[Congressional Record Volume 164, Number 195 (Tuesday, December 11, 2018)]
[House]
[Pages H10058-H10061]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
PREVENTING MATERNAL DEATHS ACT OF 2018
Mr. BURGESS. Mr. Speaker, I move to suspend the rules and pass the
bill (H.R. 1318) to support States in their work to save and sustain
the health of mothers during pregnancy, childbirth, and in the
postpartum period, to eliminate disparities in maternal health outcomes
for pregnancy-related and pregnancy-associated deaths, to identify
solutions to improve health care quality and health outcomes for
mothers, and for other purposes, as amended.
The Clerk read the title of the bill.
The text of the bill is as follows:
H.R. 1318
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Preventing Maternal Deaths
Act of 2018''.
SEC. 2. SAFE MOTHERHOOD.
Section 317K of the Public Health Service Act (42 U.S.C.
247b-12) is amended--
(1) in subsection (a)--
(A) in paragraph (1)--
(i) by striking ``purpose of this subsection is to
develop'' and inserting ``purposes of this
[[Page H10059]]
subsection are to establish or continue a Federal initiative
to support State and tribal maternal mortality review
committees, to improve data collection and reporting around
maternal mortality, and to develop or support'';
(ii) by striking ``population at risk of death and'' and
inserting ``populations at risk of death and severe''; and
(B) in paragraph (2)--
(i) by amending subparagraph (A) to read as follows:
``(A) The Secretary may continue and improve activities
related to a national maternal mortality data collection and
surveillance program to identify and support the review of
pregnancy-associated deaths and pregnancy-related deaths that
occur during, or within 1 year following, pregnancy.''; and
(ii) by inserting after subparagraph (C) the following:
``(D) The Secretary may, in cooperation with States, Indian
tribes, and tribal organizations, develop a program to
support States, Indian tribes, and tribal organizations in
establishing or operating maternal mortality review
committees, in accordance with subsection (d).'';
(2) in subsection (b)(2)--
(A) in subparagraph (A)--
(i) by striking ``encouraging preconception'' and inserting
``prepregnancy''; and
(ii) by striking ``diabetics'' and inserting ``women with
diabetes and women with substance use disorder'' before the
semicolon;
(B) in subparagraph (H)--
(i) by inserting ``the identification of the determinants
of disparities in maternal care, health risks, and health
outcomes, including'' before ``an examination''; and
(ii) by inserting ``and other groups of women with
disproportionately high rates of maternal mortality'' before
the semicolon;
(C) in subparagraph (I), by striking ``domestic'' and
inserting ``interpersonal'';
(D) by redesignating subparagraphs (I) through (L) as
subparagraphs (J) through (M), respectively;
(E) by inserting after subparagraph (H) the following:
``(I) activities to reduce disparities in maternity
services and outcomes;''; and
(F) in subparagraph (K), as so redesignated, by striking
``, alcohol and illegal drug use'' and inserting ``and
substance abuse and misuse'';
(3) in subsection (c)--
(A) by striking ``(1) In general--The Secretary'' and
inserting ``The Secretary'';
(B) by redesignating subparagraphs (A) through (C) as
paragraphs (1) through (3), respectively, and adjusting the
margins accordingly;
(C) in paragraph (1), as so redesignated, by striking ``and
the building of partnerships with outside organizations
concerned about safe motherhood'';
(D) in paragraph (2), as so redesignated, by striking ``;
and'' and inserting a semicolon;
(E) in paragraph (3), as so redesignated, by striking the
period and inserting ``; and''; and
(F) by adding at the end the following:
``(4) activities to promote physical, mental, and
behavioral health during, and up to 1 year following,
pregnancy, with an emphasis on prevention of, and treatment
for, mental health disorders and substance use disorder.'';
(4) by redesignating subsection (d) as subsection (f);
(5) by inserting after subsection (c) the following:
``(d) Maternal Mortality Review Committees.--
``(1) In general.--In order to participate in the program
under subsection (a)(2)(D), the applicable maternal mortality
review committee of the State, Indian tribe, or tribal
organization shall--
``(A) include multidisciplinary and diverse membership that
represents a variety of clinical specialties, State, tribal,
or local public health officials, epidemiologists,
statisticians, community organizations, geographic regions
within the area covered by such committee, and individuals or
organizations that represent the populations in the area
covered by such committee that are most affected by
pregnancy-related deaths or pregnancy-associated deaths and
lack of access to maternal health care services; and
``(B) demonstrate to the Centers for Disease Control and
Prevention that such maternal mortality review committee's
methods and processes for data collection and review, as
required under paragraph (3), use best practices to reliably
determine and include all pregnancy-associated deaths and
pregnancy-related deaths, regardless of the outcome of the
pregnancy.
