[House Hearing, 117 Congress]
[From the U.S. Government Publishing Office]
BIRTHING WHILE BLACK:
EXAMINING AMERICA'S BLACK
MATERNAL HEALTH CRISIS
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON
OVERSIGHT AND REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED SEVENTEENTH CONGRESS
FIRST SESSION
__________
MAY 6, 2021
__________
Serial No. 117-20
__________
Printed for the use of the Committee on Oversight and Reform
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available on: govinfo.gov,
oversight.house.gov or
docs.house.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
44-572 PDF WASHINGTON : 2021
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COMMITTEE ON OVERSIGHT AND REFORM
CAROLYN B. MALONEY, New York, Chairwoman
Eleanor Holmes Norton, District of James Comer, Kentucky, Ranking
Columbia Minority Member
Stephen F. Lynch, Massachusetts Jim Jordan, Ohio
Jim Cooper, Tennessee Paul A. Gosar, Arizona
Gerald E. Connolly, Virginia Virginia Foxx, North Carolina
Raja Krishnamoorthi, Illinois Jody B. Hice, Georgia
Jamie Raskin, Maryland Glenn Grothman, Wisconsin
Ro Khanna, California Michael Cloud, Texas
Kweisi Mfume, Maryland Bob Gibbs, Ohio
Alexandria Ocasio-Cortez, New York Clay Higgins, Louisiana
Rashida Tlaib, Michigan Ralph Norman, South Carolina
Katie Porter, California Pete Sessions, Texas
Cori Bush, Missouri Fred Keller, Pennsylvania
Danny K. Davis, Illinois Andy Biggs, Arizona
Debbie Wasserman Schultz, Florida Andrew Clyde, Georgia
Peter Welch, Vermont Nancy Mace, South Carolina
Henry C. ``Hank'' Johnson, Jr., Scott Franklin, Florida
Georgia Jake LaTurner, Kansas
John P. Sarbanes, Maryland Pat Fallon, Texas
Jackie Speier, California Yvette Herrell, New Mexico
Robin L. Kelly, Illinois Byron Donalds, Florida
Brenda L. Lawrence, Michigan
Mark DeSaulnier, California
Jimmy Gomez, California
Ayanna Pressley, Massachusetts
Mike Quigley, Illinois
David Rapallo, Staff Director
Tori Anderson, Deputy Chief Oversight Counsel
Elisa LaNier, Chief Clerk
Contact Number: 202-225-5051
Mark Marin, Minority Staff Director
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C O N T E N T S
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Page
Hearing held on May 6, 2021...................................... 1
Witnesses
Panel 1
The Honorable Ayanna Pressley, Member of Congress, 7th District
of Massachusetts
Oral Statement............................................... 8
The Honorable Cori Bush, Member of Congress, 1st District of
Missouri
Oral Statement............................................... 9
The Honorable Alma S. Adams, Ph.D., Member of Congress, 12th
District of North Carolina Co-Chair, Black Maternal Health
Caucus
Oral Statement............................................... 10
The Honorable Lauren Underwood Member of Congress, 14th District
of Illinois Co-Chair, Black Maternal Health Caucus
Oral Statement............................................... 12
Panel 2
Tatyana Ali, Actress and Advocate
Oral Statement............................................... 14
Charles Johnson, Husband of Kira Johnson and Founder of
4Kira4Moms
Oral Statement............................................... 16
Tamika Auguste, M.D., Chair of the Obstetrician and Gynecologist
Clinical Practice Council, MedStar Health
Oral Statement............................................... 19
Veronica Gillispie, M.D., F.A.C.O.G., M.S., Medical Director,
Louisiana Perinatal Quality Collaborative
Oral Statement............................................... 20
Joia Adele Crear-Perry, M.D., F.A.C.O.G., Founder and President,
National Birth Equity Collaborative
Oral Statement............................................... 22
Jamila Taylor, Ph.D., Director of Health Care Reform and Senior
Fellow The Century Foundation
Oral Statement............................................... 25
Written opening statements and statements for the witnesses are
available on the U.S. House of Representatives Document
Repository at: docs.house.gov.
INDEX OF DOCUMENTS
----------
Documents entered during the hearing by Unanimous Consent (UC),
and Questions for the Record (QFR's) are listed below.
* UC - Letter from Dr. David Nelson; submitted by Chairwoman
Maloney.
* UC - Report comparing in-person and audio-only virtual
prenatal visits; submitted by Chairwoman Maloney.
* UC - Article regarding patient perspectives on audio-only
prenatal visits amidst pandemic; submitted by Chairwoman
Maloney.
* UC - Article regarding false labor at term in singleton
pregnancies; submitted by Chairwoman Maloney.
* UC - Testimony from Dr. Heather Irobunda; submitted by Rep.
Ocasio-Cortez.
* UC - Testimony from Bruce McIntyre III, husband of Amber Rose
Isaac; submitted by Rep. Ocasio-Cortez.
* UC - Testimony from Carmen Mojica, midwife; submitted by Rep.
Ocasio-Cortez.
* UC - Testimony from Dr. Anne Gibeau, Director of Midwifery;
submitted by Rep. Ocasio-Cortez.
* UC - Testimony from Melissa Enama Bair, midwife; submitted by
Rep. Ocasio-Cortez.
* UC - Letter from Mothering Justice; submitted by Rep. Tlaib.
* UC - Letter from March of Dimes; submitted by Rep. Kelly.
* UC - Letter from Blue Cross Blue Shield Association;
submitted by Rep. Kelly.
* UC - Letter from the American Medical Association; submitted
by Rep. Kelly.
* UC - Report regarding improving maternal health in America;
submitted by Rep. LaTurner.
* QFRs to: Dr. Gillispie-Bell- State of LA, including response;
submitted by Rep. Connolly.
Documents are available at: docs.house.gov.
BIRTHING WHILE BLACK:
EXAMINING AMERICA'S BLACK
MATERNAL HEALTH CRISIS
----------
Thursday, May 6, 2021
House of Representatives,
Committee on Oversight and Reform,
Washington, D.C.
The committee met, pursuant to notice, at 11:12 a.m., in
room 2154 of the Rayburn House Office Building, Hon. Carolyn
Maloney [chairwoman of the committee] presiding.
Present: Representatives Maloney, Norton, Connolly, Raskin,
Khanna, Mfume, Ocasio-Cortez, Tlaib, Porter, Bush, Wasserman
Schultz, Welch, Johnson, Sarbanes, Kelly, DeSaulnier, Gomez,
Pressley, Comer, Foxx, Gibbs, Keller, Clyde, Mace, Franklin,
LaTurner, Fallon, and Donalds.
Chairwoman Maloney. Welcome, everybody, to today's hybrid
hearing. Pursuant to House rules, some members will appear in
person and others will appear remotely via Zoom.
Since some members are appearing in person, let me first
remind everyone that pursuant to the latest guidance from the
House attending physician, all individuals attending this
hearing in person must wear a face mask.
Members who are not wearing a face mask will not be
recognized. For members appearing remotely, I know you are all
familiar with Zoom by now, but let me remind everyone of a few
points.
First, the House rules require that we see you, so please
have your cameras turned on at all times.
Second, members appearing remotely who are not recognized
should remain muted to minimize background noise and feedback.
Third, I will recognize members verbally, but members
retain the right to seek recognition verbally, and regular
order members will be recognized in seniority order for
questions.
Last, if you want to be recognized outside of regular
order, you may identify that in several ways. You may use the
chat function to send a request, you may send an email to the
majority staff, or you may unmute your mic to seek recognition.
We will begin the hearing in just a moment when they tell
me they are ready to begin the live stream.
The committee will come to order. Without objection, the
chair is authorized to declare a recess of the committee at any
time. I now recognize myself for an opening statement.
Our nation is facing a maternal health crisis. Across the
globe, our maternal mortality rate ranks the absolute worst
among similarly developed nations and 55th overall, and the
danger of giving birth in the United States is not equally
distributed.
The Centers for Disease Control and Prevention estimates
that Black women are more than three times as likely to die
during or after childbirth as a white woman. Black Americans
experienced higher rates of life-threatening complications at
every stage of childbirth, from pregnancy to postpartum.
It doesn't have to be that way. The CDC estimates that 60
percent of these deaths are preventable. So, how does one of
the most medically advanced nations in the world continue to
fail Black birthing people at such high rates?
To understand, we have to take the blinders off our history
and acknowledge that our healthcare system, including
reproductive health care, was built on a legacy of systemic
racism and the mistreatment of Black people and that that
legacy continues today.
Our current health care system is rife with implicit bias
and structural barriers that put Black people at an inherent
disadvantage before, during, and after their pregnancies.
Thankfully, Black women leaders here in the halls of
Congress and across the country have developed policies to
systemically shift the way we approach health care for birthing
people of color and promote programs and resources that are
proven to reduce the rates of maternal mortality in these
communities.
I am honored that several of these leaders are with us
today to discuss policies they have written and championed and
that Congress needs to implement to protect the health and well
being of Black people and Black families.
These include bills like Congresswoman Kelly's MOMMA's Act,
Congresswoman Pressley's Healthy MOMMA's Act, and Congresswoman
Underwood and Adams' Black Maternal Health Momnibus bill.
We are also joined today by experts and individuals who
have firsthand experience with the ways that our healthcare
system fails Black people in birth settings.
I urge all of my colleagues to consider today's testimony
and recommendations carefully. Health equity for Black birthing
people is attainable as long as we address racial disparities
with the urgency, empathy, and focus that this issue requires.
I believe that this is a historic hearing that, together
with my colleagues, we will work to have similar hearings and
all of the seven different committees of jurisdiction and that
we will pass these bills out of the House and to the Senate and
send them to the president for his signature.
I now want to introduce my co-chair for this hearing,
Congresswoman Robin Kelly. From the moment she set foot in
Congress, Ms. Kelly has championed efforts to turn the tide on
this crisis.
Her efforts recently led to a groundbreaking provision in
the American Rescue Plan that allows state Medicaid programs to
cover new moms for a full year postpartum.
Ms. Kelly, it is my privilege to share the gavel with you
today and you are now recognized for your opening statement.
Ms. Kelly?
Ms. Kelly. [Presiding.] Thank you, Chairwoman Maloney, for
inviting me to co-chair this very important hearing as we take
action to address the Black maternal mortality crisis within
our Nation.
To Ranking Member James Comer and my colleagues on both
sides of the aisle, thank you for your attentiveness and
efforts to address the maternal health crisis. The maternal
mortality rate in the United States is an issue that reaches
into communities across our Nation, but it is especially
concerning for communities of color.
Black women are three times more likely and indigenous
women are more than twice as likely to die from pregnancy-
related causes as non-Hispanic white women. Recently, the
Center for Disease Control and Prevention released a report
which showed that maternal mortality continues to rise.
The rate continues to rise. Even worse, more than two-
thirds of the deaths are preventable. For every maternal death
in the United States, there are approximately 100 women who
experience severe maternal morbidity or a near miss. This is
all unacceptable and the time for action is now.
The Federal Government has a critical role to play in
addressing the crisis and the unacceptable racial inequities in
health care delivery and outcomes.
Specifically, the Federal Government should support access
to and the provision of patient-centered data-driven quality
maternal care, enhance coverage and support for birthing people
during the postpartum period, and address social determinants
of health including structural and systemic inequities in the
country's health care, economic, social, and criminal legal
systems.
I have been advocating for evidence-based solutions for the
legislation to address maternal mortality for a long time, as
the chairwoman said. Despite all the hard work to address this
issue, there is still a long way to go in preventing maternal
deaths.
In the recently passed American Rescue Plan, language from
my Healthy Moms bill was included, which provided states the
option of expanding postpartum coverage from 60 days to one
full year after giving birth.
Let me explain why this is such an important step forward.
The American College of Obstetricians and Gynecologists
recommends that women have access to continuing health coverage
to increase preventive care, reduce avoidable adverse health
outcomes, and increase early diagnosis of disease and reduce
maternal mortality rates.
There are major risks associated with becoming uninsured
shortly after experiencing pregnancy. Lapses in insurance
coverage is one of the continuing factors in the maternal
mortality crisis, with one-third of all pregnancy-related
deaths occur as late as one year after delivery.
Women of color are disproportionately affected by
disruptions in insurance coverage. Nearly half of all non-
Hispanic Black woman had discontinuous insurance from pre-
pregnancy to postpartum, and half of Hispanic Spanish-speaking
women became uninsured in the postpartum period.
Earlier this year, I led my colleagues in a letter urging
HHS Secretary Becerra to approve Illinois' waiver to allow for
additional Medicaid coverage beyond the current 60-day
allowance. Secretary Becerra approved the waiver, making
Illinois the first state that allows women to receive the
postpartum care they deserve.
Additionally, I reintroduced my supporting best practices
for Healthy MOMMIES Act. This bill would require CMS to publish
guidance for hospitals and other maternal care providers on
ways to reduce maternal mortality and morbidity under Medicaid
and the Children's Health Insurance Program.
In the next few weeks, I will introduce my key maternal
health legislation, the Mothers and Offspring Mortality and
Morbidity Awareness Act, also known as the MOMMA's Act.
This bill will help standardize data collection, provide
grants that improve maternal and infant health, and establish
regional centers of excellence, which will improve how our
health care professionals are educated in implicit bias and
delivering culturally competent health care.
As we go into Mother's Day weekend, let us recommit our
efforts and support to ensure that every birthing person across
this Nation is empowered and feels safe when making that
wonderful and exciting decision to become a mother.
This hearing is a testament to the hard work of advocates
and researchers and my other colleagues who have fought so long
to elevate this issue.
I look forward to hearing from the witnesses. Thank you so
much.
Chairwoman Maloney. [Presiding.] I now recognize the
distinguished ranking member, Mr. Comer, for an opening
statement.
Mr. Comer?
Mr. Comer. Thank you, Madam Chair. I want to thank all of
our witnesses for being here to share your stories and
expertise with us here today.
According to the CDC's most recent available data, the
maternal mortality rate in the U.S. for 2018 was 17.4 deaths
per 100,000 live births. Maternal mortality for Black women is
2.5 times the ratio for white women and three times the ratio
for Hispanic women.
We all agree that that is unacceptable. The United States
is one of the most advanced healthcare systems in the world. We
can and should have lower mortality rates. There are a range of
factors contributing to this crisis, from lack of access to
proper care to the maternal mental health crisis, which takes
the lives of so many mothers.
I hope today we can explore innovative solutions to ensure
that maternal mortality rates in the U.S. decline.
Historically, this issue has been approached in a bipartisan
manner. I hope we can continue that posture today.
This hearing is about what we can do right now to save the
lives of women and their babies. I look forward to hearing from
our witnesses on the amazing work they are already doing to
solve this problem, as well as exploring suggestions for what
we can do better.
With that, I yield the remainder of my time to Dr. Foxx and
then Congresswoman Mace for their opening statements.
Chairwoman Maloney. The gentleman yields back.
I now recognize Dr. Foxx for an opening statement.
Ms. Foxx. Thank you very much, Madam Chairman, and thanks,
Ranking Member Comer, for your participation in the hearing
today.
As the ranking member stated, the situation regarding
maternal health is unacceptable and we must work together to
determine the proper response.
Historically, data collection on the maternal mortality
rate in the United States has been incomplete. In order to
target relief in a manner that can actually affect positive
outcomes, we need better information.
Shining a light on the data will, we hope, improve the
health outcomes of mothers and their newborn children. I look
forward to hearing from the witnesses today on how we can
gather better data for better outcomes.
As the ranking member of the Education and Labor Committee,
today I hope we can address the impending shortage of OB/GYN
care providers and the lack of proper education for some in the
health care industry.
Currently, the U.S. and Canada have the lowest overall
supply of midwives and obstetrician/gynecologists, or OB/GYNs,
relative to comparable countries. There is expected to be a
shortage of between 3,000 to 9,000 physicians by 2030.
We must act now to ensure this shortage does not get worse.
Further exacerbating this problem is a lack of education for
care providers on early warning signs of life-threatening
complications. I know many of our witnesses here today are
working tirelessly to provide best practices for physicians,
nurses, midwives, and other care providers to ensure these
preventable deaths do not occur.
One potential way to address the shortage of caretakers now
is to use nonphysician clinicians such as midwives, nurse
practitioners, and physician assistants, especially for low-
risk pregnancies.
Expanding access to midwife care can improve access to
maternity care in under resourced areas, reduce interventions
that contribute to the risk of maternal mortality and
morbidity, and lower the cost of care.
Incorporating nonphysician clinicians as part of a health
care team, led by an OB/GYN, has shown to improve outcomes for
both the mother and baby.
Implementing these patient teams and best practices for
care is something hospitals can start doing right now, which
can have an immediate impact on lives.
I look forward to hearing more from our witnesses today
about solutions we can implement to address this.
I now yield to Representative Mace for her opening remarks.
Chairwoman Maloney. I know----
Ms. Mace. Thank you, Congresswoman.
Chairwoman Maloney. I now recognize Ms. Mace for an opening
statement.
Ms. Mace. Thank you, Chairwoman Maloney and your co-chair,
this morning, Congresswoman Kelly. I want to thank Ranking
Member Comer and Dr. Foxx as well.
I echo the statements of my colleagues this morning. This
maternal health crisis is unacceptable in our advanced society
today. It is entirely unacceptable that Black women are nearly
three times more likely to die during childbirth than white
women.
I hope among the many important topics of discussion today
that we hear about we can address the mental health and
substance abuse crisis which also afflicts so many mothers out
there today.
Opioid use and suicide combined are the leading cause of
death for mothers in the postpartum period. Data shows that one
in five women experience maternal mental health conditions.
About 75 percent of those go undiagnosed and untreated.
All childbearing women should be educated about and
screened for postpartum mental health conditions throughout the
relevant timeframe and have access to quality treatment
options.
Personally, with my firstborn, I didn't have postpartum
mental health issues. But with my second, I experienced those
firsthand and I cannot imagine for those women that don't have
the resources or the ability to access health care
professionals to access those who could provide resources in a
time of tremendous need. Those are things that we have all got
to address and I hope will be addressed today.
Having check-ins and subsequent care before and after
childbirth are essential to any mother's maternal health for
that and her child. To the mothers out there who are struggling
to hold down a job and educate your children at the same time,
we see you.
We are working to shine a light on your plight and the
challenges that you face today. They are real, and we want to
be there and provide the resources we can at every level--
national, state, and local.
There are national and local organizations and providers, a
few of which are represented here today and that we will hear
from, who are ready and willing to help you.
Please do not be afraid to reach out for help if you are
struggling. I also feel it is important to note that this
maternal health crisis has been further exacerbated by the
pandemic. I would be remiss if we didn't mention the needs are
so much more--are so much greater today than they were even
just a year ago.
While we won't have hard data on the effect of COVID-19 on
maternal mortality for some time yet, we know generally that
opioid use, intimate partner violence, domestic violence, and
mental health crisis have been exacerbated.
They have increased exponentially due to the pandemic, due
to lockdowns, due to children being unable to be at home--I
mean, be at school and be at home.
We also know women have borne the brunt of this pandemic
from job loss to childcare responsibilities. Recent studies
show that pregnant women and new moms are experiencing anxiety
and depression at levels three to four times the levels or the
rate prior to the pandemic.
This increased stress increases the likelihood of
pregnancy-related complications. The problem is real. Perhaps
the only good thing that has come out of this devastating
pandemic is the increased access to telehealth, the expanded
telehealth use, which studies have shown improve outcomes for
pregnant women.
A recent study from the University of Texas Southwestern
Medical Center found that prenatal doctor visits conducted over
the phone or with video technology encouraged more women to
make and keep their appointments during the pandemic,
particularly among vulnerable populations, and resulted in
similar pregnancy outcomes compared with women who were able to
come in in person.
The telehealth options should continue to be utilized and,
perhaps, even expanded, not just now but at a high rate even
after return to some sense of normalcy post-COVID-19 pandemic.
What telehealth appointments have shown us that they are
especially helpful for rural communities and women who are
unable to get to an appointment in person physically due to
transit or financial or other limitations to get to a doctor
for face-to-face check-ins.
As the number of pre-and post-natal care appointments go
up, the risk for maternal mortality goes down. I hope today we
can continue to explore additional innovative options for care
for these women who are exponentially hurt greater in pregnancy
and postpartum.
I want to thank the chairwoman for your time today and I
yield back.
Chairwoman Maloney. The gentlelady yields back.
We have two panels today and our first panel is a member
panel, so I would like to introduce them first.
Our first witness today is Congresswoman Ayanna Pressley
from Massachusetts. Since 2019, Congresswoman Pressley has been
a powerful voice for equity on this committee.
She has introduced numerous bills to improve Black maternal
health outcomes and address structural racism as a public
health crisis, including the Healthy MOMMIES Act, which, among
other things, extends Medicaid coverage to birthing people for
one year postpartum, the COVID-19 Safe Birthing Act, and the
Anti-Racism in Public Health Act, which would empower the CDC
to address structural racism in public health.
We are lucky to have her as a part of our committee and as
a part of our panel.
Following her, we have Congresswoman Cori Bush from
Missouri. She recently shared her story about giving birth as a
Black woman in America. Like many Black birthing people,
doctors ignored and dismissed her pain, which led to her son's
premature birth.
She has worked in Congress to protect Black maternal health
and Black babies. She is a strong part of this committee, and
we thank her for sharing her story with us today.
