What This Bill Does
This bill works to improve maternal health and reduce deaths among pregnant women and newborns. The bill establishes grant programs for states and organizations to develop better maternal health services, improve data collection, and conduct research. It also creates awareness campaigns about maternal health warning signs and vaccine safety for pregnant women and children.
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Who It Affects
- Pregnant women and women in the postpartum period (the time after birth)
- States and state health departments
- Indian Tribes and tribal health organizations
- Hospitals and birthing facilities
- Maternal health researchers and health care providers
- Communities with high rates of maternal and infant deaths, particularly Black women, American Indian/Alaska Native women, and Hispanic women
- Rural communities with limited access to maternal health care
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Key Provisions
- The federal government will continue to award grants to states and eligible organizations to create maternal health improvement plans, collect better data on maternal deaths, and test new ways to deliver maternal health services (Sec. 3)
- States will receive grants to classify birthing hospitals by their ability to handle different levels of risk and to improve care based on findings (Sec. 4)
- Grant programs will support improving the accuracy of pregnancy checkbox data on death certificates to better track maternal deaths (Sec. 4)
- The government will establish a National Maternal Health Research Network to fund research on ways to reduce maternal death and severe maternal illness (Sec. 7)
- Rural areas will receive grants to use telehealth and specialty care to improve access to pregnancy and childbirth care (Sec. 8)
- A national public awareness campaign will educate pregnant women and health care providers about maternal health warning signs and vaccine safety (Sec. 9)
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What Changes
If this law passes, the federal government will award billions of dollars in grants over multiple years to states, tribes, hospitals, and research organizations to improve maternal health services and outcomes. States will be required to work with health departments and hospitals to better classify their birthing facilities and improve maternal care quality. The government will fund research to find new treatments and approaches to prevent maternal deaths. Rural regions will receive funding to use technology like telehealth to connect pregnant women to specialists. Health care providers and the public will receive education about the warning signs of dangerous pregnancy complications and the safety of vaccines for pregnant women.
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Important Definitions
- **Maternal mortality** - deaths of women while pregnant or within one year of the end of pregnancy
- **Severe maternal morbidity** - serious health conditions that occur during pregnancy or after birth that may cause long-term health problems
- **Neonatal** - relating to newborns
- **Postpartum period** - the time after childbirth, including at least one year following birth as specified in the bill
- **Risk-appropriate care** - medical care matched to the level of risk involved in a pregnancy or delivery
- **Telehealth** - health care provided using technology like video calls or remote monitoring
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Effective Date
Not specified in bill text
II
118TH CONGRESS
1ST SESSION
S. 964
To amend the Public Health Service Act to improve maternal health and
promote safe motherhood.
IN THE SENATE OF THE UNITED STATES
MARCH 23, 2023
Mr. KAINE (for himself and Ms. MURKOWSKI) introduced the following bill;
which was read twice and referred to the Committee on Health, Edu-
cation, Labor, and Pensions
A BILL
To amend the Public Health Service Act to improve maternal
health and promote safe motherhood.
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 Newborns
4
Success Act’’.
5
SEC. 2. FINDINGS AND SENSE OF THE SENATE.
6
(a) FINDINGS.—Congress finds the following:
7
(1) Among developed nations, the United States
8
has disturbingly high rates of maternal and infant
9
mortality.
10
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(2) The United States maternal mortality rate
1
in 2020 was 23.8 deaths per 100,000 live births,
2
which is significantly higher than the Organisation
3
for Economic Co-operation and Development (re-
4
ferred to in this section as the ‘‘OECD’’) average of
5
9.8, according to the Commonwealth Fund.
6
(3) The United States infant mortality rate in
7
2020 was 5.4 deaths per 1,000 live births, while the
8
OECD average was 4.1 deaths per 1,000 live births.
9
(4) In the United States, there are significant
10
maternal mortality and infant mortality inequities.
11
(5) The maternal mortality rate for non-His-
12
panic Black women in 2020 was 55.3 deaths per
13
100,000 live births. This rate is 2.89 times higher
14
than the maternal mortality rate of 19.1 deaths per
15
100,000 live births for non-Hispanic white women
16
and more than 3 times higher than the maternal
17
mortality rate of 18.2 deaths per 100,000 live births
18
for Hispanic women of any race.
19
(6) The Centers for Disease Control and Pre-
20
vention data from 2016 through 2018 shows that
21
American Indian/Alaska Native women also have
22
significantly
higher
rates
of
pregnancy-related
23
deaths than white, Hispanic, and Asian/Pacific Is-
24
lander women. American Indian/Alaska Native
25
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women had a rate of 26.5 pregnancy-related deaths
1
per 100,000 live births from 2016 through 2018,
2
which is 1.9 times higher than the rate of 13.7
3
deaths per 100,000 live births for white women dur-
4
ing the same time period.
5
(7) The mortality rate for infants of non-His-
6
panic Black women is 10.6 deaths per 1,000 live
7
births and for infants of American Indian or Alaska
8
Native women it is 7.9 deaths per 1,000 live births.
