[Congressional Record Volume 165, Number 77 (Thursday, May 9, 2019)]
[House]
[Pages H3668-H3671]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                      BLACK MATERNAL HEALTH CAUCUS

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 3, 2019, the Chair recognizes the gentlewoman from North 
Carolina (Ms. Adams) for 30 minutes.


                             General Leave

  Ms. ADAMS. Madam Speaker, I ask unanimous consent that all Members 
have 5 legislative days to revise and extend their remarks and include 
extraneous material on the subject of my Special Order.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from North Carolina?
  There was no objection.
  Ms. ADAMS. Madam Speaker, I rise today as the founder and co-chair of 
the Black Maternal Health Caucus. I want to take this time to briefly 
speak about the importance of Black maternal health.
  Our country is in the midst of a national public crisis. Black 
mothers are dying.
  Across the country, Black women from all walks of life are dying from 
preventable pregnancy-related complications at three to four times the 
rate of non-Hispanic White women. Sixty percent of maternal deaths are 
preventable. Their infants are twice as likely to die by their first 
birthday as infants born to White mothers.
  Black women are 50 percent more likely than non-Hispanic White women 
to give birth preterm, accounting for more than half of the disparity 
in infant mortality rates among Black and non-Hispanic White women.
  Reducing this gap through interventions like better medical care and 
increased social support can improve maternal outcomes for African 
American women, while also reducing racial disparities in infant 
mortality.
  Research 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 inadequate in 
addressing the health consequences of living with the stress.
  As a Black mother and as a grandmother, this issue is very personal 
to me. That is why Representative Lauren Underwood and I founded the 
Black Maternal Health Caucus, with

[[Page H3669]]

the goal of closing the racial disparities gap.
  The caucus aims to raise awareness about this crisis, to educate 
Members of Congress, and to find meaningful legislative solutions to 
improve maternal health outcomes. We intend to amplify the voices and 
needs of mothers and families all across this Nation.
  I have been working closely with healthcare providers and with 
stakeholders and policymakers to begin identifying a comprehensive path 
forward for eliminating these disparities.
  On average, African American women receive lower quality healthcare 
than their non-Hispanic White peers. This disparity in care quality 
starts as early as birth, with African American infants in neonatal 
intensive care units receiving lower quality care than non-Hispanic 
White infants.

