[Congressional Record Volume 167, Number 199 (Tuesday, November 16, 2021)]
[House]
[Pages H6286-H6288]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                 PROTECTING MOMS WHO SERVED ACT OF 2021

  Mr. TAKANO. Mr. Speaker, I move to suspend the rules and pass the 
bill (S. 796) 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:

                                 S. 796

       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 of 2021''.

     SEC. 2. DEFINITIONS.

       In this Act:
       (1) Maternal mortality.--The term ``maternal mortality'' 
     means a death occurring during pregnancy or within a one-year 
     period after pregnancy that is caused by pregnancy-related or 
     childbirth complications, including 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.--The term ``postpartum'', with respect to 
     an individual, means the one-year period beginning on the 
     last day of the pregnancy of the individual.
       (3) Pregnancy-associated death.--The term ``pregnancy-
     associated death'' means the death of a pregnant or 
     postpartum individual, by any cause, that occurs during 
     pregnancy or within one year following pregnancy, regardless 
     of the outcome, duration, or site of the pregnancy.
       (4) Pregnancy-related death.--The term ``pregnancy-related 
     death'' means the death of a pregnant or postpartum 
     individual that occurs during pregnancy or within one year 
     following 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 that 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 a mental 
     health condition or substance use disorder, 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.

     SEC. 3. SUPPORT BY DEPARTMENT OF VETERANS AFFAIRS OF 
                   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 Directive 1330.03.
       (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 those veterans in the 
     Armed Forces.
       (b) Authorization of Appropriations.--
       (1) In general.--There is authorized to be appropriated to 
     the Secretary $15,000,000 for fiscal year 2022 for the 
     program under subsection (a)(1).
       (2) Supplement not supplant.--Amounts authorized under 
     paragraph (1) are authorized in addition to any other amounts 
     authorized for maternity health care and coordination for the 
     Department of Veterans Affairs.
       (c) Definitions.--In this section:
       (1) Community maternity care providers.--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 any other law administered by the 
     Secretary of Veterans Affairs.
       (2) Non-department facilities.--The term ``non-Department 
     facilities'' has the meaning given that term in section 1701 
     of title 38, United States Code.

     SEC. 4. 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 Committee on Veterans' 
     Affairs of the Senate and the Committee on Veterans' Affairs 
     of 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) an assessment of the racial and ethnic disparities in 
     maternal mortality and severe

[[Page H6287]]

     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 
     service in the Armed Forces;
       (F) identification of the causes of maternal mortality and 
     severe maternal morbidity that are unique to veterans from 
     racial and ethnic minority groups and such other at-risk 
     populations as the Comptroller General considers 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 a health care provider of the Veterans Health 
     Administration each year in the most recent five years, 
     disaggregated by age, race, ethnicity, sex, marital status, 
     and geographical location;
       (I) the number of veterans who have received a clinical 
     diagnosis of unexplained infertility by a health care 
     provider of the Veterans Health Administration each year in 
     the most recent five years; and
       (J) an assessment of 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 who--
       (A) have health care coverage through the Department;
       (B) are enrolled in the TRICARE program (as defined in 
     section 1072 of title 10, United States Code);
       (C) have employer-based or private insurance;
       (D) are enrolled in the Medicaid program under title XIX of 
     the Social Security Act (42 U.S.C. 1396 et seq.);
       (E) are eligible to receive health care furnished by--
       (i) the Indian Health Service;
       (ii) Tribal health programs; or
       (iii) urban Indian organizations; or
       (F) 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 veteran populations.
       (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 (F) 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.
       (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 care coverage through the 
     Department of Veterans Affairs compared to maternal mortality 
     rates in the general population of the United States.
       (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.
       (c) Definitions.--In this section, the terms ``Tribal 
     health program'' and ``urban Indian organization'' have the 
     meanings given those terms in section 4 of the Indian Health 
     Care Improvement Act (25 U.S.C. 1603).

  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. 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 material on S. 796.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from California?
  There was no objection.
  Mr. TAKANO. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise today in support of S. 796, the Protecting Moms 
Who Served Act of 2021, sponsored by Senator Tammy Duckworth. The House 
companion to this bill, H.R. 958, was championed by the gentlewoman 
from Illinois (Ms. Underwood) and unanimously passed the House this 
past May.
  The Protecting Moms Who Served Act of 2021 will codify the maternity 
care coordination program that the Veterans Health Administration first 
established in 2012 and updated in a November 2020 policy directive. 
This will help ensure that veterans across the Nation receive high-
quality, culturally competent healthcare throughout their pregnancies 
and immediately afterward.
  The majority of veterans' maternity care is delivered by a contracted 
network of non-VA community providers. However, many veterans have 
coexisting medical or mental health conditions for which they receive 
ongoing care from VA providers. This means it is absolutely critical to 
ensure pregnant veterans' care is coordinated among all healthcare 
professionals involved in it. Such information sharing is crucial for 
patient safety and positive health outcomes--for parents and newborns.
  In addition to codifying VA's maternity care coordination program, S. 
796 will require the Department to provide training for community 
providers on the unique needs of pregnant and postpartum veterans and 
on behavioral health conditions related to service in the Armed Forces.
  Today, women veterans are the fastest growing cohort in the veteran 
population, and more than 40 percent of women veterans using VA 
healthcare are of reproductive age. Black women serve in higher numbers 
and represent nearly one-third of women using VA for their healthcare.
  In the population at large, Black, American Indian, and Alaska Native 
moms die from pregnancy-related complications at approximately three 
times the rate of White, Latina, Asian American, and Pacific Islander 
women, regardless of income or education levels.
  However, little is known about whether pregnant and postpartum 
veterans have better, worse, or equal rates of maternal mortality 
compared to nonveterans. That is why S. 796 also mandates a U.S. 
Government Accountability Office study on maternal mortality and 
morbidity among pregnant and postpartum veterans, with a particular 
focus on racial and ethnic disparities in maternal health outcomes for 
veterans.
  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 
healthcare equity. I therefore ask my colleagues to join me in 
supporting final passage of S. 796, the Protecting Moms Who Served Act 
of 2021.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BOST. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise in support of S. 796, the Protecting Moms Who 
Served Act.
  This bill would require VA to improve the care that is provided to 
veterans who are pregnant. More and more women are volunteering to 
serve in the military and seeking services from VA as veterans.
  As they grow their families, VA must provide them with high-quality, 
easy-to-access, pre- and postpartum care.
  Strengthening services to women veterans is one of my priorities as 
the lead Republican on this committee, and I am proud to help do that 
by supporting this bill today.
  I thank Illinois Senator Tammy Duckworth for sponsoring this bill on 
behalf of our fellow veterans. I urge my colleagues to support it 
today.
  Mr. Speaker, I reserve the balance of my time.
  Mr. TAKANO. Mr. Speaker, I have no further speakers. I am prepared to 
close, and I reserve the balance of my time.
  Mr. BOST. Mr. Speaker, I encourage my colleagues to support this 
bill. I yield back the balance of my time.

