[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1212 Introduced in House (IH)]

<DOC>






117th CONGRESS
  1st Session
                                H. R. 1212

To end preventable maternal mortality and severe maternal morbidity in 
 the United States and close disparities in maternal health outcomes, 
                        and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 23, 2021

Ms. Adams (for herself, Ms. Underwood, Mr. Khanna, Ms. Velazquez, Mrs. 
 McBath, Mr. Smith of Washington, Ms. Scanlon, Mr. Lawson of Florida, 
 Mrs. Hayes, Mr. Butterfield, Ms. Moore of Wisconsin, Ms. Strickland, 
    Mr. Ryan, Mr. Schiff, Mr. Johnson of Georgia, Mr. Horsford, Ms. 
   Wasserman Schultz, Ms. Barragan, Mr. Deutch, Mr. Blumenauer, Mr. 
 Moulton, Mr. Soto, Mr. Nadler, Mr. Trone, Ms. Clarke of New York, Ms. 
Schakowsky, Ms. Bass, Ms. Pressley, Mr. Evans, Ms. Blunt Rochester, Ms. 
Castor of Florida, Ms. Sewell, and Ms. Williams of Georgia) introduced 
 the following bill; which was referred to the Committee on Energy and 
                                Commerce

_______________________________________________________________________

                                 A BILL


 
To end preventable maternal mortality and severe maternal morbidity in 
 the United States and close disparities in maternal health outcomes, 
                        and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Kira Johnson Act''.

SEC. 2. INVESTMENTS IN COMMUNITY-BASED ORGANIZATIONS TO IMPROVE BLACK 
              MATERNAL HEALTH OUTCOMES.

