AMA advocacy to improve maternal health

The American Medical Association is committed to tackling the issues surrounding maternal mortality and morbidity. The U.S. has the highest maternal mortality rate among developed countries. A 2019 report by the Centers for Disease Control and Prevention (CDC) found that Black women are 3-4 times more likely to die from pregnancy-related causes than white women.

The AMA understands that there are a multitude of considerations necessary to address this epidemic, including:

• Lack of insurance or inadequate coverage prior to, during and after pregnancy.
• Closures of maternity units in many rural and urban communities.
• A lack of inter-professional teams trained in best practices.

There are concrete actions that should be taken to reduce and prevent rising rates of maternal mortality and serious or near-fatal maternal morbidity in the United States.

We urge policy makers to:

• Extend Medicaid and Children's Health Insurance Program (CHIP) coverage to 12 months postpartum.
• Increase support for maternal mortality review committees.
• Implement equitable standardized data collection methods.
• Expand access to medical and mental health care and social services for postpartum women.
• Continue to develop a health care workforce that is diverse in background and experience.
• Address shortcomings in our institutions.
• Adopt standards to ensure respectful, safe and quality care before, during and after delivery.

• On Jan. 16, 2024, the AMA signed onto a letter commenting on the U.S. Preventive Services Task Force (USPSTF) Draft Recommendation: High Body Mass Index in Children and Adolescents: Interventions.
• On May 16, 2023, the AMA commented on the U.S. Department of Agriculture (USDA) Food and Nutrition Service (FNS) on the “Special Supplemental Nutrition Program for Women, Infants, and Children (WIC): Online Ordering and Transactions and Food Delivery Revisions to Meet the Needs of a Modern, Data-Driven Program” proposed rule. By removing barriers to online ordering and internet-based transactions, harmonizing the near-complete transition to electronic benefit transfer (EBT), and modernizing regulations to support food delivery and minimize burden on WIC food suppliers, FNS will modernize the WIC program and increase accessibility so that WIC can meet the evolving needs of the millions who rely on the benefit.
• On April 10, 2023, the AMA commented on the U.S. Department of Agriculture’s (USDA or Department) Food and Nutrition Service (FNS) on the proposed revisions to the Child Nutrition Programs: Revisions to Meal Patterns Consistent with the 2020 Dietary Guidelines for Americans. Overall, the AMA applauded the Child Nutrition Program’s primary goal of revising the program to align with the current Dietary Guidelines for Americans (DGA) while providing flexibility in the variety and choices offered in school meals. However, the AMA provided more detailed comments and suggestions on improving the nutritional density and limiting the fat, added sugar, and sodium content in school-based food programs, accommodating food substitutions based on cultural and medical needs and preferences, and supporting initiatives to improve access to healthy, affordable foods and promoting lifelong healthy diet and lifestyle choices.
• On Feb. 21, 2023, the AMA commented on the proposed revisions to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Food Packages. Overall, the AMA supports the primary goal of revising the program to align with the current Dietary Guidelines for Americans while providing flexibility in the variety and choice of foods and beverages. This flexibility will better reflect cultural and medical needs and personal preferences while adhering to the science associated with nutritional necessities that promote growth and health in pregnant, breastfeeding, and non-breastfeeding postpartum individuals and children.

2024

• To bolster federal and state efforts and provide recommendations to improve maternal health outcomes, the AMA has worked collaboratively over the last year with a variety of members of the Federation of Medicine, including relevant specialty societies, state medical associations and physicians from rural areas. On Apil 11, the AMA released (PDF) a new set of concrete steps that the administration and Congress can take to improve maternal health outcomes in the United States. The AMA has also developed a comprehensive document (PDF) providing a more detailed explanation of the recommendations outlined in our April 11 correspondence to the federal government.
• The AMA voiced support for H. Res. 217 (PDF) and S. Res. 90 (PDF) to increase the endometriosis research that is desperately needed. The AMA believes that there should be increased endometriosis research that addresses health disparities in the diagnosis, evaluation and management of endometriosis as well as increased funding for endometriosis related research for patients of color.
• On Feb. 28, the AMA sent a letter to Administrator Brooks-LaSure recommending several steps the Center for Medicare and Medicaid Innovation (CMMI) can take to ensure the new Transforming Maternal Health (TMaH) program significantly improves birthing outcomes for pregnant and postpartum individuals and their babies.