We will then hear from Congresswoman Alma Adams from North
Carolina. Ms. Adams is co-chair of the Black Maternal Health
Caucus. The caucus has introduced the Black Maternal Momnibus
Act, a sweeping proposal to comprehensively address the
country's maternal health crisis.
She has tirelessly championed policies to systematically
address Black maternal health, and we thank her for her passion
and for appearing here today.
Last but not least, we will hear from Congresswoman Lauren
Underwood from Illinois. She is the other co-chair of the Black
Maternal health Caucus and has led efforts to pass the Momnibus
and comprehensively address every dimension of the Black
maternal health crisis.
She has been a bold leader for a more equitable America
since she first set foot in Congress.
I want to thank all of them for their extraordinary work.
We are all deeply grateful for their leadership.
Without objection, your written statements will be made
part of the record, and with that, Congresswoman Pressley, you
are now recognized for your testimony.
STATEMENT OF HON. AYANNA PRESSLEY, REPRESENTATIVE, CONGRESS,
MASSACHUSETTS
Ms. Pressley. Thank you, Madam Chair. This hearing is
historic, and I am honored to participate alongside my sisters
in service, my colleagues who are committed to achieving
maternal health justice.
Today, we will likely hear a consistent drumbeat of
sobering statistics which underscore the often life-
threatening, too often fatal experience of birthing while
Black.
Now, while some may be tired of hearing these alarming data
points, they should know that Black people are tired of living
them, and more accurately, tired of losing loved ones.
My paternal grandmother, who I never had the blessing to
know, died in the 1950's giving birth to my father's youngest
brother, sending my father and his five siblings into a
downward spiral of great trauma and hardship.
And decades later, the Black maternal mortality crisis is
still killing our loved ones and destabilizing our families. My
family's history is not unfamiliar for many Black folks who
have heard mothers, grandmothers, aunties, and partners recount
tragic losses or their own harrowing birth experiences.
Black people have been vocal about this pain, but that pain
has fallen on deaf ears or been delegitimized for generations.
It is now incumbent upon this body to hear this Black pain and
to legislate solutions.
Today, in partnership with Senator Booker, we reintroduced
our MOMMIES Act, which would ensure that every state allows
Medicaid-eligible pregnant people to remain covered for at
least a full year postpartum, and this coverage is
comprehensive and not limited to arbitrarily selected
pregnancy-related services. We are demanding the type of
responsible accessible person-centered care that is required to
save lives.
This bill would also mandate the collection of critical
information on the coverage of and barriers to receiving doula
services. One bill alone will not end this crisis. That is why
I am proud to support the Black Maternal Health Momnibus Act of
2021, which includes my legislation to provide care and dignity
for pregnant people in the criminal legal system.
The Justice for Incarcerated Moms Act would end the
practice of shackling people who are pregnant, an
unconscionable practice, fund diversion programs as
alternatives to incarceration, and create maternal health
initiatives for pregnant people behind the wall, including
access to doulas, healthy food and nutrition, mental health and
substance use counseling.
These bills were developed in close partnership with Black
women who are leaders in maternal and reproductive health care.
I testify today not to remind Black people of our plight,
but instead, to demand the action and the meaningful change
that we deserve. The policy is ready.
What we need now is a commitment from our colleagues that
Black maternal health, that Black mamas, that Black babies,
that Black lives are, indeed, a priority.
Birthing while Black should not be a death sentence, and if
we believe in health care justice, as we espouse that we do,
then we should legislate like it.
Thank you. I yield.
Chairwoman Maloney. Thank you.
Congresswoman Bush is here in person and we now recognize
your testimony.
STATEMENT OF HON. CORI BUSH, REPRESENTATIVE, CONGRESS, MISSOURI
Ms. Bush. Thank you.
First of all, let me just say that I think it is disgusting
that we have colleagues on this hearing who won't acknowledge
Black women suffering, that there are stark differences in our
pain.
But St. Louis and I thank you, Chairwoman Maloney and
Congresswoman Kelly, for your leadership in convening this all-
important hearing. It is an honor to join my sisters in
service--Congresswomen Pressley, Underwood and Adams--as part
of today's panel.
I sit here before you as a mother, a single mother of two.
Zion, my eldest child, was born at 23 weeks gestation versus
what is considered a normal pregnancy of 40 weeks. When I was
early in my pregnancy with him, I didn't think that there could
even be a possibility that there could be a complication.
I became sick during my pregnancy. I had hyperemesis
gravidarum, which was severe nausea and vomiting. I was
constantly throwing up for the first four months of my
pregnancy.
Around five months, I went to see my doctor for a routine
prenatal visit. As I was sitting in the doctor's office, I
noticed a picture on the wall that said, if you feel like
something is wrong, something is wrong. Tell your doctor.
I felt like something was wrong so I--so that is what I
did. I told my doctor. I told her that I was having severe
pains, and she said, oh no, you are fine. You are fine. Go
home, and I will see you next time.
So, that is what I did. I went home. One week later, I went
into preterm labor. At 23 weeks, my son was born one pound,
three ounces. His ears were still in his head. His eyes were
still fused shut. His fingers were smaller than rice and his
skin was translucent. A Black baby, translucent skin. You could
see his lungs. He could fit within the palm of my hand. He
was--we were told he had a zero percent chance of life.
The chief of neonatal surgery happened to be in the
hospital that morning and saw my case on the surgical board and
she decided to try to resuscitate him. It worked, and for the
first month of his life as Zion was on a ventilator fighting to
live, for four months he was in the neonatal care unit. The
doctor who delivered my son apologized. She said, ``You were
right and I didn't listen to you. Give me another chance.''
Two months later, I was pregnant again. So, I went back to
her. At 16 weeks I went for an ultrasound at the clinic and saw
a different doctor who was working that day. I found out again
I was in preterm labor.
The doctor told me that the baby was going to abort. I
said, no, you have to do something. But he was adamant. He
said, ``Just go home. Let it abort. You can get pregnant again
because that is what you people do.''
My sister, Kelly, was with me. We didn't know what to do
after the doctor left. So, we saw a chair sitting in the
hallway. My sister picked up the chair and she threw it down
the hallway. Nurses came running from everywhere to see what
was wrong.
A nurse called my doctor and she put me on a stretcher. The
next morning my doctor came in and placed a cerclage on my
uterus and I was able to carry my baby, my daughter, my angel,
who is now 20 years old. My son who was saved is now 21 years
old.
This is what desperation looks like, that chair flying down
a hallway. This is what being your own advocate looks like.
Every day Black women are subjected to harsh and racist
treatment during pregnancy and childbirth. Every day Black
women die because the system denies our humanity. It denies us
patient care.
I sit before you today as a single mom, as a nurse, as an
activist, and as a Congresswoman, and I am committed to doing
the absolute most to protect Black mothers, to protect Black
babies, to protect Black birthing people, and to save lives.
Thank you, and I yield back.
Chairwoman Maloney. Thank you for your very moving
testimony.
Congresswoman Adams, you are now recognized for your--for
your testimony.
Congresswoman Alma Adams?
STATEMENT OF HON. ALMA S. ADAMS, PH.D., REPRESENTATIVE,
CONGRESS, NORTH CAROLINA, CO-CHAIR, BLACK MATERNAL HEALTH
CAUCUS
Ms. Adams. Thank you, Madam Chair, Chairwoman Maloney,
Ranking Member Comer, Congresswoman Kelly, and to other
distinguished colleagues serving on the Oversight Committee.
Thank you for the opportunity to join you today for this
historic hearing in the House Oversight Committee on maternal
mortality and the disparate and unacceptable outcomes that
Black women and birthing persons face.
As the founder and co-chair of the Black Maternal Health
Caucus, I want to just take time to speak about the Black
maternal health crisis in America. Black mamas are
disproportionately and needlessly dying.
The U.S. is one of 13 countries in the world where the rate
of maternal mortality is worse than it was 25 years ago, and
even more disturbing is that across the country Black women
from all walks of life, regardless of socioeconomic status and
education, are dying from preventable pregnancy-related
complications at three to four times the rate of non-Hispanic
by women.
And the shocking fact is that 60 percent of maternal deaths
are preventable. Research also suggests that the cumulative
stress of racism and sexism undermines Black women's health,
making them more vulnerable to complications that endanger
their lives and the lives of their infants.
Unfortunately, current healthcare practices are
insufficient in addressing the health consequences of living
with this stress. In fact, the healthcare system often fails
Black women, providing inadequate and culturally insensitive
care that is plagued by bias, racism, and discrimination.
This crisis demands urgent attention and serious action to
save the lives of Black mothers and women of color and other
marginalized women across the country, which is why
Congresswoman Underwood and I crafted and introduced a
comprehensive package of nine bills called the Black Maternal
Health Momnibus Act, and this February we introduced an updated
package of 12 bills with Senator Cory Booker.
You know, the Momnibus will comprehensively address every
dimension of the maternal health crisis in America to save
lives and end racial and ethnic disparities in maternal health
outcomes.
The bill makes investments in social determinants of
health, increasing maternal vaccinations, improving our
national response to pandemics with respect to maternity care,
the growth and the diversification of the perinatal work force,
improvements in data collection and quality measures, digital
tools like telehealth and innovative payment models.
It focuses on environmental justice, because recent studies
have reinforced the linkage between man-made climate change and
the toll that it takes on pregnant women and their infants.
And very importantly, the Momnibus provides critical
funding for community-based organizations, perinatal workers,
doulas, and midwives, and lactation consultants who are doing
the work right now to save Black mamas and babies, especially
in communities of color.
We know the solutions that our communities need, and I am
fighting hard every day in Congress to speak up and stand up to
make sure that my colleagues understand what Black women need
and what they must have.
The Momnibus is a bold and compassionate solution that
unequivocally says Black mamas matter. That is why I am calling
today for the Momnibus to be included in the American Families
Plan, which is a once in a generation investment in health--
healthcare and education and childcare.
Inclusion of the Momnibus would build on the Biden's
administration American Rescue Plan, a bold and compassionate
relief bill that included a provision to extend Medicaid
coverage for up to 12 months.
In 1962, Malcolm X said that the most disrespected person
in American is the Black woman. The most unprotected person in
America is the Black woman. The most neglected person in
America is the Black woman.
Sadly, that continues to be true and evident in the health
and economic outcomes that we continue to face. The pandemic
has revealed these disparities all too well and it has further
exacerbated them.
In 1966, Martin Luther King declared of all other forms of
inequality and injustice, injustice in healthcare is the most
shocking and most inhumane.
Including the Momnibus in the American Families Plan is a
key way to address long-standing health injustices and to
ensure that our moms and our babies have the resources they
need to not only survive, but to thrive.
It doesn't matter what side of the aisle you are on. Either
you have a mother or you are a mother or you know women who are
moms. If we raise the tide for Black women who are who are
among the most marginalized and the most vulnerable, we
ultimately raise the tide for all women.
All moms deserve equal access to quality maternal care
without bias. Passing the Momnibus, we can begin to take action
now to truly hold ourselves, our health systems, and our
society accountable.
I urge my colleagues to support the Momnibus. Our Black
women and our mamas deserve better. I yield back, Madam Chair.
Thank you so very, very much.
Chairwoman Maloney. Thank you for your important leadership
on this issue.
Congresswoman Underwood, you are now recognized for your
testimony.
Congresswoman Underwood?
STATEMENT OF HON. LAUREN UNDERWOOD, REPRESENTATIVE, CONGRESS,
ILLINOIS, CO-CHAIR, BLACK MATERNAL HEALTH CAUCUS
Ms. Underwood. Chairwoman Maloney, Ranking Member Comer,
and members of this committee, thank you for holding this
hearing on the urgent topic of Black maternal health.
Two years ago this month, I joined Congresswoman Alma Adams
to co-found the Black Maternal Health Caucus, a bipartisan
group of 115 members united in our commitment to ending our
Nation's maternal mortality crisis.
My colleagues have shared the alarming statistics about
maternal health outcomes in the United States, and behind every
one of these statistics is a story, stories like my friend,
Shalon.
Dr. Shalon Irving was a graduate school classmate of mine
at Johns Hopkins University. She went on to become a lieutenant
commander in the U.S. Public Health Service Commission Corps,
utilizing her dual Ph.D.
She was also a CDC epidemiologist. She was a talented
photographer, a chef, an author. She traveled the world and she
was so excited to become a mom.
But we still lost her. Three weeks after giving birth to
her beautiful daughter, Soleil, Shalon died due to
complications from her pregnancy. I couldn't believe it. But
while Shalon's story is devastating, it is not unique. Too many
families have stories of their own of loss or near misses.
It was with these stories in my heart that my team and I
committed to developing a comprehensive set of data-driven
evidence-based policies that would build on existing
legislation to address every driver of maternal mortality,
morbidity, and disparities in the United States.
The result was the Black Maternal Health Momnibus Act,
which I introduced with Congresswoman Adams and then Senator,
now Vice President Kamala Harris in March 2020.
This Congress, I reintroduced the Momnibus with Senator
Cory Booker, and now more than 140 co-sponsors between the
House and Senate, including many members of this committee.
The Momnibus has wide support, including Speaker Pelosi who
said last month that we, quote, ``Must pass the Momnibus.''
The Momnibus is a suite of 12 bills that include bipartisan
policies to save lives, end racial and ethnic disparities, and
achieve true equity and justice for all mothers and birthing
people.
As the Congress considers proposals for the American
Families Plan, I urge my colleagues to support the policies in
the Momnibus, which are even more important in response to a
pandemic that has both underscored and intensified the need to
make robust investments in high-quality care.
At the heart of these investments is the principle that in
America every family has the right to thrive, a principle that
begins with a safe and healthy pregnancy and birth.
To realize this promise for every mother, the Momnibus
includes investments in community-based organizations, funding
to grow and diversify the perinatal work force, data collection
improvements, expanded access to maternal mental health care,
and programs to address social determinants of health, like
housing, nutrition, and environmental risks.
These are necessary investments that will save lives and
support families.
I look forward to working with my colleagues to get the
Black Maternal Health Momnibus Act included in the American
Families Plan and signed into law.
We don't have any time to wait. Our moms are worth it. Our
families depend on it and this moment demands it. Thank you,
and I yield back.
Chairwoman Maloney. Thank you for your powerful testimony
and for your continued leadership on this critically important
issue.
The first panel is now excused and we will pause for a
moment while we get the second panel ready.
[Pause.]
Chairwoman Maloney. Now I would like to recognize my co-
chair for this hearing, Congresswoman Kelly, to introduce the
witnesses on our second panel.
Congresswoman Kelly?
Ms. Kelly. [Presiding.] Thank you again, Madam Chair.
Our expert witnesses today have all seen or felt the tragic
impact of our Nation's Black maternal health crisis up close.
Tatyana Ali is an actress, advocate, and mother who
confronted the consequences of systemic racism during her own
2016 delivery of her first son. She was left traumatized and
feeling alone at the questionable decisions and missteps by her
health care providers, culminated in an emergency C-section, an
outcome that unnecessarily put her life at risk and was
entirely divorced from her original birth plan.
Charles Johnson is the founder of the maternal health
advocacy organization 4Kira4Moms. Mr. Johnson's wife, Kira, was
an extraordinarily accomplished woman in perfect health when
her planned C-section resulted in severe internal hemorrhaging.
Charles and Kira's pleas for help were ignored by hospital
staff for 12 hours while her abdomen filled with blood. She
died only 12 hours after giving birth.
Dr. Veronica Gillispie is a board-certified obstetrician
and gynecologist, an associate professor for Oschner Health in
New Orleans, Louisiana, and the medical director at the
Louisiana Perinatal Quality Collaborative and Pregnancy
Associated Mortality Review for the Louisiana Department of
Health. She leads initiatives to improve birth outcomes for all
birthing persons in Louisiana and eliminate health disparities.
Dr. Joia Crear-Perry is the founder and president of the
National Birth Equity Collaborative, which focuses on creating
solutions that optimize Black maternal and infant health
through training, policy advocacy, research, and community-
centered collaboration. She is a mother, OB/GYN, activist, and
thought leader around racism as a root cause of health
inequalities.
Dr. Jamila Taylor is the director of healthcare reform and
senior fellow at the Century Foundation where she leads TCS
work to expand access to affordable health care by focusing on
the structural barriers to access to health care, and the
racial and gender disparities in health outcomes.
And Dr. Tamika Auguste, who serves on the board of
directors for the American College of Obstetricians and
Gynecologists. Dr. Auguste is a practicing OB/GYN at MedStar
Washington Hospital Center and a renowned physician expert on
issues of Black maternal and infant health.
I want to thank all of our witnesses for joining us today.
Ms. Ali, you are now recognized for five minutes for your
opening statement.
STATEMENT OF TATYANA ALI, ACTRESS AND ADVOCATE
Ms. Ali. Thank you for inviting me to share my story. I
hope I can honor the mamas and babies who are no longer with
us.
I had a very healthy pregnancy, and when it came time I was
laboring and dilating normally. When my husband and I got to
the hospital, it was like we were on a clock that kept very
close track of the hours.
I remember them trying to get me to take an epidural though
it wasn't in my birth plan, interrupting me again and again in
the midst of my labor pains, making it seem imperative until,
finally, we relented.
I wanted to get onto my hands and knees to push because I
could still feel my legs. But every time I tried, five of the
10 people in the room, all screaming at me at the top of their
lungs, would push me back down. They pinned me down by my feet.
I could feel my baby's wet hair because he had been crowned
for hours. One doctor climbed up onto the side of the bed and
pushed his forearm into my belly and squeezed downward, like my
baby was two-faced. I could still feel the pain days later.
Then when my husband and I yelled no to the forceps, they
use suction, a plunger. I screamed stop because they were
aggressively popping it off of his head again and again four
times. Then, without warning, one doctor pushed my baby all the
way back inside me. I screamed in pain. My body started shaking
uncontrollably. Then I lost consciousness.
When I woke I heard my baby cry. That is our baby, I told
my husband. Don't let them hurt him. Go. Go and get him and he
went, and then I went unconscious again.
I remember the warmth that washed over me when I finally
got to hold him. I remember two nurses in particular in the
maternity ward who were kind and gentle with me.
He spent four days in the NICU. The head pediatric
urologist explained to us that it would take time for our baby
to urinate on his own because of the traumatic nature of his
birth, and our prayers were answered when he did and we could
leave.
When we found out we were pregnant again, we vowed to find
another way. The first time we met our midwife I felt like I
had met her before. She is a brilliant Black woman with a
beautiful smile. Her laugh reminds me of my very own cousin,
Valerie. I remember her spending hours with us visiting in our
home, helping my eldest as he was just learning to walk up the
stairs on his own.
I remember her asking for permission every time she touched
my belly and never used a speculum or did an intervaginal check
like my OB/GYN did at every appointment.
We decided to have a home birth VBAC. She gave us choices
and was a reservoir of information, never too busy to take a
call or answer a text. Last minute, my youngest changed his
position and went lateral so I had to have another C-section.
But we had planned so thoroughly that we knew exactly which
hospital would respect our team.
When I broke down weeping after the anesthesiologist said I
would feel nothing from the chest down again, my midwife prayed
while she held my feet. My midwife knew my story and prepared
me for the time when the trauma of my first birth might return,
and she also knows that I believe in prayer. She knew me that
well.
She suggested that I walk into the OR instead of being put
on a gurney in order to feel a sense of agency and autonomy
that had been taken from me previously. I got to hold my
youngest right after he entered the world and he latched right
away.
During postpartum visits with our midwife, she provided
lactation support. She checked in on my baby's growth, my
physical wellness, my nutrition, my mental and emotional well
being, and how we were adjusting as a family.
Both of my babies were born via C-section, but the
experiences could not have been more diametrically opposed. My
eldest and I were not safe. My youngest and I, cared for by a
Black midwife, were. The birth of my oldest was my first
experience of a kind of institutionalized racism and
paternalism that can kill.
Throughout my advocacy efforts, I have heard firsthand
stories of people in pain being dismissed, threatened, called
drug seeking. I have heard stories of the sheriff's department
coming to homes in the middle of the night because families
refused to take elective tests.
I have heard stories of Child Services being called moments
after babies are born because the parents seem unfit. The
similarities amongst Black families and the treatment and
similar outcomes for indigenous families and queer families and
disabled families and incarcerated birthing people are stunning
and they all have similar root causes.
We are being mishandled, ignored, sterilized, and
completely disrespected. Many are now scared to start families
because they know we are dying in hospitals. There are groups
on the ground providing the support that we need, but they need
the resources to scale their efforts.
We need more Black midwives, Black doulas, culturally
competent birth workers, and they need to be supported in their
work. They need to be covered by all health plans so that
adequate care ceases to be a luxury. We need to demedicalize
birth.
We need redress with hospitals that fail us so completely.
We need racial bias and trauma training, postpartum and
lactation support. We need to be heard and believed. All
pregnant and birthing people deserve to be treated with loving
patient-centered care.
Thank you for this time.
Ms. Kelly. Thank you so much, Ms. Ali.
And now we will turn to Mr. Johnson. You are now recognized
for your testimony.
STATEMENT OF CHARLES JOHNSON, HUSBAND OF KIRA JOHNSON AND
FOUNDER OF 4KIRA4MOMS
Mr. Johnson. We are going to jump right into it.
I was fortunate enough to meet a woman that absolutely
changed my life, and so when we talk about my wife, Kira, we
are talking about truly sunshine personified. We are talking
about a woman who raced cars, who ran marathons, who spoke five
languages fluently, and really challenged me to be a better man
in every single aspect of my life.