    (a) Awards.--Following the 1-year period described in subsection 
(c), the Secretary of Health and Human Services (in this section 
referred to as the ``Secretary'') shall award grants to eligible 
entities to establish or expand programs to prevent maternal mortality 
and severe maternal morbidity among Black pregnant and postpartum 
individuals.
    (b) Eligibility.--To be eligible to seek a grant under this 
section, an entity shall be a community-based organization offering 
programs and resources aligned with evidence-based practices for 
improving maternal health outcomes for Black pregnant and postpartum 
individuals.
    (c) Outreach and Technical Assistance Period.--During the 1-year 
period beginning on the date of enactment of this Act, the Secretary 
shall--
            (1) conduct outreach to encourage eligible entities to 
        apply for grants under this section; and
            (2) provide technical assistance to eligible entities on 
        best practices for applying for grants under this section.
    (d) Special Consideration.--
            (1) Outreach.--In conducting outreach under subsection (c), 
        the Secretary shall give special consideration to eligible 
        entities that--
                    (A) are based in, and provide support for, 
                communities with high rates of adverse maternal health 
                outcomes or significant racial and ethnic disparities 
                in maternal health outcomes, to the extent such data 
                are available;
                    (B) are led by Black women; and
                    (C) offer programs and resources that are aligned 
                with evidence-based practices for improving maternal 
                health outcomes for Black pregnant and postpartum 
                individuals.
            (2) Awards.--In awarding grants under this section, the 
        Secretary shall give special consideration to eligible entities 
        that--
                    (A) are described in subparagraphs (A), (B), and 
                (C) of paragraph (1);
                    (B) offer programs and resources designed in 
                consultation with and intended for Black pregnant and 
                postpartum individuals; and
                    (C) offer programs and resources in the communities 
                in which the respective eligible entities are located 
                that--
                            (i) promote maternal mental health and 
                        maternal substance use disorder treatments and 
                        supports that are aligned with evidence-based 
                        practices for improving maternal mental and 
                        behavioral health outcomes for Black pregnant 
                        and postpartum individuals;
                            (ii) address social determinants of 
                        maternal health for pregnant and postpartum 
                        individuals;
                            (iii) promote evidence-based health 
                        literacy and pregnancy, childbirth, and 
                        parenting education for pregnant and postpartum 
                        individuals;
                            (iv) provide support from perinatal health 
                        workers to pregnant and postpartum individuals;
                            (v) provide culturally congruent training 
                        to perinatal health workers;
                            (vi) conduct or support research on 
                        maternal health issues disproportionately 
                        impacting Black pregnant and postpartum 
                        individuals;
                            (vii) provide support to family members of 
                        individuals who suffered a pregnancy-associated 
                        death or pregnancy-related death;
                            (viii) operate midwifery practices that 
                        provide culturally congruent maternal health 
                        care and support, including for the purposes 
                        of--
                                    (I) supporting additional 
                                education, training, and certification 
                                programs, including support for 
                                distance learning;
                                    (II) providing financial support to 
                                current and future midwives to address 
                                education costs, debts, and other 
                                needs;
                                    (III) clinical site investments;
                                    (IV) supporting preceptor 
                                development trainings;
                                    (V) expanding the midwifery 
                                practice; or
                                    (VI) related needs identified by 
                                the midwifery practice and described in 
                                the practice's application; or
                            (ix) have developed other programs and 
                        resources that address community-specific needs 
                        for pregnant and postpartum individuals and are 
                        aligned with evidence-based practices for 
                        improving maternal health outcomes for Black 
                        pregnant and postpartum individuals.
    (e) Technical Assistance.--The Secretary shall provide to grant 
recipients under this section technical assistance on--
            (1) capacity building to establish or expand programs to 
        prevent adverse maternal health outcomes among Black pregnant 
        and postpartum individuals;
            (2) best practices in data collection, measurement, 
        evaluation, and reporting; and
            (3) planning for sustaining programs to prevent maternal 
        mortality and severe maternal morbidity among Black pregnant 
        and postpartum individuals after the period of the grant.
    (f) Evaluation.--Not later than the end of fiscal year 2026, the 
Secretary shall submit to the Congress an evaluation of the grant 
program under this section that--
            (1) assesses the effectiveness of outreach efforts during 
        the application process in diversifying the pool of grant 
        recipients;
            (2) makes recommendations for future outreach efforts to 
        diversify the pool of grant recipients for Department of Health 
        and Human Services grant programs and funding opportunities 
        related to maternal health;
            (3) assesses the effectiveness of programs funded by grants 
        under this section in improving maternal health outcomes for 
        Black pregnant and postpartum individuals, to the extent 
        practicable; and
            (4) makes recommendations for future Department of Health 
        and Human Services grant programs and funding opportunities 
        that deliver funding to community-based organizations that 
        provide programs and resources that are aligned with evidence-
        based practices for improving maternal health outcomes for 
        Black pregnant and postpartum individuals.
    (g) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $10,000,000 for each of fiscal 
years 2022 through 2026.

SEC. 3. INVESTMENTS IN COMMUNITY-BASED ORGANIZATIONS TO IMPROVE 
              MATERNAL HEALTH OUTCOMES IN UNDERSERVED COMMUNITIES.

