[Congressional Record Volume 167, Number 82 (Wednesday, May 12, 2021)]
[House]
[Pages H2215-H2217]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                     PROTECTING MOMS WHO SERVED ACT

  Mr. TAKANO. Madam Speaker, I move to suspend the rules and pass the 
bill (H.R. 958) to codify maternity care coordination programs at the 
Department of Veterans Affairs, and for other purposes.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                                H.R. 958

       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 ``Protecting Moms Who Served 
     Act''.

     SEC. 2. SUPPORT FOR MATERNITY CARE COORDINATION.

       (a) Program on Maternity Care Coordination.--
       (1) In general.--The Secretary of Veterans Affairs shall 
     carry out the maternity care coordination program described 
     in Veterans Health Administration Handbook 1330.03, or any 
     successor handbook.
       (2) Training and support.--In carrying out the program 
     under paragraph (1), the Secretary shall provide to community 
     maternity care providers training and support with respect to 
     the unique needs of pregnant and postpartum veterans, 
     particularly regarding mental and behavioral health 
     conditions relating to the service of the veterans in the 
     Armed Forces.
       (b) Authorization of Appropriations.--There is authorized 
     to be appropriated to the Secretary $15,000,000 for fiscal 
     year 2022 for the maternity care coordination program. Such 
     amounts are authorized in addition to any other amounts 
     authorized for such purpose.
       (c) Definitions.--In this section:
       (1) The term ``community maternity care providers'' means 
     maternity care providers located at non-Department facilities 
     who provide maternity care to veterans under section 1703 of 
     title 38, United States Code, or other provisions of law 
     administered by the Secretary of Veterans Affairs.
       (2) The term ``non-Department facilities'' has the meaning 
     given that term in section 1701 of title 38, United States 
     Code.

     SEC. 3. REPORT ON MATERNAL MORTALITY AND SEVERE MATERNAL 
                   MORBIDITY AMONG PREGNANT AND POSTPARTUM 
                   VETERANS.

       (a) GAO Report.--Not later than two years after the date of 
     the enactment of this Act, the Comptroller General of the 
     United States shall submit to the Committees on Veterans' 
     Affairs of the Senate and the House of Representatives, and 
     make publicly available, a report on maternal mortality and 
     severe maternal morbidity among pregnant and postpartum 
     veterans, with a particular focus on racial and ethnic 
     disparities in maternal health outcomes for veterans.
       (b) Matters Included.--The report under subsection (a) 
     shall include the following:
       (1) To the extent practicable--
       (A) the number of pregnant and postpartum veterans who have 
     experienced a pregnancy-related death or pregnancy-associated 
     death in the most recent 10 years of available data;
       (B) the rate of pregnancy-related deaths per 100,000 live 
     births for pregnant and postpartum veterans;
       (C) the number of cases of severe maternal morbidity among 
     pregnant and postpartum veterans in the most recent year of 
     available data;
       (D) the racial and ethnic disparities in maternal mortality 
     and severe maternal morbidity rates among pregnant and 
     postpartum veterans;
       (E) identification of the causes of maternal mortality and 
     severe maternal morbidity that are unique to veterans, 
     including post-traumatic stress disorder, military sexual 
     trauma, and infertility or miscarriages that may be caused by 
     such service;
       (F) identification of the causes of maternal mortality and 
     severe maternal morbidity that are unique to veterans from 
     racial and ethnic minority groups and other at-risk 
     populations as deemed appropriate;
       (G) identification of any correlations between the former 
     rank of veterans and their maternal health outcomes;
       (H) the number of veterans who have been diagnosed with 
     infertility by Veterans Health Administration providers each 
     year in the most recent five years, disaggregated by age, 
     race, ethnicity, sex, marital status, sexual orientation, 
     gender identity, and geographical location;
       (I) the number of veterans who receive a clinical diagnosis 
     of unexplained infertility by Veterans Health Administration 
     providers each year in the most recent five years; and
       (J) the extent to which the rate of incidence of clinically 
     diagnosed infertility among veterans compare or differ to the 
     rate of incidence of clinically diagnosed infertility among 
     the civilian population.
       (2) An assessment of the barriers to determining the 
     information required under paragraph (1) and recommendations 
     for improvements in tracking maternal health outcomes among 
     pregnant and postpartum veterans--
       (A) who have health care coverage through the Department;
       (B) enrolled in the TRICARE program;
       (C) who are eligible to use the Indian Health Service, 
     Tribal health programs, or urban Indian health organizations;
       (D) with employer-based or private insurance;
       (E) enrolled in the Medicaid program; and
       (F) who are uninsured.
       (3) Recommendations for legislative and administrative 
     actions to increase access to mental and behavioral health 
     care for pregnant and postpartum veterans who screen 
     positively for maternal mental or behavioral health 
     conditions.
       (4) Recommendations to address homelessness, food 
     insecurity, poverty, and related issues among pregnant and 
     postpartum veterans.
       (5) Recommendations on how to effectively educate maternity 
     care providers on best practices for providing maternity care 
     services to veterans that addresses the unique maternal 
     health care needs of the veteran population.
       (6) Recommendations to reduce maternal mortality and severe 
     maternal morbidity among pregnant and postpartum veterans and 
     to address racial and ethnic disparities in maternal health 
     outcomes for each of the groups described in subparagraphs 
     (A) through (E) of paragraph (2).
       (7) Recommendations to improve coordination of care between 
     the Department and non-Department facilities for pregnant and 
     postpartum veterans, including recommendations to improve--
       (A) health record interoperability; and
       (B) training for the directors of the Veterans Integrated 
     Service Networks, directors of medical facilities of the 
     Department, chiefs of staff of such facilities, maternity 
     care coordinators, and staff of relevant non-Department 
     facilities.