I have always wanted to be a father, and so I was ecstatic
when we found out. We welcomed our second son, Charles the V in
September 2014, and Kira and I always talked about how cool it
would be to have back to back boys. They would grow up, just
being rambunctious, best friends. And so we were absolutely
over the moon when we found out we were welcoming our second
son, Langston, in April 2016.
And the painful irony of what I am going to share with you
this afternoon is that as a father and as a husband, you want
the best for your family. You want the best for your wife.
And so we made the decision to give birth at Cedar Sinai
Medical Center in Los Angeles, California, because it was our
understanding that this hospital had what was supposed to be a
sterling reputation, particularly in the area of obstetrics and
delivery.
And so on April 12 of 2016, we walked into Cedar Sinai
Hospital in Los Angeles for what we expected to be the happiest
day of our lives and walked straight into a nightmare.
It is important to understand that throughout Kira's entire
pregnancy she was not only in good health, Madam Chairwoman,
she was in exceptional health. All signs pointed to both her
and our new son, Langston, being extremely healthy.
And so at our doctor's recommendation we went in for what
was supposed to be a routine scheduled C-section. Langston was
born perfectly healthy, 10 fingers, 10 toes, and we were just
overwhelmed with joy welcoming this tremendous gift into our
lives.
Shortly after birth, we were taken back to recovery, which
is standard in a Cesarean delivery, and as we were there in the
recovery room, and Kira is resting and I am watching her rest,
and Langston is in what I called a little toaster, the little
incubator thing, and I am just soaking all of this in, all the
pride of being a father for the second time and our family was
finally complete.
And then things began to take a turn for the worse. As I am
sitting there watching Kira rest, I look and I see by her
bedside the catheter coming from her bedside begin to turn pink
with blood. Now, keep in mind, this is around 4 o'clock in the
afternoon and so I brought it to the attention of the doctors
and the staff at Cedars Sinai.
They came and they examined Kira physically. They took her
vitals, they drew blood, and they did an ultrasound, and very
early on they can see that her abdomen is beginning to fill
with fluid. And very quickly they ordered a CT scan that was
supposed to be performed stat and by stat, for everybody on the
committee, what does that mean to you all? Immediately.
Five o'clock came, no CT scan. Six o'clock came. Seven
o'clock came, no scan. By 7 o'clock, my wife is shivering
uncontrollably because she is losing so much blood. Eight
o'clock comes, no scan. I am begging and pleading, please do
something. Help her. Nine o'clock, nothing.
At around 9 o'clock, I pulled a nurse aside and I asked
her, please help me. My wife isn't doing well. She is weak. She
is in pain. She is losing color. Please help me. And she
responded to me, sir, your wife just isn't a priority right
now. Your wife isn't a priority.
Ten o'clock came. Eleven o'clock came. It wasn't until
after 12:30 a.m. that they finally made the decision to take
Kira back for surgery. When they took Kira back to surgery and
they opened her up, there were three and a half liters of blood
in my wife's abdomen from where she had been allowed to bleed
and suffer needlessly. For 10 hours while myself and my family
begged and pleaded for them simply to just help us, and our
cries for help fell on deaf ears.
And as I said when I was here in 2018 in support of the
Preventing Maternal Deaths Act, I am going to say it again, you
are going to hear from brilliant people, many of whom I look up
to tremendously. They are going to tell you about the
statistics.
But there is no statistic that can quantify for what it is
like to tell an 18-month-old that his mommy's never coming
home. There is no point on your data collection that can begin
to measure the impact of what it is like to try and explain to
a son that will never know his mother just how amazing she is.
And what I want to say is this. I am going to share with
this committee a harsh truth, and that truth is for all the
wonderful work that you are doing you cannot legislate
compassion. You cannot legislate compassion, and it was lack of
compassion and lack of humanity that failed my wife and is
failing Black mothers time and time again.
It was not my wife's race that was a risk factor. She did
everything right. It was racism. That was the risk factor. And
so we must do better, and while you cannot legislate compassion
and humanity, what you can do is you can take bold steps like
the Momnibus Bill to invest in community-based care models.
You can make sure that every woman in this country that
wants access to a doula has it. You can make sure that we
diversify the perinatal work force. You can make sure that
women have the resources that they need to thrive and survive
before, after, and during childbirth.
And as we approach Mother's Day, my heart is heavy as I sit
here representing the thousands upon thousands of families that
have been impacted.
And so, Madam Chairwoman, let me share with you on behalf
of those families what our expectation is, what my expectation
is, of this committee, of this Congress, and of our leadership.
My expectation is that this committee will come together in
a bold bipartisan fashion to stand in solidarity and sound--and
send a loud definitive message that mothers and babies and
Black birth and people are important and will make the
investments and legislate as such.
What I will share with you is this in closing. These are my
sons, Charles and Langston. My wife, Kira, won't wake up to
breakfast in bed this Mother's Day because she gave birth in a
country that didn't see her, that didn't value her. We must do
better.
This is Amber Rose Isaac. Her son, Elias, won't have the
chance to spend his first Mother's Day with his mother. Elias
deserves better.
Shamony Gibson should be here with her son, Khari, and her
daughter, Anari. She deserves so much better.
Tahmesha Dickey should be here this Mother's Day with her
son, Muhsin. She deserved better.
Tamara Johnson Thompson should be here--should be here with
our daughter, Ryan Rose.
Dr. Shalon Irving should be here with her daughter, Soleil.
Precious Triplett Strokes should be here with her son, Jacob.
Yolanda Kadima, a doula--a doula--should be here with
Jamayla, Zaden, Armand, Alanna, Zaire, Qashar, Shivran and
Yavin, her eight children, this Mother's Day.
I refuse to allow my children, these children, and the
children and families affected by this maternal crisis--
maternal health care crisis to inherit a world where they fear
that their wives or that their selves may meet the same fate as
their mothers. We must and we can do better.
Thank you for your time.
Ms. Kelly. Thank you so much for sharing your words and
your testimony. We really appreciate it.
Dr. Auguste, you are now recognized for your five minutes
of testimony. Thank you.
STATEMENT OF TAMIKA AUGUSTE, M.D., BOARD OF DIRECTORS,
AMEREICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS; CHAIR OF
THE OBSTETRICIAN AND GYNECOLOGIST CLINICAL PRACTICE COUNCIL,
MEDSTAR HEALTH
Dr. Auguste. Thank you.
Good afternoon, Chairwoman Maloney, Chairwoman Kelly,
Ranking Member Comer, and members of the House Oversight and
Reform Committee. Thank you for inviting me to speak with you
today on behalf of the American College of Obstetricians and
Gynecologists, or ACOG.
It is an honor to join this esteemed panel. As an
obstetrician/gynecologist practicing in Washington, DC, I have
dedicated my career to ensuring patients have happy and healthy
pregnancies and births.
I currently serve as a member of ACOG's board of directors
and as vice chair of the Council on Patient Safety and Women's
Health, an effort convened by ACOG to improve patient safety,
promote equity, and drive culture change in women's health
care.
Confronting our Nation's rising maternal mortality rate,
which disproportionately impacts Black and indigenous women, is
one of ACOG's paramount priorities. ACOG recognizes its
position as the leading medical organization dedicated to
women's health and treats this responsibility with reverence
and humility.
We also recognize the need and are committed to changing
the culture of medicine, eliminating racism, and racial
inequities that leads to disparate health outcomes, and
promoting equity in women's health and health care.
As members of the committee are aware, the U.S. is the only
industrialized nation with a maternal mortality rate that is on
the rise, with unacceptably high rates among Black and
indigenous birthing people.
Additionally, data indicates that the COVID-19 pandemic is
disproportionately affecting communities of color, and maternal
health experts caution that it may be exacerbating the maternal
mortality crisis.
This is a multi-factorial crisis that requires multi-
factorial solutions. The list of programs and initiatives
critical to improving Black maternal health is long. In the
interest of time, I will highlight only some of the evidence-
based quality improvement programs that are helping us make
progress in moving the needle.
In order to fully confront this crisis, we must recognize
that race is a social construct, not biologically based, and
that racism, not race, impacts healthcare, health, and health
outcomes.
Systemic and institutional racism are pervasive in our
country and in our country's healthcare institutions, including
the fields of obstetrics and gynecology.
We must invest in quality improvement initiatives that
standardize care and improve the provision of respectful and
culturally congruent care. We must increase the access to care,
including telehealth in rural communities.
We must address social determinants of health and we must
ensure that all pregnant, birthing, and postpartum people have
access to the care they need.
One initiative key to this work is the Alliance for
Innovation on Maternal Health, or AIM program. AIM provides
technical assistance, capacity building, and data support for
the adoption of evidence-based patient safety practices, or
bundles, which address issues like obstetric hemorrhage,
hypertension, and safe reduction of primary Cesarean birth.
Ongoing work of AIM includes the development of a new
bundle on cardiac conditions and incorporating equitable and
respectful patient care into each of the existing bundles.
Continued investment in this program is necessary to
achieve implementation of patient safety bundles in every
birthing facility across the country. Perinatal Quality
Collaborative and Maternal Mortality Review Committees also
play an important role in improving maternal health outcomes.
Together, the AIM Program, Perinatal Quality collaborative,
and Maternal Mortality Review Committees make up an
infrastructure key to our efforts to promote high-quality
respectful care and eliminate preventable maternal mortality
and inequities in outcomes.
To simplify, Maternal Mortality Review Committees make
recommendations for preventing maternal deaths. The AIM program
provides tools and resources and the Perinatal Quality
Collaboratives provide the networks to facilitate system wide
implementation of these best practices.
Last, I would like to emphasize the critical need to close
the postpartum coverage gap in Medicaid. Medicaid covers nearly
half of births nationwide and we see alarming postpartum
coverage gaps in both expansion and nonexpansion states.
As we learn more about the timing of maternal death, it is
clear that continuous coverage of people who rely on Medicaid
is critical to confronting this crisis. We urge Congress to do
more to incentivize every state to provide 12 months of
continuous postpartum coverage in Medicaid.
I am heartbroken every time I see a Black patient who comes
to me for prenatal care, and says, Doc, please just let me die.
This happens far too often.
No one should have to experience this type of fear. In the
most highly resourced country in the world, people should not
be dying from what should be the happiest times of their lives.
Thank you for the opportunity to be part of this urgent
conversation and to help inform the critical work ahead to end
preventable maternal deaths and improve Black maternal health.
Ms. Kelly. Thank you so much, Dr. Auguste, for your
testimony.
We will now hear from Dr. Gillispie. You are now recognized
for five minutes for your testimony.
STATEMENT OF VERONICA GILLISPIE-BELL, M.D., FACOG, M.S.,
MEDICAL DIRECTOR, LOUISIANA PERINATAL QUALITY COLLABORATIVE
Dr. Gillispie-Bell. Thank you.
Madam Chairwoman Maloney, Co-Chairwoman Kelly, Ranking
Member Comer, and members of the Committee on Oversight and
Reform, thank you for inviting me to testify and give my
perspective on America's Black maternal health crisis. It is
truly an honor.
I am Dr. Veronica Gillispie-Bell. Today, I bring forth my
knowledge as an OB/GYN who has practiced in New Orleans for the
last 13 years. I also bring the perspective as the medical
director of the Louisiana Pregnancy-Associated Mortality Review
and of the Perinatal Quality Collaborative, and finally, the
perspective as a Black mama.
I bring this knowledge, but I am here today to be the voice
of my Black patients, of my Black families. Do you know what it
is like to have someone look you in your eyes with fear in
theirs and ask, Dr. Gillispie, if you are not there when I give
birth, am I going to die?
Our Black persons are afraid and they have every right to
be, when 700 mothers, wives, sisters, daughters are lost in
childbirth every year, when our chance of dying is three to
four times that of our white counterparts.
And as you have heard today, it doesn't matter if we are
rich or poor, if we are sick or well, if we are educated or
not. The chance we will experience a severe maternal morbidity
or a death is increased by one factor, race. And for those who
think that being Black is the problem, let me be crystal clear.
Race is a social construct, not a biological condition.
Four hundred years of systemic racism has created a world where
we, as Black women, are two steps behind before we even emerge
from the womb. False narratives have shaped biases that have
led to inequities in the care that we receive.
But I came today to not only discuss the problem but also
the solutions. We need congressional support for state
Perinatal Quality Collaboratives. The Louisiana Perinatal
Quality Collaborative, by using improvement science to
implement equitable care delivery processes in birthing
facilities, has seen a 35 percent reduction in severe maternal
morbidity related to hemorrhage, a 49 percent reduction in our
Black birthing persons, and a 12 percent reduction in severe
maternal morbidity related to hypertension.
Evidence-based patient safety bundles like the AIM bundles
tell us what to do. Improvement science tells us how to do it.
It takes 17 years for evidence-based medicine to be implemented
at the bedside without improvement science. With the
improvement science, it takes only three years.
We need state Perinatal Quality Collaboratives to help
teach our birthing facilities the how. We need congressional
support for state Maternal Mortality Review Committees. Through
the Louisiana Pregnancy-Associated Mortality Review Committee,
we review all maternal deaths to quantify the drivers of
maternal mortality.
This data is used to drive improvement. Funding is needed
to secure the resources of time and people to support these
committees in every state so they are able to locally identify
the drivers of maternal mortality.
We need congressional support to ensure the extension of
Medicaid postpartum coverage to one year. The year after birth
is a crucial critical time to optimize medical conditions and
provide an opportunity for family planning.
Through the American Rescue Plan Act, Congress took an
important step to incentivize states to extend postpartum
Medicaid coverage to 12 months after the end of pregnancy. Even
with those incentives, not all states will choose to extend
Medicaid.
We need to ensure all Medicaid individuals have coverage
through the critical postpartum period. We need congressional
support for systems that ensure pregnant women receive the
appropriate level of care based on the complexity and the
acuity of their medical issues.
The American College of Obstetricians and Gynecologists and
the Society for Maternal Fetal Medicine have established a
classification system that standardizes the maternity facility
capabilities and personnel to facilitate patients receiving
risk-appropriate maternal care.
Not all states have adopted this system. As I have led the
work to adopting this system in Louisiana, it is also apparent
that states will need resources to meet these requirements,
especially for hospitals in smaller and more rural communities.
We need congressional support for infrastructure to ensure
telehealth is available to all. The benefits of telehealth with
remote home-monitoring devices are well noted in the obstetric
population.
Through our Connected Mom program at Oschner, I have
diagnosed someone with preeclampsia with severe features
between her regularly scheduled visits because she was able to
take her blood pressure more frequently than in traditional
care.
Telehealth has the potential to really improve outcomes,
but it also has a potential to exacerbate barriers if we do not
address infrastructure and access to home broadband.
We need to create and support programs to increase
diversity within the physician work force, such as the Summer
Health Professions Education Program. I am the result of that
program when it was called the Minority Medical Education
Program. We must support the development of minorities with a
desire to pursue careers in healthcare.
I would like to thank you for the opportunity to share my
perspective on the causes and solutions for the Black maternal
health crisis, and I want to leave you with one thought.
Privilege should not be the gateway to equitable safe care.
It is a right of everyone and our Black mothers deserve better
and we can be better.
Thank you so much.
Ms. Kelly. Thank you so very much, Dr. Gillispie, for your
powerful testimony.
Now I would like to introduce Dr. Crear-Perry. You are now
recognized for your testimony for five minutes.
Thank you.
STATEMENT OF JOIA ADELE CREAR-PERRY, M.D., FACOG, FOUNDER AND
PRESIDENT, NATIONAL BIRTH EQUITY COLLABORATIVE
Dr. Crear-Perry. Good afternoon, Chairwoman Maloney,
Congresswoman Kelly, Ranking Member Comer, and members of the
House Committee on Oversight and Reform.
My name is Dr. Joia Crear-Perry and I am an OB/GYN by
training and serve as the founder and president of the National
Birth Equity Collaborative, where we create global solutions
that optimize Black maternal, infant, sexual, and reproductive
well being.
We shift systems and culture through training, research,
technical assistance, policy, advocacy, and community-centered
collaboration. In the United States, the legacy of devaluing
Black women's lives is directly linked to today's Black
maternal health crisis. Slavery as an institution and white
supremacy as a framework have had a direct impact on the
maternal mortality crisis among Black birthing people in the
United States and around the globe.
From the stories told by Black women regarding the lack of
respect for maternity care received in their birthing
experiences as well as recent occurrences received in their--I
am sorry, forced sterilization of women in ICE detention
centers, it is clear that the very systems in place today that
perpetuate harm are keeping the legacy of eugenics and
population control alive and well. From Lucy, Betsey, and
Anarcha to Kira, Shalon and Amber Rose, Black mamas deserve
better.
The structure of our American society causes poor maternal
health outcomes for Black people, not individual choices or
genetics. Structural forces include our political, economic,
justice, and education systems, as well as racism, immigration
status, classism, gender oppression. All are reinforcing
systems of oppression that cause harm and death.
In the last five years, at least 48 Black women have been
killed by police and zero officers have been convicted. In
order to end the Black maternal health crisis, we need to
center Black women's lives and experiences, and that means
addressing interlocking systems of oppression.
So we must, first, infuse a reproductive justice lens into
policymaking, as demonstrated with the Black Maternal Health
Momnibus Act of 2021. The Momnibus Act advances reproductive
justice by joining once fragmented issues like racism within
the healthcare system, implicit bias training, veterans,
substance use disorder, climate change and environmental
justice, criminal justice, and medical technology by censoring
the most marginalized Black and indigenous birthing people.
No more silos. No more toolkits and drills as the solution.
Health is a right and reproductive justice is the pathway to
codify that right. We must establish the White House Office of
Sexual and Reproductive Health and Well Being.
Sexual and reproductive health and well being are a key
component of people's overall health and quality of life. We
need to reproductive health equity. Efforts related to maternal
and child health are siloed. Family planning services and
social supports are disinvested in and have their roots in
eugenics and population control in the United States and
abroad.
We don't need a plan. We need power. A permanent
infrastructure is needed to develop a Federal strategy for
promoting sexual and reproductive health and well being through
a human rights and racial equity lens and to better coordinate
the many--the work of the many departments and agencies whose
actions impact our well being.
Since I can breastfeed and have abortion on the same day,
the Federal structures that support me should work together to
support the full personal bodily autonomy of all people.
The establishment of the office can drive change and foster
accountability by developing a national strategy for
integrating sexual and reproductive health equity into
established Federal processes.
And we have to reckon with the effects of COVID-19 on
maternal health. The COVID-19 pandemic has disproportionately
affected Black women and exacerbated inequities in maternal
health outcomes.
Black women are more likely than white women to be
essential workers, thus, increasing the likelihood of exposure
and contraction of COVID-19. These physicians tend to have
lower wages and they don't come with benefits like employer-
sponsored insurance or paid sick leave. Without these
coverage--without insurance coverage, routine maternal care
visits are delayed or disrupted. Barriers to providers are
heightened.
To address the impact that COVID-19 has had on Black
maternal health, funding should be allocated to Black women-led
community-based organizations to support the delivery of care
in person or via telehealth through the Centers for Medicare
and Medicaid that should support hybrid models of healthcare by
providing guidance, incentives, and promoting telehealth and
birth center services.
Congress should pass the COVID-19 Safe Birthing Act to
promote birth equity during the pandemic and after. Further, we
must increase health insurance coverage by mandated Medicaid
postpartum coverage to be extended for at least one year.
The American Rescue Plan grants states the option to extend
Medicaid postpartum coverage between the typical 60 days to at
least 12 months. However, allowing the states to have the
option to opt out of providing continuous coverage does not go
far enough to address the maternal mortality crisis, an
additional barrier for Black and indigenous women to access
high quality and affordable health insurance. We applaud
Illinois, but we worry about our sisters who live in Florida
and Texas and other places.
Last, we must increase the pathways for birth workers of
color. There are not enough Black workers of color, leaving
Black birthing people with limited autonomy or opportunity to
receive racially concordant care, which is associated with
improved maternal health outcomes for Black mamas and babies.
Community-based birth workers such as doulas, midwives,
lactation consultants, and community workers, and my colleagues
who are members of the Black Mamas Matter Alliance, are
essential to improving maternal and infant health.
Medicaid and private insurance can reimburse and cover, but
most states have not. Requiring Medicaid reimbursement for all
types of perinatal birth workers will help to rebuild and
repair community trust and lead to reduction of health
disparities in noncentered communities where health--holistic
healthcare plays an essential role.
Further, we should invest in midwifery schools at
historically Black colleges and universities as a pathway to
increase the number of Black midwives and increase investment
in pipeline programs for Black physicians, including OB/GYNs
like myself.
Data shows that cultural concordance matters for Black
births. I am committed to Black justice, liberation, and joy,
and yes, liberation and joy can even be part of birth. They are
core tenets of sexual and reproductive well being that values
more than just mere survival or the absence of disease, but the
ability to thrive.
So, that is what birth equity is all about. Thank you, and
I look forward to your questions.
Ms. Kelly. Thank you so much, Dr. Crear-Perry. And now I
would like to introduce our last witness, Dr. Taylor.
You are now recognized for your testimony.
STATEMENT OF JAMILA TAYLOR, PH.D., DIRECTOR OF HEALTH CARE
REFORM AND SENIOR FELLOW, THE CENTURY FOUNDATION
Dr. Taylor. Good afternoon.