[[Page H6288]]

  

  Mr. TAKANO. Mr. Speaker, I ask all of my colleagues to join me in 
passing this important piece of legislation, S. 796, the Protecting 
Moms Who Served Act of 2021, and I yield back the balance of my time.
  Ms. ADAMS. Mr. Speaker, I rise today to speak in strong support of 
the bipartisan legislation, Protecting Moms Who Served Act.
  But before I do, I want to thank Congresswoman Lauren Underwood for 
her leadership on this bill. I would also like to thank Senator 
Duckworth and Representatives Julia Brownley, Gus Bilirakis, and Brian 
Fitzpatrick for their co-leadership.
  Together, Congresswoman Underwood and I are the co-founders and co-
chairs of the Black Maternal Health Caucus, as well as lead sponsors of 
the Momnibus--comprehensive legislation that addresses every dimension 
of the maternal health crisis in the United States.
  And it gives me great joy to say that the Protecting Moms Who Served 
Act will be the first bill of the Momnibus to pass in Congress.
  The United States continues to have the highest maternal mortality 
rates in the developed world. Women and birthing people of color die 
during or after pregnancy at 3 to 4 times the rates of their White 
counterparts.
  For the nearly 2 million women Veterans, maternal health outcomes are 
not any better. Pregnant and postpartum women who served face unique 
maternal health risks that deserve our attention.
  For example, the risk of pregnancy complications may be higher for 
women Veterans receiving maternity care through Veterans Affairs, since 
these women frequently have multiple medical conditions that can 
increase pregnancy complications.
  Furthermore, it is suggested that military deployment may increase 
the risk of post-traumatic stress disorder or PTSD. A post-traumatic 
stress disorder diagnosis can increase the risk of spontaneous pre-term 
birth, preeclampsia, or gestational diabetes.
  Women Veterans with more symptoms of PTSD or moral injury like shame, 
guilt, or demoralization, are also at greater risk for postpartum 
depression in the three years following the end of their military 
service.
  More specifically a study on the impacts of PTSD or moral injury, 
found that one in two women Veterans who became pregnant during the 
study, had a negative pregnancy outcome.
  These outcomes include postpartum depression or anxiety, miscarriage, 
obstetrical medical conditions, emergency c-sections, the baby's need 
for intensive care post-delivery, preterm birth, stillbirth, and 
ectopic or tubal pregnancy.
  Our women Veterans have upheld their duty to serve and protect and, 
we as Members of Congress must do the same.
  The Protecting Moms Who Served Act bill will codify and strengthen 
the Department of Veterans Affairs maternity care coordination programs 
to ensure Veterans receive the high-quality maternal health care and 
support they have earned.
  This is a noteworthy advancement since maternity care coordination 
programs are associated with improved maternal and birth outcomes, 
increased use of beneficial health services, and decreased costs, 
especially among women with chronic or pregnancy-related physical or 
mental health conditions, or social vulnerabilities.
  Additionally, this bill will commission the first-ever comprehensive 
study of America's maternal health crisis among women Veterans, with a 
particular emphasis on racial and ethnic disparities.
  This study is needed to provide further understanding of the maternal 
health challenges experienced among women who served.
  On May 12th, this legislation passed the house with unanimous 
bipartisan support.
  Today, we are here to vote once more and finally send this bill to 
the President's desk, changing the lives of millions of women Veterans 
and their children.
  Let's remember that strong and supportive healthcare for birthing 
people supports the future of our Nation by investing in the well-being 
of children and families.
  And today's vote ensures a healthcare system for women Veterans that 
will offer the best maternal care available.
  I am proud to see our progress towards ending maternal mortality and 
disparities among our moms who served. I look forward to continuing to 
address these issues in Congress as we examine and discuss the maternal 
mortality and morbidity issues that threaten our Nation.
  To all my colleagues--lets pass the Protecting Moms Who Served Act 
for our women Veterans, their children, and their families.
  What we do here today will live beyond our time in Congress and 
impact generations of women who serve.
  It is time we make sure that Veterans, who have done so much for our 
country, receive the support and resources they need.
  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, S. 796.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mr. TAKANO. Mr. Speaker, on that I demand the yeas and nays.
  The SPEAKER pro tempore. Pursuant to section 3(s) of House Resolution 
8, the yeas and nays are ordered.
  Pursuant to clause 8 of rule XX, further proceedings on this motion 
are postponed.

                          ____________________