[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.
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