Chairwoman Maloney, Ranking Member Comer, and members of
the committee, thank you for the opportunity to testify on
structural racism and Black maternal health.
I serve as the director of health care reform and senior
fellow at the Century Foundation, a 100-year-old progressive
think tank that conducts research, develops solutions, and
drives policy change to make people's lives better.
According to the CDC, Black women are dying of pregnancy-
related causes more than any other racial or ethnic group. We
are also most likely to experience severe maternal morbidity.
Poor maternal health outcomes among Black women cannot
solely be attributed to social determinants such as poverty or
educational attainment. Rather, structural racism is the main
culprit.
Racism cannot be understood as simply interpersonal bias
and animus. It is a powerful social condition that has its
roots in a centuries-long system of oppression and devaluing of
Black people and Black women in particular.
It not only persists today in our healthcare policies and
practices; it has real significant impacts on people's health.
According to the Aspen Institute, structural racism is defined
as a system where public policies, institutional practices, and
cultural representations work to reinforce and perpetuate
racial inequity.
Much of American history and culture in which whiteness is
privileged and color is disadvantages squarely fits this
definition. The Aspen Institute also affirms that structural
racism has been a mainstay in the social, economic, and
political systems in which we all take part.
Healthcare is one of those systems. Throughout history,
Black women have endured abuses by some in the medical
profession. Enslaved Black women were forced to undergo
experimental surgeries to advance the study of obstetrics and
gynecology. Low-income Black women have been subject to forced
sterilization. Our bodily pain has been diminished or outright
ignored.
There are too many examples to list. These events have
lasting implications for the health care challenges Black women
face today. Harmful institutional practices and negative
cultural representations have led to trauma inducing pregnancy
and birthing experiences, and even death for some women.
This has to change, and, fortunately, it can be done. For
one, healthcare providers should be trained in ways that afford
them the opportunity to recognize and address racism and bias
in their interactions with Black patients.
Practitioners should be equipped to ensure safety protocols
that offer quality care that respects and values Black life.
Public policy which can also perpetuate racial inequity needs
to change as well.
The groundbreaking report on equal treatment published by
the Institute of Medicine in 2003 asserted that health
disparities not only emerged from how healthcare systems
operate, but also from the legal, regulatory, and policy
climate within which health is delivered.
One example of this is how some policy decisions make it
harder for Medicaid enrollees, a program that
disproportionately serves women of color, to access the health
care they need. Almost half of all births in this country are
covered by Medicaid. But for women who enroll in pregnancy only
Medicaid, coverage ends just 60 days after giving birth.
The American Rescue Plan Act takes steps to remedy this
shameful policy by giving states a time-limited option to
extend coverage for new mothers up to one year. The Act also
incentivizes Medicaid for states that have yet to do so, states
which are, largely, concentrated in the South, where about half
of African Americans live.
And while both of these provisions are progress, we
desperately need long-term fixes to support the health care
needs of Black women and birthing people. This means all states
expanding Medicaid, mandatory extension of postpartum coverage
to at least one year, and passage of the Black Maternal Health
Momnibus.
Failure to take these steps will only further limit
coverage for women of color and perpetuate racial inequity. We
all have a role to play in dismantling structural racism, which
is a key contributor to racial disparities in maternal health.
It is past time to implement policies and healthcare
practices to ensure quality care that is equitable and
respectful of Black women and birthing people.
In addition to my testimony, I will be submitting my
article, ``Structural Racism in Maternal Health Among Black
Women,'' as published in the Journal of Law, Medicine, and
Ethics, for the record.
Thank you for the opportunity to testify today, and I look
forward to your questions.
Ms. Kelly. Thank you so very much, Dr. Taylor, for your
testimony, and at this time, I would like to turn it back over
to Madam Chair Maloney for questions.
Chairwoman Maloney. [Presiding.] Thank you, Co-Chair Kelly,
and thank you for your moving testimony. I now recognize myself
for five minutes.
Ms. Ali and Mr. Johnson, thank you for sharing your stories
with us this morning. They are heartbreaking, and I am sorry
that our health system--that our American health system harmed
you and your families.
Addressing our Black maternal mortality crisis will require
a systemic shift in our approach to maternal health care and
targeted data-driven policies. But right now, we simply don't
have the tools to collect the data we need to inform good
policy.
So, Dr. Taylor, let me start with you. How is the Federal
Government's data collection on adverse Black maternal health
outcomes lacking?
Dr. Taylor?
Dr. Taylor. Yes. Thank you so much for your question,
Chairwoman Maloney.
You know, right now, we still have a fragmented system in
terms of collecting data in this country and so, you know, the
best that we can use or what we see coming out of the CDC is,
basically, an estimate.
You know, you have heard a lot today from our colleagues
about the need to advance and ensure better funding for
maternal mortality review committees, and that is going to be
key to make sure that we have more accurate data.
The Preventing Maternal Deaths Act was passed in, you know,
2018 and that bill allocated additional funding for states to
develop and start maternal mortality review committees. But we
still don't have them in every state, and so until we do that,
you know, then we will have more accurate data, both in terms
of race and ethnicity.
And we also need to know what the impacts are on these
communities, both from a qualitative level as well as a
quantitative level.
Chairwoman Maloney. Thank you. There are a number of bills
that have been introduced in the House that would improve data
collection. For example, Congresswoman Kelly's MOMMA's Act
would standardize Federal data collection and reporting on
maternal mortality rates, and the data for MOMMA's Act, part
about Momnibus package championed by Congresswomen Underwood
and Adams, would foster improvements in data collection
practices and promote diversity and community engagement in
maternal mortality review committees.
So, Dr. Crear-Perry, how would better data collection
reduce Black maternal mortality and morbidity in the United
States?
Dr. Crear-Perry. Thank you. So, we know that during the
COVID pandemic there was a highlight of the need for data,
right. We were sending resources to places based upon bias. We
were hearing words like it is the Chinese virus and all those
biased, and so that made our infrastructure shift.
It is the same thing that happens when it comes to Black
maternal health. If you don't have the actual information, you
are going to create solutions not based upon what is really
happening.
The beauty of us having, finally, the data released by the
CDC after the testimony that Charles and I were able to give to
increase funding for the CDC to help support states for
recording show that, you know, Black birthing people were still
five times more likely to die in childbirth, despite having an
advanced degree.
That is the kind of thing that you need in order to be able
to then say, so don't just blame them and say go to school and
your outcomes will become better, because we go to school and
we still die.
So, we need to have data so they don't operate out of bias
when we create policies and strategies and investments just
like we had to do during the COVID pandemic.
Chairwoman Maloney. Thank you for your excellent answer.
I was pleased to join my colleagues on the Oversight
Committee and in the Black Maternal Health Caucus earlier this
week in asking the Government Accountability Office for three
new reports that were crafted from the Momnibus legislation,
and these are the three reports that we have requested.
The first will examine how the coronavirus pandemic has
exacerbated America's Black maternal health crisis and how our
efforts to build back better are impacting these outcomes.
The second will analyze the state of our country's
perinatal work force, including barriers to assessing care by
midwives and other maternity care professionals.
And the third will evaluate how America's Black maternal
health crisis disproportionately harms people who are
incarcerated.
In each of these requests we asked GAO to assess how
limitations in data collection inhibit their abilities to draw
conclusions. This will help us to understand what we still do
not know.
Mr. Johnson, let me end by asking you what do you hope will
come out of this hearing today?
Your mic is not on.
Mr. Johnson. Anybody? There we go. OK.
Chairwoman Maloney. Now we hear you.
Mr. Johnson. OK, here we go.
So, thank you, Madam Chairwoman. Let me, first, say, as I
expressed earlier, that although the statistics and the stories
that we are hearing are devastating, what I want you to
understand and I want all the members of this committee to
understand is on behalf of the families that have been impacted
by this crisis, legislation like the Momnibus gives us hope. It
gives us hope.
And day in and day out, I talk to families who are
grieving, families that are devastated, fathers that are trying
to find their way in their new reality, and to be able to tell
them that we understand your loss.
And there are people in the highest offices of power who
are making the sacrifice of their loved one a priority and who
are working tirelessly to make sure that it does not continue
to happen.
So, my hope is that this committee, this Congress, will
come together in a bipartisan fashion the likes of which we
have never seen. Because the reality of the situation is, as I
have said before, is that there are two types of people in this
country--either you have a mama or you are one. It is that
simple, and we have to make this a priority.
And I hope that people will begin to realize what this is.
This is not a Black issue. This is not a Black women's health
issue. This is a human rights issue. It should be a fundamental
human right to deliver a healthy child in this country and live
to raise that child. That is my hope.
Chairwoman Maloney. Well, I hope they will be able to
deliver on your hope by coming together in a bipartisan way and
working collectively to change the system and to pass the over
15 bills that were under consideration today.
And thank you for sharing your story and your pain and your
loss with us, and it will inspire all of us to work harder to
help you and families like yours.
Mr. Johnson. Thank you very much.
Chairwoman Maloney. I want to thank all of our witnesses
for sharing their very powerful and personal perspective with
the committee today, and I want to thank my colleagues for
lending their outstanding leadership and expertise to today's
hearing.
In the United States, it should be a national scandal
anytime a parent is lost during childbirth, and we should not
rest, any of us, until we turn the tide on this crisis.
I now recognize the gentlewoman from North Carolina, my
Republican colleague, Ms. Foxx from North Carolina, for five
minutes, after which the leadership will return to my co-chair,
Ms. Kelly, for the duration of this hearing.
Again, I thank all of the participants and I look forward
to everyone's questions.
Ms. Foxx, you are now recognized for five minutes.
Ms. Foxx. Thank you, Madam Chairman, and I thank our
witnesses for being here today also.
The questions I have are all for Dr. Auguste. The U.S. and
Canada have the lowest overall level of midwives and
obstetrician/gynecologists, between 12 and 15 providers per
1,000 live births respectively.
In contrast, all other countries have between two and six
times more midwives and OB/GYNs. How does this lack of
providers impact expectant mothers?
Dr. Auguste. Thank you, ma'am, for the question.
So, I think that this contributes--the lack of these
providers around midwives contributes to the lack of work force
that we are seeing that contributes to the lack of attention
that is given to all of our mothers, particularly Black women.
So I think that, like many of the other panelists have
mentioned, you know, being able to make sure that midwives are
part of the healthcare delivery team will absolutely help and
assist with the improvement of Black maternal health outcomes.
Access to----
Ms. Foxx. Let me ask you--let me ask you to add to that.
What can we do to encourage more people to enter birthing
helper professions?
Dr. Auguste. Thank you again for that question.
I think that it starts earlier on. I think we have to make
this more of a awareness of the type of medical care that
people can offer being midwives. Again, include them as part of
the team to deliver healthcare. Make this more of the
conversation. Have it well known and understood that the
improved outcomes with this entire team--a physician, midwives,
and doulas--will help on maternal health efforts.
Ms. Foxx. Well, we think--you agree that having midwives
and other nonphysician partners can help decrease the risk for
mothers. Is that correct?
Dr. Auguste. Access to nonclinical support personnel like
doulas and midwives is associated with improved outcomes for
women in labor. I have worked alongside both for my entire
career and I appreciate and extremely value the care that they
provide for the patients of a low-risk nature. Absolutely.
Ms. Foxx. Great. The COVID-19 pandemic seems to have forced
care providers to increase telehealth options, which has
increased the likelihood that pregnant women receive prenatal
care. How does an increase in prenatal care impact the
potential outcome for the mother?
Dr. Auguste. Thank you. Yes, you are correct. Telehealth
will increase the impact and the occurrence of prenatal care.
Entering and adhering to prenatal care enriches the
conversation and the relationship between the patient and the
providers.
It allows time for the patients and the providers to
discuss concerns, again, based on that relationship that they
develop, have the women be heard and to have all their
questions and concerns answered.
So, I think this is just a win-win situation in terms of
solidifying the relationship between patients and their
providers.
Ms. Foxx. A lot has been said today about the need to
increase care for rural communities, and we all know it is
difficult to get physicians of all kinds to live in rural
communities.
But talk a little bit about the impact of increased
telehealth services on rural communities.
Dr. Auguste. Sure. So, I think that in rural communities we
have to very clearly understand that studies have found that
pregnancy-related mortality ratios rise with increasing
rurality.
So, again, the lack of access to high-quality maternal
services in rural communities is a result of many factors and
telehealth can very much help.
So, again, being able--we cannot forget to have those
resources available to the rural communities so that we can
improve the access and the adherence to prenatal care.
Ms. Foxx. Great. I have 39 seconds left. Is there anything
you wanted to say that you have not been able to say in your
testimony so far in my questioning?
Dr. Auguste. Thank you for that opportunity.
I just wanted to say that with all of the panelists here,
it highlights the fact that this crisis is multi-factorial and
that we have to work together on this.
All the panelists here bring together a different point of
view, but this is all very important. It is multi-factorial
problems. We have to have a multi-factorial solution, and all
the panelists here are bringing that together, along with all
the members of this committee in Congress. Thank you.
Ms. Foxx. Thank you, and thank you, Chairwoman Kelly, for
allowing me the time to ask questions. I yield back.
Ms. Kelly. [Presiding.] Thank you, Representative. The
gentlelady yields back.
And now the gentleman from Virginia, does he have his
camera on? Congressman Connolly?
Mr. Connolly. Yes.
Ms. Kelly. You have five minutes, sir.
Mr. Connolly. I don't know why my camera went off. I am
sorry.
Thank you, Chairwoman Kelly, and thank you, Chairwoman
Maloney. This--I can't imagine a more important and gripping
hearing we have had in recent history than this.
Mr. Johnson, your testimony goes to everybody's heart. What
you and your family have gone through and suffered no American
family should ever have to go through or suffer, and I can only
assure you your words matter. You sharing your experience is
going to matter, and this is an issue we won't let go of in the
U.S. Congress and, hopefully, in a strong bipartisan fashion,
as you suggest.
Dr. Taylor, we heard from Ms. Ali and we heard from Mr.
Johnson stories of blatant indifference to, you know, women who
were suffering, who were in pain, who were going through a
difficult experience, and it cost one woman her life.
How in the 21st century is it possible that the medical
profession is still capable of that kind of gross negligence
and indifference to any patient, white or Black? And help us
reflect on that. I mean, what does that say about hospitals and
medical care in America?
Dr. Taylor. Thank you for your question, Mr. Connolly.
You know, I think it is important to note here, you know,
there is a reason why this hearing has a theme about racism,
right, and when we talk about racism in a structural sense or
when it is institutionalized, sometimes it can be harder to
see.
You know, it could be more in covert forms instead of overt
forms. And we have also heard today that there is this of
legacy of oppression and white supremacy that has really been--
you know, was first instituted during when African Americans or
Black people were enslaved and it has followed us until where
we are now.
And when you hear in those stories the fact that women's
pain has been ignored, they have not been listened to, that is
a manifestation of racism within the healthcare system. And,
you know, from my perspective, that also dates back to slavery
where women were abused, you know, used for the experimentation
of surgeries in the study of obstetrics and gynecology. Their
pain was ignored.
You know, there is this perception that Black people have
thicker skin. They may not feel pain in the same ways that
white people do, and so that is being institutionalized in the
healthcare system and it has led to, you know, the grave
challenges that we have seen in terms of Black women, Black
birthing people, and their experiences.
And so, I think, for us to move beyond this issue and
really see change, we really have to deal with these racist
perceptions of pain in the Black body.
Mr. Connolly. Thank you.
Dr. Gillispie, would you like to comment on that?
Dr. Gillispie-Bell. Yes, thank you so much. I echo what Dr.
Taylor has said. When we look, historically, especially in
obstetrics and gynecology, and we look at the racism in
medicine, just starting back to Marion Sims, who was known as
the father of modern gynecology, who performed his procedures
on slave women without anesthesia, even though anesthesia was
available at the time.
What got perpetuated and what that published in the
textbooks is that Black individuals don't feel pain in the same
way, and in a recent study that was done at a medical school
where they interviewed over 200 white residents and white
medical students, they believed that Black individuals have
thicker skin and that our nerve endings are not the same so
that we don't feel pain in the same way.
They also found in this study that the higher their
disbelief was about Black individuals and their pain tolerance,
the more likely they were to not prescribe appropriate pain
medications.
And so what has been perpetuated through history has to be
corrected, and I am speaking about pain. But there are
hundreds, hundreds of biases that have formed the way we
educate our medical students and our residents to then go and
practice medicine.
And so we have got to start to undo these biases and we
have to diversify the work force so that we have providers that
are bias interrupters to be able to bring truth to the way
medicine should be performed and the way that we--that we
respect all birthing persons.
Mr. Connolly. Thank you. In my brief--my time is up but I
just want to conclude by observing we not only have to look at
the huge inequities in terms of access to health care, we also
have to look at how healthcare is practiced.
Thank you so much, all of you, for the courage of being
here today and for riveting and enlightening testimony.
Thank you, Chairwoman Kelly.
Ms. Kelly. The gentleman from Virginia yields back.
And now the gentleman from Ohio, Congressman Gibbs, has
five minutes.
Mr. Gibbs. Thank you, Madam Chair.
First of all, I would like to say the birth of a child that
should be for the family--for celebration and excitement and
look forward to a bright future, and it is sad to hear when
there is problems, obviously.
Well, I am going to start off, first, and ask Mr. Johnson a
question. Obviously, that was tragic what happened, the loss of
his wife and child.
Was there anybody held accountable or any legal action
taken for the unacceptable behavior that you can't tolerate,
Mr. Johnson?
Mr. Johnson. Certainly. Thank you for that question, and
extremely unfortunately there has been zero accountability in
my wife's case, for multiple factors.
In the state of California, they have a set of caps on
medical malpractice recovery that limit the value of human life
to $250,000. So, what happens is, oftentimes, doctors who are
perpetual bad actors are not held accountable. Not only that,
the medical systems and the hospitals are not forced to be
transparent.
So, the anniversary of my wife's death was five years on
April 13. To this day, the doctor who was mainly responsible
for taking her back to surgery and was found grossly negligent
in her death by the California Medical Board is still
practicing medicine.
He was disciplined with only three years probation after
being found grossly negligent not only in Kira's death, but in
the death of, I think, six other women, right. So, there has
been zero accountability. There has been zero transparency,
which adds insult to injury to families like mine. And I could
go on and on and on----
Mr. Gibbs. Let me interrupt. I don't want to run out of
time. But the medical board did hold him accountable, but then
they didn't really hold him accountable. They just said he was
grossly negligent, and that is an issue that should be
addressed either through the legal system or, obviously, the
legislature, too.
We shouldn't let bad actors, if it is bad doctors, bad
police, bad anybody, they should be--they should be held
accountable and removed from their positions.
So, I know about racism, right, and I struggle a lot with
that, knowing that, you know, in our society, you know, in the
medical community, we have lots of Black nurses and doctors and
same thing in the police and in the cities where we have--and
some of the written testimony there was talk about police
brutality. I am sure it happens.
But in these areas where we have--in these urban centers
the leadership is Black, in most cases, in a lot of cases, and
elected--and some elected officials. I just want to mention
that. So, there are some things that are hard to reconcile
with.
I will also say that, you know, I think we have--poverty,
you know, these people in our inner cities the Black community
has been trapped in poverty, in housing, mental health issues,
drugs, suicides.
We have all heard of that--heard about that, and one of the
reasons they are trapped in poverty is because our education
system has totally failed our Black community and they don't
have a choice to get out or get to a better opportunity.
We have loss in the Black community, a lot of families with
the fathers not there. So, there is a lot of other issues that
go into this, too, I believe.
And so economic opportunities--on the last Congress, we
passed opportunity zones targeted to these areas to provide
jobs and opportunities and also criminal justice reform, a
bipartisan bill.
Hopefully, that will help address some of these issues.
In my district here in Ohio in my largest county, Stark
County, with a program called Thrive that helps especially with
the Black community, safe, affordable housing.
They have mentoring programs for fathers. They also supply
baby supplies, food, and diapers, and those--you know,
obviously, those programs are helpful and help people lift out
of poverty, because I think poverty is a--is a root cause of
this issue.
Voice. My God.
Mr. Gibbs. Pardon? OK. Somebody was just--so unmuted there.
Anyways, I want to ask Ms. Auguste--Dr. Auguste, has there
ever been any studies done that you know that determine the
correlation between infant mortality and opioids and drug abuse
in the--you know, I guess, in the Black community, or any
community, for that matter?
Dr. Auguste. Sure. Thank you very much, sir, for that--for
that question. There are very clear links to opioid use and
increased opioid use with both maternal and infant mortality.
So yes, there definitely are.
So, I think that it is important that those issues as well
need to be addressed.
Mr. Gibbs. OK. And I think some of the other--as I
mentioned. I am out of time so I have to yield back. But I
think we do need to address the poverty issue, especially how
it is affecting the education system and the lack of
opportunities, especially in the African-American community.
I yield back.
Ms. Kelly. The gentleman from Ohio yields back.
And now I would like to recognize the gentleman from
Maryland, Congressman Raskin.
Mr. Raskin. Thank you, Madam Chair, Congresswoman Kelly,
Congresswoman Pressley, Congresswoman Maloney. This is truly an
extraordinary hearing and it has got history-making potential,
depending on what we do with it, and I just want to thank you
all for arranging such an extraordinary panel of witnesses.
Dr. Gillispie-Bell, let me start with you. You stated that
one factor stands out when you control for all of the
variables, and I want to be very clear about this.