``(2) Process for confidential reporting.--States, Indian
tribes, and tribal organizations that participate in the
program described in this subsection shall, through the State
maternal mortality review committee, develop a process that--
``(A) provides for confidential case reporting of
pregnancy-associated and pregnancy-related deaths to the
appropriate State or tribal health agency, including such
reporting by--
``(i) health care professionals;
``(ii) health care facilities;
``(iii) any individual responsible for completing death
records, including medical examiners and medical coroners;
and
``(iv) other appropriate individuals or entities; and
``(B) provides for voluntary and confidential case
reporting of pregnancy-associated deaths and pregnancy-
related deaths to the appropriate State or tribal health
agency by family members of the deceased, and other
appropriate individuals, for purposes of review by the
applicable maternal mortality review committee; and
``(C) shall include--
``(i) making publicly available contact information of the
committee for use in such reporting; and
``(ii) conducting outreach to local professional
organizations, community organizations, and social services
agencies regarding the availability of the review committee.
``(3) Data collection and review.--States, Indian tribes,
and tribal organizations that participate in the program
described in this subsection shall--
``(A) annually identify pregnancy-associated deaths and
pregnancy-related deaths--
``(i) through the appropriate vital statistics unit by--
``(I) matching each death record related to a pregnancy-
associated death or pregnancy-related death in the State or
tribal area in the applicable year to a birth certificate of
an infant or fetal death record, as applicable;
``(II) to the extent practicable, identifying an underlying
or contributing cause of each pregnancy-associated death and
each pregnancy-related death in the State or tribal area in
the applicable year; and
``(III) collecting data from medical examiner and coroner
reports, as appropriate;
``(ii) using other appropriate methods or information to
identify pregnancy-associated deaths and pregnancy-related
deaths, including deaths from pregnancy outcomes not
identified through clause (i)(I);
``(B) through the maternal mortality review committee,
review data and information to identify adverse outcomes that
may contribute to pregnancy-associated death and pregnancy-
related death, and to identify trends, patterns, and
disparities in such adverse outcomes to allow the State,
Indian tribe, or tribal organization to make recommendations
to individuals and entities described in paragraph (2)(A), as
appropriate, to improve maternal care and reduce pregnancy-
associated death and pregnancy-related death;
``(C) identify training available to the individuals and
entities described in paragraph (2)(A) for accurate
identification and reporting of pregnancy-associated and
pregnancy-related deaths;
``(D) ensure that, to the extent practicable, the data
collected and reported under this paragraph is in a format
that allows for analysis by the Centers for Disease Control
and Prevention; and
``(E) publicly identify the methods used to identify
pregnancy-associated deaths and pregnancy-related deaths in
accordance with this section.
``(4) Confidentiality.--States, Indian tribes, and tribal
organizations participating in the program described in this
subsection shall establish confidentiality protections to
ensure, at a minimum, that--
``(A) there is no disclosure by the maternal mortality
review committee, including any individual members of the
committee, to any person, including any government official,
of any identifying information about any specific maternal
mortality case; and
``(B) no information from committee proceedings, including
deliberation or records, is made public unless specifically
authorized under State and Federal law.
``(5) Reports to cdc.--For fiscal year 2019, and each
subsequent fiscal year, each maternal mortality review
committee participating in the program described in this
subsection shall submit to the Director of the Centers for
Disease Control and Prevention a report that includes--
``(A) data, findings, and any recommendations of such
committee; and
``(B) as applicable, information on the implementation
during such year of any recommendations submitted by the
committee in a previous year.
``(6) State partnerships.--States may partner with one or
more neighboring States to carry out the activities under
this subparagraph. With respect to the States in such a
partnership, any requirement under this subparagraph relating
to the reporting of information related to such activities
shall be deemed to be fulfilled by each such State if a
single such report is submitted for the partnership.
``(7) Appropriate mechanisms for indian tribes and tribal
organizations.--The Secretary, in consultation with Indian
tribes, shall identify and establish appropriate mechanisms
for Indian tribes and tribal organizations to demonstrate,
report data, and conduct the activities as required for
participation in the program described in this subsection.