• The AMA requested the ICD-10 Coordination and Maintenance Committee make revisions to the current International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) to remove derogatory language and adopt destigmatizing terminology. Specifically, the AMA noted the use of “elderly” and “young” in the context of pregnancy.
• On July 26, the AMA signed onto a letter in support of the bipartisan Preventing Maternal Deaths Reauthorization Act of 2023 (H.R.3838/S.2415). This legislation continues crucial federal support for the state-based maternal mortality review committees (MMRCs) that review pregnancy-related deaths to identify causes and make recommendations for the prevention of future mortalities.
• On Jan. 31, the AMA sent a letter commenting to the Centers for Medicare & Medicaid Services (CMS) on the Request for Information (RFI) on Essential Health Benefits (EHB) published in the Federal Register. Comments covered a number of topics including maternal health.
• On Feb. 21, the AMA commented on the proposed revisions to the "Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Food Packages." Overall, the AMA applauded the WIC program’s demonstrated success in improving the health of individual participants by increasing consumption of nutritious foods and decreasing food insecurity. Moreover, the AMA supported the primary goal of revising the program to align with the current Dietary Guidelines for Americans while providing flexibility in the variety and choice of foods and beverages. This flexibility will better reflect cultural and medical needs and personal preferences while adhering to the science associated with nutritional necessities that promote growth and health in pregnant, breastfeeding and non-breastfeeding postpartum individuals and children.
• On March 13, the AMA sent comments on the CMS Notice of Proposed Rule Making (NPRM) outlining proposals to advance interoperability and improve prior authorization (PA) in Medicare Advantage (MA) plans, state Medicaid agencies and Medicaid managed care plans, Children’s Health Insurance Program (CHIP) agencies and CHIP managed care entities and issuers of Qualified Health Plans (QHPs) on the Federally-Facilitated Exchanges (FFEs). A number of topics were covered including a request for information entitled: "Advancing Interoperability and Improving Prior Authorization Processes for Maternal Health." As such the AMA provided information on how to strengthen data collection and the prior authorization process for pregnant, birthing and postpartum individuals. 
• In a joint webinar, Manatt Health, the AMA and a panel of stakeholders shared key lessons for states seeking to innovate and expand access to evidence-based care for pregnant people with a substance use disorder (SUD) who are incarcerated or under judicial supervision.
• On the judicial front, the AMA signed on to an amicus brief in the State of Ohio v. Tara Hollingshead, which concerned a pregnant person who was sentenced to a lengthy prison term for using illicit drugs during the third trimester. The AMA strongly opposes criminalizing pregnant individuals who have substance-use disorders. The AMA joined seven other Ohio and national organizations to file an amicus brief that urged the court to overturn the verdict that would have sent the woman to prison for eight to 12 years. They were joined in the brief by 31 experts on maternal, fetal and neonatal health and the effects of drug use on pregnant people, pregnancies and babies. In May, the court vacated the conviction.

• AMA supported S. 198, the Data Mapping to Save Moms’ Lives Act, which was signed into law in Dec. 2022.
• The AMA sent a letter commenting on questions posed by the Healthy Future Task Force Security Subcommittee. Part of the letter touches on the importance of increasing maternal health.
• The AMA signed onto a letter to members of Congress urging the highest possible funding level in fiscal year 2023 for federal programs at HRSA, CDC and NIH to improve maternal health and eliminate inequities in maternal health outcomes.
• The AMA signed onto a letter urging Congress to direct $20M to the Centers for Disease Control & Prevention (CDC) Hospitals Promoting Breastfeeding line item in the Fiscal Year (FY) 2023 Labor, Health and Human Services, and Related Agencies appropriations bill, $10.5M above the President's budget level and $10.25M above the FY 2022 level.
• The AMA sent a letter concerning the Hospital Inpatient Prospective Payment Systems (IPPS) Rule. A large portion of the letter focused on maternal health including, but not limited to, maternal health equity issues, the “birthing friendly” designation and Conditions of Participation for labor and delivery.
• The AMA sent a letter urging the CDC to better support maternal and child health as it considers revisions to its 2016 opioid prescribing guideline. 
• The AMA and Manatt Health released a state toolkit to End the Nation’s Drug Overdose Epidemic. The toolkit provides recommendations across several domains, including that “States should provide evidence-based medical care to incarcerated populations, including continuing, initiating and ensuring access to MOUD. States should remove criminal and other penalties for pregnant, postpartum, and parenting women for whom MOUD is part of treatment for an opioid use disorder.”
• The AMA has drafted model state legislation to help ensure that pregnant, postpartum and parenting individuals and families have access to MOUD and essential social and other supports to improve maternal and child health. The AMA will be working with state and specialty societies to seek introduction of the model bill in the 2023 state legislative sessions.