                              {time}  2045

  This continues throughout adulthood with three out of four Black 
women giving birth at low-quality hospitals where their risk of poor 
maternal health outcomes is the highest.
  More than a third of Black women undergo cesarean sections, C-
sections, even for low-risk pregnancies. This is 4 percent higher than 
the U.S. average, higher than any other racial or ethnic group.
  Although a C-section can save lives when a pregnancy is high risk, it 
is, nevertheless, a major surgical procedure accompanied by risks, 
including surgical injury to either the mother or infant, infection, 
and heavy bleeding.
  Here we have a few areas that we need to focus on. We must improve 
access to critical services. We must improve the quality of care 
provided to pregnant women. And we must address maternal and infant 
mental health.
  May is Mental Health Month. Too often, however, maternal and infant 
mental health problems go unrecognized or unaddressed, particularly for 
women and infants of color, with devastating consequences.
  We should also enhance supportive services for families before and 
after birth. All families need support to thrive, but not all have the 
support that they need.
  Adjusting to parenthood can be especially difficult for families 
experiencing economic insecurity. As a consequence of structural 
racism, many families experiencing this insecurity are in lower-income 
communities of color.
  Programs that help families meet their basic needs--including 
nutrition assistance, housing assistance, and other social supports--
are underfunded, and the application and enrollment process can be 
difficult and time-consuming.
  We must also improve data collection and oversight. Collecting and 
sharing reliable, consistent data on maternal and infant mortality is 
essential to developing solutions.
  Although some progress has been made, such as H.R. 1318, which helped 
to provide States with resources for maternal mortality review 
committees, there is still more work we need to do.
  To address these problems, Federal policymakers should help States 
standardize and improve the quality of the data being collected and 
ensure diversity among stakeholders who serve on mortality review 
committees.
  There is no easy fix for this issue. It is going to require many 
steps to begin closing the gaps.
  I look forward to working with my colleagues to begin implementing 
some of these important strategies to save our mothers.
  Madam Speaker, I yield to the gentlewoman from Michigan (Mrs. 
Lawrence), my good friend who is co-chair of the Democratic Women's 
Caucus.
  Mrs. LAWRENCE. Madam Speaker, I am proud to be here today, and I 
thank my colleagues, Representative Adams and Representative Underwood, 
for establishing the Black Maternal Health Caucus, of which I am a 
proud member.
  I also want to recognize my colleague Robin Kelly for her continuous 
leadership in healthcare when it comes to maternal health.
  I am also here to let the public know that this issue of maternal 
health is a priority for the Women's Caucus here in Congress. As my 
colleague Alma Adams has said, we in America have a crisis. Maternal 
mortality is not only a public health crisis, but it is also an 
American crisis.
  It is an American crisis because we are the highest for any developed 
country in the world when it comes to deaths from maternal mortality. 
The CDC reported this week that most of the maternal mortality deaths 
in our country are preventable.
  It saddens me that the maternal mortality rate in the United States, 
again, is the highest among developed countries in the world. We have 
women, mostly Black women and women of color, dying for no reason. It 
is unacceptable. It is heartbreaking.
  In my home State of Michigan, 80 to 90 maternal deaths occur every 
year. These are women who are losing their lives to give birth.
  We must do all that we can to end this crisis. As a leader on this 
issue, joining my other colleagues in their leadership, I look forward 
to working on both sides of the aisle to address this issue.
  Madam Speaker, when we elected a record number of women to Congress 
this Congress, this issue, which has been escalating year after year, 
has finally been brought to the forefront. I am proud to say, when a 
woman sits at the table, the conversation changes, and we will fight 
for the lives of women giving birth.
  To every woman who has given birth, who has been a parent, I want to 
say happy Mother's Day. We are fighting to make sure that every woman 
coming forth to be a mother can live.
  Ms. ADAMS. Madam Speaker, I thank the congresswoman from Michigan, 
not only for her work with the Women's Caucus but all of her work in 
this area.
  Of course, when we can improve the quality of health for women, we 
are going to make our families much more sustainable.
  Madam Speaker, it is my pleasure to welcome someone who has been a 
leader on the issue of health, who chairs the CBC Health Braintrust, 
and who has continued to lift her voice in the area of health.
  She is a member, as well, of the Energy and Commerce Committee. She 
is also the founder of the Black Women and Girls Caucus.
  I am pleased to have my colleague from the State of Illinois, Robin 
Kelly, join us this evening to speak on this issue.
  Madam Speaker, I yield to the gentlewoman from Illinois (Ms. Kelly).
  Ms. KELLY of Illinois. Madam Speaker, I thank my colleague from the 
great State of North Carolina and my colleague from the great State of 
Michigan.
  I rise today because American moms are tragically dying. The majority 
of these deaths are entirely preventable, as we have heard.
  This weekend is Mother's Day, the day when we celebrate our mothers, 
grandmothers, aunts, stepmothers, and all the women who love and 
nurture us. There will be brunches and mimosas, cards and flowers, 
backyard barbecues and fancy dinners. Or it might just be a quick call 
saying: Hey, Mom, I love you.
  But each year, more than 700 American kids begin their lives without 
moms. Nearly 100 of these deaths are in my State of Illinois. These 
kids will never know their moms or celebrate a Mother's Day with her 
because of America's embarrassing maternal mortality crisis.
  Perhaps most shocking of all, a recent CDC report shows that 60 
percent of these deaths are entirely preventable.
  While hundreds die, thousands suffer severe health complications that 
can endanger their lives and limit the ability of mothers to care for 
their families.
  Recently, Serena Williams and Beyonce have boldly spoken out about 
their personal experiences with these terrifying complications.
  As the mother and stepmother of adult daughters, it worries me that 
it will be more dangerous for them to have a baby today than it was for 
me to have them 20 years ago.
  On nearly every health issue, death rates have declined, except for 
pregnancy and birth-related deaths. In fact, America is the only 
developed Nation where the number of women dying continues to grow.
  We can and must do better because all mommas deserve the chance to be 
mommas.
  What can be done? Last year, Congress came together in a moment of 
bipartisanship to pass the Preventing

[[Page H3670]]

