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.

2024

• On Oct. 31, the AMA signed onto a letter urging for the passage of the bipartisan Preventing Maternal Deaths Reauthorization Act of 2023 (H.R. 3838/S. 2415) or its inclusion in the final FY 2025 appropriations package or any other must-pass legislative package.
• In October, the AMA sent letters in support of several pieces of federal maternal health legislation:
  • Preventing Maternal Deaths Reauthorization Act (S. 2415/H.R. 3838): This bipartisan legislation, which passed the House in March, would increase federal funding for state-based efforts to improve and continue maternal mortality review committees (MMRCs). This would help identify solutions to prevent future maternal deaths and eliminate disparities in maternal health outcomes for pregnancy-related and pregnancy-associated deaths. 
  • Connected MOM Act (S. 712/H.R. 8532): This bill would require the Centers for Medicare & Medicaid Services (CMS) to report on, and provide resources for states related to, coverage of remote physiologic devices and related services (e.g., blood glucose monitors) under Medicaid.  
  • PREEMIE Reauthorization Act of 2023 (S. 1573/H.R. 3226): This bill, which passed the House, would reauthorize the PREEMIE Act until 2028, allowing for continued research and data collection on infants who are born prematurely, the continuation of programs aimed at improving treatment and outcomes, and the establishment of a study on the factors that lead to preterm births. 
  • Pregnant and Postpartum Women Treatment Reauthorization Act (S. 3447): This bipartisan legislation would reauthorize funding for the Grant Program for Residential Treatment for Pregnant and Postpartum Women, which helps pregnant women and new mothers receive residential treatment for substance use disorders and offers a range of services for prevention and recovery support. 
  • Rural Obstetrics Readiness Act (S. 4079/H.R. 8383): This bipartisan legislation would provide grant funding toward evidence-based training programs on emergency obstetrics services for rural health care facilities without dedicated obstetrics units.  
• The AMA supports several additional legislative efforts aimed at improving maternal health care and outcomes, and has been engaged with sponsors and leadership in advancing the following bills:
  • SHINE for Autumn Act of 2023 (S. 2647/H.R. 5012): This bill aims to prevent stillbirths through enhanced data collection, research, and education, authorizing grants to improve stillbirth data quality and train pathologists on fetal autopsies to better understand and prevent stillbirths. 
  • Promoting Maternal and Child Health Through Substance Use Prevention Act (S. 3370): This legislation supports initiatives to prevent substance use during pregnancy, improving care coordination and access to treatment for pregnant women and new mothers struggling with addiction. 
  • Improving Access to Maternal Health for Military and Dependent Moms Act of 2024 (H.R. 7214/S. 3722): This bill would expand maternal health services for military families by ensuring access to high-quality care for pregnant service members and their dependents.  
  • NIH IMPROVE Act (S. 4147/H.R. 8037): This bill would provide additional funding for research to reduce maternal mortality and severe maternal complications through the NIH's IMPROVE initiative. 
  • Advancing Safe Medications for Moms and Babies Act of 2023 (H.R. 1117): This bill promotes research on the safety and efficacy of medications used during pregnancy and breastfeeding to protect the health of mothers and infants. 
• On May 16, 2024, the AMA submitted a Statement for the Record (PDF) to the U.S. Senate Committee on Finance as part of the hearing entitled, “Rural Health Care: Supporting Lives and Improving Communities.” The statement covered a number of issues including recommendations to increase and retain physicians who provide maternal care and discussed the importance of remote patient monitoring in the maternal health space.
• On May 2, 2024, the AMA submitted a Statement for the Record (PDF) to the U.S. Senate Committee on Health, Education, Labor, and Pensions (HELP) as part of the hearing entitled, “What Can Congress Do to Address the Severe Shortage of Minority Health Care Professionals and the Maternal Health Crisis?” Our comments highlighted our recently developed maternal health recommendations.
• The AMA recently created a BHI Compendium (PDF) which includes important information about providing behavioral health treatment which can be utilized in the maternal care space. The AMA also hosted a webinar on behavioral health screening which includes an important discussion about what this should look like in the OB setting. Additionally, our BHI Workflow Guide has important information about best practices for implementing effective behavioral health care across different patient populations and which can be utilized for maternal care.
• The AMA recently hosted a Postpartum Hypertension Expert Convening in which key providers from across the country gathered to discuss how to address postpartum hypertension. Materials based on this convening should be soon forthcoming and additional work will continue on in this space.
• 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.

• On May 21, 2024, the AMA submitted a Statement for the Record to the U.S. Senate Committee on Health, Education, Labor and Pensions, Subcommittee on Primary Health & Retirement Security following their hearing entitled "Feeding a Healthier America: Current Efforts and Potential Opportunities for Food is Medicine."
• 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.

Learn more about the AMA’s earlier advocacy to improve maternal health (PDF).

• AMA recommendations to improve maternal health outcomes
• AMA initiatives to improve maternal health outcomes