Democrats seek to boost maternal-health research

With the contours of the Democrats' social-spending bill coming into focus, health advocates are hoping investments in maternal-mortality research will get across the finish line.

House Democrats unveiled preliminary language Thursday afternoon that includes money for data-collection efforts to track and study maternal health. The Democrats' bill borrowed several maternal-health proposals, including data-collection and research provisions, from the Black Maternal Health Momnibus Act.

The legislation would provide $80 million to expand the work of maternal-mortality review committees and to promote community engagement with these groups.

The panels, which operate in states and localities across the country, include various experts such as gynecologists, forensic pathologists, and community groups, among others. They examine cases of death within a year of pregnancy.

"These maternal-mortality review committees can really promote the kind of community engagement that you need to have good data, and then also to come up with good solutions based on that data for what to do," Sen. Tina Smith of Minnesota said.

Smith has sponsored legislation with similar goals to what lawmakers included in the reconciliation language released Thursday. Her Data to Save Moms Act would provide funds to enhance community engagement in these review committees and to colleges and universities serving minority populations to study maternal mortality and morbidity.

"Too often, solutions for these kinds of problems are kind of imposed from the top down and not coming through folks in the community who know what to do," she said. "That is why I think these maternal-mortality review committees offer such promise for not only getting to the data and the facts that we need, but then also figuring out what to do."

Rep. Sharice Davids of Kansas, who sponsored the House version of the Data to Save Moms Act, said she was pleased to see the policies included in the reconciliation legislation.

"The U.S. is falling desperately short on the issue of maternal health, and frankly, it is shameful—but we can't fix a problem we don't understand," Davids said in an emailed statement to National Journal.

A policy recommendation from maternal-mortality review committees in several states is reflected in the Democratic reconciliation proposal: the extension of Medicaid postpartum coverage beyond 60 days.

The American Rescue Plan Act, which was passed into law in March, provided states with the temporary option to extend postpartum coverage in Medicaid from 60 days to one year. But the Democrats' Build Back Better Act proposal would make this a mandatory policy for all states.

"This is actually a recommendation that we've seen come out of a growing number of maternal-mortality review committees," said Rachel Tetlow, federal-affairs director at the American College of Obstetricians and Gynecologists. "They are finding increasingly that there are a number of maternal deaths that are happening in that postpartum period outside of that 60-day window."

But data collection between the different review committees can be inconsistent, said Rebecca Abbott, director of government relations at the Society for Maternal-Fetal Medicine. "How [maternal-mortality review committees] are measuring deaths, what counts, do they look at suicides or overdoses or not—all of that's kind of different by state, and so the funding is really important on that side to make sure that we have an understanding," Abbott said.

"This extra funding from [the Centers for Disease Control and Prevention] will really create that even playing field and also create a standardization of definition across the review committees, and also help to kind of aggregate the data that's coming out of them," she added.

The funding in the House proposal also aims to boost diversity in the committees and include groups and individuals who are especially affected by pregnancy-related deaths and lack of access to maternal care. The Center for Reproductive Rights's Breana Lipscomb described this as a "critical piece."

"Just a couple of years ago, a lot of the state maternal-mortality review committees were primarily driven or attended by physicians or nurses or individuals from clinical settings," said Lipscomb, who is the senior manager of the maternal-health and human-rights initiative at the Center. "There was really no perspective of the community in those discussions."

Lipscomb added that key issues, like barriers that prevented access to care and questions around the quality of care, were left out of the committees' consideration. "If that's not part of the discussion, then that impacts the recommendations that come out from these committees, and then of course that impacts the funding and other policy and programmatic decisions that are made, particularly at the state level," she said.

Another provision includes $100 million that would go to support a system within the CDC that tracks the effects of new health threats on pregnant people and babies. The money would support the analysis of clinical data to observe the impact of COVID-19 on pregnant and postpartum patients.

The system builds on a registry used to collect health information on pregnant people who had Zika and their infants. K.J. Hertz, senior director of federal affairs at March of Dimes, said funding for this system has lagged over the years.

"Funding really wasn't sustained to the degree to keep programs going in every state around the country, so we're really looking to get an additional investment in that initiative so that could be taken to scale nationwide," Hertz said.

Smith said she also strongly supports the provision because such research would help detect future concerns for pregnant people.

"It is just good public-health strategy to be able to look out and identify what are the systemic issues that are going to be creating problems for pregnant women looking forward," she said. "A perfect example of that, obviously, is the threats of pandemic illnesses that cause women to not get the prenatal care that they need, [and] threats around substance-abuse issues and how those substance-abuse issues affect women as they are seeking to get the very best prenatal care. ... But it's important to look out and try to identify what's coming."