Such mechanisms may include technical assistance with respect
to grant application and submission procedures, and award
management activities.
``(8) Research availability.--The Secretary shall develop a
process to ensure that data collected under paragraph (5) is
made available, as appropriate and practicable, for research
purposes, in a manner that protects individually identifiable
or potentially identifiable information and that is
consistent with State and Federal privacy law.
``(e) Definitions.--In this section--
``(1) the terms `Indian tribe' and `tribal organization'
have the meanings given such terms in section 4 of the Indian
Self-Determination and Education Assistance Act;
``(2) the term `pregnancy-associated death' means a death
of a woman, by any cause,
[[Page H10060]]
that occurs during, or within 1 year following, her
pregnancy, regardless of the outcome, duration, or site of
the pregnancy; and
``(3) the term `pregnancy-related death' means a death of a
woman that occurs during, or within 1 year following, her
pregnancy, regardless of the outcome, duration, or site of
the pregnancy--
``(A) from any cause related to, or aggravated by, the
pregnancy or its management; and
``(B) not from accidental or incidental causes.''; and
(6) in subsection (f), as so redesignated, by striking
``such sums as may be necessary for each of the fiscal years
2001 through 2005'' and inserting ``$58,000,000 for each of
fiscal years 2019 through 2023''.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
Texas (Mr. Burgess) and the gentleman from Texas (Mr. Gene Green) each
will control 20 minutes.
The Chair recognizes the gentleman from Texas (Mr. Burgess).
General Leave
Mr. BURGESS. Mr. Speaker, I ask unanimous consent that all Members
may have 5 legislative days in which to revise and extend their remarks
and insert extraneous materials in the Record on the bill.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Texas (Mr. Burgess)?
There was no objection.
Mr. BURGESS. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I rise today in support of H.R. 1318, the Preventing
Maternal Deaths Act. I am glad that we are finally calling up this bill
for a vote, as it is a truly important bill that will impact the lives
of pregnant women and new mothers across this country. The media's
attention to the issue of maternal morbidity and mortality has shed
light on serious problems within our healthcare system in terms of pre-
and postpartum care and complications in the delivery room.
I thank Representative Jaime Herrera Beutler and Representative Diana
DeGette for their leadership on this critical legislation. Ms. Herrera
Beutler testified before the Energy and Commerce Committee's
Subcommittee on Health this September in support of her bill, which she
and her staff have been working on daily to get across the finish line.
She and I have shared a goal to improve maternal outcomes, and I am
grateful that we had an opportunity to continue to push this priority
forward together.
I also thank the committee staff, which has been working through the
language with the various stakeholders over the course of the past
year. Their work has been imperative in getting this bill to the floor.
Having spent nearly three decades as an OB/GYN, I believe it should
be a national goal to eliminate all preventable maternal deaths. A
single one is too many.
The alarming trend in our country's rate of maternal mortality first
came to my attention in September 2016 when I was reading in my
professional journal called The Green Journal, the journal of
Obstetrics & Gynecology. The original research found that the maternal
mortality rate had increased in 48 States and Washington, D.C., from
2000 to 2014 while the international trend was moving in the opposite
direction. Since reading that article, I have spoken with providers,
hospital administrators, State task forces, and public health experts.
The more I dove into this troubling issue, the more I realized how
little we understand about how our data is lacking.
The Health Subcommittee has held both a member briefing and a hearing
on the issue of maternal mortality. Our hearing this past September had
a varied panel of witnesses, including Charles Johnson, who lost his
wife, Kira, following the birth of their second child in 2016. Mr.
Johnson's wife was a healthy and energetic woman, yet he now has to
explain to his two sons why their mother is never coming home.
The Johnson family is not alone in living through such tragedy.
However, if we pass this bill today and send it to the President's
desk, we will be taking a step in the right direction toward preventing
future maternal deaths.
This is a problem that we cannot address without accurate data.
According to the Centers for Disease Control and Prevention, the United
States' maternal mortality rate was 7.2 deaths per 100,000 live births
in 1999 and increased to 18 deaths per 100,000 live births in 2014.
These are statistics that deserve our full attention.
