Growing concern over maternal health disparities is prompting a flurry of congressional action, with lawmakers moving closer to consideration of policies that they say could reduce the rising number of maternal deaths.
The House Oversight and Reform Committee at a hearing Thursday examined ways to expand the perinatal workforce, collect data and reduce the effects of racism on Black maternal health in the United States.
Committee Chairwoman Carolyn B. Maloney, D-N.Y., said she hopes to work in a bipartisan way to advance 15 maternal health bills, which she did not specify, under consideration in the House.
The overall maternal mortality rate was 20.1 per 100,000 live births in the U.S. in 2019, according to the Centers for Disease Control and Prevention. That number jumps to 44 deaths per 100,000 live births for non-Hispanic Black women.
Improving maternal health outcomes is a priority for lawmakers and the White House this year.
Rep. Lauren Underwood, D-Ill., who testified as part of a panel of lawmakers before the committee, said she is pushing for a comprehensive 12-bill package known as the “Momnibus” to be included in President Joe Biden’s infrastructure legislation that focuses on services for families.
Maloney highlighted a provision in the “Momnibus” that seeks to improve data collection processes and build on research at institutions that serve primarily minority communities. She also pointed to a bill from the last Congress by Rep. Robin Kelly, D-Ill., that would standardize federal data collection on maternal health.
“Right now, we simply don’t have the tools to collect the data we need to inform good policy,” Maloney said.
She said the committee has asked the Government Accountability Office to produce three reports involving data collection. The first report would address how the COVID-19 pandemic affected the Black maternal health crisis. The second would analyze the perinatal health workforce, and the third would evaluate how the Black maternal health crisis has affected incarcerated populations.
Experts also testified in support of expanding the diversity and type of perinatal professionals.
Rep. Virginia Foxx, R-N.C., the ranking member of the Education and Labor Committee, said she hopes to address the shortage of obstetrician-gynecologists and midwives.
“There is expected to be a shortage between 3,000 and 9,000 physicians by 2030. We must act now to ensure this shortage does not get worse,” she said. “One potential way to address a shortage of caretakers now is to utilize nonphysician clinicians, such as midwives, nurse practitioners and physician assistants, especially for low-risk pregnancies.”
The witnesses and lawmakers also discussed racial biases.
Jamila Taylor, director of health care reform and senior fellow at The Century Foundation, told Rep. Cori Bush, D-Mo., there are many negative stereotypes about how Black people feel pain that need to be addressed in health care.
“Slavery and the barbaric situations that we saw during that time have a definite connection to some of the same challenges that Black women are going through today,” Taylor said, citing a goal of working “with providers to make sure that we root out those racist stereotypes and those mindsets to the point that it doesn’t show up in their interactions with patients.”
Rep. Debbie Wasserman Schultz, D-Fla., asked, “Given all of what we have discussed this afternoon, what can we do to make sure that we can impact Black maternal mortality that would impact the inherent racism that clearly exists in the health care system?”
Veronica Gillispie-Bell, medical director at the Louisiana Perinatal Quality Collaborative, said it is not easy.
“We cannot legislate racism out, but we can legislate for implicit bias training,” she said. “It is a longitudinal action. It is not a one-and-done kind of training.”
Legislation in both chambers
The Booker-Pressley bill would make permanent a provision of the recent COVID-19 law, which allows states to apply to the Centers for Medicare and Medicaid Services to extend postpartum Medicaid coverage beyond 60 days up to 12 months during the public health emergency.
The bill also would establish a demonstration project that focuses on maternity care homes, increase access to doula support and study telehealth as a way to improve maternal care access in Medicaid.
“Our bill would help change [maternal health outcomes] by promoting community-based, holistic approaches to maternity and postpartum care so that every pregnant person is treated with the dignity and respect they deserve during and after childbirth. Our fight for maternal justice continues,” Pressley told CQ Roll Call before the hearing.
Booker said in an interview that their bill is an important first step.
“We live in a nation that spends more than any other country on health care, yet we still have the highest rate of pregnancy-related deaths of any of our peer countries,” he said. “By expanding Medicaid coverage for pregnant people, we can begin to stem the rising tide of maternal mortality and close the egregious racial gaps that exist in maternal and infant health outcomes.”
In Booker’s home state of New Jersey, he said Black women are five times more likely to die from pregnancy-related complications than white women. The Garden State also has one of the highest overall mortality rates in the country.
Medicaid covers about half of all births in the U.S., which is a reason many advocates are pushing to make the Medicaid extension permanent. The expansion also would increase coverage of primary care services beyond those tied to pregnancy or postpartum care.