You are saying that African-American women suffer
disproportionately negative outcomes regardless of income or
wealth. So, that even within the category of affluent African-
American women, they--we are still seeing racial disproportion.
Is that right?
Dr. Gillispie-Bell. That is absolutely correct. Thank you
so much for recognizing that. Yes, we find that looking
specifically at severe maternal morbidity that a Black woman
with a college degree is twice as likely to experience a severe
maternal morbidity when compared to a white woman with less
than a high school diploma. And so, again, as you have already
said, and that is a testament to addressing--for addressing
education, addressing those socioeconomic factors and still
having adverse outcomes.
Mr. Raskin. And you are citing studies that have isolated
all kinds of variables that refute different theories about
biological differences, physiological differences, all of it.
It comes down, as Dr. August or Auguste--forgive me, I
missed the original pronunciation--but, Dr. Auguste, let me
come to you. It comes down to what you say is not race, but
racism.
And I love this point, Dr. Auguste, because you have made a
point I think several of the panelists have also echoed, which
is that race itself is a social construction. The whole concept
of race was a construction of racism, the ideology of racism
that in America was put to service for enslavement and
oppression and exploitation of people. And so you blame it,
generally, on race. It makes it sound like there is nothing we
can do about it.
But if you identify specific structures of racism, that is
something that we can actually change. We have got the power to
change that, and it is so moving to hear these doctors come in
and say that.
So, Dr. Auguste, let me ask you, what are some of those
specific manifestations of racism in our medical practices, in
our medical system, that we can alter by being conscious of
this and intervening?
Dr. Auguste. Thank you very much for the question.
So yes, as you can see from the conversation that we are
having here, it highlights that there is racism at all levels
and, unfortunately, we know that racism is structural and
institutional, and implicit bias on our healthcare providers
contribute to the racial and ethnic disparities that we are all
talking about and have contributed to this poor outcome.
So, organizations like ACOG are committed to addressing the
issues around racism in medicine, particularly at the base of
structural and institutional racism, and we want to be able to
partner and are glad to partner with Congress in correcting
these.
I just want to say that, you know, in my experience,
healthcare providers, physicians, don't enter the profession
with intention of providing inequitable health care. It is--it
is the fact of the implicit bias on part of our healthcare
professionals that needs to be addressed.
Mr. Raskin. Very nice. OK.
Dr. Taylor, I want to ask you, quickly, if I could, how has
insurance coverage been shown to improve health outcomes for
women who are delivering? And I say this because Medicaid, I
think, and Medicaid coverage can be a critical part of the
answer here. So, does it--how does expanding health insurance
coverage work to improve outcomes, Dr. Taylor?
Dr. Taylor. Thank you for that question, Representative
Raskin.
Absolutely. Health insurance coverage is essential to not
only ensure that women can keep up with their medical
appointments, you know, support--it also supports, you know,
the health of the infant as well. When mom is healthy, the
infant is also healthy.
So, the continuum of care is critical, and that goes hand
in hand with having insurance coverage.
Mr. Raskin. Thank you so much.
Finally, Mr. Johnson, your testimony just broke my heart,
and I want to thank you for being out there speaking up for
your wife, your kids' mom and for all of those moms.
And I wonder if you would just say a word about the
importance of making this an issue not just for women, but for
men, too.
Mr. Johnson. So absolutely. So, thank you--thank you for
your comments. It is critically important that as we are
fighting to protect mothers that we are doing everything that
we can to also empower their partners, if that means a father,
if that means a support person, if that means whatever--however
they are coming to their birthing experience, that they are
informed, they are empowered about potential warning signs,
that they understand how to advocate for them if their partner
can't advocate for herself.
But it is also critically important that we reform systems
in a manner in which these voices are heard and they are not
dismissed, and a Black man such as myself, who is advocating
for his wife at her most vulnerable point, is seen and heard
and not seen as a threat.
That is what we must do, moving forward.
Mr. Raskin. Thank you so much. I yield back, Madam Chair.
Thank you for your indulgence.
Ms. Kelly. The gentleman from Maryland yields back.
And I now recognize the gentleman from Pennsylvania,
Congressman Keller.
Mr. Keller. Thank you, Madam Chairwoman. Every mother and
newborn child in America deserves access to high-quality
healthcare before and after delivery. Far too many rural
communities do not have a qualified childbirth provider.
Healthcare providers such as midwives must work around
scope of practice requirements, licensing laws, and regulations
surrounding physician supervision.
Dr. Auguste, to what extent are Federal restrictions
surrounding midwives contributing to these work force
challenges?
Dr. Auguste. Thank you, sir, for the question.
So, I am a clinical expert and am not exactly familiar with
all the legislative and Federal restrictions. However, I think
the key takeaway point here is that there is a known shortage
of healthcare providers in these rural areas.
So, we are talking about midwives and physicians. There is
also a maldistribution of where those health providers are. So,
we can look at those sort of--look at those sort of issues and
really help to bring them into the communities where they are
needed.
Some programs, like the National Health Service Corps, will
help to bring those needed maternal health providers to some of
those rural areas and urban areas where they are needed.
Mr. Keller. So, that would be one of the steps. Would there
be any other steps that could be taken to ease the regulatory
burden on midwives or other in order to recruit more providers
to the profession?
Dr. Auguste. Sir, but I do apologize, I am not qualified to
speak on the regulatory burdens on midwives. But our
organization like ACOG and our legislative department can and
will happy to get back to some of those.
Mr. Keller. I appreciate that. A study done by the Harvard
Chan School found that as many as 36 percent of post-delivery
deaths are caused by suicide. While even a single suicide is
unacceptable, these statistics tragically illustrate the need
for continued maternal care after birth.
Dr. Auguste, how could an increase in telehealth
availability help new mothers experiencing mental health
challenges in rural areas of America?
Dr. Auguste. Thank you, again, for that question.
Maternal mental health is one of the most common medical
complications during pregnancy and, particularly, in the
postpartum period that affect many women.
ACOG's guidance has been very clear. We have actually just
put out new clinical guidance recently on optimizing the
postpartum care that really does have a large focus on the
mental health conditions. ACOG is also a supporter of
telehealth modalities in this space as well.
ACOG works with having a working group on telehealth. It is
important to understand that it is not--telehealth, that it is
not just video but also audio. All of these modalities of
telehealth are going to help all of our women particularly in
the postpartum period.
If they have multiple children in addition to a newborn, it
may be more feasible for them to use a telehealth modality to
contact their health provider, and that point of contact,
regardless if it is in person, by video, or by phone is going
to be critical in preventing any further maternal mortality or
morbidity.
Mr. Keller. Thank you. I appreciate that. And also, would
there also be a telehealth that would be helpful before
delivery that might help some of the mothers take care--you
know, get that kind of help that maybe before delivery that
would help a more positive outcome, you know, for childbirth?
Dr. Auguste. Absolutely. ACOG provides the guidance to
obstetricians to continuously monitor and ask about a woman's
maternal mental health throughout the course of pregnancy.
Telehealth can be used during the whole course of
pregnancy. It is--again, as many of the other panelists have
mentioned, it is now expected to be part of prenatal care and
health delivery.
So, utilizing telehealth, perhaps, for a quick check-in
when someone may not feel well or they feel like something's
amiss, to have that connection point with a health care
provider is critical.
Mr. Keller. And I think it is just as critical prior to
delivery throughout the pregnancy, and I think if we look at
that would you agree that if we make sure people have that
access to telehealth for mental health and emotional issues
that might create a more positive outcome and not as many
mothers would have problems during delivery or after?
Dr. Auguste. I think--yes, I think that telehealth, in
person, addressing mental--maternal mental health will make a
difference in terms of our maternal mortality.
Mr. Keller. Thank you, everyone, for your testimony and
attention to this extremely important subject. Congress needs
to remain committed to decreasing the maternal mortality rate
so that more American families can get the care they need and
lead healthy lives.
Thank you, and I yield back.
Ms. Kelly. The gentleman from Pennsylvania yields back and
now I would like to recognize the gentleman from California,
Congressman Khanna.
Mr. Khanna. Thank you, Madam Chair, and thank you for your
extraordinary leadership for many years on this issue. Thank
you to my colleagues who testified so powerfully this morning,
and thank you to the distinguished panel.
This hearing is long overdue and I am really grateful to
all of you for helping educate us on this and spur us to
action. As we work to enact policies to make childbirth safe,
we must ensure that every single patient is listened to and
supported, as we have heard from a number of the panelists, and
one way we can do this is expanding access to doulas and
midwives.
In fact, my understanding is there are multiple studies
showing that integrating midwives into the healthcare system is
associated with better outcomes for both mothers and babies.
Dr. Crear-Perry, if I could start with you. Could you
please, briefly, explain the role of doulas and midwives for
pregnant people?
Dr. Crear-Perry. Yes, thank you for that question. So, it
is important for us to realize that midwifery was decimated in
this country when we ended grand midwifery, which Black women
were birthing babies around--Black and white babies when this
country was founded.
And so undoing the racism and the harm means acknowledging
that and ensuring that we have a full spectrum of access to
birth workers. Doulas provide social support and safety. My
colleagues, as OB/GYNs, we understand that. When it comes to
high-income patients, we expect them to have social support.
What we have not been able to grapple with is the need and
the desire for people who are less centered to have social
support and sometimes that we are not capable or we are not--we
have not gotten to being able to appreciate how that is
important as well.
So, it is important for us to be able to broaden our view
and make room for all the people and who--to support birthing
people, and we recognize that birthing people want doulas and
midwives.
In every other country that has better birth outcomes than
we do, that is who delivers those babies. And so instead of
us--and we know we have maternity deserts. So, it is not a
fight. It is not pie. There is room for all of us. We need more
Black doctors but we also need more Black midwives and more
Black doulas.
Mr. Khanna. Thank you, Dr. Crear-Perry. In fact, a study
published in the Journal of Perinatal Education found that
people who use doulas were four times less likely to have a low
birth weight baby and two times less likely to have a
complication.
Dr. Taylor, maybe I could turn to you. How could access to
these resources improve outcomes specifically for Black
birthing people?
Dr. Taylor. Sure. Absolutely. I mean, you have already gone
over the stats. I mean, for Black birthing people having access
to doulas and midwives is essential, particularly if those
doulas and midwives look like them.
Research also shows that for doulas and midwives that focus
on having care models that center their patients and their
lived experiences, they have better birth outcomes.
And so this also means--we have talked a lot about today,
you know, ensuring the pipeline of a diverse work force and so
that means we do have to make sure that we are creating
opportunities, particularly for people of color, to be in those
professional pipelines to get their certifications, to get
their trainings, and to get the education that they need in
order to support Black families and meeting them where they
are. In most times, they are the ones that are on the front
lines, meeting their needs, again, that is consistent with
their lived experiences.
Mr. Khanna. Thank you. One of the things many of us believe
in this body is that we need universal health care. We need
Medicare for all. We need equal resources.
But what I am hearing from you and some of the panelists is
that that is not enough to deal with racism, that even if you
have health care as a human right, even if you have Medicare
for all, even if you have everyone having the same amount of
access to doulas, you still have a problem of race. You still
have a problem of discrimination that is leading to disparate
outcomes.
I wonder, Dr. Taylor or Dr. Crear-Perry, if you can talk to
us about what we need to do as we craft a Medicare for all bill
or other bills of universal health care to deal specifically
with the issue of race?
Dr. Taylor. Well, I can start. Oh, go ahead, Dr. Perry--
Crear-Perry.
Dr. Crear-Perry. Oh, I am sorry. I was just going to say
that you can never do race-neutral policies to end racist
policy. So, we created Medicare and Medicaid in a racist
strategy. You know, Medicaid is a states' rights issue, and you
see that play out over and over and over again.
So, when you do Medicare for all or any kind of universal
health care coverage, you have to actually explicitly undo the
racist harm that is currently being done by the current
policies that we have.
Mr. Khanna. Dr. Taylor, did you have any comment? And then
I think my time is up.
Dr. Taylor. I would just say I agree with that. You know, I
think you said it precisely. Coverage is not enough. So, you
know, my opinion is that we need to not only fix our health
care policies and ensure that health care is accessible and
affordable to all families.
We also need to address the racism that is systemic within
a restructure in this country and that is going to have to go
hand in hand with the fixes for the--for health insurance.
Mr. Khanna. Thank you. Thank you so much to the entire
panel.
Ms. Kelly. The Congressman from California yields back.
And now I would like to recognize the Congressman from
Kansas, Congressman LaTurner.
Mr. LaTurner. Thank you, Madam Chairwoman. I want to thank
you for holding this critical hearing to help the committee
explore the causes of the unacceptable high maternal mortality
rate in the United States, especially among Black, American
Indian, and Alaska Native women.
While the U.S. has one of the most advanced health care
systems in the world, we are lagging behind several other
developed nations in the area of maternal mortality rate.
Nearly 700 women die every year in the U.S. because of
pregnancy-related complications, and an additional 25,000 women
will suffer from unintended health consequences due to
pregnancy.
The worst part is that, according to the CDC, nearly two-
thirds of every pregnancy-related death is preventable. We must
take action to fix this immediately. I do want to point out
some important solutions in this area that were--that were
provided by the previous administration to achieve what
everyone in this hearing desires, fewer deaths and health
complications due to pregnancy in America.
Last December, then HHS Secretary Azar released a 184-page
report entitled ``Action Plan to Improve Maternal Health in
America,'' which sets forth a comprehensive well-thought out
plan to achieve demonstrable targets by 2025.
Madam Chairwoman, I would like to submit a copy of the
action plan for the record.
Ms. Kelly. Without objection.
Mr. LaTurner. Thank you. It is my strong hope that the
Biden administration will not abandon this deeply important
effort by the previous administration. We should continue the
good work that has already begun in this area and build off of
it, moving forward.
Our country already lags too far behind other developed
nations when it comes to maternal mortality. We cannot afford
to abandon the significant progress this action plan offers and
start from scratch.
Before I ask today's witnesses to comment on the plan, let
me briefly summarize what the action plan does. According to
the 184-page report, HHS provides a roadmap for addressing risk
factors before and during pregnancy, improving the quality of
and access to maternity and postpartum care, and support a
research agenda to fill gaps in current evidence.
The vision behind the action plan is to, quote, ``make the
United States one of the safest countries in the world for
women to give birth,'' end quote, especially for Black women,
who are 2.5 times more likely than white women to suffer a
pregnancy-related death or a serious complication.
The action plan includes four goals to help achieve the
vision along with three ambitious health outcome targets by
2025. As set forth by former HHS Secretary Azar, the four goals
include achieve healthy outcomes for all women of reproductive
age by improving prevention treatment, achieve healthy
pregnancies and births by prioritizing quality improvement,
achieve healthy futures by optimizing postpartum health, and
improve data and bolster research to inform future
interventions.
By putting our complete focus and resources on these four
broad goals, the action plan sets forth three significant
maternal health outcomes to be achieved by 2025.
One, reduce the MMR across the board by 50 percent in five
years; two, reduce low-risk Cesarean delivery by 25 percent in
five years; three, achieve blood pressure control in eight out
of 10 women of reproductive age who suffer from hypertension in
five years.
Madam Chairwoman, I hope HHS Secretary Becerra, along with
Congress, will take the hard look at the previous
administration's action plan and choose to buildupon its
progress for the sake of American mothers.
With my remaining time, I would welcome any of today's
witnesses to share what they know about the action plan and
their thoughts on the plan.
Dr. Crear-Perry. I will start. This is Joia.
We were working with HHS currently on the C-section work
and a continuation of the action plan. With the previous
administration it was exciting to see there was a desire to
work on maternal health and there was a desire even in this
body to pass bills.
What was missing and still--what we hope this can buildupon
is an explicit identification of racism as a root cause,
because even though we can decrease C-sections and we can
improve outcomes when it comes to hypertension, we cannot do
those things without addressing the bias that makes people do
C-sections unnecessarily or makes people say Black people just
have high blood pressure so I won't treat it.
So, it is a both/and so it is important to build on that,
but explicitly call out the root cause of racism. So, thank
you.
Mr. LaTurner. In the remaining time, would anyone else like
to comment on their knowledge of the plan or their thoughts
about opportunities to build on it?
Dr. Auguste. Thank you, sir. This is Dr. Auguste, though I
may not be familiar with every aspect of the plan, it is very
important to know that ACOG and other organizations, but ACOG
particularly, continues to support some of the programs
outlined, particularly the support for the AIM Program that was
mentioned previously in my testimony, the Perinatal Quality
Collaboratives, and optimizing postpartum care.
These are all things that many of the panelists have
mentioned and ACOG supports as well. So, thank you.
Mr. LaTurner. Thank you, Madam Chairwoman. My time has run
out. Thank you for holding this hearing. I appreciate the time.
Ms. Kelly. Thank you. The gentleman from Kansas yields
back, and now I would like to recognize the gentleman from
Maryland, Congressman Mfume.
Mr. Mfume. Madam Chair, thank you for this opportunity. I
want to thank you, Chairwoman Maloney, Ranking Member Comer,
and everybody else that has participated in these last two, two
and a half hours on what, clearly, is a topic that begs for
discussion and cries out for action.
I would--I do want to thank the ranking member for pointing
out that this must be and has to be a bipartisan approach to
get this done, and I would hope that other members of the House
and of the Senate see that and act on it as well.
I do want to say to my colleague, the gentleman from Ohio,
that we must be very, very careful when we start suggesting
that maladies in a community, whether it is poverty or lack of
education or lack of opportunity, contributes to these high
death rates.
That is not the case. As has been said over and over again,
this affects the most affluent African Americans. It has
nothing to do with your status in life. It has everything to do
with your race, and all we need to do would be to drive 90
miles from D.C. into Appalachia to see that poverty besets
everybody and lack of education is not solely the exclusive
domain of one race.
And as Exhibits A and B, I would suggest that Ms. Ali and
her husband, and Mr. Johnson and his wife, represent affluent,
well-educated, good taxpaying citizens who had a single hope
and that was to bring forth a child, and in each case underwent
things that we don't want to happen to anybody.
And so when you consider that here we are in 2021, after
200 years of slavery, oppression, deprivation, degradation,
denial, disprivilege, that we are still back at the center of
the argument and that center of the argument is this whole
construct of race, as my colleague from Maryland, Mr. Raskin,
pointed out in his comments, and that is what has to be
dismantled before we would make any progress.
I do want to say that I don't have questions. I am just
spouting out my observations. I have been around this body lots
of times, both previously in the 1980's and the 1990's and now
again, and I know that sometimes questions don't take the place
of how something hits you, and when it hits you, you have an
observation that you can't run away from.
And I am hoping that other Members of the Congress get a
chance to read this committee's report as well as the report of
the other six committees that have joint jurisdiction over this
to understand that there is a crisis.
You cannot be the greatest democracy in the world and be
55th in the world in terms of child mortality. You can't have a
situation where one segment of your population, in this
particular instance African Americans, tend to be three times
more likely to face a deadly situation as it relates to
birthing.
We can't ignore the fact that PAs and midwives are the
stopgap measures that we have right now until we do something
more disciplined to deal with this problem, that we ought to be
trying to find a way to support and advance them and others.
I am happy to be a co-sponsor of the Momnibus bill. I have
said to a number of people this is not just about women. This
is about men as well, which is why I appreciated the testimony
earlier from Mr. Johnson, and that we, as men, have to find a
way, regardless of whether we are Black or white or anything
else, to talk about this with men, even if they are not in the
stage of being in a situation where their wife or partner can
bear children because of their age. They still have to find a
way to help move this effort forward, I think.
I spent a few years back some time as the executive
director of the National Medical Association, and I can tell
you that Black physicians across the country have been ringing
this bell for years and years and decades and decades with
early publications going back to the 1930's about how this
problem has beset the African-American community and how it has
done so in a way out of, again, this construct of race.
So, I just want to commend everyone who has spoken. I think
that, clearly, the panel--the first panel of our colleagues--
had an effect on me as did the second panel of persons who have
undergone these tragedies. I don't know where Representative
Bush might be.
But as soon as I see her, I am going to tell her I can't
wait to see her son and meet Zion 21 years after the fact, when
he was supposed to have been dead had it not been for her
advocacy.
I want to thank Ms. Ali for her advocacy to make sure that
her son's head was not sucked off by people who were using
devices and apparatuses that only could cause problems.
Mr. Johnson, I don't know what to say to you except that,
man, it is a tragedy and a nightmare, that I am so honored and
pleased and I thank God that I did not go through with the
birth of my six sons. I can only imagine your heartbreak, and I
just want to pledge to you today personally and man to man that
we will find a way to get something done to move this forward,
to get it the attention that it needs of the entire House and
Senate and to finally create what Jamie talked about as a
historic moment in a committee of oversight to do something
that will have lasting effects and make real and lasting
differences.
Madam Chair, with that I will yield back any time that I
might have.
Ms. Kelly. The gentleman from Maryland yields back.
And now I would like to recognize the gentleman from
Georgia, Congressman Clyde.
Mr. Clyde. Thank you, Chairwoman and Ranking Member, for
holding this hearing today. I appreciate your shining a light
on our Nation's unacceptably high mortality--maternal mortality
rate and advocating for upholding the sanctity of life.
As you know, the CDC defines maternal mortality as the
death of a woman while pregnant or within one year of the end
of pregnancy. The irony is not lost on me that while my
Democrat colleagues sit here today to talk about protecting the
life of mothers, we cannot forget that mothers are, indeed, the
bearers of life, and so we must protect the sanctity of life in
its entirety.