Maternal Deaths Act thanks to the leadership of Congresswoman Herrera 
Beutler and Senator Heitkamp. This law will standardize data and 
reporting so we have a clearer picture of this crisis.
  Building on this bipartisan progress, I have proposed a 
comprehensive, multipronged approach called the Mothers and Offspring 
Mortality and Morbidity Awareness Act, or, simply, the MOMMA's Act.
  It starts by expanding what is working. It builds on last year's work 
to further standardize data and reporting. It also takes the highly 
successful Alliance for Innovation on Maternal Health program, called 
the AIM program, developed by our Nation's obstetricians and 
gynecologists and grows it.
  AIM's emergency protocols and best shared practices are already 
saving lives in hundreds of U.S. hospitals. The MOMMA's Act would 
leverage Federal resources and publications to grow this proven 
program.
  It also uses another proven strategy to prevent future deaths: 
mortality review committees. These committees examine every tragic 
death in great detail to prevent further ones.
  When the city of Philadelphia established one, it cut the number of 
deaths by 75 percent in just 1 year. Imagine what we could do with a 
nationwide committee.
  The MOMMA's Act also addresses a bizarre gap in current law that 
prevents many mothers from seeing their doctor. We know that one-third 
of deaths occur after giving birth. Right now, moms on Medicaid lose 
their coverage just 60 days after giving birth, but it takes a woman's 
body a full year to recover.
  More than 70 percent of moms will have some complications within a 
year of giving birth. These mothers should be able to see their doctors 
and get the care they need.
  While we are seeing approximately the same rate of maternal deaths 
regardless of a woman's income, education level, or other demographics, 
the recent CDC report shows that Black, American Indian, and Native 
Alaskan mothers are dying at more than three times the rate of White 
mothers. In my home State of Illinois, that disparity climbs to six 
times more likely to die for Black moms.
  My bill directly addresses this disparity by pushing for culturally 
competent care throughout the care continuum.
  As we celebrate Mother's Day, I hope my colleagues will join me in 
working to ensure that everyone gets a chance to know a mother's warm 
love and affection.
  We can prevent mothers from dying. We know how. The question is, do 
we have the will?
  Ms. ADAMS. Madam Speaker, I thank my colleague from Illinois, not 
only for her comments tonight but for all the work that she has done in 
this area.
  It is a preventable issue and something that we can do something 
about. That is why we are here tonight to shed some more light on this, 
Madam Speaker, and to try to make sure that we are all educated so that 
we will know.
  This comes right on the heels of Mother's Day. As we think about our 
mothers, our grandmothers, and all of those who have been mentors to 
us, this is an issue that we want to try to make right.
  Madam Speaker, I am pleased to welcome the congresswoman from 
California, who is a senior member on the Appropriations Committee, has 
been a champion of reproductive rights, and sits on the Budget 
Committee.

  Madam Speaker, I yield to the gentlewoman from California (Ms. Lee), 
my colleague.
  Ms. LEE of California. Madam Speaker, I thank Representative Adams.
  First, I have to thank the gentlewoman for her tremendous leadership 
on so many issues. Our young people at our Historically Black Colleges 
and Universities really owe her a debt of gratitude.
  I thank her and Congresswoman Underwood for forming the Black 
Maternal Health Caucus, and also Congresswoman Robin Kelly, who has 
been such a tremendous leader in healthcare. Her MOMMA's Act, which I 
am proud to cosponsor, is really, truly, making a huge difference 
already.
  The horror of health disparities for African American women in many 
ways is very personal to me. Let me just share a quick story about my 
birth.
  When my mother, Congresswoman Adams, went into labor--this was in El 
Paso, Texas--she went to the hospital, and she needed a cesarean 
section. They refused her admission, and she nearly died as a result.
  By the time the very racist--it was a hospital that did not allow 
African Americans into the hospital. By the time they allowed her in, 
though, after my grandmother had to fight to get her in--as she told me 
the story over and over again as a child--they put her on a gurney in 
the hall. They just left her there. Again, she needed a C-section.
  She became delirious, became unconscious. Somebody finally saw her. 
By then, it was too late to do a C-section.
  They pulled her in, and the doctors really didn't know quite what to 
do. They finally decided to deliver me using forceps.
  My mother almost died. I almost didn't get here. And I bore those 
scars on my eye, the forceps scars, for many years. They went away just 
a few years ago, actually.