9
These rates are significantly higher than the infant
10
mortality rate of non-Hispanic white infants at 4.5
11
deaths per 1,000 live births and the infant mortality
12
rate of Hispanic infants of any race at 5 deaths per
13
1,000 live births.
14
(b) SENSE OF THE SENATE.—It is the sense of the
15
Senate that the following should apply:
16
(1) The United States should dramatically re-
17
duce maternal and infant mortality, ensure that all
18
infants can grow up healthy and safe, and protect
19
women’s health before, during, and after pregnancy.
20
(2) Any pregnant woman choosing to have a
21
child should be able to do so safely without regard
22
to income, race, ethnicity, employment status, geo-
23
graphic location, ability, or any other socio-economic
24
factor. United States policy should support women’s
25
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health so that women thrive and newborns have the
1
maximum chance for a healthy life.
2
(3) The evidence of serious racial inequities in
3
maternal and infant mortality, especially between
4
Black women and white women demonstrates the
5
persistence of racism and racial bias in our society
6
and health care system. A 2017 systemic review of
7
implicit bias in health care professionals found that
8
35 studies found evidence of negative implicit biases
9
towards people of color among health care profes-
10
sionals. Those biases were correlated with ‘‘lower
11
quality of care’’. Therefore, the programs authorized
12
by this Act should be specifically deployed in ways
13
to counter such inequities.
14
(4) In the next 5 years, the United States
15
should aim to reduce its overall maternal and infant
16
mortality rates such that they are no higher than
17
the OECD average. The United States should dra-
18
matically reduce the maternal mortality and infant
19
mortality inequities between Black and American In-
20
dian/Alaskan Native women and white women.
21
(5) By advancing evidence-based policies to im-
22
prove maternal and infant health outcomes, the
23
United States can work to reduce and eliminate pre-
24
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ventable maternal and infant mortality and severe
1
maternal morbidity.
2
SEC. 3. STATE MATERNAL HEALTH INNOVATION.
3
Title III of the Public Health Service Act is amended
4
by inserting after section 330P (42 U.S.C. 254c–22) the
5
following:
6
‘‘SEC. 330Q. STATE MATERNAL HEALTH INNOVATION.
7
‘‘(a) IN GENERAL.—The Secretary, acting through
8
the Administrator of the Health Resources and Services
9
Administration, shall continue in effect the State Maternal
10
Health Innovation Program and the Supporting Maternal
11
Health Innovation Program to award competitive grants
12
to eligible entities for the purpose of assisting States to
13
implement State-specific actions that address racial, eth-
14
nic and geographic inequities in maternal health and im-
15
prove maternal health outcomes, including the prevention
16
and reduction of maternal mortality and severe maternal
17
morbidity.
18
‘‘(b) USE OF FUNDS.—An entity receiving a grant
19
under this section may use such funds—
20
‘‘(1) to translate recommendations on address-
21
ing maternal mortality and severe maternal mor-
22
bidity into action through activities which may in-
23
clude—
24
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‘‘(A) establishing a State- or regional
1
multi-State-focused
Maternal
Health
Task
2
Force to create and implement a strategic plan;
3
‘‘(B) improving the collection, analysis,
4
and application of State- or regional multi-
5
State-level data on maternal mortality and se-
6
vere maternal morbidity; and
7
‘‘(C) promoting and executing innovation
8
in maternal health service delivery, such as im-
9
proving access to maternal health care services,
10
identifying and addressing workforce needs, in-
11
cluding maternal health provider shortages;
12
identifying and addressing implicit and explicit
13
bias based on race or ethnicity; or supporting
14
postpartum and inter-pregnancy care services;
15
or
16
‘‘(2) to provide support to entities receiving as-
17
sistance under paragraph (1), and other initiatives
18
of the Department of Health and Human Services to
19
improve maternal health outcomes as the Secretary
20
determines appropriate, States, multi-State regions
21
and other stakeholders working to reduce and pre-
22
vent maternal mortality and severe maternal mor-
23
bidity through activities which may include—
24
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‘‘(A) providing capacity-building assistance
1
to such entities to implement innovative and
2
evidence-informed strategies; and
3
‘‘(B) establishing or continuing the oper-
4
ation of a resource center to provide national
5
guidance to such entities, States, and key stake-
6
holders to improve maternal health.
7
‘‘(c) ALIGNMENT OF ACTIVITIES.—An entity carrying
8
out activities under subsection (b)(1) shall coordinate and
9
align such activities with the activities to improve mater-
10
nal health outcomes carried out by such entities under title
11
V of the Social Security Act.
12
‘‘(d) ELIGIBLE ENTITIES.—To be eligible for a grant
13
under subsection (a), a domestic public or non-profit pri-
14
vate entity, Indian Tribe, or Tribal serving organization,
15
such as a Tribal health department or other organization
16
fulfilling similar functions for the Tribe, shall submit to
17
the Secretary an application at such time, in such manner,
18
and containing such information as the Secretary may re-
19
quire. In the case of applicants intending to carry out ac-
20
tivities described in subsection (b)(1), such applicants
21
shall demonstrate in such application that the entity has
22
a commitment from a State or group of States to collabo-
23
rate as part of the project on strengthening State-level ca-
24
pacity in achieving the program aims.
