Despite having one of the world’s most advanced health care systems, the United States is experiencing a crisis of maternal morbidity and mortality. There are approximately 700 deaths from pregnancy-related complications in the United States every year and sixty percent of pregnancy-related deaths are preventable. As with many health issues, this epidemic of preventable injury and death disproportionately impacts Black and Hispanic mothers. These alarming statistics have led lawmakers to introduce a host of legislation designed to address maternal mortality in the current session, an interest that will likely continue through the 2020 election cycle.
Proposed legislation to reduce maternal mortality rates and disparities in mortality between Black and White women
Eight bills introduced in the last two Congressional terms attempt to improve maternal health and reduce both the maternal mortality rate and disparities in maternal mortality between Black and White women. According to the National Partnership for Women and Families, which is tracking the legislation, several of these bills were introduced or are cosponsored by Democratic presidential candidates.
Three of the bills target maternal mortality directly: the Mothers and Offspring Mortality and Morbidity Awareness (MOMMA’s) Act (H.R. 1897, S. 916) and the Modernizing Obstetric Medicine Standards (MOMS) Act (S. 116) target increasing and standardizing maternal mortality and morbidity data collection. They call on the Centers for Disease Control and Prevention (CDC) to publish best practices for maternal mortality and morbidity prevention and work with state maternal mortality review committees to improve national maternal mortality surveillance. The Ending Maternal Mortality Act of 2018 (H.R. 5761) calls for the Department of Health and Human Services to publish a national plan every two years aimed at reducing maternal mortality.
Sen. Kamala Harris introduces bill recognizes racial bias and its impact on health care
Sen. Kamala Harris reintroduced a bill, the Maternal Care Access and Reducing Emergencies (CARE) Act (S. 1600, H.R. 2902), which aims to address the maternal mortality disparity faced by women of color by training providers on recognizing implicit racial bias and its impact on care. The MOMMA’s Act also authorizes funding for implicit bias and cultural competency education.
States that expanded Medicaid have better maternal health outcomes
Though these bills are a step in the right direction, states already have a means to address preventable maternal harm that requires no action by Congress. A report from researchers at Georgetown University found that states that expanded Medicaid have better maternal health outcomes, including increased access to preventative care, reduced adverse health effects before, during and after pregnancy, and reduced maternal mortality compared to the seventeen states that haven’t expanded Medicaid.
Because the percentage of uninsured non-elderly African Americans in non-expansion states is nearly double that of those in states which have expanded their program, expanding Medicaid would help address racial disparities in pre- and postnatal care and improve the health of mothers and babies.
Newborns continued access to care
As a result, it’s important that newborns have continued access to care, three of the newly introduced bills extend postpartum Medicaid coverage for women for a full year after giving birth: the Healthy Maternal and Obstetric Medicine (Healthy MOM) Act (H.R. 2778, S. 1481), the Mothers and Offspring Mortality and Morbidity Awareness (MOMMA’s) Act (H.R. 1897, S. 916), and the Maximizing Outcomes for Moms through Medicaid Improvement and Enhancement of Services (MOMMIES) Act (S. 1343).
The MOMMIES Act, introduced by Sen. Corey Booker and Rep. Ayanna Pressley, in addition to addressing postpartum Medicaid coverage, also ensures full Medicaid coverage for pregnant women, and increases the Medicaid payment rate for maternity services to at least the level of Medicare primary care rates.
Increasing alternative care models, addressing racism and bias
Some maternal health advocates note that while the proposed legislation takes on maternal mortality from a variety of angles, the bills do not focus enough on addressing the beginning of maternal health problems like improving prenatal care and the health of women before they become pregnant. For example, expanding Medicaid access to non-pregnant reproductive age women could increase access to contraceptive and preconception counseling. Other areas that potentially need to be addressed are an increased focus on alternative care models like group prenatal care and midwifery care which show promise, addressing racism and bias among currently practicing clinicians, and increasing research on maternal morbidity and “near misses” which would help improve pregnancy care delivery.