    (a) Awards.--Following the 1-year period described in subsection 
(c), the Secretary of Health and Human Services (in this section 
referred to as the ``Secretary'') shall award grants to eligible 
entities to establish or expand programs to prevent maternal mortality 
and severe maternal morbidity among underserved groups.
    (b) Eligibility.--To be eligible to seek a grant under this 
section, an entity shall be a community-based organization offering 
programs and resources aligned with evidence-based practices for 
improving maternal health outcomes for pregnant and postpartum 
individuals.
    (c) Outreach and Technical Assistance Period.--During the 1-year 
period beginning on the date of enactment of this Act, the Secretary 
shall--
            (1) conduct outreach to encourage eligible entities to 
        apply for grants under this section; and
            (2) provide technical assistance to eligible entities on 
        best practices for applying for grants under this section.
    (d) Special Consideration.--
            (1) Outreach.--In conducting outreach under subsection (c), 
        the Secretary shall give special consideration to eligible 
        entities that--
                    (A) are based in, and provide support for, 
                communities with high rates of adverse maternal health 
                outcomes or significant racial and ethnic disparities 
                in maternal health outcomes, to the extent such data 
                are available;
                    (B) are led by individuals from racially, 
                ethnically, and geographically diverse backgrounds; and
                    (C) offer programs and resources that are aligned 
                with evidence-based practices for improving maternal 
                health outcomes for pregnant and postpartum 
                individuals.
            (2) Awards.--In awarding grants under this section, the 
        Secretary shall give special consideration to eligible entities 
        that--
                    (A) are described in subparagraphs (A), (B), and 
                (C) of paragraph (1);
                    (B) offer programs and resources designed in 
                consultation with and intended for pregnant and 
                postpartum individuals from underserved groups; and
                    (C) offer programs and resources in the communities 
                in which the respective eligible entities are located 
                that--
                            (i) promote maternal mental health and 
                        maternal substance use disorder treatments and 
                        support that are aligned with evidence-based 
                        practices for improving maternal mental and 
                        behavioral health outcomes for pregnant and 
                        postpartum individuals;
                            (ii) address social determinants of 
                        maternal health for pregnant and postpartum 
                        individuals;
                            (iii) promote evidence-based health 
                        literacy and pregnancy, childbirth, and 
                        parenting education for pregnant and postpartum 
                        individuals;
                            (iv) provide support from perinatal health 
                        workers to pregnant and postpartum individuals;
                            (v) provide culturally congruent training 
                        to perinatal health workers;
                            (vi) conduct or support research on 
                        maternal health outcomes and disparities;
                            (vii) provide support to family members of 
                        individuals who suffered a pregnancy-associated 
                        death or pregnancy-related death;
                            (viii) operate midwifery practices that 
                        provide culturally congruent maternal health 
                        care and support, including for the purposes 
                        of--
                                    (I) supporting additional 
                                education, training, and certification 
                                programs, including support for 
                                distance learning;
                                    (II) providing financial support to 
                                current and future midwives to address 
                                education costs, debts, and other 
                                needs;
                                    (III) clinical site investments;
                                    (IV) supporting preceptor 
                                development trainings;
                                    (V) expanding the midwifery 
                                practice; or
                                    (VI) related needs identified by 
                                the midwifery practice and described in 
                                the practice's application; or
                            (ix) have developed other programs and 
                        resources that address community-specific needs 
                        for pregnant and postpartum individuals and are 
                        aligned with evidence-based practices for 
                        improving maternal health outcomes for pregnant 
                        and postpartum individuals.
    (e) Technical Assistance.--The Secretary shall provide to grant 
recipients under this section technical assistance on--
            (1) capacity building to establish or expand programs to 
        prevent adverse maternal health outcomes among pregnant and 
        postpartum individuals from underserved groups;
            (2) best practices in data collection, measurement, 
        evaluation, and reporting; and
            (3) planning for sustaining programs to prevent maternal 
        mortality and severe maternal morbidity among pregnant and 
        postpartum individuals from underserved groups after the period 
        of the grant.
    (f) Evaluation.--Not later than the end of fiscal year 2026, the 
Secretary shall submit to the Congress an evaluation of the grant 
program under this section that--
            (1) assesses the effectiveness of outreach efforts during 
        the application process in diversifying the pool of grant 
        recipients;
            (2) makes recommendations for future outreach efforts to 
        diversify the pool of grant recipients for Department of Health 
        and Human Services grant programs and funding opportunities 
        related to maternal health;
            (3) assesses the effectiveness of programs funded by grants 
        under this section in improving maternal health outcomes for 
        pregnant and postpartum individuals from underserved groups, to 
        the extent practicable; and
            (4) makes recommendations for future Department of Health 
        and Human Services grant programs and funding opportunities 
        that deliver funding to community-based organizations that 
        provide programs and resources that are aligned with evidence-
        based practices for improving maternal health outcomes for 
        pregnant and postpartum individuals.
    (g) Definition.--In this section, the term ``underserved groups'' 
refers to pregnant and postpartum individuals--
            (1) from racial and ethnic minority groups (as such term is 
        defined in section 1707(g)(1) of the Public Health Service Act 
        (42 U.S.C. 300u-6(g)(1)));
            (2) whose household income is equal to or less than 150 
        percent of the Federal poverty line;
            (3) who live in health professional shortage areas (as such 
        term is defined in section 332 of the Public Health Service Act 
        (42 U.S.C. 254e(a)(1)));
            (4) who live in counties with no hospital offering 
        obstetric care, no birth center, and no obstetric provider; or
            (5) who live in counties with a level of vulnerability of 
        moderate-to-high or higher, according to the Social 
        Vulnerability Index of the Centers for Disease Control and 
        Prevention.
    (h) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $10,000,000 for each of fiscal 
years 2022 through 2026.