Representative Jaime Herrera Beutler's bill will address the complex
issue of maternal mortality by enabling States to form maternal
mortality review committees to evaluate, improve, and standardize their
maternity death data. Once we fully understand the problem, there will
be an opportunity to use the data to implement best practices.
Texas is an excellent example of a State that has created and
sustained a maternal mortality and morbidity task force. Texas has put
time, effort, and funding into reviewing maternal deaths in order to
identify trends and causes.
Most of the pregnancy-related and pregnancy-associated deaths--or
many, I should say--are preventable, but they are all tragic. We should
not be losing women to such a fixable problem, leaving their newborn
babies and their families to have to wake up each day to face the
unsolved mystery of why the mother did not make it home from the
hospital or died shortly thereafter.
Mr. Speaker, I reserve the balance of my time.
Mr. GENE GREEN of Texas. Mr. Speaker, I yield myself such time as I
may consume.
Mr. Speaker, I rise today in strong support of H.R. 1318, the
Preventing Maternal Deaths Act, sponsored by Representatives Jaime
Herrera Beutler and Diana DeGette.
This is an important first step to addressing the maternal mortality
crisis that is claiming the lives of too many new mothers in our
country. Hundreds of women die each year from pregnancy-related and
pregnancy-associated complications in the U.S. More than 60 percent of
these deaths are preventable.
The Preventing Maternal Deaths Act encourages States to implement
maternal mortality review committees that track maternal deaths and
identify their underlying causes. Together, the data generated by these
review committees will help experts identify trends, patterns, and
disparities that contribute to preventable maternal deaths in order to
save lives in the future.
It is shocking that the maternal mortality rate in the United States
has increased while in most of the rest of the developed world it has
fallen. It is also shocking that women of color, low-income women, and
women in rural areas are disproportionately more likely to face
pregnancy-related complications. This must change.
But in order to reverse this unconscionable trend, we must have the
necessary data so providers can monitor their practices and improve
their care delivery.
The mortality rate is a critical indicator of the quality of our
healthcare system, as well as how we prioritize women's health in this
country. While much more work still must be done, including improving
access to care, I am proud to support this bill and believe it will set
us on a path to understanding why women are dying and how we can stop
it.
Mr. Speaker, I urge my colleagues to support this important piece of
legislation, and I reserve the balance of my time.
Mr. BURGESS. Mr. Speaker, I yield such time as she may consume to the
gentlewoman from Washington (Ms. Herrera Beutler), who is the principal
author of the bill.
Ms. HERRERA BEUTLER. Mr. Speaker, I thank Chairman Burgess for his
tireless commitment on this issue. It is not just the gentleman's
career, but it has been something that the gentleman has fought for
here in Congress as well, and I am very grateful to be standing here
today. I also want to thank my co-conspirator, Diana DeGette, for her
work on this bipartisan legislation that has more than 180 cosponsors.
So why is this bill important to you, Mr. Speaker, or to those who
are listening? Well, you either are a mom or you have got a mom. This
bill impacts you.
I stand in strong support of the Preventing Maternal Deaths Act, a
bill to save mothers' lives and prevent more parents, husbands,
grandparents, and children from the profound loss of their mother.
Today in the 21st century United States of America, the U.S. is
ranked fourth globally for maternal mortality. Many are shocked to
learn that the
[[Page H10061]]
U.S. not only has the worst maternal mortality rate in the entire
developed world, but that these rates are on the rise. Seriously, Mr.
Speaker, we are worse than Iran.
Every year, between 700 and 900 maternal deaths occur in the United
States, and I have seen tears brought to the eyes of many a colleague
when they learn that more than 60 percent of these deaths could have
been prevented, according to the CDC. It is difficult to imagine the
grief felt by these families when a life is cut short and they learn
that it could have been prevented.
As a mom, as an American, and as a lawmaker, we must do better.
Combating maternal mortality must become a national priority, which is
why I urge my colleagues to support this bill. The Preventing Maternal
Deaths Act represents the biggest step taken by Congress to date on
this issue. It would enable States to establish and strengthen maternal
mortality review committees, which bring together experts in public
health, in maternal health, and in infant health to investigate each
and every pregnancy-related death to understand what went wrong and how
to save future mothers' lives.
Currently, the available data is woefully inadequate, which hinders
our ability to understand why moms are dying and why certain women are
more at risk. Right now, African American women are three to four times
more likely to die from pregnancy-related causes, and women living in
rural areas are also facing higher risk. This bill will not only
improve data collection, but it will empower States to participate in
national information sharing, increase collaboration, and develop best
practices.
