBFK8HB2PROD with BILLS 8 •HR 1897 IH cerning the types of, causes of, and best practices to 1 thwart, pregnancy-related or pregnancy-associated 2 mortality and morbidity. 3 (15) The United Nations’ Millennium Develop- 4 ment Goal 5a aimed to reduce by 75 percent, be- 5 tween 1990 and 2015, the maternal mortality rate, 6 yet this metric has not been achieved. In fact, the 7 maternal mortality rate in the United States has 8 been estimated to have more than doubled between 9 2000 and 2014. Yet, because national data are not 10 fully available, the United States does not have an 11 official maternal mortality rate. 12 (16) Many States have struggled to establish or 13 maintain Maternal Mortality Review Committees 14 (referred to in this section as ‘‘MMRC’’). On the 15 State level, MMRCs have lagged because States have 16 not had the resources to mount local reviews. State- 17 level reviews are necessary as only the State depart- 18 ments of health have the authority to request med- 19 ical records, autopsy reports, and police reports crit- 20 ical to the function of the MMRC. 21 (17) The United Kingdom regards maternal 22 deaths as a health systems failure and a national 23 committee of obstetrics experts review each maternal 24 death or near-fatal childbirth complication. Such 25 VerDate Sep 11 2014 22:59 Apr 03, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H1897.IH H1897 pamtmann on DSKBFK8HB2PROD with BILLS 9 •HR 1897 IH committee also establishes the predominant course of 1 maternal-related deaths from conditions such as 2 preeclampsia. Consequently, the United Kingdom 3 has been able to reduce its incidence of preeclampsia 4 to less than one in 10,000 women—its lowest rate 5 since 1952. 6 (18) The United States has no comparable, co- 7 ordinated Federal process by which to review cases 8 of maternal mortality, systems failures, or best prac- 9 tices. Many States have active MMRCs and leverage 10 their work to impact maternal wellness. For exam- 11 ple, the State of California has worked extensively 12 with their State health departments, health and hos- 13 pital systems, and research collaborative organiza- 14 tions, including the California Maternal Quality Care 15 Collaborative and the Alliance for Innovation on Ma- 16 ternal Health, to establish MMRCs, wherein such 17 State has determined the most prevalent causes of 18 maternal mortality and recorded and shared data 19 with providers and researchers, who have developed 20 and implemented safety bundles and care protocols 21 related to preeclampsia, maternal hemorrhage, and 22 the like. In this way, the State of California has 23 been able to leverage its maternal mortality review 24 board system, generate data, and apply those data 25 VerDate Sep 11 2014 22:59 Apr 03, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H1897.IH H1897 pamtmann on DSKBFK8HB2PROD with BILLS 10 •HR 1897 IH to effect changes in maternal care-related protocol. 1 To date, the State of California has reduced its ma- 2 ternal mortality rate, which is now comparable to 3 the low rates of the United Kingdom. 4 (19) Hospitals and health systems across the 5 United States lack standardization of emergency ob- 6 stetrical protocols before, during, and after delivery. 7 Consequently, many providers are delayed in recog- 8 nizing critical signs indicating maternal distress that 9 quickly escalate into fatal or near-fatal incidences. 10 Moreover, any attempt to address an obstetrical 11 emergency that does not consider both clinical and 12 public health approaches falls woefully under the 13 mark of excellent care delivery. State-based maternal 14 quality collaborative organizations, such as the Cali- 15 fornia Maternal Quality Care Collaborative or enti- 16 ties participating in the Alliance for Innovation on 17 Maternal Health (AIM), have formed obstetrical pro- 18 tocols, tool kits, and other resources to improve sys- 19 tem care and response as they relate to maternal 20 complications and warning signs for such conditions 21 as maternal hemorrhage, hypertension, and 22 preeclampsia. 23 (20) The Centers for Disease Control and Pre- 24 vention reports that nearly half of all maternal 25 VerDate Sep 11 2014 22:59 Apr 03, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H1897.IH H1897 pamtmann on DSKBFK8HB2PROD with BILLS 11 •HR 1897 IH deaths occur in the immediate postpartum period— 1 the 42 days following a pregnancy—whereas more 2 than one-third of pregnancy-related or pregnancy-as- 3 sociated deaths occur while a person is still preg- 4 nant. Yet, for women eligible for the Medicaid pro- 5 gram on the basis of pregnancy, such Medicaid cov- 6 erage lapses at the end of the month on which the 7 60th postpartum day lands. 8 (21) The experience of serious traumatic 9 events, such as being exposed to domestic violence, 10 substance use disorder, or pervasive racism, can 11 over-activate the body’s st [Text truncated for display. Full text available on Congress.gov.]