The 2023 Momnibus Bill: What's In It & How it Could Help End the Black Maternal Healthcare Crisis
This story is part of a larger conversation on the Black Maternal Health Crisis.
The US is one of the richest nations in the world and a global superpower, yet it ranks highest among these nations for maternal mortality at 32.9 deaths per 100,000 live births in 2021. In 2021, over 1,200 people died of maternal causes in the United States, according to the CDC, and the majority of victims in these deaths are women of color.
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CDC data also shows that in 2021, there were 69.9 deaths per per 100,000 live births among Black people, which is 2.6 times higher than the maternal mortality rate for white people. The numbers show that the number of maternal deaths — especially among Black women — only grew amid the COVID-19 pandemic.
Despite the bleak reality facing Black women and birthing persons nationwide, this crisis has not gone unnoticed. To respond to the maternal care crisis and the dire outcomes facing Black women and other birthing people of color, a bipartisan coalition in Congress called the Black Maternal Health Caucus has been working since March of 2020 to pass a number of bills to address the maternal care crisis in America.
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These bills comprise the Black Maternal Health Momnibus Act of 2021, and while the bill was not enacted in that session of Congress, it’s since been revived by the bill’s original sponsor, Rep. Lauren Underwood, and Sen. Cory Booker as the Black Maternal Health Momnibus Act of 2023. I spoke with Irnise Williams, JD RN — known as the Nurse Lawyer online — to break down each act (there are 13!), what it will do and how it will have a direct impact on the Black maternal care crisis.
Social Determinants for Moms Act
This bill is focused on where people “live, learn, work, and play.” The conditions in these areas of people’s lives can affect their birth outcomes. If someone lives in a community that does not have easy access to transportation, low rates of health insurance or other necessary aid, this bill will make sure the programs to improve quality of life are funded.
Williams said this bill will make sure that mothers have wrap-around services from housing to healthcare and everything in between to make sure that they can properly care for their child. This also includes expanding Medicaid to care for mothers through their pregnancy and a year after delivery. The current cutoff in places where Medicaid has not been expanded is 60 days after delivery even though birthing people can experience complications up to a year after delivery.
In the states that do not opt in to the Medicaid expansion, birthing people in need will be able to seek help at federally-funded qualified health care centers.
Williams said, “Federal qualified health care centers are clinics that serve marginalized and underserved communities. They take you If you have Medicaid and they take you if you have no insurance. They usually put you on a sliding fee, and the government reimburses them.”
The only drawback to these federal clinics is access. They will help in places where they are available, but those locations could be few and far between.
Extending WIC for New Moms Act
A new addition to the 2023 version of the Momnibus Bill, this act would extend eligibility to the Special Supplemental Nutrition Program for Women, Infants, and Children programs, aka WIC. Eligibility currently lasts for 6 months postpartum and 12 months in the breastfeeding period; this bill would extend that 24 months postpartum and 24 months in the breastfeeding period.
According to the press release announcing the legislation, WIC is a “critical federal program” that provides supplemental foods, health care referrals, and nutrition education to low-income pregnant, breastfeeding, and postpartum people, as well as infants and children up to age 5 who are at nutritional risk. The release notes that pregnant, postpartum, and breastfeeding WIC participants “have lower likelihoods of pregnancy-related risk factors, lower risk of preterm birth, and lower risk of low-birthweight infants.” Maternal WIC participation has also been linked to reduced infant mortality and improved nutrition and health outcomes for infants and children.
Kira Johnson Act
Kira Johnson died twelve hours after delivering her second child via Caesarean in April 2016. She had internal bleeding that was ignored for hours despite her husband Charles Johnson, IV, alerting medical staff that there was blood in his wife’s catheter. He has been speaking out and advocating on her behalf via the 4 Kira 4 Moms foundation, ever since testifying before Congress twice.
This bill supports bias and racism training for medical staff by establishing grants, awarded by the Department of Health and Human Services, given to community-based programs that improve maternal health outcomes for Black people and other underserved groups; train healthcare providers on reducing and preventing racism and discrimination; and respectful maternity care compliance programs in healthcare facilities.
Essentially, there are already community organizations doing the work of addressing maternal health disparities, but they don’t have good funding, according to The Century Foundation, a progressive think tank tracking the Momnibus Bill. This act would seek to provide that funding via grants.
Protecting Moms Who Served Act
This bill passed and was signed into law by President Biden at the end of 2021. The goal of this new law is to make sure the U.S. Department of Veterans Affairs (VA) has adequate maternal care programs across all of their facilities. These programs include childbirth classes, identifying mental and behavioral risks among pregnant people, as well as making sure community resources are available to veterans and/or their spouses on their pregnancy and birth journey.
The new law will also look at the rate of maternal mortality among the veteran community by commissioning a new comprehensive study of the issue to track the data.
In the 2023 version of the Momnibus Bill, this act was replaced with the Maternal Health for Veterans Act, which seeks to reauthorize funding from Protecting Moms Who Served.
Perinatal Workforce Act
The goal of this bill is to expand the practitioners, clinicians, and support staff who all work in maternal care. This includes nurse practitioners, doulas, midwives, lactation consultants, and more. The goal of this bill is to also diversify this workforce to reduce adverse outcomes—like death—because of bias, discrimination, and racism.