[[Page H2216]]

       (8) An assessment of the authority of the Secretary of 
     Veterans Affairs to access maternal health data collected by 
     the Department of Health and Human Services and, if 
     applicable, recommendations to increase such authority.
       (9) To the extent applicable, an assessment of potential 
     causes of or explanations for lower maternal mortality rates 
     among veterans who have health coverage through the 
     Department of Veterans Affairs compared to maternal mortality 
     rates in the general United States population.
       (10) Any other information the Comptroller General 
     determines appropriate with respect to the reduction of 
     maternal mortality and severe maternal morbidity among 
     pregnant and postpartum veterans and to address racial and 
     ethnic disparities in maternal health outcomes for veterans.

     SEC. 4. DEFINITIONS.

       In this Act:
       (1) Maternal mortality.--The term ``maternal mortality'' 
     means a death occurring during or within a one-year period 
     after pregnancy, caused by pregnancy-related or childbirth 
     complications, including a suicide, overdose, or other death 
     resulting from a mental health or substance use disorder 
     attributed to or aggravated by pregnancy-related or 
     childbirth complications.
       (2) Postpartum and postpartum period.--The terms 
     ``postpartum'' and ``postpartum period'' refer to the 1-year 
     period beginning on the last day of the pregnancy of an 
     individual.
       (3) Pregnancy-associated death.--The term ``pregnancy-
     associated death'' means a death of a pregnant or postpartum 
     individual, by any cause, that occurs during, or within 1 
     year following, the individual's pregnancy, regardless of the 
     outcome, duration, or site of the pregnancy.
       (4) Pregnancy-related death.--The term ``pregnancy-related 
     death'' means a death of a pregnant or postpartum individual 
     that occurs during, or within 1 year following, the 
     individual's pregnancy, from a pregnancy complication, a 
     chain of events initiated by pregnancy, or the aggravation of 
     an unrelated condition by the physiologic effects of 
     pregnancy.
       (5) Racial and ethnic minority group.--The term ``racial 
     and ethnic minority group'' has the meaning given such term 
     in section 1707(g)(1) of the Public Health Service Act (42 
     U.S.C. 300u-6(g)(1)).
       (6) Severe maternal morbidity.--The term ``severe maternal 
     morbidity'' means a health condition, including mental health 
     conditions and substance use disorders, attributed to or 
     aggravated by pregnancy or childbirth that results in 
     significant short-term or long-term consequences to the 
     health of the individual who was pregnant.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
California (Mr. Takano) and the gentleman from Illinois (Mr. Bost) each 
will control 20 minutes.
  The Chair recognizes the gentleman from California.


