WASHINGTON — The push to reduce poor maternal health outcomes has seen new momentum as lawmakers and Biden administration officials previewed their priorities — including reversing a rise in maternal disparities among Black women.
The United States leads among developed nations in its poor maternal mortality rates, referring to deaths during or up to one year after childbirth. These deaths — alongside maternal morbidity, or long-term health problems arising from pregnancy or childbirth — are growing problems nationally.
Centers for Disease Control and Prevention data for 2020 shows the maternal mortality rate was 23.8 deaths per 100,000 live births. But for non-Hispanic Black women, that number jumped to 55.3 deaths per 100,000 live births.
The data shows a 26 percent increase year-over-year in Black maternal deaths. Black women face three times higher maternal mortality rates than white women, even when accounting for other factors like income and education.
“You can look at folks like Serena Williams, Beyonce, and clearly they have some of the best health insurance,” said Black Maternal Health Caucus Co-Chair Alma Adams, D-N.C., at a Capital B event on April 14, referring to two celebrities who have spoken publicly about maternal health struggles.
“The situation today is worse than it was 25 years ago, and even 50 years ago for me when I had my son and my daughter, and that should not be.”
These maternal health disparities are not unique to the pandemic, with concern about the inequities increasingly a bipartisan issue.
Congress and the Biden administration have both taken some steps toward reducing maternal deaths.
Two provisions included in a 2021 legislative package known as the “Momnibus” have been enacted into law. The larger package would bundle 12 bills focused on improving maternal health in minority communities.
In November, President Joe Biden signed legislation that would improve maternity care coordination for veterans and require a report on maternal mortality and severe maternal morbidity among veterans, including a focus on minority populations.
And the fiscal 2022 spending law included language from a bill that would improve awareness of the safety and efficacy of vaccines for pregnant and postpartum women to increase vaccination rates.
Last year’s COVID-19 relief law gave states the ability to cover pregnant women up to 12 months post-pregnancy under Medicaid. Federal law requires states to cover 60 days postpartum.
The policy was approved for five years, but advocates also back a bipartisan bill to make the policy permanent.
Since it went into effect April 1, four states have already begun implementation. Michigan received federal approval on April 14, and several more are considering or implementing 12-month or somewhat shorter extensions.
Congressional concern
The largest focus for most maternal health advocates remains advancing the remaining pieces of the “Momnibus” package.
“You know, the politics of all this has really shifted,” Rep. Lauren Underwood, D-Ill., a caucus co-chair, said at a recent event with The Century Foundation. “We have bipartisan provisions of the Momnibus. We have a bipartisan Black Maternal Health Caucus. And we have folks who believe deeply in this mission of saving moms’ lives for deeply personal reasons.”
Eight of the 12 bills were included in the House-passed reconciliation package once known as the Build Back Better plan. Advocates still hope to see these elements included in some sort of legislative vehicle this year.
The bills include:
- One that would fund grants for community-based maternal health organizations that work with underserved groups.
- One that would establish grant programs for mothers with maternal mental health conditions and substance use disorders.
- One that would build programs to broaden and diversify the perinatal workforce and require HHS to distribute guidance on respectful maternity care.
“I have faith in our Senate colleagues that there is a deal to be had and that our maternal health provisions will remain in that legislation,” Underwood said, pointing to discussions on a second Momnibus that would focus on morbidity and other reproductive health issues.
Two senior House Democratic aides emphasized the importance of improving Black maternal health but did not disclose any specific upcoming initiatives. One of the aides pointed to the chamber’s work to include and pass more elements of the original Momnibus plan.
Both the House and Senate have passed similar bipartisan bills this year that would direct the Federal Communications Commission to include maternal health outcomes data in its broadband health mapping tool.
A spokesperson for Sen. Jacky Rosen, D-Nev., said she hopes Congress will be able to reconcile differences between her bill and the House version from Rep. G.K. Butterfield, D-N.C., to get the bill signed into law. While both Black Maternal Health Caucus co-chairs are Democrats, efforts to address maternal disparities are bipartisan.
Stacey Stewart, president of March of Dimes, said her group has had about 350 meetings with members of both parties on maternal and infant health legislation, including the “Momnibus,” since 2021.
“The issue of maternal health is uniquely bipartisan,” she said. “There are people from all walks of life and all parts of the political spectrum who really understand that, you know, it is a sign of our health as a country overall, how we invest in newborn babies and the pregnant people that give birth to them.”
Rep. Byron Donalds, R-Fla., said that while he is concerned by the maternal mortality discrepancies in the Black community, he thinks state governments are more suited to address these inequities.
“The issue at hand is inadequate standards of care in poorer neighborhood medical facilities that directly negatively impact maternal health,” said Donalds, one of two Black GOP House members. “Members of Congress cannot make laws to fix neglectful behavior, be it deliberate or unintentional. It is incumbent on medical institutions to self-police and ensure every patient receives exceptional medical treatment regardless of race.”
Appropriations vehicles
The annual appropriations process could be a vehicle for some maternal health policy changes. The White House’s fiscal 2022 budget request asks for $470 million in funding to reduce maternal mortality and morbidity across multiple agencies, including the CDC and the Health Resources and Services Administration.
That request would boost funding over fiscal 2022 enacted levels for existing efforts, including the CDC’s Maternal Mortality Review Committees and HRSA’s State Maternal Health Innovation Grants.
And it proposes pilot HRSA programs, including efforts that would fund implicit-bias training for health providers, grow and diversify the maternal workforce and support maternity medical homes.
The budget also calls for $86 million for the Office of Minority Health to focus on reducing disparities in areas with high rates of poor maternal outcomes and with higher rates of racial and ethnic disparities.
The American College of Obstetricians and Gynecologists told CQ Roll Call it urges lawmakers to support the administration’s budget requests for the Alliance for Innovation on Maternal Health, Women’s Preventive Services Initiative and Safe Motherhood and Infant Health.
The House Appropriations Committee is tentatively expected to begin marking up its 12 spending bills this summer. But the panel has not yet released any draft bill text.
Administrative steps
The White House also has ramped up efforts aimed at reducing maternal disparities.
Vice President Kamala Harris — who sponsored several bills on the issue as a senator — held a meeting with 14 Cabinet officials on April 13 on Black maternal health to discuss ongoing efforts and possible other remedies.
“This is an issue that is not just about health care, it is about treating a woman as a whole human being, understanding that if we are to expect and actually influence positive outcomes on this issue we must see her then as a whole human being,” said Harris.
The meeting came on the heels of the Centers for Medicare and Medicaid Services announcing details about the agency’s new birthing-friendly hospital designation to help patients choose the best care for them.
Hospitals that follow best practices related to maternal care and health equity and safety, and that work to improve the quality of maternal care, would be eligible to earn this designation.
CMS plays an important role in maternal care, as Medicaid funds more than four in 10 births nationwide.
“When we talk about the huge racial and ethnic inequities, Medicaid finances two-thirds of births among people who are Black and people who are Native American,” said Usha Ranji, associate director for women’s health policy at the Kaiser Family Foundation.
Since the federal COVID-19 public health emergency designation remains in place, no mothers who receive coverage would continue benefiting until the PHE ends.
“Nobody’s being dropped from coverage now, but the PHE might end this year,” Ranji said. “In which case, you know, we could start seeing postpartum drop-offs.”