SEC. 4. RESPECTFUL MATERNITY CARE TRAINING FOR ALL EMPLOYEES IN 
              MATERNITY CARE SETTINGS.

    Part B of title VII of the Public Health Service Act (42 U.S.C. 293 
et seq.) is amended by adding at the end the following new section:

``SEC. 742. RESPECTFUL MATERNITY CARE TRAINING FOR ALL EMPLOYEES IN 
              MATERNITY CARE SETTINGS.

    ``(a) Grants.--The Secretary shall award grants for programs to 
reduce and prevent bias, racism, and discrimination in maternity care 
settings and to advance respectful, culturally congruent, trauma-
informed care.
    ``(b) Special Consideration.--In awarding grants under subsection 
(a), the Secretary shall give special consideration to applications for 
programs that would--
            ``(1) apply to all maternity care providers (as defined in 
        section 8 of the Kira Johnson Act) and any employees who 
        interact with pregnant and postpartum individuals in the 
        provider setting, including front desk employees, sonographers, 
        schedulers, health care professionals, hospital or health 
        system administrators, security staff, and other employees;
            ``(2) emphasize periodic, as opposed to one-time, trainings 
        for all birthing professionals and employees described in 
        paragraph (1);
            ``(3) address implicit bias, racism, and cultural humility;
            ``(4) be delivered in ongoing education settings for 
        providers maintaining their licenses, with a preference for 
        trainings that provide continuing education units;
            ``(5) include trauma-informed care best practices and an 
        emphasis on shared decision making between providers and 
        patients;
            ``(6) include antiracism training and programs;
            ``(7) be delivered in undergraduate programs that funnel 
        into health professions schools;
            ``(8) be delivered in settings that apply to providers of 
        the special supplemental nutrition program for women, infants, 
        and children under section 17 of the Child Nutrition Act of 
        1966;
            ``(9) integrate bias training in obstetric emergency 
        simulation trainings or related trainings;
            ``(10) include training for emergency department employees 
        and emergency medical technicians on recognizing warning signs 
        for severe pregnancy-related complications;
            ``(11) offer training to all maternity care providers on 
        the value of racially, ethnically, and professionally diverse 
        maternity care teams to provide culturally congruent care; or
            ``(12) be based on one or more programs designed by a 
        historically Black college or university or other minority-
        serving institution.
    ``(c) Application.--To seek a grant under subsection (a), an entity 
shall submit an application at such time, in such manner, and 
containing such information as the Secretary may require.
    ``(d) Reporting.--Each recipient of a grant under this section 
shall annually submit to the Secretary a report on the status of 
activities conducted using the grant, including, as applicable, a 
description of the impact of training provided through the grant on 
patient outcomes and patient experience for pregnant and postpartum 
individuals from racial and ethnic minority groups and their families.
    ``(e) Best Practices.--Based on the annual reports submitted 
pursuant to subsection (d), the Secretary--
            ``(1) shall produce an annual report on the findings 
        resulting from programs funded through this section;
            ``(2) shall disseminate such report to all recipients of 
        grants under this section and to the public; and
            ``(3) may include in such report findings on best practices 
        for improving patient outcomes and patient experience for 
        pregnant and postpartum individuals from racial and ethnic 
        minority groups and their families in maternity care settings.
    ``(f) Definitions.--In this section:
            ``(1) The term `postpartum' means the one-year period 
        beginning on the last day of an individual's pregnancy.
            ``(2) The term `culturally congruent' means in agreement 
        with the preferred cultural values, beliefs, world view, 
        language, and practices of the health care consumer and other 
        stakeholders.
            ``(3) The term `racial and ethnic minority group' has the 
        meaning given such term in section 1707(g)(1).
    ``(g) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $5,000,000 for each of fiscal 
years 2022 through 2026.''.