                             General Leave

  Mr. TAKANO. Madam Speaker, I ask unanimous consent that all Members 
may have 5 legislative days in which to revise and extend their remarks 
and to insert extraneous material on H.R. 958.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from California?
  There was no objection.
  Mr. TAKANO. Madam Speaker, I yield myself such time as I may consume.
  Madam Speaker, the United States is the only industrialized nation 
where the maternal mortality rate is on the rise, and we have one of 
the highest rates of maternal mortality in the developed world.
  Black, American Indian, and Alaska Native moms die from complications 
from pregnancy at approximately three times the rate of White, Latina, 
Asian-American, and Pacific Islander women, regardless of income or 
education levels.
  Today, women veterans are the fastest-growing cohort in the veteran 
population, and more than 40 percent of women veterans using VA for 
their healthcare are of reproductive age. Black women serve in high 
numbers and represent nearly one-third of women using VA for their 
healthcare.
  The Protecting Moms Who Served Act, introduced by Congresswoman 
Lauren Underwood, would codify maternity care coordination in law and 
provide additional resources to the Department of Veterans Affairs to 
ensure that veterans receive the best prenatal and postpartum care 
possible.
  Madam Speaker, we do not yet know if pregnant veterans have better, 
worse, or equal rates of maternal mortality compared to nonveterans. 
This bill would address this knowledge gap by requiring the Government 
Accountability Office to conduct a comprehensive study on maternal 
mortality and morbidity among veterans.
  This study would not only examine racial and ethnic disparities in 
maternal mortality and morbidity but also would seek to capture data 
from Federal programs besides VA, including TRICARE and Medicaid as 
well as the Indian Health Service, private insurance, and the 
uninsured.
  While there is not yet enough data to make an authoritative 
conclusion, there is some evidence that veterans who use VA have lower 
maternal mortality rates than nonveterans. The study mandated by this 
bill would identify what best practices VA has implemented that result 
in better maternal health outcomes.
  Madam Speaker, last year, approximately 6,000 veterans using VA 
became new moms. Moms who have served our Nation exemplify strength and 
resilience. Supporting moms means ensuring gender equity, and that 
begins with health equity. I, therefore, ask my colleagues to join me 
in supporting the Protecting Moms Who Served Act.
  Madam Speaker, I reserve the balance of my time.
  Mr. BOST. Madam Speaker, I yield myself such time as I may consume.
  Madam Speaker, I rise today in support of H.R. 958, the Protecting 
Moms Who Served Act.
  Just 3 days ago, we celebrated Mother's Day, so it is particularly 
fitting to be here to discuss a bill to improve the care that is 
provided to veteran mothers.
  Women are volunteering to serve in uniform at a rapid rate, and when 
they become veterans, they seek VA healthcare at a rapid rate as well.
  I am committed to making sure the VA is equipped to provide them with 
the high-quality care that they have earned.
  The Protecting Moms Who Served Act will strengthen VA's maternity 
care coordination program. It will expand training on the physical and 
mental health needs of pregnant and postpartum veterans. It will also 
require a GAO assessment of maternal health outcomes among women 
veterans.
  I am grateful to the bill's sponsor and my fellow Illinoisan, 
Congresswoman Underwood, for introducing this bipartisan bill. I am 
pleased to support it this afternoon.
  Madam Speaker, I reserve the balance of my time.