Unfortunately, many of my Democrat colleagues have not
committed to upholding life at all stages, as their leadership
continues to block the Born Alive Abortion Survivors Protection
bill, as well as repeated requests from the Republican side of
the aisle to ensure taxpayer dollars do not fund abortion
providers such as Planned Parenthood.
And so I want to take a second to reflect on that latter
point. As it is critical that we work to ensure all communities
have access to quality health care, including maternal health
care, the bottom line is that Planned Parenthood and other
abortion providers do not have any regard for the sanctity of
life, and so by no means provide quality health care. In fact,
their founder advocated for the exact opposite of life.
It sickens me that the government continues to funnel tax
moneys to Planned Parenthood and abortion providers that claim
to provide quality care to expectant mothers in several of our
communities, including those that need it most, but fail to do
so.
While the facts show that Black communities are reeling
from high rates of maternal mortality, rural communities such
as my district in North Georgia, Georgia's 9th, are also
struggling. Just as the COVID-19 does not know racial
boundaries, maternal mortality rates, at large, do not either.
And so I do not believe my constituents should be left out
of today's conversation just because they do not fit into the
racial lens of today's hearing. In fact, Georgia is in the top
10 of the highest maternal mortality rates in the country with
48.8 per 100,000 deaths.
In 2019, the Georgia House of Representatives formed a
study committee on maternal mortality and reviewed three years
of maternal death rates in that state--in the state. They found
that 60 percent of deaths were preventable.
Furthermore, it was found that rural women have a much
higher maternal mortality rate than do urban women. While white
women--excuse me, white women in rural areas have a 50 percent
higher maternal mortality rate than white women in urban areas,
and Black women in rural areas have a 30 percent higher
mortality rate than their urban counterparts.
To reduce these unnecessary deaths, the state of Georgia
created the Perinatal Quality Collaboration--Collaborative,
which has been implemented several of the initiatives put
together by the Alliance for Innovative Maternal Health.
Specifically, it sets forth the best practices for maternal
care and provides recommendations for hospitals, protocols,
policies, and a system of date tracking.
Over 60 Georgia hospitals participate in these maternal
health initiatives touching 87 percent of all births in Georgia
to date.
While ensuring quality maternal health care remains a top
issue nationally along with protecting against maternal
mortality, I want to take this opportunity to commend my state
leaders and officials for taking steps to protect the life
across all communities in the state.
There is more work to be done, and I am committed to
looking for ways to support them.
With that said, I turn now to a few of today's witnesses.
This question is for Dr. Auguste.
Doctor, thank you for being here today and thank you for
your testimony. As you know, 40 percent of all U.S. counties,
most of them rural, lack a qualified childbirth provider. Do
you believe an increase in quality maternal care providers will
positively affect maternal morbidity rates and how so?
Dr. Auguste. Thank you, sir, for that question. Simply put,
yes, definitely. I think this is an issue in our rural areas
where there is a lack of providers, both physicians, midwives,
and I think that there has to be--there has to be efforts to
increase that, things like--things like the National Health
Service Corps that will aid in providing--putting and placing
providers in those rural areas are critical here, utilizing
some of the tools.
Some of these providers that are there that are the only
providers for hundreds of miles, giving them the tools that
they need, things from AIM, from different bundles. Utilizing
the Perinatal Quality Collaboratives to make sure that they
have the resources that are there for those providers in the
rural areas, I think, will be critical.
If we provide the resources and a streamline for increased
providers in those rural areas, we should be able to see
improvements in maternal mortality.
Mr. Clyde. Thank you very much, Doctor. I appreciate your
answer.
Ms. Kelly. The gentleman from Georgia----
Mr. Clyde. And I yield back.
Ms. Kelly [continuing]. Yields back, and I would like to
recognize the gentlewoman from New York, Congresswoman Ocasio-
Cortez, for five minutes.
Ms. Ocasio-Cortez. Thank you. Thank you so much,
Chairwoman--Madam Chairwoman.
That was just a lot, and I think it is really important
that it is addressed very directly right now and in this
moment.
First and foremost, I don't want to hear a single person on
this committee or outside of this committee talk about what--
about valuing life when they continue to uphold the death
penalty, when they continue to support policies that
disproportionately incarcerate and lead to the deaths of Black
men and people throughout this country, and uphold in a--an
absolutely unjust medical system that exists for profit that
allows people to die because they can't afford to live.
In addition to that, if we want to talk about Planned
Parenthood, let us talk about how many lives Planned Parenthood
has saved and how many babies have been born because of the
prenatal care provided by Planned Parenthood.
And if you don't--if you don't believe it and if you have
never met a Planned Parenthood baby, I am happy to let you know
that I am one, and that my mother received and relied on
prenatal care from Planned Parenthood when she was pregnant
with me.
And so if we are concerned about life, we don't get to talk
about anyone else who is not concerned about the full spectrum
of that when we are upholding policies that kill people.
Moving on, I would like to submit some incredible testimony
from healthcare providers and champions and advocates from my
district right here in the Bronx and Queens: Dr. Heather
Irobunda, and three midwives--Carmen Mojica, Melissa Enama
Bair, and Dr. Anne Gibeau, as well as the testimony from one of
my constituents, Bruce McIntyre, who, like Mr. Johnson, lost
his love and life partner, Amber Rose Isaac.
Ms. Kelly. Without objection, so ordered.
Ms. Ocasio-Cortez. Thank you so very much.
And I want to thank every single one of our witnesses that
were here today to share their story, many of which were
intensely personal, and it should not be up to us to rely on
sharing a trauma that is so personal in order to enact change.
The right thing should just be done without doing--without
having to share and relive these traumatic experiences. But you
all have chosen to do so and I thank you, particularly Ms. Ali
and Mr. Johnson, for sharing that and opening your experiences
today. So, thank you.
I would like to start--you know, every single one of these
medical providers and people who offer testimony from the--to
my office as well pointed to social indicators of health. They
said, if you want to protect Black women, we need to talk about
housing. We need to talk about livable wages. We need to talk
about guaranteed access to health care.
And also, when it came to Mr. McIntyre, we need to talk
about medical racism. Because this isn't just about poverty or
education at all. This--you could have all the access to the
resources of the world and still be subject to medical racism
within our system.
In fact, Mr. McIntyre, with his partner, Amber Rose, tried
to get family leave approved by their OB/GYN and their OB/GYN
didn't believe her. And while she saw white women patients at
the same income level and opportunities as her due at a later
date routinely get approval for FMLA, she didn't because her
pain wasn't believed and her concerns weren't believed.
So, I had--I know I have just a minute left but I wanted to
ask two questions, one on midwives and one on that--on the role
of men.
So, I wanted to ask Ms. Ali if you felt that perhaps
midwifery or doulas in your experience or in experiences that
you have seen in your advocacy could help stem or be a
protectant against medical racism in having that advocate there
by your side, and I also wanted to ask Mr. Johnson about how
this system is hurting men and spouses as well.
So, we will start with Ms. Ali. Thank you.
Ms. Ali. Thank you for that question and for what you said
earlier as well. You gave my heart some rest.
In the advocacy work that I have done and in meeting a lot
of different midwives, you know, and doulas, they kind of--they
play more than birth worker roles, in many cases.
They--they are--you know, in some cases, they are often put
in positions where they have to defend the rights to autonomy,
the rights of their--the people they are seeing, their
families, their rights to choice. And, you know, I know--the
thing is, though, there is this, you know, OB/GYN-led kind of
conversation happening. There are--I have--I know a lot of
people where, you know, the doulas don't necessarily have the
authority to be able to do what they really can in the
hospitals.
So, there is this kind of tug of war that is taking place
in the hospital who--you know, what the patients want them
advocating for the patients but not really having the power
that--or this--the same so to have their choices be heard, have
the patients' choices be heard.
I know. I mean, I said it in my statement, but the
experience I had with my midwife was completely different. It
is a completely different--it is a paradigm shift in the way
that they care for you.
My OB/GYN, I only saw him 20 minutes every session. He
didn't really get to know me and my family or my desires, and
when I even talked about natural birthing positions and, you
know, when I had questions to that nature, he made a joke and
he told me that I could hang from the lights in the delivery
room if I wanted to. And when it came to actually birthing, he
wasn't even there. He was on vacation.
And so midwives have a completely different--it is a
totally different modality, that it made me feel--she made me
feel safe. We felt safe with her, even when we had to go to the
hospital.
Ms. Ocasio-Cortez. Thank you.
Mr. Johnson. So, thank you for that question. First, let me
say thank you for uplifting and centering the story of Amber
Rose Isaac and the work of Bruce McIntyre, who is a dear, dear
friend of mine and I draw inspiration from him daily because he
is a champion.
And so with specificity to your question, I think that it
is--this maternal mortality crisis is impacting men in ways
that are immeasurable. But I want to talk specifically about
the layered roles that racism plays in the lived experiences of
Black families and, particularly, Black fathers.
So in my situation, when my wife was most vulnerable and I
was doing everything I could to advocate for her, Kira, at her
most vulnerable state, the thing that she kept saying to me as
I was getting increasingly frustrated and angry was, ``Baby,
just please stay calm. Stay calm.'' Because Kira knew that if I
raised my voice, if I slammed my fist on the table, if I
grabbed a doctor by the collar, if I turned over a table, then
I would have immediately been seen as a threat as a Black man
and been removed from the hospital or the situation.
And every single day, I ask myself the question what is it
that I should have done or what could I have done differently,
and that haunts me. Should I have yelled? Should I have--I
mean, but the reality of the situation as a Black man I did not
have the same autonomy to raise my voice, scream, that a
Caucasian father would.
And as I look back on April 12 of 2016, the only outcome
that I can conceive that could have been worse than what
happened to Kira is had I been thrown out of the hospital or
detained and then my wife not survived.
But at bare minimum, at bare minimum, I can wake up every
day knowing that I was there and I did everything within my
power to try and save her.
Ms. Ocasio-Cortez. And you continue to do everything in
your power to honor her life and her legacy, and to protect so
many other women and their partners and birthing people from
having to endure the experiences that you have. So, thank you.
Thank you so much.
Mr. Johnson. Thank you.
Ms. Kelly. The gentlewoman from New York yields back. And
now I would like to recognize the gentlewoman from Washington,
DC, Congresswoman Eleanor Holmes Norton, for five minutes.
Ms. Norton. Thank you very much, Madam Chair.
We have been hearing about losing a parent to childbirth
and how devastating it is to families, and that too many
African-American families are forced to endure this trauma.
So, I thought I should share with--share with you a few
stories that I think will drive this home. Dr. Chaniece Wallace
worked as a resident physician at Riley's Children's Health
Hospital in Indianapolis. She was only 30 years old and died
just two days after she and her husband welcomed their first
child, a daughter named Charlotte.
Yolanda Kadima from Atlanta had previously worked as a
lactation specialist. She died three days after she had a C-
section delivery and gave birth to twins. She left behind a
husband and five other children.
Mr. Johnson, who has stepped out--I am sorry. That is who
my question was for because that is who I had a question for.
If I can pause a minute. If we can pause a minute, because that
is who I had written a question for.
Ms. Kelly. We can pause.
Ms. Norton. If we can pause on the hearing just a moment.
[Pause.]
Ms. Kelly. Congresswoman, do you want me to go to the next
person and come back to you?
Ms. Norton. Would you please?
Ms. Kelly. Sure. I would like to recognize the gentlewoman
from Michigan, Congresswoman Tlaib.
Ms. Tlaib. Well, thank you so much, Chair Kelly, and thank
you so much to all of our panelists for being here. This is an
incredibly emotional and personal issue, just as a mother
myself and also as a Detroiter, where we see our babies, you
know, approximately 15 out of every 1,000 of our babies are not
surviving or not getting to their first birthday and we see
more of a risk, obviously, among Black mothers who face, you
know, obstacles like massive water shut offs, hospital deserts,
and other increased stresses, which is experienced every single
day due to structural racism in our country.
But, you know, I have been compelled and this question is
for you, Ms. Ali, to address this myth that we are hearing in
committee. I mean, you are an accomplished actress. What is
your opinion on this myth posed during this committee that this
is solely a, quote, ``income problem'' and nothing to do with
structural racism?
Ms. Ali. I--how do I react to that? It makes me angry. It
doesn't matter. You know, when you are--when you are in the
hospital, you are in the same blue gowns, or green, depending
on what the hospital puts you in.
You don't have your makeup on. You are stripped down. You
are in labor. And your concern is for the safety of your child,
you know, even before your own. And so whatever fancy words I
learned at the Ivy League school I went to they are not there
anymore. You know what I mean?
Those things, they should never matter, which is really
problematic about this as an argument to not--as an argument
against fixing this. Because it shouldn't matter what--where I
went to school or how much money I make or, you know, I was an
actor when I was a kid. None of that should matter. I
actually--I come from a humble background. You know, I happened
to get on a show when I was a kid, and none of that should
matter and the truth is, it doesn't.
Ms. Tlaib. I agree with you, Ms. Ali. You know, Black
mothers are more likely to suffer from a stroke or a heart
attack or given C-sections, which carry a far higher risk of
maternal mortality, even during low-risk pregnancies. And so
for many of us that have been championing this issue, this is a
public health emergency and I truly believe the cause is
structural racism.
So, you know, Mr. Johnson, the story of what happened to
your wife, Kira, after she gave birth is heartbreaking
testament. I couldn't even, you know, stop shaking because I
knew what it was going to lead to, but just hearing your pain.
One, you should know that the guilt you might still feeling
just as that person, the husband, the spouse, the partner, know
this, that we failed you. You didn't fail her. So, I want you
to hear that from me.
But you said something that race didn't kill her, but
racism did. Can you talk about and explain further what you
are--you meant by those words?
Mr. Johnson. Absolutely. Thank you for that. So, let me
give a very vivid kind of example of where the intersection of
policy and legislation and racism intersect specifically in
Kira's case.
So, keep in mind that we gave birth at Cedars Sinai
Hospital in the state of California. So, some of the people--
some of the members of this committee may be familiar with AIM
and the work that they have done with their bundles and their
obstetric hemorrhage bundles, right.
So, in short, there were policies and procedures in place
at Cedars Sinai Hospital that should happen when a woman is
showing signs of hemorrhage post-delivery, right. This hospital
and the staff had been trained extensively to utilize these
toolkits provided by ACOG.
However, in my wife's case, they just chose not to use
them. There were tools that were there at their disposal to
save my wife's life. Hemorrhage after childbirth is not
something that is abnormal and I am sure that the doctors and
the experts on this--on this that have been chosen to testify
can speak to that.
But when she wasn't prioritized and she wasn't seen as a
party, and when her pain was dismissed and when my concerns
were dismissed repeatedly, that is when the intersection of
bias, racism, can--bias and racism can have catastrophic and
very oftentimes fatal consequences.
And this is what I say when I have the opportunity to speak
to care providers, systems, and medical students. If you are
civilian and you hold bias in your heart--we all have bias,
right. But if you are a civilian, you have the luxury to work
those biases out in your own time or not.
But if you are a care provider who is responsible for the
life and well being of families, you have two options, as far
as I am concerned. You can identify those biases, take steps to
get better, or you need to find something else to do. It is
that simple.
Ms. Tlaib. Thank you. And, Chair Kelly, if I may, I would
like to submit for the record a letter from Mothering Justice,
which states Black maternal and infant death rates force us to
acknowledge that bias isn't simply wrong, but it is deadly.
And so I encourage all my colleagues to also read this
important letter from Black mothers right in my community. This
is an amazing advocacy organization that truly needs to be seen
and heard in the halls of Congress.
Thank you so much, and I yield.
Ms. Kelly. Without objection, so ordered.
Ms. Kelly. The gentlewoman from Michigan yields back.
I would now like to recognize again the gentlewoman from
Washington, DC, Congresswoman Holmes Norton.
Ms. Norton. Thank you, Madam Chair.
Mr. Johnson, I had been particularly moved by your
experience as a father, and that is why I had shared a few
stories that I wanted to lay before you before asking my
question.
One was from a physician, a woman who had worked as the
resident who was only 30 years old and died two days after she
and her husband had a first child. Another was a lactation
specialist--you see, nobody is immune from this experience--who
had died three days after a C-section and had given birth to
twins, leaving five children behind.
These families can never recover from this kind of impact,
and you testified about losing your wife, Kira, after a routine
C-section just after the birth of your second child.
I would like to hear more about how the loss of your wife
impacted you and your family, and whether you have heard from
other families about any lasting impacts that they have
experienced.
Mr. Johnson. So thank you, Congresswoman, for that
question. Thank you for centering the impact and the pain of
the families in this conversation.
And so my heart is particularly heavy, as it is every year
as we approach Mother's Day, and I--we celebrated my son
Langston's fifth birthday on April 12, and every year April 13
is the day that Kira transitioned.
And so it has been five years for us and I am still
struggling to find understanding. One of the main reasons I am
struggling with understanding is there has been zero
accountability, if I am being frank. There has been zero
accountability, and with all the work that we are doing, with
the tremendous allies that have come to the table in meaningful
ways, we are still losing mothers.
We are still losing mothers in an alarming rate, and I
have, in fact, heard from and I have talked to families--it
almost seems like Groundhog's Day. Almost every day or weekly
or biweekly, I am speaking to another father whose world has
been devastated, another family who is searching for answers on
why a perfectly healthy woman with so much to contribute is no
longer here.
And there is nothing that I can do to bring reason or
rationale to this because it is--other than we are falling
short time and time again.
And so that is why I am here, and although we cannot bring
these precious mothers back, we have an opportunity. We have an
opportunity for everybody on this committee to do everything we
can. We owe it to these mothers and we owe it to these families
to do everything we can to make sure we send other mothers home
with their precious babies.
Ms. Norton. Thank you, Mr. Johnson. We needed to hear that.
Mr. Johnson. Thank you.
Ms. Kelly. The gentlewoman from Washington, DC, yields
back. And now I would like to recognize the gentlewoman from
California, Congresswoman Porter.
Ms. Porter. Thank you so much.
Ms. Ali, thank you for being here today. You wrote in
detail about your birthing experience and the racism that
threatened your life and the life of your child. I wanted to
talk with you today about not just the physical challenges that
Black mothers endure in childbirth, but the mental and
emotional ones as well.
Would you describe your first birthing experience as
traumatic?
Ms. Ali. Yes, absolutely.
Ms. Porter. And was this trauma something you had to deal
with in those first few weeks in motherhood--first few weeks
and months of motherhood?
Ms. Ali. I did, while I was, you know, also learning to
breastfeed, and I would say I just didn't deal with it. My
husband did as well. It is a good thing that we like to talk
because we also didn't even realize that what we went through
was something that we might, you know, want to talk to somebody
about.
It took a good year or so to really unravel everything that
happened and that something bad had happened. A lactation
consultant that I worked with, I remember telling her--she just
asked me kindly, how was your birth? You know, what happened,
da, da, da, and I shared a little and the look on her face is
what let me know that my feelings were valid.
Ms. Porter. Now, and I will also--as a mom of three who has
gone through some of this herself, it can also--in addition to
having an influence on the spouse, if it happens when you
already have children in the home, the trauma of the arrival
can be a real impact for those other young children who were
afraid of their mother being sick, of losing the child,
watching her heal.
And, of course, you talked about this going on during the
time that you were dealing with breastfeeding, lack of sleep,
hormonal changes, physical healing, isolation.
Were you able to get mental health services during that
time? You talked a little bit about that lactation consultant.
But so often I think people don't know that their birth has
been traumatic or that they need those services, in some cases
until they go to get pregnant a second time.
And, for me, that was really when I realized that I had had
a traumatic first birth. There was this enormous sense of fear
and dread that I felt about being pregnant again, and what was
supposed to be an incredible joyful thing. It was a planned
pregnancy. Can you talk a little bit about your experience with
getting mental health services?
Ms. Ali. I think that, very similar to what you just
described, when we were planning our--to get pregnant again.
You know, we talked about all of the joys of seeing our first
baby with a sibling and all of those things. But, really, the
big discussion was how do we not let that happen again.
And speaking with my midwife, actually being invited into
these birth advocacy spaces, because I actually shared my
breastfeeding story online and I was invited into the spaces
and this world of advocates and birth workers just opened up
for me, and it was a world that I didn't know existed.
And that is--and that is when I really--that education--
that is when I was able to seek help for those feelings. And I
still--you know, I still go through it.
Ms. Porter. Well, and I just will echo what you are saying
about the way--the level of care and support, that world, when
you are in it and you are getting the help that you need to
heal versus the level of despair and trauma and isolation, it
really does save lives.
And I want to turn to Dr. Crear-Perry to ask you about
this. Are perinatal mood disorders, things like postpartum
depression or postpartum psychosis, a contributor to maternal
mortality--in maternal mortality?
Dr. Crear-Perry. Yes. We know--thank you for that question.
We know that postpartum anxiety disorder and postpartum
depression are huge contributors to maternal mortality and that
we have not created a infrastructure to support birthing people
so that they can feel safe and heard and valued.
Most places don't even have access to even therapy if you
are--or even a social circle. And so we have kind of
disconnected our mental health from our physical health in our
American healthcare system and it shows up greatly in our
birthing--the anxiety--and then we don't provide the social
support that people need.
So, we send people off to go back to work, usually within
10 days after having a baby in this country with no pay leave,
with no equal pay, with no childcare, and then we say, oh, but
don't be nervous. We don't have access for anything for you,
right.