In closing, Mr. Speaker, I would like to dedicate this bill to the
mothers whom we have lost, moms like Kira Johnson who lost her life
just hours after giving birth to a healthy baby boy.
I will never forget hearing from Kira's husband, Charles, who has
been a tireless advocate on this issue. He is a single father of two
boys and now lives by the motto: ``Wake up, make mommy proud, repeat.''
Stories like Kira's have struck at the hearts of many of us and have
compelled us to action today. Today, we honor the lives of these moms
and the loved ones who remember them.
Mr. Speaker, I urge my colleagues to vote ``yes'' on the Preventing
Maternal Deaths Act.
Mr. GENE GREEN of Texas. Mr. Speaker, I have no other speakers. I
thank both Congresswoman DeGette and Congresswoman Herrera Beutler for
bringing this issue to our committee and also to the House.
Mr. Speaker, I urge a positive vote today, and I yield back the
balance of my time.
Mr. BURGESS. Mr. Speaker, I yield 2 minutes to the gentleman from
Georgia (Mr. Carter), who is a valuable member of the Health
Subcommittee.
Mr. CARTER of Georgia. Mr. Speaker, I thank the gentleman for
yielding.
Mr. Speaker, I rise today in support of H.R. 1318, the Preventing
Maternal Deaths Act.
Unfortunately, we know all too well in Georgia the need to address
maternal mortality rates in the Nation. My home State of Georgia has
one of the highest maternal mortality rates in the country, and we
learned about the challenges leading to this statistic on September 27
in the Energy and Commerce Committee when we were able to hear from my
colleague and the sponsor of the bill, Congresswoman Herrera Beutler.
As my colleague noted in the hearing, we are seeing an estimated
number of between 700 and 900 maternal deaths per year, a number that
is unacceptable in today's world. A 2015 World Health Organization
report noted that nearly half of these deaths were preventable.
From 1987 to 2009, the number of pregnancy-related deaths per 100,000
births nearly doubled. That is why this legislation is so important.
Whether it is updates to maternal mortality data collection or mental
treatment options, or the reforms and changes for the maternal
mortality review committees, this legislation is necessary to helping
us curb this trend and reduce the number of maternal mortality deaths.
We can and we should do more, and I hope that this will be one of our
many steps to help us save the lives of mothers across the country.
Mr. Speaker, I urge my colleagues to support this bill.
Mr. BURGESS. Mr. Speaker, I yield 2 minutes to the gentlewoman from
Colorado (Ms. DeGette).
Ms. DeGETTE. Mr. Speaker, I know that the ranking member already
yielded back, so I thank Mr. Burgess for yielding.
Mr. Speaker, I wanted to hurry down here to speak in favor of this
bill because I have been working on it for many years with my colleague
and friend, Jaime Herrera Beutler.
According to the CDC, maternal mortality rates rose by 26 percent in
the U.S. between 2000 and 2014. These deaths are preventable, and they
should not be happening in 2018. So to combat this alarming trend, 33
States have established maternal mortality review committees made up of
healthcare professionals who review individual maternal deaths and then
recommend policy decisions.
Our bill provides Federal support for these committees and supports
efforts to standardize them. It has 190 cosponsors. It has received
support from 90 national public health organizations.
It is really a great example of how the Energy and Commerce Committee
works in a bipartisan way. So I thank everybody for being here and
thank the chairman for his comity.
{time} 1415
Mr. BURGESS. Mr. Speaker, I yield myself the balance of my time.
Just in addition to all the other people who have been thanked, I
want to acknowledge the work of my personal staff, Mr. Ed Kim and
Elizabeth Allen, who have worked so hard on this bill, as well as Dr.
Kristen Shatynski on the Energy and Commerce Subcommittee on Health
staff, who really helped push this along and made sure that we got here
today in a successful manner.
Mr. Speaker, I urge my colleagues to support the legislation, and I
yield back the balance of my time.
The SPEAKER pro tempore. The question is on the motion offered by the
gentleman from Texas (Mr. Burgess) that the House suspend the rules and
pass the bill, H.R. 1318, as amended.
The question was taken; and (two-thirds being in the affirmative) the
rules were suspended and the bill, as amended, was passed.
A motion to reconsider was laid on the table.
____________________