                              {time}  1300

  Mr. TAKANO. Madam Speaker, I yield 2 minutes to the gentlewoman from 
California (Ms. Brownley), my good friend and chairwoman of the 
Subcommittee on Health, and also the cosponsor of this important piece 
of legislation.
  Ms. BROWNLEY. Madam Speaker, I rise today in support of H.R. 958, the 
Protecting Moms Who Served Act, which I was proud to co-lead with 
Congresswoman Underwood, Congressman Bilirakis, and Congressman 
Fitzpatrick.
  Madam Speaker, this bill will ensure that veterans get the high-
quality maternal care they have earned by codifying the Maternity Care 
Coordination Program. Additionally, this bill will require the GAO to 
report on maternal mortality and morbidity among veterans.
  I thank the chairman for his support on this issue, and I am proud 
that this bill passed the committee with broad bipartisan support.
  Madam Speaker, as you may know, among developed countries, the United 
States has one of the highest maternal mortality rates in the world, 
with an average rate of 17.2 deaths per 100,000 live births.
  For women of color, the rates are even higher. For Black women, the 
maternal mortality rate is 41.7 deaths per 100,000. And for American 
Indian and Alaska Native women, it is 28.3 deaths per 100,000 live 
births. More than 50 percent of pregnancy-related deaths happen after 
delivery.
  Today, there are 2 million women veterans living in the United 
States, and women comprise the fastest growing subpopulation of both 
the military and veteran populations, yet many of their health needs go 
unaddressed in a VA system that has not evolved to equitably serve a 
rapidly changing population.
  As the chairwoman of the Women Veterans Task Force and chair of House 
Veterans' Affairs Subcommittee on Health, I am proud to join 
Congresswoman Underwood, who has truly,

[[Page H2217]]