And so, like, all the ways that we are creating the
nervousness by our policy choices, and then we don't also
provide for safety--for mental health for people. So, we are
doing a disservice on both ends.
Ms. Porter. I could not agree more.
Dr. Taylor, I just wanted to ask you, are new Black
mothers--how likely are they, more or less likely, to be
screened for depression during the postpartum period than white
mothers? Can you talk about is there--is there a disparity and
what you think the reason might be?
Dr. Taylor. Well, there is, certainly, a disparity in terms
of access to the mental health care and services that Black
mothers need. You know, there is still a issue--I just want to
say this--across the board in terms of accessing mental health
care in this country, particularly for communities of color.
We are less likely to have access to mental health
providers that look like us, which I think is really critical,
especially to ensure that we have, you know, culturally
responsive care. Also, too, that even for people that do have
health insurance, the costs that can be associated with mental
health care is also a barrier for us.
And so, whereas I think it really just comes down to
whether or not you have health insurance and then also whether
or not the providers that you do have access to are they--do
they provide culturally responsive care, which is really
critical for Black moms.
Ms. Porter. I really appreciate that, and my time is about
to expire. But I just want to emphasize there are policy things
that we can do to address some of this.
Building on what Dr. Crear-Perry said, last year I fought
for the creation of a National Maternal Mental Health hotline,
and one of my priorities this year is to secure increased
funding for the hotline, which provides 24-hour voice and tech
support, including culturally and linguistic--to meet
individual cultural and linguistic needs.
So, as someone who, you know, went through three children
and, you know, was told, we will see you in----
Ms. Kelly. The gentlelady's time is up.
Ms. Porter [continuing]. We will see you in six weeks, good
luck, that is not an appropriate response. That is not what
mothers and fathers and kids and parents in this country
deserve.
Thank you very much, Madam Chair, for your indulgence.
Ms. Kelly. The gentlelady from California yields back, and
now the gentlewoman from Missouri, Congresswoman Bush, and
thank you so much for your testimony earlier and sharing your
personal experience.
Ms. Bush. Thank you, and St. Louis and I thank you. Today's
conversation is a necessary step in the work to address the
Black birthing crisis in our country, a crisis rooted in our
Nation's legacy of slavery, let us be clear. A country that did
not even recognize Black people as full of people under the
law, words that are still written in our Constitution.
America's history is one that too often stripped away the
humanity of Black women and Black people. Malcolm X once said
the most disrespected person in America is the Black woman. The
most unprotected person in America is the Black woman. The most
neglected person in America is the Black woman. What a painful
truth.
In St. Louis, Black women and birthing people are four
times more likely to die during childbirth birth. Four times.
Missouri ranks 16th in the Nation for Black infant mortality,
and these statistics outpace national averages.
To truly understand what is happening to us today, we must
first understand where it begin--where it began. Black enslaved
women, my ancestors, were valued for their ability to increase
the wealth for white slave owners, forced to provide strenuous
labor and reproduce children that will later be torn from their
arms and sold off. Your child born, torn from your arms and
sold off, for you to never see them again, possibly, and that
was OK with our society back then, and no one wants to really
talk about that.
Black enslaved mothers often only received medical care
from trained doctors when their lack of fertility or
difficulties during childbirth threatened that profitability.
Dr. Taylor, how has the legacy of slavery affected Black
maternal health?
Dr. Taylor. Thank you, Representative Bush, for that
question. You know, as I said in my testimony today, it is
absolutely
[inaudible.] I think if you look at, you know, some of the
examples that you talked about, as well as others on the panel
today, you know, discounting Black women's pain, you know, this
focus on replenishing the population of slaves by using Black
women's bodies, abusing Black women's bodies.
You know, the pain piece is key because it is hard when we
have this conversation, folks don't understand that there is a
direct connection to some of the same, you know, situations
that we see now, you know, in terms of Black women's pain being
ignored or outright diminished in the context of their
interactions with healthcare providers.
That is based on negative stereotypes of how Black people
feel pain, whether or not we feel pain, we have thicker skin.
And so slavery and the barbaric, you know, situations that we
saw during that time have a definite connection to some of the
same challenges that Black women are going through today.
And I will just say, too, I mean, we can rise above this,
right. I mean, we haven't had a conversation today about what
we need to do in terms of ensuring that providers have the
right training.
First, we need to acknowledge that that history is there
and then how do we work with providers to make sure that we
root out those racist stereotypes, those mindsets, to the point
that it doesn't show up in their interactions with patients.
Ms. Bush. Thank you. Black people were also used as
scientific test subjects for the development of tools and
surgical methods and medical procedures, exactly going down the
lane you were just speaking about, Dr. Taylor, always without
consent and often without anesthesia under the false racist
belief, like Dr. Taylor just said, that Black people did not
feel pain.
Dr. Crear-Perry, Black women have been begging to be heard
when it comes to our pain and our trauma. Can you describe the
harm caused on Black birthing people, Black women, when
providers dismiss or ignore our pain?
Dr. Crear-Perry. Yes, and I think it has been--thank you
for that question, Congresswoman. I am so excited to meet you,
actually.
Anyway, I think it has been mentioned earlier that there
was a study that showed that medical students believed that we
had thicker skin. I think Dr. Gillispie mentioned it. The truth
is the reason they pick medical students because that is who
would answer the question.
But that is not just medical students. That is department
chairs, the CEOs, that is everywhere that we go, this idea that
we don't feel pain, the way that we have to minimize ourselves,
we don't get access to treatment.
There was another study that was done by our colleague at
UNC, Dr. Johnson, who showed that we were less likely after
having the C-section, a major abdominal surgery where we remove
your uterus, place it on your chest, sew you back up--we were
less likely to receive the same anesthesia as our white
counterparts having the same exact surgery.
So, we have data that shows that this devaluation, this
belief that we are superwomen and we are super powerful and we
don't feel pain shows up in how we are treated and how we are
seen.
We can think about Dr. Susan Moore, who had to fight to
live from COVID-19, who said, ``I have pain,'' and they didn't
believe her, and she ended up fighting for her life and then
dying in a hospital, even as a physician who knew how to
advocate and what to do.
And in your place in St. Louis, there is a lot of work that
is being done at the birth center and with the networks there
to ensure that we increase and improve the outcomes by training
providers around racism and the history of the legacy of racism
in our field.
Ms. Bush. Thank you. And, last, I will say, Ms. Ali, I
wanted to ask you a question but we ran out of time. I want to
thank you for sharing your story. Thank you, and I yield back.
Ms. Kelly. The gentlewoman from Missouri yields back.
And now I would like to recognize the gentlewoman from
Florida, Congresswoman Wasserman Schultz. You have five
minutes.
Ms. Wasserman Schultz. Thank you so much, Madam Chair, and
I really want to thank all of the witnesses today. I had an
opportunity to listen to the testimony, and thank you so much
to our colleagues who testified.
Congresswoman Bush, your story was poignant and impactful,
and just so appreciate you sharing that. I know how difficult
that must have been.
So, I am a mom. I was--I was pregnant during my first
campaign for Congress. Gave birth to all three of my children
while serving in office, and I can tell you that I experienced
nothing like the stories that I have heard today, and I have
heard countless stories like these.
One thing that was important that was said during the
testimony earlier was that we can't legislate against racism.
So, I would really like to hear from any of the witnesses that
would like to--that would like to share a response.
Given all that we have--that we have discussed this
afternoon, what can we do to make sure that we can impact Black
maternal mortality, that would impact the inherent racism that,
clearly exists in the healthcare system, exists among
healthcare professionals?
What I haven't really heard so much of, at least not in
detail today, is the kind of--training is not the right word
because you can't train out racism.
But what can we do to open eyes of healthcare professionals
and healthcare institutions so that at the outset, when a Black
woman, a woman of color, presents with a pregnancy that they
are cared for equitably all the way through their experience?
Dr. Gillispie-Bell. If I may. I agree we cannot legislate
racism out, but we can legislate for implicit bias training.
There is data that--from social psychologist Patricia Devine
that shows that you can teach others to undo their biases.
It is a longitudinal action. It is not a one and done type
of training. You have to think--because biases are unconscious
it is like undoing a habit. So, just like I am not going to be
here today saying, oh, I want to stop smoking and then in two
days, I won't stop--I will stop smoking, that habits don't work
that way.
And so implicit bias training in the same way is about
acknowledging that you have your bias and then doing actionable
items to undo those biases.
Now, it can be done legislatively. Every year, as a
physician, I have to go in and I have to renew my medical
license. So every year, you can require me to be trained to
do----
Ms. Wasserman Schultz. Right.
Dr. Gillispie-Bell [continuing]. To undergo implicit bias
training. So, there are things that we can--that we can do
legislatively to address biases in the healthcare system.
Ms. Wasserman Schultz. Thank you. Do any of the other
panelists want to add to that?
Mr. Johnson. Yes, I certainly would. So, I think that
implicit bias training is critical, as we move forward. But
from my perspective, it doesn't go far enough, and the reality
of the situation is we cannot legislate the humanity.
And as we are working on structural racism and all the
things that are contributing, the reality we have to face is
some of these are generational fixes.
So, what we must do immediately if we want to see drastic
changes is we need to, first, establish a fundamental dignified
care threshold that we can quantify and then we must tie
payment to meeting that standard.
That is we must do. So, while we are working on all these
issues of color, of what is--of white, Black, and how people
are seeing or not seeing and working on those issues, let us
make it about green. We should tie performance and payment to
medical providers' ability to meet a standard of care for their
patients.
Dr. Crear-Perry. I just have to say that--he said we can't
legislate humanity. But we can legislate anti-racism. Like, it
was--racism was built into these policies. You can create
policies that say we cannot be racist.
For example, all the hospitals are still just as segregated
as they were when we tried to desegregate them by law. So, you
can say if you are taking Medicare and Medicaid and you only
see two percent Medicaid in your facility that is illegal.
There has to be a threshold so that we don't have a burden
of illness on lower-resourced hospitals who only--that is
racism that segregates hospital care. That is racism that says
we can't open a birth center.
That is racism. All of those things are policies that we
can fix in this House, in this hall. You have an opportunity to
undo racism.
Ms. Wasserman Schultz. Madam Chair, thank you so much for
the opportunity to have this discussion. I appreciate being
able to elicit the responses that we did.
And I will yield back the time that I don't have.
[Laughter.]
Ms. Kelly. This woman, the gentlewoman from Florida, will
yield back the time she doesn't have. And now I would like to
recognize the gentleman from Vermont, Congressman Welch, for
five minutes.
Mr. Welch. Thank you very much.
First of all, I want to say thank you to my colleagues who
testified in the first panel for doing such a terrific job
bringing attention to this incredibly important issue.
And second, I want to thank the witnesses for your
excellent testimony.
One of the concerns that I have, and I know we all do, is
about work force issues, and I think that is very much
integrated into access and the quality of service. And I want
to ask Doctors Taylor and Dr. Crear-Perry about the challenges
of building a diverse work force as something that I see and I
think many of us do that could help in addressing the severe
inequities in maternal health and beyond.
Dr. Crear-Perry. Dr. Taylor, I was going to let her go
first. But so I will go.
So, we know that having culturally congruent providers or
providers who look like their patients is actually lifesaving.
My colleague, Dr. Hardeman, and her team showed that Black
babies who were cared for by a Black provider were five times
more likely to survive in a NICU. So, it is critical for us to
invest in diversity in our work force.
My colleague, Dr. Gillispie, mentioned the pipeline
programs that we all used to participate in that have been
decimated, where we could go and do research at LSU and other
medical schools around the country, and middle school and high
school and college.
When we get rid of those pipeline programs you don't see
diversity. When we don't--when we say we are going to invest in
Black midwifery but we don't invest in HBCUs that have nursing
programs where you can build on them to have nurse-midwives
come from Black universities, that is a policy choice, right.
There is an opportunity to invest in how we even support birth
centers across this country.
And I just want to go back to the conversation earlier
about rural. I am from the rural South. I am from rural
Louisiana. Rural does not just mean white. There is a diversity
in ruralness.
I also grew up in a place that needed work force and we
needed access to birth centers. We needed access to doulas. We
needed access to midwives in all of America, rural, urban,
suburban, because all of it is diverse and rich and beautiful.
Mr. Welch. Thank you. Go ahead.
Dr. Taylor. Hi. Thank you for the question. Just to
followup briefly, I agree with everything Dr. Joia Crear-Perry
said, and then I will just add, too, that sometimes costs can
be a barrier in terms of having access to training and
schooling, particularly for the Black community, you know, and
again, that also is directly connected to structural racism and
income inequality in this country that tends to fall hardest on
our communities.
And so, in addition to everything that Dr. Perry said, I
think we also need to make sure that we don't have any barriers
in place in terms of costs that can keep us out of the
pipeline.
Mr. Welch. Thank you. I want to ask a little bit about
telehealth as well. That, in the pandemic, has been a lifesaver
for many of us in rural Vermont, and can you speak about
telehealth?
I will ask this to Dr. Gillispie and Dr. Auguste. Can you
speak about telehealth and what it would provide in Black
America before and after birth and if this telehealth would be
an essential component of a tool for getting access to quality
health care?
Dr. Gillispie-Bell. Yes, I think that telehealth has the
potential, definitely, to be a tool for access. As I mentioned
in my testimony, here at Oschner we have a telehealth program
called Connected Mom and it was crucial to making sure I could
maintain prenatal care with my patients during the pandemic in
a safe way for the visits that they did not have to come to the
office for, to be able to--they had home monitoring devices and
to be able to still continue that care.
And so I think, definitely, for rural America, urban
America, for all people, I think telehealth has the potential
to be a benefit. But at the same time, we have to be very
careful to make sure we are not furthering our disparities if,
in those urban and rural communities, they don't have the
infrastructure that they need to be able to maintain those
services.
Dr. Auguste. Thank you for that question, and to build on
what Dr. Bell said is one of the crux items here is that we
have to make sure that telehealth is equitable. We fail to
recognize any full potential that telehealth or telemedicine
could have if we don't properly implement that. And so we have
to prioritize some of those advances in telehealth and
particularly around telehealth access.
So, we are talking about increased access to broadband,
access, like I said, to audio only visits for those that don't
have video capabilities or who aren't comfortable using video,
and then coverage for durable, like, medical equipment, like,
for remote patient monitoring, like blood pressure cuffs, and
scales.
So, I think this needs to be part of the conversation
around telehealth in order to make it equitable.
Mr. Welch. Thank you very much. I yield back.
Ms. Kelly. The gentleman from Vermont yields back.
And now I would like to recognize the gentleman from
Georgia, Congressman Johnson, for five minutes.
Mr. Johnson. I thank the gentlelady for recognizing me and
I thank the Chairwoman Maloney for holding this hearing today.
My home state of Georgia is the most dangerous state in the
country for pregnant Black women where the maternal mortality
rate is double the national rate, a problem that
disproportionately affects Black women in childbirth, in
addition to the usual stress, fear, costs, and obstacles faced
by all people who give birth in America looking for the best
possible medical care. Black people are forced to contend with
discriminatory treatment and racial biases in the healthcare
system.
And this is a difficult topic and issue for white people,
in general, to deal with, particularly my friends on the other
side of the aisle. There seems to be a--just a mental block
when it comes to the issue of systemic racism when they hear
that term used or even just the simple term racism.
It, like, shuts them down, and they start coming up with
other reasons. Like, I have heard today, lack of education,
poverty, crime, the lack of a male in the household as being
reasons for what has been testified to today.
And I even heard one of my colleagues ask you, Mr. Johnson,
you know, whether or not you had, you know, filed suit, you
know, trying to infer that maybe you are here to--with some
kind of financial motive in mind.
And, Mr. Johnson, I am deeply sorry for the loss of your
dear wife and the mother of your two children. She was not the
victim of a bad education system. She would not have been
helped by charter schools or public schools. She was not the
victim of lack of economic opportunity. Opportunity zones would
not have helped your wife.
She was not the victim of the criminal justice system that
would have prevented her from losing her life. The passage of
the Tim Scott Justice Act would not have helped your wife. Your
wife was not the victim of not having a man at home. Your wife
was not the victim of poverty.
Your wife was killed because of exactly what was said and
that is that she was not a priority, and the reason why she was
not a priority was because of systemic racism. Until we
understand that basic concept, there will never be anything
that we can do to address the issue.
White folks have to understand that racism is endemic in
the soil of this Nation and in the hearts of its people, and
until we recognize that we won't be able to root it out.
Black people who give birth are often personally blamed for
the systemic failures, compromising their care. Dr. Taylor, why
must we ensure that issues such as the denial of healthcare and
the mistreatment of Black people who give birth are considered
within the context of systemic racism?
Dr. Taylor. Thank you for that question. You know, I think
we have heard across the board today that it doesn't matter
what your socio-economic status is. As a Black person, this is
an issue for us, and so I think when it comes to our care, you
know, we definitely need to think more clearly about what we
can do to at least address some of the issues on the surface in
terms of provider training, ensuring that that training is
rooted in anti-racism, which will also, in effect, deal with
the issues around implicit bias, which I think folks are more
comfortable with addressing and talking about.
Mr. Johnson. Well, you can call it implicit bias or you can
call it just straight out racism, systemic racism. But I will
go with implicit bias, if that is what it takes.
Dr. Taylor. Yes. I mean, I think for some people, it is--
you know, most likely, you know, our colleagues on the right
side of the aisle as well as I think white folks in this
country, it is more comfortable to talk about it as implicit
bias.
But we have to go deeper. I think one of the key things
that we have seen, particularly in the last year, around racial
reckoning in this country is that we can't address this issue
with kid gloves.
You know, as you said, sir, it is a part of every corner of
this country and in order for us to address it in a substantive
way as well as in a way that is going to root out the needless
deaths that we are seeing in terms of maternal mortality for
Black women and other women of color, we have to address it
head on and we can't just focus on implicit bias.
Mr. Johnson. Thank you. I am out of time, Madam Chair.
In 2011, Amnesty International issued a report that
identified the inappropriate, disrespectful, and discriminatory
treatment of Black women of childbearing age and pregnant women
as a human rights violation, and I ask unanimous consent to
enter that Amnesty International report into the record.
Ms. Kelly. Without objection, and so ordered.
Ms. Kelly. The gentleman----
Mr. Johnson. And with that, I yield back.
Ms. Kelly [continuing]. From Georgia yields back.
And now I would like to recognize the gentleman from
Maryland, Congressman Sarbanes, for five minutes.
Mr. Sarbanes. Thank you very much, Madam Chair, and thank
you for the hearing, and to all of the witnesses this was
incredibly powerful and moving testimony. And I hope that today
will turn out to be transformational in terms of focusing the
House of Representatives and Congress, more broadly, on
addressing the issues that have been raised.
The question I was going to ask has actually been asked a
number of times, and there has been terrific answers--how do we
drive the bias out of the medical profession and all those who
can impact when it comes to the issues we have discussed today,
and there has been good answers about the training on that.
I did want to observe, and maybe it has happened already in
the hearing, but as we know, recently the Centers for Disease
Control, the head of the CDC, finally declared what has been a
long time coming, which is that racism poses a threat to public
health, and the CDC is now going to be studying that,
collecting data on it, making the connection and drawing that
much more clearly.
And, hopefully, that kind of research and study and focus
can benefit the issues that we have been addressing today.
And I just invite maybe Dr. Crear-Perry and Dr. Taylor,
among others, to observe whether you think that that new focus
on the part of the CDC can help with respect to the issues that
we are describing and talking about today.
Dr. Crear-Perry. Yes, I was super excited to hear about
that. That is a continuation of the work of my mentor, Dr.
Camara Jones, who back at the CDC years ago asked for us to
really focus on racism as a public health emergency.
And when I think about our colleagues in Georgia at the
same breath that we are talking about that white women in
Georgia are dying, we don't want to understand--while we can't
articulate how structural racism is the reason they are dying
as well.
When you don't expand Medicaid, when you don't invest in
childcare, when you don't invest in paid leave, that also
impacts white folks who are in Georgia.
And so what we could do to undo this harm of believing that
certain people should have and should not have having a place
like CDC really look at the levers and the ways that structural
racism harms all of humanity, sucks the resources from all of
us.
It deeply harms Black and brown people, but it also harms
white folks, right. It is harmful to believe that you should
have things just because of your skin color, and so, therefore,
you show up and have a insurrection when, really, you are not
supposed to have things just because of your skin color, right.
It is important for us to really acknowledge the harm that
white supremacy culture causes to folks as well. So, I am
excited to see the CDC lean into creating actual real policies
and strategies and helping us to understand that racism is not
a feeling or an emotion.
It is not calling you a bad name. There is a historic and a
current belief of a hierarchy of human value based upon skin
color, and we can create solutions to end that.
Mr. Sarbanes. Thank you very much. Any other thoughts from
the other panelists?
Dr. Taylor. I will just followup and say, you know, I also
think I was encouraged by the announcement. But we also need
investment in a whole of government approach to address the
racism issue in this country, and I think that with the CDC
proclamation that is just the first step. But we need much more
to focus on.
Mr. Sarbanes. Thank you very much. Madam Chair, I
appreciate the opportunity, and I yield back.
Ms. Kelly. The gentleman from Maryland yields back, and now
I finally get five minutes.
[Laughter.]
Ms. Kelly. You know, I have been running this hearing and
listening to all the testimony and, Mr. Johnson, he and I have
been together a number of times and, you know, I find myself
tearing up, angry at some of the things that I heard because I
have felt like some victim blaming.