                              {time}  2100

  I share that story because here we are now, in 2019, and we are 
talking about many of the same issues that my mother had to face, 
maternal death, infant mortality with African American women now here 
in this country.
  We have gone backwards. The United Nations did a report indicating 
that we have gone back 25 years in this country. This is unacceptable. 
It is totally unacceptable.
  As a member of the Labor, Health and Human Services, Education, and 
Related Agencies Appropriations Subcommittee, though, we are working 
every day to address the crisis swiftly and with a firm resolve to turn 
the tide on these unacceptable disparities in health plaguing the 
African American community and African American women.
  It is utterly unacceptable that Black women are four times more 
likely to die--again, I have to think about my mother tonight--four 
times more likely to die from preventable pregnancy complications than 
White women. We do have a Black maternal health crisis in America.
  So as we celebrate Mother's Day, and as we honor our grandmothers and 
our aunts and our mothers for giving us life, let us recommit 
ourselves, on their behalf, to improving Black maternal outcomes.
  But also, as Congresswoman Adams continues to remind us, we must 
address the structural racism, structural racism which is really at the 
core of this deadly issue. And it is a deadly issue.
  So let me just remind us tonight that Black lives do matter.
  Ms. ADAMS. Madam Speaker, I thank Congresswoman Lee. Black lives 
matter, and Black mamas' lives matter.
  As you talked about your mother giving birth to you and the story 
that she told, I thought--I was reminded of 13 years ago, my daughter 
giving birth to her daughter who, they both almost didn't make it. She 
had a very difficult pregnancy, right at the end. She had to have a 
Cesarean, what we call a C-section, and she had to give blood. All 
kinds of things started going wrong at the last minute.
  And once she did return home--because the baby was premature, 2 
months early, once she did go home, probably less than 10 days, she had 
to go back, she was having complications.
  So the problems that our women have don't always occur while you are 
in the hospital, so they need to have that support, not only before the 
baby is born, but even after.
  I thought about that, and it was a very difficult time for us. But 
now you wouldn't believe my granddaughter is taller than I am, and she 
is a really healthy young lady, a beautiful young lady.
  But you have to think about that, that it does not matter. I think I 
may have heard the gentlewoman or one of our other speakers say, even 
your socioeconomic status, all those things really don't matter. 
Sometimes doctors don't really listen to women.
  Ms. LEE. Madam Speaker, I say to Congresswoman Adams, race is a 
factor in everything in this country, and especially in terms of 
maternal deaths and

[[Page H3671]]

infant mortality rates with Black women.
  Ms. ADAMS. Madam Speaker, I thank the gentlewoman for her leadership 
and for all that she continues to do. I appreciate that very, very 
much; and thank her for being here as we kick off this Mother's Day. I 
am missing my mom. I know the gentlewoman is missing hers because they 
passed away very close to each other.
  Ms. LEE. Madam Speaker, it was very close, very close. It is very 
difficult coming toward this Mother's Day, but we have to thank them 
and honor them for giving us life.
  Ms. ADAMS. Madam Speaker, I thank the gentlewoman for being here and 
for her support of what we are trying to do collectively here in 
Congress.
  Madam Speaker, it is my pleasure at this point to introduce another 
warrior, a champion here in the U.S. House, a member of the Judiciary 
Committee, Homeland Security Committee, who has continued to lift her 
voice over and over and over again.
  Madam Speaker, how much time do I have remaining?
  The SPEAKER pro tempore. The gentlewoman from North Carolina has 6\1/
2\ minutes remaining.
  Ms. ADAMS. Madam Speaker, I yield to the gentlewoman from Texas (Ms. 
Jackson Lee).
  Ms. JACKSON LEE. Madam Speaker, first of all, let me thank 
Congresswoman Alma Adams for gathering us a couple of weeks ago to 
stand and be counted as members of the Black Maternal Mortality Caucus; 
and to continue her recognition that if we don't become problem solvers 
the problems will continue.
  So I want to join with my colleagues, and, in particular, 
Congresswoman Adams and Congresswoman Lee, both of whom I knew in the 
time that they were going through the loss of their moms.
  A mom and a mother are always a mom and a mother, so let me, in the 
name of my late mother, who I continue to remember, Ivalita Bennett 
Jackson, indicate that we stand here in your name and in the names of 
young mothers around the Nation and young mothers-to-be.
  I don't believe we could be doing a more important task than what we 
are doing, to not only bring relevance and substance to this question 
of why Black women, African American women, suffer more with maternal 
mortality and infant mortality; because we know what happens when that 
bond is broken by death or sickness, particularly in the infant stages 
of a young child's life.
  So I want to remind us of the beauty of pregnancy, and particularly, 
those pregnancies that these young women are certainly evidencing, just 
the beauty of the spirit, the softness of their faces and the contours 
of their body, excitement. If you have been around a pregnant expectant 
mother, meaning expectant of joy and excitement, then you understand.
  Should they not live? Should they not live, and should their 
children, their babies not live?
  We have come to find out that Black women are three to four times as 
likely than White women to die of pregnancy-related causes. A Black 
baby born today is twice as likely as a White baby born the same day, 
in the same California city--and I will mention the fact that 
California has made great strides--to perish before she can take her 
first steps or experience her first birthday.