• The AMA sent a letter voicing our support for H.R. 955 and S. 285, the “Medicaid Reentry Act” which would provide states with the flexibility to allow Medicaid payment for medical services furnished to an incarcerated individual during the 30-day period preceding the individual’s release.
• The AMA signed onto a letter urging the Senate to direct $20M to the Centers for Disease Control & Prevention (CDC) Hospitals Promoting Breastfeeding line item in the Fiscal Year (FY) 2022 Labor, Health and Human Services, and Related Agencies (Labor-H) appropriations bill, $10.5M above the President’s budget and House Labor-H appropriations bill level.
• The AMA sent a letter in support of H.R. 4217 and S. 2779, the “Taskforce Recommending Improvements for Unaddressed Mental Perinatal & Postpartum Health for New Moms Act of 2021,” or the TRIUMPH for New Moms Act of 2021. This bill would create a Task Force on Maternal Mental Health to identify, evaluate, and make recommendations to coordinate and improve federal responses to maternal mental health conditions, as well as create a national strategic plan for addressing maternal mental health disorders.
• The AMA sent a letter sharing our support for two of the bills that the Committee on Energy and Commerce discussed during a hearing: the “Data Mapping to Save Moms’ Lives Act” (H.R. 1218/S. 198) and the “Dr. Lorna Breen Health Care Provider Protection Act” (H.R. 1667/S. 610)."
• Signed on to a letter urging for the highest possible funding for specific federal programs to improve maternal health in fiscal year (FY) 2022. This funding, if granted, would aim to prevent maternal deaths, eliminate inequities in maternal health outcomes and improve maternal health overall.
• Maternal health was among the top issues physicians and medical students advocated with their members of Congress during the AMA National Advocacy Conference and the AMA Medical Student Advocacy Conference. In particular, these advocacy efforts focused around asking members of Congress to cosponsor the Mothers and Offspring Mortality and Morbidity Awareness (MOMMA's) Act.
• Sent a support letter for S. 411, the MOMMA's Act which would establish national obstetric emergency protocols through a federal expert committee; ensure dissemination of best shared practices and coordination amongst maternal mortality review committees; standardize data collection and reporting; improve access to culturally competent care throughout the care continuum; provide guidance and options for states to adopt and pay for doula support services; and expand Medicaid coverage to new moms for one year postpartum.
• Submitted comments to CMS regarding, “Maternal and Infant Health Care in Rural Communities” and the 2021 Medicare Physician Fee Schedule proposed rule. AMA comments prompted agency action that recognized the importance of preventive prenatal and postpartum care for the health of women and infants.
• Joined a sign-on letter urging CMS to act as soon as possible to approve pending Section 1115 demonstration projects aimed at extending the postpartum coverage period for individuals who were enrolled in Medicaid while pregnant to a full year after the end of pregnancy.
  • This advocacy led to CMS approving Illinois Section 1115 waiver to cover post-partum care for Medicaid beneficiaries for up to one year after pregnancy. AMA Chief Health Equity Officer Aletha Maybank, MD, MPH, participated in the congressional call hosted by Senators Durbin (D-IL), Duckworth (D-IL) and Rep. Robin Kelly (D-IL-2) in celebration of the announcement.
• Supported the “Connected Maternal Online Monitoring (MOM) Act," which would require CMS to report to Congress on state Medicaid barriers to coverage of remote physiologic devices in programs to improve maternal and child health outcomes and update state resources.
• Urged Congressional support for at least $750 million for Title V Maternal and Child Health Services Block Grant in the fiscal year 2022 Labor, Health and Human Services, Education, and Related Agencies appropriations bill.
• Urged House Congressional leaders to support the highest possible funding level in FY 2022 for programs at Health Resources and Services Administration (HRSA), CDC and National Institutes of Health (NIH) that seek to prevent maternal deaths, eliminate inequities in maternal health outcomes and improve maternal health.
• Joined a sign-on letter urging Congress to direct $20M to the "CDC Hospitals Promoting Breastfeeding" line item in the FY 2022 Labor, Health and Human Services, and Related Agencies appropriations bill. See Senate letter and House letter.
• Submitted an extensive statement for the record to the U.S. House of Representatives Committee on Oversight and Reform as part of the hearing entitled, “Birthing While Black: Examining America’s Black Maternal Health Crisis.”
• Supported H.R.1218 and S. 198, “Data Mapping to Save Moms’ Lives Act,” which would instruct the Federal Communications Commission (FCC) to consult with the CDC to determine ways to incorporate data on maternal health outcomes for at least one year postpartum into broadband health mapping tools in an effort to reduce maternal mortality and morbidity in the U.S.
• Supported S. 796 and H.R. 958, the “Protecting Moms Who Served Act,” signed into law Nov. 30, 2021, which would require the Department of Veterans Affairs to implement the maternity care coordination program with community maternity care providers trained to address the unique needs of pregnant and postpartum veterans; and require the U.S. Government Accountability Office to report on pregnant and postpartum veteran maternal mortality and severe maternal morbidity with a focus on veteran racial and ethnic disparities in maternal health outcomes.
• Supported S. 1675, “Maternal Health Quality Improvement Act,” which would provide grants to identify, develop and disseminate best practices to improve maternal health care quality and outcomes; promote collaboration with state maternal mortality review committees to identify ways to reduce preventable maternal mortality and severe maternal morbidity; promote perinatal collaboration on quality; and implement integrated health care services for pregnant and postpartum women.
• Joined a second sign-on letter urging Congress to direct $20M to the CDC Hospitals Promoting the Breastfeeding line item in the fiscal year 2022 Labor, Health and Human Services, and Related Agencies appropriations bill, an increase of $10.5M above the president’s budget level.
• Joined other health care organizations in urging Congress to approve through appropriations for FY 2022 which would prioritize the highest possible funding level for certain programs that seek to prevent maternal deaths, eliminate inequities in maternal health outcomes and improve maternal health.
• Supported a provision in the American Rescue Plan Act of 2021 that established a temporary, optional provision to assist states in expanding Medicaid and CHIP coverage opportunities to one year postpartum.