SEC. 5. STUDY ON REDUCING AND PREVENTING BIAS, RACISM, AND 
              DISCRIMINATION IN MATERNITY CARE SETTINGS.

    (a) In General.--The Secretary of Health and Human Services shall 
seek to enter into an agreement, not later than 90 days after the date 
of enactment of this Act, with the National Academies of Sciences, 
Engineering, and Medicine (referred to in this section as the 
``National Academies'') under which the National Academies agree to--
            (1) conduct a study on the design and implementation of 
        programs to reduce and prevent bias, racism, and discrimination 
        in maternity care settings and to advance respectful, 
        culturally congruent, trauma-informed care; and
            (2) not later than 24 months after the date of enactment of 
        this Act--
                    (A) complete the study; and
                    (B) transmit a report on the results of the study 
                to the Congress.
    (b) Possible Topics.--The agreement entered into pursuant to 
subsection (a) may provide for the study of any of the following:
            (1) The development of a scorecard or other evaluation 
        standards for programs designed to reduce and prevent bias, 
        racism, and discrimination in maternity care settings to assess 
        the effectiveness of such programs in improving patient 
        outcomes and patient experience for pregnant and postpartum 
        individuals from racial and ethnic minority groups and their 
        families.
            (2) Determination of the types and frequency of training to 
        reduce and prevent bias, racism, and discrimination in 
        maternity care settings that are demonstrated to improve 
        patient outcomes or patient experience for pregnant and 
        postpartum individuals from racial and ethnic minority groups 
        and their families.

SEC. 6. RESPECTFUL MATERNITY CARE COMPLIANCE PROGRAM.