But, you know, I have been working on this for a while, and
then Congresswoman Lauren Underwood and Congresswoman Ayanna
Pressley came to Congress, and Congressman Underwood represents
Illinois and Congresswoman Pressley is a native. And even
though we are all working on this, the rates in Illinois are
going up. They are not going down, even though we are working
on this.
And I want to let you guys know, and I promise you that I
have a bill, the MOMMA's Act and in that bill I talked about
Medicaid coverage for a year and I wanted it to be--to have to
be for every state.
But I could not get it passed. That is why we wound up
doing what we did, because I could not get that bill passed.
Included in that bill was cultural competency, review
committees, best practices, but I could not get that bill
passed.
So, I am so glad that everyone is hearing your testimony
today so they could see what you are saying, the experts, how
very important that this is and we need a lot of different
things.
There is not just one answer, and we even do work around--I
am the chair of the congressional Black Caucus Health Brain
Trust--how do we diversify the healthcare pipeline. And I am so
proud that my cousin is a Black OB/GYN in New Jersey.
But and also the other thing is I--not anymore, but I was a
proud member of Planned Parenthood. So, I know the services
that they bring to the table for men and for women.
But I just actually wanted to give any of you the
opportunity. Is there something we haven't asked that you want
to say, you want to drive home? I want to give you the
opportunity to do that.
Dr. Crear-Perry. Well, Congresswoman, I want to thank you
for supporting the Office of--White House Office of Sexual
Reproductive Health and Well Being. I really want to publicly
thank you for leaning in to thinking about something bigger and
more important at this moment that Black women have fought to
ensure that we got the White House and we got Georgia. We
deserve reproductive justice at the White House. And so we
just--I just want to thank you. OK.
Ms. Kelly. You are welcome. Anybody else?
Mr. Johnson. So, I just also want to thank you,
Congresswoman Kelly. I remember that you were the first person
to actually bring me to D.C. to give me an opportunity to share
Kira's story, and I am grateful. And I just am grateful for
your leadership and you continue to be relentless to fight for
families.
The point that I want to drive home has been said but I
want to make sure that we leave the members with it, is as we
work to gain support, particularly bipartisan support, when and
if you are asked--well, the first thing--the first point I want
to make is, well, why are we making this about race. We didn't
make this about race. The statistics did, first.
Second point is that for all the members who were present
today, if and when you are asked by your colleagues why we need
specific legislation for Black women, the clear response is
because if and when we fix this for Black women we fix it for
all mothers.
Ms. Kelly. That is such a excellent point and so true. And
we keep talking about bipartisanship. I do have a bipartisan
bill, H.R. 1350, Senate colleague Senator Brown and Toomey and
my House colleague, Bob Latta. It would create the first
representative National Advisory Committee on reducing maternal
deaths. I will let you read the whole bill. But I hope many of
you sign on to the bill.
And I will just leave you with I am a mom and step mom. My
husband and I have four kids between us, three adult women and
my son. And I have one grandson, I have one on the way due in
June and then we have one that is taking her sweet time.
And I pray we get to the bottom of this and we do
everything we can do to make sure all women deliver but
particularly Black women can deliver healthy babies and can see
their healthy babies grow up and have productive lives.
I thank you all so much. It means the world. Yield back.
Mr. Johnson. Madam Chair? Madam Chair?
Ms. Kelly. Yes?
Mr. Johnson. If I might interject right now. I neglected to
commend you for your yeoman's work behind the scenes and in
front of the scenes as chair of the CBC's Health Brain Trust.
Ever since you have come to Congress, you--that was the
mission and the mantle that you wanted to pick up and you
picked it up and you have run with it, and you have gone across
the country with it, educating people about issues of health
care in the Black community, particularly as it relates to
women.
And so I want to commend you for your work, and there is no
greater champion in Congress other than you on this issue.
Thank you.
Ms. Kelly. Thank you so much, and I yield back.
And I would like to recognize another champion, the
gentlewoman from Massachusetts, native Chicagoan Congresswoman
Ayanna Pressley.
Ms. Pressley. Thank you, Madam Chair, and thank you to the
witnesses, again, for your willingness to share your expertise,
an expertise that has been born out of great pain and trauma.
Today, we hold space for that pain. When we know that for
centuries Black pain has been ignored and delegitimized. So, we
thank you for your dedication to maternal health justice in
spite of that deep trauma and adversity that you have faced.
You have set an example for Members of Congress to take
immediate action and to save lives.
My colleague was talking about how some colleagues might
feel uncomfortable. This is not a space for fragility. This is
not a space for timidity. The purpose of this hearing has been
as investigative as it has been educational, as it has been
prescriptive, about how we do the work of saving lives, because
Black mamas matter, Black babies matter, Black lives matter.
And although I appreciate the symbolism of plazas that
paint that that and enlist that and on the ground--demonstrate
on the ground very artfully, I never asked for a plaza.
What this moment requires are policies and budgets that
codify the value of Black lives. Those are the only receipts
that matter in this moment of reckoning, and as has been stated
throughout this hearing but bears repeating, we will never be
able to fully address the Black maternal mortality crisis if we
do not confront the underlying racism that has created it.
And so while some have wrongfully asserted that racism is
only interpersonal--one person hating someone else because of
the color of their skin, today's discussion demonstrates that
structural racism in our society is pervasive and far more
insidious than a single act. In fact, some of the commentary by
my colleagues across the aisle bears that out and proves that.
So, again, this hearing is not focused on individual
doctors and individual pregnancies. We are discussing a
widespread culture of racism within systems and policies that
endanger Black pregnant people across our Nation.
And so that is why, because policy is my love language.
because we have seen policy, policy violence, create
inequities, disparities, racial injustices across every
outcome, including health care.
None of that is naturally occurring. So, if we can
legislate hurt and harm, we can legislate equity, we can
legislate healing, we can legislate justice, and we can, in
fact, be actively anti-racist as lawmakers.
And that is why I have partnered with Representative
Barbara Lee and Senator Warren to introduce the Anti-Racism in
Public Health Act. This is a first of its kind bill that will
create a center on anti-racism in health at the CDC.
If we seek to dismantle the racist systems and practices
that create inequities that contribute to the Black maternal
health crisis, we need robust comprehensive research on the
public health impacts of structural racism and policy solutions
to bring an end to these disparities once and for all.
And so because I find myself at the unenviable end of this,
most of my questions have already been asked and effectively
answered. So, I will simply just end here and say structural
racism puts Black people giving birth in danger and regardless
of personal strength, educational attainment, or even fame or
fortune.
As Mr. Johnson so eloquently asserted, this is a matter of
human rights. So, Congress has both the obligation and the
tools to enact legislation, like the Anti-Racism and Public
Health Act, like the Momnibus, all aimed at dismantling the
racist policies that put Black people at risk daily.
So, again, I thank our esteemed panel. I thank my sister in
solidarity here who has been a teacher and a pacesetter on this
issue. I thank our chair here, Robin Kelly, and, of course, our
chair, Carolyn Maloney, for bringing us together today for this
historic convening.
Ms. Kelly. The gentlewoman from Massachusetts yields back.
And now I would like to recognize the gentleman from
California, Congressman Gomez.
Mr. Gomez. Thank you so much, Madam Chair.
First, let me thank Chairwoman Maloney for holding this
important hearing. Also, I want to thank--just thank my
colleagues Representatives Adams, Kelly, Pressley and
Underwood. Thank you for your tireless work and leadership to
secure equitable health outcomes for Black mothers and Black
people.
One of the things that--this is an issue that is not new to
me. It is something I have been working on regarding just
health equity, the health outcomes, and you see these
statistics not only on maternal health but also when it comes
to cancer outcomes.
We know that a Black woman is more likely to die from
breast cancer even though the incidence of breast cancer is
higher in white women. This is something that has been not only
bothering me but frustrating me and kind of making me angry,
and because I tried of compare it to other injustices that we
see.
I tell people, if you are angry and you get mad when you
hear that somebody is pulled over because of the color of their
skin, you should just be as--just as angry and offended that a
person, especially a Black woman, is more likely to die at
childbirth because of the color of her skin.
I equate them to being similar because it is--it is
something that that we can--we can change if we take proactive
steps to change it.
It is something that we started talking about in the Ways
and Means Committee. I am a member of the Ways and Means
Committee. We had a hearing on it--on this issue as well.
And the committee is so interested in trying to undo the
inequity that is built into our system from the tax code to the
health care system across the board that we have now a Racial
Equity Working Group that I am part of with Congresswoman Terri
Sewell from Alabama and Congressman Horsford from Nevada.
And we had a speaker last week on one of the symposiums we
had. It was Dean Bowen Matthews from the--she is a professor of
law at George Washington University, and she was talking about
health equity, health outcomes and she mentioned that access is
just one part of it, that if you include--increase access, it
improves outcome only by about 10 percent. So, she was saying
that there is deeper, deeper inequities built into the system.
And so it doesn't mean that we are not going to take care
of that access component, but there is something else that we
need to take care of.
Dr. Taylor, I wanted to just ask, what are those other
things that we can do through legislation? I know we have great
pieces of legislation, but what is something that people don't
think about when it comes to health outcomes for Black birthing
people and Black mothers?
Dr. Taylor. Thank you so much for your question.
You know, it is interesting that you mentioned the example
about breast cancer, and one of the things that we haven't
touched on today is the health impacts of racism.
When I say that, I mean, you know, what if Black folks deal
with racist experiences on a day-to-day basis? That actually
causes us to have premature death. It causes us to be
chronically ill. It causes us to have mental health challenges.
And so that means that when we are in a situation where we
do get sick with a disease like cancer or we have issues with
our pregnancies, they were already in a--you know,
shortchanged, so to say, in a situation where, you know, our
defenses are already down and that wear and tear on our bodies
due to the racism that we experience on a day-to-day basis
impacts our health. It makes us sick.
So, I did want to lift that up because I think that also is
directly connected to some of the stats that you lifted up in
the conversation just about the health impacts of racism as
well.
In terms of policy, I think we have talked a lot today
about, you know, issues around ensuring coverage, you know, for
everyone, particularly for people of color, for Black women. We
have talked about access issues.
But, again, because racism is so ingrained in every corner
of this country, meaning that the same woman that has those is
going to have those challenges in the context of her pregnancy-
related outcomes may also be dealing with income inequality.
She may also be dealing with the wealth gap. She may also
be dealing with issues around access to higher education. And
even though those things aren't directly related to, you know,
her having worse maternal health outcomes because we know it is
something that hits every person, every family, across the
socio-economic strata, it is a problem and, you know,
structural racism is directly connected to those issues as
well.
So, for me, I think we have to have a holistic approach in
how we address racism. We have talked about legislation like
the Momnibus, which is a comprehensive package of bills that
address almost every dimension of the Black maternal health
crisis.
It deals with some of these other challenges around the
social determinants of health and other issues. So, whatever we
are putting forth, it needs to be comprehensive and it needs to
be a whole of government approach.
Mr. Gomez. Thank you so much for your answer. And although
I am out of time, I just want to address, you know, I know some
folks on the other side of the aisle don't believe this is a
real thing.
But I want--you got to look at the statistics. Why are the
outcomes just worse for Black women, right, when it comes to
health care and health outcomes? Answer the why, and then you--
and if everything is equal and that still exists, that means
that there is something deeper than just access and what do we
need to do to take care of it and reverse that problem, and I
believe these bills are a step in that direction.
With that I yield back.
Ms. Kelly. The gentleman from California yields back.
Now I would like to recognize the ranking member,
Congressman Comer, from Kentucky.
Congressman?
Mr. Comer. Thank you, Madam Chair. And I have heard a lot
of mention of the fact that one of the problems may be the fact
that there aren't enough people of color in the medical field.
And I was wondering what--to anyone on the panel, what can
we do to change that? What can we do from a policy standpoint,
in a bipartisan way, to try to create a situation where we have
more people of color in the medical field serving the high
minority populations, the underserved populations in the
minority districts? And I will let anyone on the panel answer
that.
Dr. Crear-Perry. Well, I think that the pipeline--this is
Joia--the pipeline programs are really important, especially in
places like Kentucky, having access to, from elementary school,
to middle school, to high school, being able to go to the
medical school and see researchers, to see what research is, to
be tied to--and, in fact, we have fewer Black men in medical
school today than we did in the 1970's and that is because we
have disinvested.
And I wouldn't call it affirmative action. It is reparative
action, to repair, the things that we need to do to repair the
harm that has been caused by generational trauma.
So, investing in pipeline programs, again, would be really
critical and that--Congressman Gomez, when he mentioned breast
cancer, I just want to give an explicit example of how that
shows up in healthcare.
I was trained that breast cancer in Black women was higher
because we had higher--just higher rates biologically. Mayo
Clinic did a study that made sure that every person had the
same access to treatment, had the time off paid, had childcare
services, and they were able to debunk this myth that we have a
biological basis of higher rates of breast cancer, because we
all have different breasts, different pelvises, different
kidneys.
So, that is the kind of information that we have to put in
to our training schools when we get this pipeline together for
ensuring that we have more providers of color.
Dr. Gillispie-Bell. And I think if I can add to that, too,
and I mentioned in my testimony having the pipeline programs
for minorities to show them different careers in medicine, not
just physicians or being a physician, but midwifery and
physician's assistants, nurse practitioners, midwives, all of
all of those different disciplines.
But also, specifically, I can speak from medicine, there is
structural racism even trying to get into medical school. The
number of hoops and loops that you have to jump through,
through tests that have been shown to just be able to take a
test.
They are not tests that show your ability to practice
medicine, to accumulate the information that you need to be
able to practice medicine, and not to even think about the cost
that is incurred in going on interviews for medical school
positions and, again, being able to take the test.
So, also looking at those financial barriers that prevent
people of color from being able to pass the many hoops and
loops that we have now created to get into these professional
schools.
Mr. Comer. Anyone else want to pop in?
Representative Pressley, are you still on the panel? Would
you like to comment on that?
Ms. Pressley. Oh, would I like to comment on that which
they just offered?
Mr. Comer. No. What can--what can we do to attract more
minority students to the medical profession? That was one of
the issues that they said was a problem, that we needed to get
more African-American--more people of color involved in the
medical profession and medical school, nursing, healthcare?
Ms. Pressley. Well, actually, I am not on this panel. I was
on the first panel.
Mr. Comer. Oh, OK.
Ms. Pressley. Yes. So but I--so I co-sign all with--all
that which they just offered. I thought it was very specific in
enumerating both the challenges, you know, and the
opportunities necessary in order to diversify.
Mr. Comer. And I--that is something that I would support
and I think we would support, you know, anything that would be
able to attract more people of color into the medical
profession.
And if there are instances of universities making it
harder, discriminating against people of color to try to get
into any type of medical profession, I would gladly join with
Chairwoman Maloney in a bipartisan investigation into that or
any barriers into financial aid to people of color that are
trying to get into the medical profession or any other field,
for that matter.
So, hopefully, we can try to come up with some solutions to
the problem in a bipartisan way, and I think that our side of
the aisle--the minority--the minority conference is more than
willing to do that.
And we--many of us represent rural districts. I actually
live in Appalachia. Appalachia was referred to earlier. I know
that when my wife went into labor, we were real nervous because
the hospital is an hour and a half away. You know, you are very
spread out in, you know, rural America has challenges in health
care.
My local hospital--something was mentioned about Medicaid.
My local hospital here, which is the second biggest employer in
my hometown where I am sitting right now--is 89 percent
Medicaid. That is what the annual rate is for our hospital
every year. Eighty-nine percent of the revenue in the hospital,
89 percent of the patients in the hospital are Medicaid
patients.
So, you know, and I think there is challenges throughout
healthcare. Healthcare is the biggest problem we have in
America.
And I just want to close by saying we are more than willing
to do anything we can to help with the situation and,
obviously, I appreciate today's hearing and acknowledge that
there is a problem and would be more than willing to work with
any Democrat to try to solve the problem.
So, Madam Chair, thank you for this hearing. And with that,
I will yield back.
Ms. Kelly. Thank you.
Chairwoman Maloney. [Presiding.] Mr. Chairman, I want to
thank you for your heartfelt response and willingness to work
across the aisle on this critically important issue, to turn
what we have learned today--the heart and purpose of this
hearing--to turn it into the reality of laws, which can only
happen in a bipartisan way. I thank you so much.
I yield to my distinguished good friend and colleague, the
great Robin Kelly, for her closing statements, and I also have
a closing statement.
Robin, thank you for your leadership today and for, really,
your selfless leadership all the time that you have been in
Congress toward the goal of passing these bills we are
discussing today.
I yield to Robin Kelly.
Ms. Kelly. [Presiding.] Thank you, Chairwoman Maloney.
I would like to thank all of our witnesses for sharing
their expertise and heart-wrenching experiences with the
committee and thank all of my colleagues for their careful
attention to this testimony today.
I also thank our colleagues for speaking on today's first
panel. Congresswoman Pressley, Congresswoman Bush,
Congresswoman Adams, and Congresswoman Underwood are leaders on
this issue and have championed Federal policies to dramatically
improve the quality of health care for Black people.
And, finally, I would like to thank Chairwoman Maloney for
her leadership in bringing this issue before the full committee
and for her continued commitment to supporting legislation that
can make a real difference in improving maternal health
outcomes for Black people and their babies.
The statistics we discussed today are shocking but not
surprising. There is absolutely no justification for Black
Americans to face three or four times the risk of dying during
or after childbirth than white Americans.
There is no justification for the American healthcare
system failing to protect Black families from these, largely,
preventable losses. We can and must take an evidence-based
approach to root out systemic racism and racial bias in our
healthcare system.
We must undo the structural barriers that prevent Black
people from receiving the care that they need and deserve. Now
is the time to turn the tide on this crisis. Congress needs to
enact the policies we heard about today to protect the health
and well being of Black people and Black families across the
United States.
Before I close, I would like to enter into the record
letters and statements the committee received regarding the
urgent need to enact comprehensive reforms that will address
our Nation's Black maternal health crisis.
These include statements from the American Medical
Association, the Blue Cross Blue Shield Association, March of
Dimes, the University of Texas Southwestern Medical Center.
And without objection, these materials are entered into the
official hearing record.
Ms. Kelly. And just thank you so much, again, Chairman
Maloney, and I turn it back to you.
Chairwoman Maloney. [Presiding.] Without objection, and I
also add the UT Southwestern Medical Center to be added to the
official record, without objection.
Chairwoman Maloney. I just must say that I really believe
that this hearing is transformational, I feel it is historical,
and I feel that it is going to bring lasting change. I really
do.
And I feel the way we bring this change is by following up
on what we have learned today, which I don't think anyone could
listen to this hearing and listen to Mr. Johnson and Ms. Ali
and not be moved in fundamental ways, and by the
professionalism of our witnesses coming forward with concrete
actions, in addition to the excellent hard work of my
colleagues and friends in Congress.
I congratulate Congresswomen Underwood and Adams for
founding the Black Maternal Health Crisis Committee on which I
serve with 140 of my colleagues, and, very importantly, working
with Congresswoman Bush and with Congresswoman Kelly and others
on a massive group of bills that are a step in the right
direction.
And I believe that our next step should be, and I started
writing a letter today during this hearing, to the seven other
committee chairs that have the real jurisdiction.
Mr. Comer and I do not have the jurisdiction for this
material. We decided, or I decided with all of you that we
should have this hearing and get it moving.
But if we all reach out to these chairmen, I believe they
will very quickly have hearings on this and work with us to
report the bills out so that they can be passed.
I learned so much on it but I want to particularly thank
Dr. Crear-Perry for some of the ideas that you put out that
were new, and I particularly liked your idea of an Office of
Reproductive Health and Well Being to develop the Federal
strategy for ending this outrageous--I would call it a national
scandal--a national scandal--that innocent women like Mr.
Johnson's wife would have to suffer for 10 hours without
medical treatment as they called for help.
That is a national scandal that we have to stop in America,
and your idea of having--you know, to promote the human
infrastructure and to look at the human rights and racial
equity that is involved.
But something as large as this, it has to be coordinated
throughout all of government. It is not a law. It is not one
law. It is a coordination with everyone. So, to have a sort of
central department that would interact with all of the agencies
and Congress members on both sides of the aisle, and to focus
on it in a very strategic way, I think, was a very excellent,
excellent idea and I have written a bill draft already for this
to add to our others.
And all I can say is, you know, it takes a village. This
has been a huge effort by a great number of people--doctors,
nurses, researchers, scientists, and then my wonderful
colleagues in Congress that have moved it forward so carefully
and so strategically.
It has to be bipartisan. I also want to thank my like-
minded colleagues on the other side of the aisle that are
willing, as Representative Comer is, to work in a constructive
way to move this idealism and rightful goal off the table and
into the ground, from heart and purpose into the reality of
strong laws that can be enforced.
I am very grateful to all of my colleagues and all the
professionals that made this happen, and I want to thank the
staff of the Oversight Committee that put a lot of heart and
work into this.
This has been a labor of love on the part of our staff and
I thank everyone, and all I can say is on to passage.
Now, without objection, all members will have five
legislative days within which to submit extraneous materials
and to submit additional written questions for the witnesses to
the chair, which will be forwarded to the witnesses for their
response. I ask our witnesses to please respond as quickly as
possible.
And with that, this hearing is adjourned.
[Whereupon, at 3:04 p.m., the committee was adjourned.]
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