In 2020, the AMA communicated frequently with federal legislators and regulators to advocate for maternal health. Highlights include:

• Patrice Harris, MD, MA, participated in the 2nd Annual Black Maternal Health Caucus Stakeholder Summit.
• Provided comments outlining actions that the Centers for Medicare & Medicaid Services (CMS) could take to improve health outcomes for pregnant women.
• The AMA participated in a U.S. Senate Committee on Finance staff briefing on maternal health and highlighted significant policies and conveyed the importance of expanding access to health care and social services for women for one-year postpartum under Medicaid and CHIP.
• Provided comments to the U.S. Senate Committee on Finance regarding, “Solutions to Improve Maternal Health” and urged Congress to take several bipartisan actions, such as ensuring Medicaid and CHIP coverage for women one year postpartum.
• Sent a support letter for H.R. 1897/S. 916, the MOMMA’s Act. The bill would require the CDC to provide technical assistance and best practices for collecting data, standardizing reporting and preventing maternal mortality. The bill would also establish regional centers to address implicit bias and cultural competency in the delivery of health care services. Additionally, the bill would extend coverage for pregnant and postpartum women under Medicaid and CHIP for one year postpartum and include coverage of oral health services.
• Supported H.R. 4996, the Helping Medicaid Offer Maternity Services (MOMS) Act of 2019 which would allow states to provide one year of postpartum coverage under Medicaid and CHIP and require a report on coverage of doula services under Medicaid.
• Supported H.R. 4995, the Maternal Health Quality Improvement Act of 2019 which would improve data collection in rural communities and promote perinatal quality collaborative activities and measures to address implicit bias.
• Supported S. 1365/H.R. 2569, the Comprehensive Addiction Resources Emergency (“CARE”) Act, which would provide emergency assistance to areas affected by the opioid epidemic to improve systems for the delivery of essential services to individuals with substance use disorder and their families. Three sections provide for the treatment of pregnant women.
• Supported H.R. 1329, the Medicaid Reentry Act, would provide states with the flexibility to allow Medicaid assistance for eligible incarcerated individuals up to 30 days prior to their release, to help provide for critically needed health care services, care coordination activities and linkages to care for individuals with substance use disorders.
• Submitted extensive comments and suggested edits to address concerns with the Black Maternal Health Momnibus Act of 2021 (a collection of 12 standalone bills).

As part of a coalition, the AMA, national physician organizations and heart health experts launched a campaign, Release the Pressure, with Essence—the nation’s leading lifestyle magazine brand for Black women—to partner with Black women for healthy blood pressure. The prevalence of high blood pressure in Black women is nearly 40% higher than white women in the U.S. Two of the leading causes of pregnancy-related deaths are heart conditions and stroke, which cause more than 1-in-3 deaths.

• In 2018, the AMA supported H.R. 1318, the Preventing Maternal Deaths Act of 2018, which was signed into law by the President, supported S. 1112, the Maternal Health Accountability Act of 2017 and joined stakeholders in a sign-on letter supporting these bills.
• In 2019, the AMA provided written and oral testimony as part of the hearing on Improving Maternal Health, provided written and oral testimony as part of the hearing on the Maternal Mortality Crisis and participated in the Black Maternal Health Caucus, the first Black Maternal Health Stakeholder Summit which was held in person on Capitol Hill.

• Listen to a podcast on ReachMD, "On a Mission to Mend: A Look at Maternal Health Disparities" about AMA's efforts to improve maternal health with Jennifer Brown, senior legislative and regulatory attorney at the AMA.