The way this bill will work is by providing funding, via grants. Organizations, both private and nonprofit, will be able to sign up to receive funding that will then go toward hiring the staff they need to support birthing people in their community.
Data to Save Moms Act
This provision of the Momnibus Act builds on a previously passed law in 2018 that funded the Maternal Mortality Review Committee in states across the country. This goes to further the data collection and study of the maternal care crisis in the United States and understand its root causes. This bill will also for the first time study the maternal care crisis among indigenous people — whose maternal mortality rate made up 32.5 percent per 100,000 live births from 2011-2015, per CDC data.
Williams believes data collection of this magnitude will help identify the current trends in maternal mortality as well as establish a reason for why this is happening.
“Mass data collection in this way forces them to find what connects all of these situations, which is really going to be qualitative and quantitative because it’s going to be communication. It’s going to be education,” she said. “It’s going to be the information that was received or communicated from the family or to the provider.”
While the outcome of this bill will take years to collect and analyze, it will lay a foundation to hopefully reverse the current trend of escalating maternal mortality year after year.
Moms Matter Act
This bill focuses on the mental health and or substance issues birthing people may experience.
This bill specifically seeks to invest in programs that provide both prenatal and postpartum mental health care to address the stigma associated with perinatal and postpartum depression. Per the Cleveland Clinic, 50 to 75 percent of people who give birth experience the “baby blues” after delivery, but 15 percent of these people experience a longer lasting postpartum depression.
If left untreated, postpartum depression can last for months, according to Mayo Clinic. Other birthing people may develop postpartum psychosis, a rare condition with severe symptoms like hallucination, paranoia, obsessive thoughts about your baby, and thoughts of harming themself, their child, or both.
Justice for Incarcerated Moms
Just because you go to prison does not mean that your rights cease to exist. This bill seeks to restore humanity and dignity to incarcerated mothers by, for one thing, ending the practice of shackling pregnant people. It will also provide funding for federal, state, and local prisons to establish programs and support for pregnant and postpartum women in their facilities including health workers, counselors, doulas, and more.
This bill will also fund a study to determine the rate of maternal morbidity among incarcerated people as well as the negative effects associated with ending a mother’s Medicaid coverage because she is incarcerated.
Despite the good intentions of the bill, Williams is concerned with its implementation by corrections officers and other prison staff.
“Yes, this sounds good, but the people who actually put these things into place, who is watching them to ensure that process actually happens?” Williams asks. “We have old ways of doing things and to actually change that by just passing a bill and providing more funding and money, it’s not realistic.”
Tech to Save Moms Act
This next provision of the Momnibus Act relates to doing more investment in telehealth. It would especially go to help moms and birthing people who live in maternal care deserts. March of Dimes defines a maternal care desert as a county in which access to maternal health care services is limited or absent, either through a lack of services or barriers to access. As of 2022, March of Dimes reports that up to 6.9 million women in the US live in what are considered maternal care deserts, and nearly 500,000 births have taken place in maternal care deserts.
In addition to investing in telehealth services and infrastructure — such as increased access to broadband — for moms with lack of access to maternal resources, this bill will also address racism and biases through digital tools and artificial intelligence to make sure care is not only accessible but equitable for all.
IMPACT to Save Moms Act
The Impact to Save Moms Act would create a new payment plan for birthing people to follow that would cover all of their maternal care needs. Williams said this bill creates a value-based care model for moms and birthing people in addition to creating accountability within the model to make sure care is prioritized over the payment.
The way it would work is that doctors would receive a certain amount of money to care for someone during their pregnancy with the contingent being that person makes it full term and without issues. To do that, providers then have to hit certain benchmarks during the prenatal treatment period to make sure the person is healthy and they, in the end, receive the full value of the person’s treatment.
“It’s gonna be a Cadillac of care,” Williams said.
Maternal Health Pandemic Response Act
This bill was proposed in direct response to the United State’s reaction to the COVID-19 global pandemic. Though it could (hopefully) be another 100 years before the country experiences a pandemic of this magnitude, this bill makes sure that moms are cared for through that process.
In the early days of COVID in 2020, before mass testing and vaccination were available, pregnant people weren’t truly being cared for in an effort to protect against the spread of COVID. As a consequence, many moms were getting sick and some died from the added complication of COVID because pregnancy is already a stressor on the body. Even once viable vaccines were released, pregnant people were still not the priority in terms of research and access.
This bill will address those issues, making sure pregnant people are considered and accounted for in any future pandemic response.
Protecting Moms and Babies Against Climate Change Act
This bill will provide funding to identify the climate change risks that most affect pregnant and birthing people and then try to limit their exposure to those risks.
This includes heat exposure and air pollution in the areas of the United States most vulnerable to these issues.
Maternal Vaccination Act
The final bill in the Momnibus Act will provide funding for a national campaign to encourage pregnant people to get their recommended vaccines, such as for flu, COVID, and RSV, during their pregnancy.
You can learn more about the health crisis facing Black moms and birthing people here.
A version of this article was originally published in 2022.
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