Congressional lawmakers are poised to reintroduce a sweeping package aimed at improving dismal maternal health outcomes in the U.S., particularly among Black mothers, with new proposals included to address the COVID-19 pandemic, climate change and vaccines.
Members of the Black Maternal Health Caucus are expected to reintroduce a package known as the Momnibus on Monday. The bipartisan caucus, led by Democratic Reps. Alma Adams of North Carolina and Lauren Underwood of Illinois, initially unveiled the package in March 2020, just days before the coronavirus pandemic would shut down much of the country.
“As I’ve said since the start of the COVID-19 pandemic, the disproportionate rate of mortality and morbidity among Black women is a crisis within a crisis,” Adams said, noting that many pregnant people have contracted COVID-19, the majority of whom are people of color. “As the pandemic rages on, access to quality maternal care has decreased as the barriers to receiving care have increased.”
Underwood tells U.S. News the pandemic has been devastating for pregnant people and has exacerbated existing disparities, particularly early on when hospital restrictions may have kept support people, like spouses or doulas, out of the delivery room.
“We cannot sit back,” she says.
According to a congressional staffer with knowledge of the legislation, much of the package coming next week will remain the same as last year’s. Bill text obtained by U.S. News shows it includes proposals to invest in community-based care for Black mothers; improve maternal health data collection; improve maternal health outcomes for incarcerated mothers; support programs to improve mental health for postpartum mothers; and examine policies on continuing health insurance coverage, including Medicaid, up to one year postpartum.
Three additional pieces of legislation included in the package this year deal with COVID-19 vaccination and data collection, as well as climate change. One measure is a bill introduced last August by Underwood – with a companion measure introduced by Sen. Elizabeth Warren, D-Mass. – called the Maternal Health Pandemic Response Act. It would require the Centers for Disease Control and Prevention to publicly post data on COVID-19 and pregnancy, disaggregated by race and ethnicity. Data on how COVID-19 impacts pregnant women has been limited, but the CDC says what’s available so far suggests pregnant women face a higher risk of severe illness and death.
The staffer also points out there isn’t enough data yet on COVID-19 vaccines and pregnancy, a fact which has caused frustration among some pregnant health care providers and maternal health advocates. Underwood says the lack of data has caused confusion for pregnant and lactating people on what to do when it comes to vaccines.
“This is a time for leadership and action, and we’ve heard that message loud and clear from our stakeholders,” she says.
According to a fact sheet on the legislation, the bill also would establish a task force on birthing experiences during the pandemic and promote research on the use of vaccines in pregnant populations. Influential physician groups the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine recently countered the World Health Organization’s stance that pregnant women who aren’t at high risk of exposure should not be given the Pfizer and Moderna vaccines currently deployed in the U.S. Both groups say pregnant women should be allowed to decide themselves whether to get a vaccine.
A second addition to the Momnibus package, called the Maternal Vaccination Act, would “help to increase maternal immunization rates to help promote the health of babies and moms during COVID-19 and beyond,” the staffer says. It would provide funding for educational programs to promote maternal and child vaccination.
A third addition expected in the coming package is aimed at addressing how environmental factors, including pollution, impact maternal and infant outcomes, stemming from a study published last June on the association of air pollution and heat exposure with preterm birth. The measure is called the Protecting Moms and Babies Against Climate Change Act, and is meant to home in on “the issues of environmental health and how climate change has an impact on maternal mortality and morbidity,” the staffer says. It calls for $100 million in funding for programs aimed at identifying climate change-related risks for pregnant and postpartum people, providing support for pregnant and postpartum people, and mitigating exposure.
Other tweaks to the Momnibus include adding funding to proposed grant programs aimed at improving maternal care for women of color in community-based settings. The new package doubles funding for a grant program targeted at Black women from $25 million to $50 million, and adds another $50 million for programs targeted at underserved populations.
“What we have found was a number of the groups thought that it would also be really helpful to provide similar funding … to other community-based organizations that are targeting other vulnerable populations” outside of Black women, the staffer says, including Latino women, Native women and veterans.
Additionally, a Momnibus measure that would provide grants to hospitals and health systems that establish a “respectful maternity care compliance office” – aimed at ensuring families are receiving maternal and infant care without bias or disrespect – now includes a provision to establish maternal health quality and safety programs in hospitals, along with a requirement for public reporting from those programs.
The coming package also builds upon a grant program included in the previous legislation that was aimed at training providers on bias and racial discrimination in medical schools. And it contains some language tweaks, including changing “pregnant and postpartum women” to “pregnant and postpartum individuals.”
The staffer says the changes that will be introduced Monday are meant to “meet this moment” – a public health crisis in which COVID-19 has threatened pregnant women.
A Senate companion package is also expected to be introduced next week, but this time with a new champion: Sen. Cory Booker, D-N.J., is stepping in for Vice President Kamala Harris, who introduced the package the first time while a senator from California. Underwood says the package coming this year will also be introduced in standalone bills in both the House and the Senate, with some of those bills co-sponsored by Republican lawmakers in the House.
“Because we know that there’s a possibility of some bills moving quicker than others,” Underwood explains. “While maternal mortality rates are decreasing around the world, they are increasing in the United States, and COVID-19 is making it worse. And so, you don’t have a moment to waste when it comes to … accelerating this legislative process. … I want to use every single tool that we have available.”
The package’s unveiling is expected to be just the start of action on maternal health in the new Congress. Last year, two maternal health bills – one aiming to fund rural health programs and another that would ease states’ ability to extend Medicaid coverage to low-income women up to one year after giving birth – passed the House but were never brought to the Senate floor for a vote. Those bills will be backed by Democratic Rep. Robin Kelly and are also expected to be reintroduced this month, Kelly’s office says.
Underwood says the momentum of the past year is exciting. “I’m expecting to see provisions signed into law this year,” she says. She adds the caucus is hoping to work with the Biden administration to see if some proposals can be achieved through regulatory or executive action.
“Everybody’s working together. And I think that there’s a shared sense of hope and optimism and excitement around this reintroduction. And, you know, we’re just going to be relentless,” she says.