truly been a champion--she is the founder and co-chair of the Black 
Maternal Health Caucus--in fighting to end disparities in maternal care 
for women veterans. Our veterans have sacrificed so much for our 
country. It is past time that we address this inequity.
  Madam Speaker, I urge my colleagues to support our women veterans and 
vote ``yes'' on H.R. 958.
  Mr. BOST. Madam Speaker, I yield 3 minutes to the gentleman from 
Florida (Mr. Bilirakis), my good friend.
  Mr. BILIRAKIS. Madam Speaker, I thank Ranking Member Bost and 
Chairman Takano for their leadership. This bill is very important.
  Madam Speaker, I rise in strong support of the Protecting Moms Who 
Served Act, which I co-lead with my colleague and friend, Lauren 
Underwood. I also thank Representative Underwood for her efforts on 
this bill to help ensure that all female veterans have access to the 
maternal healthcare and support they need and deserve.
  Our Nation's heroes deserve the best possible care, and this 
legislation gets us one step closer to achieving that goal. Women are 
currently the fastest growing group within the veteran population, 
creating the greatest demand for maternity care ever faced by the VA.
  I have heard from my local VA medical centers about the growing 
challenges they face in providing maternity coordination for female 
veterans. The demand on this maternity coordination process has 
significantly increased over the past few years, from an average of 50 
patients per year to now around 140, featuring a generally higher risk 
patient population than the private sector.
  My local veterans medical centers said that the additional program 
support and additional maternity care coordinators would be crucial in 
meeting the growing demand, which this bill will provide.
  The bill will also provide community maternity care providers with 
training and support with respect to the unique needs of pregnant and 
postpartum veterans, particularly regarding mental and behavioral 
health conditions in relation to the service of the veterans in the 
Armed Forces--very important.
  Madam Speaker, these veterans honorably served our country. It is 
only right that we provide the quality maternity care and support they 
deserve.
  Madam Speaker, again, I urge my colleagues to support this particular 
bill.
  Mr. TAKANO. Madam Speaker, I yield as much time as she may consume to 
the gentlewoman from Illinois (Ms. Underwood), my good friend and 
author of this bill, and a member of the Veterans' Affairs Subcommittee 
on Health.
  Ms. UNDERWOOD. Madam Speaker, I rise today in strong support of H.R. 
958, the Protecting Moms Who Served Act, my bipartisan bill to address 
maternal mortality among veterans that I proudly introduced with 
Representative Gus Bilirakis and Julia Brownley and Brian Fitzpatrick.
  Madam Speaker, the United States is currently confronting a maternal 
health crisis. We have the highest maternal mortality rate in the 
developed world and significant racial and ethnic disparities in 
maternity health outcomes.
  Some of the drivers of maternal mortality and morbidity can even be 
more common in women who serve. For example, one in three women 
veterans report that they experience military sexual trauma, which is 
linked with risk factors for pregnancy-related complications. With 
unacceptable maternal mortality rates for all U.S. mothers and unique 
risks for veterans, we must ensure that the VA is providing the highest 
quality maternal healthcare and support to moms who serve.
  My bipartisan Protecting Moms Who Served Act would codify VA's 
maternity healthcare and coordination programs, which offers screenings 
and treatments to pregnant veterans with mental health conditions and 
include measures to strengthen community partnerships with 
organizations that support new parents.
  The VA's maternity care coordination programs have been successful in 
ensuring that veterans can receive high-quality, culturally appropriate 
care and robust support throughout pregnancy, during labor and 
delivery, and for the full yearlong postpartum period and beyond. By 
codifying and strengthening these programs, veterans will continue to 
receive the world-class care and support that they have earned.
  The Protecting Moms Who Served Act would also invest in trainings for 
community maternity care providers so that nurses, midwives, and 
physicians caring for pregnant and postpartum veterans understand the 
unique needs of veteran patients, particularly related to mental and 
behavioral health conditions that might have been caused or exacerbated 
by military service or the transition back to civilian life. These 
trainings will ensure that veterans receive care that is responsive to 
the lingering physical and psychological impacts of their service.
  Finally, my bill will commission the first-ever comprehensive study 
of maternal mortality, morbidity, and racial and ethnic disparities for 
veterans. By having a complete understanding of the ways in which our 
Nation's maternity health crisis extends to our veteran population, we 
can develop evidence-based solutions to improve outcomes and save 
veterans' lives.
  Madam Speaker, I urge my colleagues on both sides of the aisle to 
support the Protecting Moms Who Served Act. I thank the chairman of the 
House Committee on Veterans' Affairs, Chairman Takano, for his 
leadership to advance this critically important bipartisan 
legislation--the first bill in our Black Maternal Health Momnibus Act 
to be considered here in the House.
  As a cofounder and co-chair of the Black Maternal Health Caucus, I am 
committed to advancing each bill in the Momnibus to save moms' lives 
and support families.
  Madam Speaker, finally, I would also really like to thank--truly, it 
has been a pleasure to work with--Representative Bilirakis, 
Representative Brownley, Representative Fitzpatrick, and Ranking Member 
Bost. Thank you for co-leading this bill with me.
  Mr. BOST. Madam Speaker, I encourage my colleagues to support this 
bill, and I yield back the balance of my time.
  Mr. TAKANO. Madam Speaker, I yield myself the balance of my time.
  Madam Speaker, I am delighted that we are taking this significant 
step in addressing the terrible mortality rates that we are facing 
among our Nation's moms, especially our moms of color. And to the 
extent that we can shed light on this issue through this very important 
legislation being brought forward by Ms. Underwood and Ms. Brownley, I 
think that this is truly, truly a tremendous step forward.
  Madam Speaker, I urge all my colleagues to vote in favor of this 
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 California (Mr. Takano) that the House suspend the rules 
and pass the bill, H.R. 958.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill was passed.
  A motion to reconsider was laid on the table.

                          ____________________