  One in seven babies are born too soon or too small. We have 
euphemisms that mask the real impact of the maternal healthcare crisis. 
Good prenatal and maternity care is critically important for healthy 
pregnancies and healthy children.
  Congresswoman Adams knows that we have been on the floor discussing 
access to healthcare. We know that pregnancy has been described as a 
preexisting condition, which means that women, even if they could, 
could not access good healthcare.
  Collectively, we need to make greater efforts to arm the next 
generation with the right mix of robustness and agility and, I would 
say, righteousness; that we are righteously indignant that we live in 
the greatest Nation in the world, and here we are talking about the 
death of mothers and the death of their infant child.
  As I listened to Congresswoman Adams speak of her beautiful, taller-
than-her grandchild, imagine that she says the healthcare that her 
daughter had, in spite of the horrific challenges--just think if she 
did not, or no one had listened to her about the pain in her body or 
how she felt.
  That is one the things that we find with Black women, that, in fact, 
they are not paid attention to as relates to the pain and medical 
symptoms that are represented by them. They are dismissed or taken less 
seriously.
  Let me quickly say that, as the senior member on the Crime 
Subcommittee, I have had the privilege of knowing that crime impacts 
humanity in many different ways. And so I introduced legislation called 
H.R. 5130, the Stop Infant Mortality and Recidivism Reduction Act of 
2016.
  I am very glad, as I wrote the Violence Against Women Act, that I was 
able to include the SIMARRA Act in the 115th Congress, but it was 
proudly passed in H.R. 1585, the Violence Against Women Reauthorization 
Act of 2019.
  The SIMARRA Act permits the Bureau of Prisons to improve the 
effectiveness and efficiency of Federal prison systems for pregnant 
offenders, many of whom are African American, by establishing a pilot 
program, a critical stage, and developmental nurseries in Federal 
prisons for children born to inmates.
  The SIMARRA Act helps decrease, unprecedentedly high current infant 
mortality rates by allowing inmate mothers to provide healthy and safe 
gestation for their unborn, as well as providing a space for bonding 
with infants during their first 30 months of life.
  It is important to administer effective services for pregnant, 
incarcerated women and transcend our divide, to protect families and 
continue sheltering the lives of our most vulnerable children, babies 
born to mothers in prison.
  And although males account for 96 percent of the deaths, according to 
the U.S. Department of Justice, in 2014, the number of female prisoners 
who died was 154.
  I use this example to simply say, we found a problem in incarcerated 
women, many of them African American, and we sought to get in the way 
of that problem by finding a solution, to be able to help those mothers 
have a healthy pregnancy and those babies be born.
  So let me just simply say that I am glad to be on the floor to be 
with my sisters. I am unhappy to be on the floor because, as we stand 
here today, some African American mother is losing her life in birth or 
losing the life of her child. That is how devastating maternal 
mortality is.
  I thank the gentlewoman for her leadership, and I am here to stand 
with her and fight with her, and this caucus is going to help save 
lives. We are saving lives tonight.
  Ms. ADAMS. Madam Speaker, I want to thank all of my colleagues for 
being here, and I yield back.

                          ____________________