25
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‘‘(e) REPORT TO CONGRESS.—Not later than Janu-
1
ary 1, 2027, the Secretary shall submit to the Committee
2
on Health, Education, Labor, and Pensions of the Senate
3
and the Committee on Energy and Commerce of the
4
House of Representatives, and make publicly available, a
5
report concerning the impact of the programs continued
6
under this section on addressing inequities in maternal
7
health and improving maternal health outcomes, including
8
the prevention and reduction of maternal mortality and
9
severe maternal morbidity, together with recommendations
10
on whether to expand such programs to additional recipi-
11
ents and the estimated amount of funds needed to expand
12
such programs.
13
‘‘(f) AUTHORIZATION
OF
APPROPRIATIONS.—To
14
carry out this section, including carrying out the programs
15
referred to in subsection (a) on a national basis (subject
16
to the availability of appropriations), there is authorized
17
to be appropriated $53,000,000 for each of fiscal years
18
2024 through 2027.’’.
19
SEC. 4. SAFE MOTHERHOOD.
20
Section 317K of the Public Health Service Act (42
21
U.S.C. 247b–12) is amended—
22
(1) by redesignating subsections (e) and (f) as
23
subsections (h) and (i), respectively;
24
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(2) by inserting after subsection (d) the fol-
1
lowing:
2
‘‘(e) LEVELS
OF
MATERNAL
AND
NEONATAL
3
CARE.—
4
‘‘(1) IN
GENERAL.—The Secretary, acting
5
through the Director of the Centers for Disease
6
Control and Prevention, shall establish or continue
7
in effect a program to award competitive grants to
8
eligible entities to assist with the classification of
9
birthing facilities based on the level of risk-appro-
10
priate maternal and neonatal care such entities can
11
provide in order to strategically improve maternal
12
and infant care delivery and health outcomes.
13
‘‘(2) USE OF FUNDS.—An eligible entity receiv-
14
ing a grant under this subsection shall use such
15
funds to—
16
‘‘(A) coordinate an assessment of the risk-
17
appropriate maternal and neonatal care of a
18
State, jurisdiction, or region, based on the most
19
recent guidelines and policy statements issued
20
by the professional associations representing
21
relevant clinical specialties, including obstetrics
22
and gynecology and pediatrics; and
23
‘‘(B) work with relevant stakeholders, such
24
as hospitals, hospital associations, perinatal
25
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•S 964 IS
quality collaboratives, members of the commu-
1
nities most affected by racial, ethnic, and geo-
2
graphic maternal health inequities, maternal
3
mortality review committees, and maternal and
4
neonatal health care providers and community-
5
based birth workers to review the findings of
6
the assessment made of activities carried out
7
under paragraph (1) and implement changes, as
8
appropriate, based on identified gaps in
9
perinatal services and differences in maternal
10
and neonatal outcomes in the State, jurisdic-
11
tion, or region for which such an assessment
12
was conducted to support the provision of risk-
13
appropriate care.
14
‘‘(3) ELIGIBLE ENTITIES.—To be eligible for a
15
grant under this subsection, a State health depart-
16
ment, Indian Tribe or other Tribal serving organiza-
17
tion, such as a Tribal health department or other or-
18
ganization fulfilling similar functions for the Tribe,
19
shall submit to the Secretary an application at such
20
time, in such manner, and containing such informa-
21
tion as the Secretary may require.
22
‘‘(4) PERIOD.—A grant awarded under this
23
subsection shall be made for a period of 3 years.
24
Any supplemental award made to a grantee under
25
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this subsection may be made for a period of less
1
than 3 years.
2
‘‘(5) REPORT TO CONGRESS.—Not later than
3
January 1, 2026, the Secretary shall submit to the
4
Committee on Health, Education, Labor, and Pen-
5
sions of the Senate and the Committee on Energy
6
and Commerce of the House of Representatives, and
7
make publicly available, a report concerning the im-
8
pact of the programs established or continued under
9
this subsection.
10
‘‘(f) PREGNANCY
CHECKBOX
QUALITY
ASSUR-
11
ANCE.—
12
‘‘(1) IN
GENERAL.—The Secretary, acting
13
through the Director of the Centers for Disease
14
Control and Prevention, may establish or continue a
15
program to award competitive grants and provide
16
technical assistance to eligible entities to implement
17
a quality assurance process to improve the validity
18
of the pregnancy checkbox data from death certifi-
19
cates.
20
‘‘(2) USE OF FUNDS.—Eligible entities receiv-
21
ing a grant under this subsection shall use grant
22
funds to implement a quality assurance process to
23
improve the validity of the pregnancy checkbox data
24
from death certificates in the State or within the In-
25
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dian Tribe. Acti
[Text truncated for display. Full text available on Congress.gov.]