[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.

                          ____________________