    (a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the ``Secretary'') shall award grants 
to accredited hospitals, health systems, and other maternity care 
settings to establish as an integral part of quality implementation 
initiatives within one or more hospitals or other birth settings a 
respectful maternity care compliance program.
    (b) Program Requirements.--A respectful maternity care compliance 
program funded through a grant under this section shall--
            (1) institutionalize mechanisms to allow patients receiving 
        maternity care services, the families of such patients, or 
        perinatal health workers supporting such patients to report 
        instances of racism or evidence of bias on the basis of race, 
        ethnicity, or another protected class;
            (2) institutionalize response mechanisms through which 
        representatives of the program can directly follow up with the 
        patient, if possible, and the patient's family in a timely 
        manner;
            (3) prepare and make publicly available a hospital- or 
        health system-wide strategy to reduce bias on the basis of 
        race, ethnicity, or another protected class in the delivery of 
        maternity care that includes--
                    (A) information on the training programs to reduce 
                and prevent bias, racism, and discrimination on the 
                basis of race, ethnicity, or another protected class 
                for all employees in maternity care settings;
                    (B) information on the number of cases reported to 
                the compliance program; and
                    (C) the development of methods to routinely assess 
                the extent to which bias, racism, or discrimination on 
                the basis of race, ethnicity, or another protected 
                class are present in the delivery of maternity care to 
                patients from racial and ethnic minority groups; and
            (4) develop mechanisms to routinely collect and publicly 
        report hospital-level data related to patient-reported 
        experience of care; and
            (5) provide annual reports to the Secretary with 
        information about each case reported to the compliance program 
        over the course of the year containing such information as the 
        Secretary may require, such as--
                    (A) de-identified demographic information on the 
                patient in the case, such as race, ethnicity, gender 
                identity, and primary language;
                    (B) the content of the report from the patient or 
                the family of the patient to the compliance program;
                    (C) the response from the compliance program; and
                    (D) to the extent applicable, institutional changes 
                made as a result of the case.
    (c) Secretary Requirements.--
            (1) Processes.--Not later than 180 days after the date of 
        enactment of this Act, the Secretary shall establish processes 
        for--
                    (A) disseminating best practices for establishing 
                and implementing a respectful maternity care compliance 
                program within a hospital or other birth setting;
                    (B) promoting coordination and collaboration 
                between hospitals, health systems, and other maternity 
                care delivery settings on the establishment and 
                implementation of respectful maternity care compliance 
                programs; and
                    (C) evaluating the effectiveness of respectful 
                maternity care compliance programs on maternal health 
                outcomes and patient and family experiences, especially 
                for patients from racial and ethnic minority groups and 
                their families.
            (2) Study.--
                    (A) In general.--Not later than 2 years after the 
                date of enactment of this Act, the Secretary shall, 
                through a contract with an independent research 
                organization, conduct a study on strategies to 
                address--
                            (i) racism or bias on the basis of race, 
                        ethnicity, or another protected class in the 
                        delivery of maternity care services; and
                            (ii) successful implementation of 
                        respectful care initiatives.
                    (B) Components of study.--The study shall include 
                the following:
                            (i) An assessment of the reports submitted 
                        to the Secretary from the respectful maternity 
                        care compliance programs pursuant to subsection 
                        (b)(5).
                            (ii) Based on such assessment, 
                        recommendations for potential accountability 
                        mechanisms related to cases of racism or bias 
                        on the basis of race, ethnicity, or another 
                        protected class in the delivery of maternity 
                        care services at hospitals and other birth 
                        settings. Such recommendations shall take into 
                        consideration medical and non-medical factors 
                        that contribute to adverse patient experiences 
                        and maternal health outcomes.
                    (C) Report.--The Secretary shall submit to the 
                Congress and make publicly available a report on the 
                results of the study under this paragraph.
    (d) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated such sums as may be necessary 
for fiscal years 2022 through 2027.

SEC. 7. GAO REPORT.

    (a) In General.--Not later than 2 years after the date of enactment 
of this Act and annually thereafter, the Comptroller General of the 
United States shall submit to the Congress and make publicly available 
a report on the establishment of respectful maternity care compliance 
programs within hospitals, health systems, and other maternity care 
settings.
    (b) Matters Included.--The report under paragraph (1) shall include 
the following:
            (1) Information regarding the extent to which hospitals, 
        health systems, and other maternity care settings have elected 
        to establish respectful maternity care compliance programs, 
        including--
                    (A) which hospitals and other birth settings elect 
                to establish compliance programs and when such programs 
                are established;
                    (B) to the extent practicable, impacts of the 
                establishment of such programs on maternal health 
                outcomes and patient and family experiences in the 
                hospitals and other birth settings that have 
                established such programs, especially for patients from 
                racial and ethnic minority groups and their families;
                    (C) information on geographic areas, and types of 
                hospitals or other birth settings, where respectful 
                maternity care compliance programs are not being 
                established and information on factors contributing to 
                decisions to not establish such programs; and
                    (D) recommendations for establishing respectful 
                maternity care compliance programs in geographic areas, 
                and types of hospitals or other birth settings, where 
                such programs are not being established.
            (2) Whether the funding made available to carry out this 
        section has been sufficient and, if applicable, recommendations 
        for additional appropriations to carry out this section.
            (3) Such other information as the Comptroller General 
        determines appropriate.

SEC. 8. DEFINITIONS.

