Hearing: “Improving Maternal Health: Legislation to Advance Prevention Efforts and Access to Care.”
Mom Congress
On September 10, the House Subcommittee on Health of the Committee on Energy and Commerce held a hearing entitled, “Improving Maternal Health: Legislation to Advance Prevention Efforts and Access to Care” which focused on the four bills to improve women’s maternal health in the United States: Mothers and Offspring Mortality and Morbidity Awareness Act, Quality Care for Moms and Babies Act, Maternal Care Access and Reducing Emergencies Act, and the Healthy MOMMIES Act. Although the hearing intented to discuss the four bills, the majority of discussion was focused on the dangers new mothers in the United States face, such as health care coverage, depression, and racism in care. The subcommittee remained bipartisan, with shared desires to address maternal mortality, especially among minorities, and to increase coverage.
Chairwoman, Representative Anna Eshoo (D-CA)
Key Takeaways:
33% of maternal deaths happen one week to one-year post-partum. To combat this, Medicaid needs expanded.
Black women are three to four times more likely die from a pregnancy-related cause.
Native American women are 2.5 more likely than other races to suffer a pregnancy-related death.
Leading cause for maternal deaths in the U.S. are cardiovascular conditions, but mental health is on the rise.
Hearing Summary/Opening Statements:
(Chairwoman) Representative Anna Eshoo (D-CA):
Four bills they’re considering to improve maternal health.
Black and Native American women are three to four times more likely than white women to die from a pregnancy-related cause.
Women are more likely to die following delivery than before, but many women don’t have the insurance for necessary care.
U.S. is the most dangerous place in the developed world to have a baby.
More than 60% of maternal deaths are preventable.
(Ranking Member) Representative Michael Burgess (R-TX):
Wants to create maternal mortality boards like Texas’s to guide health policy.
Supports dialogue of the four bills but unsure if they’d make a difference.
As a former health practitioner, combatting maternal mortality is one of his top priorities.
Supported H.R.1318 last year (Preventing Maternal Deaths Act).
Witnesses:
Wanda Irving, Mother of Dr. Shalon Irving (testimony)
Her daughter Shalon died three weeks after delivering a baby from cardiac arrest.
In the three weeks after Shalon gave birth, she suffered from elevated blood pressure, leg swelling, decreased urine output, weight-gain, and headaches.
Wanda is furious because she believed her daughter wasn’t properly treated.
Her three takeaways from her testimony: “not every maternal morality is because of lack of insurance, non-access to care, poverty or lack of education, the majority of maternal deaths are preventable, and we must demand that postpartum care be redefined and optimized.”
Patrice Harris, M.D., President of American Medical Association Board of Trustees (testimony)
Discussed the rising maternal mortality and morbidity rates in the U.S.
Black women are three to four times more likely than white women to die from pregnancy-related causes.
Said that Medicaid has been successful in maternal outcomes for low-income women, and urged Congress to safeguard Medicaid funding.
Urged Congress to ensure Medicaid coverage for one-year post-partum because 33% of maternal deaths happen one week to one-year post-partum.
Elizabeth A. Howell MD, MPP, Director, Blavatnik Family Women’s Health Research Institute, Icahn School of Medicine at Mount Sinai (testimony)
Leading causes of maternal deaths in the U.S. are cardiovascular conditions, but substance abuse disorders and mental health are on the rise.
For every death, over 100 women experience a severe complication related to pregnancy and childbirth resulting in maternal morbidity, which includes events such as stroke, blood clots, and kidney failure.
Over 60% of maternal mortality deaths are preventable.
David Nelson, M.D., Parkland Health and Hospital System; Assistant Professor of Obstetrics and Gynecology (testimony)
Works at one of the largest public maternity services in the country, with 12,671 women delivered last year.
97% of the 12,671 women access prenatal treatment prior to delivery, allowing experts to identify conditions such as hemorrhage, infection, hypertension, and diabetes.
Advocated for relevant clinical data to be reported to guide decisions for healthcare policy.
Usha Ranji, M.S., Associate Director, Women’s Health Policy, The Kaiser Family Foundation (testimony)
After the postpartum period, women who receive pregnancy-related services under Medicaid can be charged for care, which impedes access to care for low-income women and can be fatal.
There are several ways states can leverage Medicaid to enhance care and coverage for low-income pregnant women and after childbirth when they have become mothers. For instance, Illinois enacted an extension of Medicaid postpartum coverage to one year for women with incomes up to 200% of poverty.
Advocated for access to coverage for postpartum women because it can improve their use of critical services and lead to less fatalities.
Q&A Session:
(Chairwoman) Representative Anna Eshoo (D-CA)
What is the AMA doing to address racial bias?
Dr. Harriss
We haven’t begun any work with hospitals yet, but we are taking internal measures--hiring an equity officer.
(Chairwoman) Representative Anna Eshoo (D-CA)
How best do you recommend to us to address the various maternal mortality conditions, since most deaths are preventable?
Dr. Harris
We need standardized care practices based off evidence-based medicine, and we need to use metrics to assess the success of hospitals.
Representative Doris Matsui (D-CA)
In your holistic view, what is the link between coverage and quality of care?
Dr. Howell
Coverage is important pre-conception, antenatal, during delivery, and postnatal.
Representative Doris Matsui (D-CA)
What is the link between pregnancy, depression, and maternal outcomes?
Usha Ranji
Maternal mental health is a serious issue, and is a contributor to the maternal mortality and morbidity rates. It is an issue that doesn’t resolve in two months, and depending on the woman, care is needed several months.
Representative Greg Walden (R-OR)
Are there ways we can do better to improve maternal mental health?
Dr. Harris
We need to increase funding for mental health, specifically postpartum moms.