    In this Act:
            (1) Culturally congruent.--The term ``culturally 
        congruent'', with respect to care or maternity care, means care 
        that is in agreement with the preferred cultural values, 
        beliefs, worldview, language, and practices of the health care 
        consumer and other stakeholders.
            (2) Maternity care provider.--The term ``maternity care 
        provider'' means a health care provider who--
                    (A) is a physician, physician assistant, midwife 
                who meets at a minimum the international definition of 
                the midwife and global standards for midwifery 
                education as established by the International 
                Confederation of Midwives, nurse practitioner, or 
                clinical nurse specialist; and
                    (B) has a focus on maternal or perinatal health.
            (3) Maternal mortality.--The term ``maternal mortality'' 
        means a death occurring during or within a one-year period 
        after pregnancy, caused by pregnancy-related or childbirth 
        complications, including a suicide, overdose, or other death 
        resulting from a mental health or substance use disorder 
        attributed to or aggravated by pregnancy-related or childbirth 
        complications.
            (4) Perinatal health worker.--The term ``perinatal health 
        worker'' means a doula, community health worker, peer 
        supporter, breastfeeding and lactation educator or counselor, 
        nutritionist or dietitian, childbirth educator, social worker, 
        home visitor, language interpreter, or navigator.
            (5) Postpartum and postpartum period.--The terms 
        ``postpartum'' and ``postpartum period'' refer to the 1-year 
        period beginning on the last day of the pregnancy of an 
        individual.
            (6) Pregnancy-associated death.--The term ``pregnancy-
        associated death'' means a death of a pregnant or postpartum 
        individual, by any cause, that occurs during, or within 1 year 
        following, the individual's pregnancy, regardless of the 
        outcome, duration, or site of the pregnancy.
            (7) Pregnancy-related death.--The term ``pregnancy-related 
        death'' means a death of a pregnant or postpartum individual 
        that occurs during, or within 1 year following, the 
        individual's pregnancy, from a pregnancy complication, a chain 
        of events initiated by pregnancy, or the aggravation of an 
        unrelated condition by the physiologic effects of pregnancy.
            (8) Racial and ethnic minority group.--The term ``racial 
        and ethnic minority group'' has the meaning given such term in 
        section 1707(g)(1) of the Public Health Service Act (42 U.S.C. 
        300u-6(g)(1)).
            (9) Severe maternal morbidity.--The term ``severe maternal 
        morbidity'' means a health condition, including mental health 
        conditions and substance use disorders, attributed to or 
        aggravated by pregnancy or childbirth that results in 
        significant short-term or long-term consequences to the health 
        of the individual who was pregnant.
            (10) Social determinants of maternal health defined.--The 
        term ``social determinants of maternal health'' means non-
        clinical factors that impact maternal health outcomes, 
        including--
                    (A) economic factors, which may include poverty, 
                employment, food security, support for and access to 
                lactation and other infant feeding options, housing 
                stability, and related factors;
                    (B) neighborhood factors, which may include quality 
                of housing, access to transportation, access to child 
                care, availability of healthy foods and nutrition 
                counseling, availability of clean water, air and water 
                quality, ambient temperatures, neighborhood crime and 
                violence, access to broadband, and related factors;
                    (C) social and community factors, which may include 
                systemic racism, gender discrimination or 
                discrimination based on other protected classes, 
                workplace conditions, incarceration, and related 
                factors;
                    (D) household factors, which may include ability to 
                conduct lead testing and abatement, car seat 
                installation, indoor air temperatures, and related 
                factors;
                    (E) education access and quality factors, which may 
                include educational attainment, language and literacy, 
                and related factors; and
                    (F) health care access factors, including health 
                insurance coverage, access to culturally congruent 
                health care services, providers, and non-clinical 
                support, access to home visiting services, access to 
                wellness and stress management programs, health 
                literacy, access to telehealth and items required to 
                receive telehealth services, and related factors.
                                 <all>