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[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 5284 Introduced in Senate (IS)]

<DOC>

117th CONGRESS
  2d Session
                                S. 5284

To improve the public health response to addressing maternal mortality 
       and morbidity during the COVID-19 public health emergency.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                           December 15, 2022

 Ms. Warren (for herself, Mr. Booker, Mrs. Gillibrand, and Ms. Smith) 
introduced the following bill; which was read twice and referred to the 
          Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL

 
To improve the public health response to addressing maternal mortality 
       and morbidity during the COVID-19 public health emergency.

    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 ``Maternal Health Pandemic Response 
Act of 2022''.

SEC. 2. FINDINGS.

    Congress finds as follows:
            (1) The World Health Organization declared COVID-19 a 
        ``Public Health Emergency of International Concern'' on January 
        30, 2020. As of December 12, 2022, there have been over 
        643,875,000 confirmed cases of, and over 6,630,000 deaths 
        associated with, COVID-19 worldwide.
            (2) In the United States, the number of cases of COVID-19 
        has quickly surpassed the number of such cases in every other 
        nation, and as of December 12, 2022, over 99,000,000 cases and 
        1,080,000 deaths have been reported by the United States alone.
            (3) Longstanding systemic health and social inequities have 
        put communities of color at increased risk of contracting 
        COVID-19 or experiencing severe illness; age-adjusted 
        hospitalization rates from COVID-19 are highest for American 
        Indian and Alaska Native, Black, and Latinx people.
            (4) Prior to the start of the COVID-19 pandemic, the United 
        States was facing a maternal mortality and morbidity crisis, in 
        which the United States has the highest maternal mortality rate 
        in the developed world, and the crisis is worsening.
            (5) More than 50,000 women in the United States annually 
        experience severe maternal morbidity, and much larger numbers 
        experience more common harmful challenges, such as prenatal and 
        postpartum mood disorders, including depression, anxiety 
        disorder, and PTSD; limited access to prenatal and postpartum 
        care, diagnosis, and treatment of complications; intimate 
        partner violence; and lack of support for meeting breastfeeding 
        goals. Many perinatal complications are preventable or 
        treatable, and most injuries, long-term adverse effects, and 
        deaths are preventable.
            (6) Compared to White women, Black and American Indian and 
        Alaska Native women in the United States are 2 to 4 times more 
        likely to die from pregnancy-related complications, and Black 
        and American Indian and Alaska Native women suffer 
        disproportionately high rates of maternal morbidity. The 
        maternal mortality rate for Hispanic women, which historically 
        has been lower than such rate for White women, is increasing 
        and is now nearly the same as that of White women.
            (7) The causes of maternal mortality and morbidity are 
        complex and include racial, ethnic, socioeconomic, and 
        geographic inequities; racism, bias, and discrimination; 
        comorbidities; and inadequate access to the health care system, 
        including behavioral health care, which are factors that have 
        similarly contributed to the racial disparities seen in COVID-
        19 outcomes.
            (8) The burden of morbidity and mortality in the United 
        States for both COVID-19 and maternal health outcomes has also 
        fallen disproportionately on Black, Latinx, and American Indian 
        and Alaska Native communities, who suffer the most from great 
        public health needs and are the most medically underserved. 
        Underserved women also include those living in maternity care 
        deserts, which lack obstetric providers and hospitals or birth 
        centers offering obstetric care.
            (9) According to the Centers for Disease Control and 
        Prevention, ``pregnant and recently pregnant people with COVID-
        19 are at increased risk for severe illness when compared with 
        non-pregnant people''. Additionally, ``pregnant people with 
        COVID-19 are also at increased risk for preterm birth and some 
        data suggest an increased risk for other adverse pregnancy 
        complications and outcomes, such as preeclampsia, coagulopathy, 
        and stillbirth, compared with pregnant people without COVID-
        19''. Research has also shown that COVID-19 infection during 
        pregnancy may increase the risk of preeclampsia; having 
        preeclampsia and other pregnancy complications also increases 
        the risks of serious COVID-19 infection.
            (10) As of December 2022, the latest information from the 
        Centers for Disease Control and Prevention indicates that 
        pregnant women are more likely to be hospitalized and are at 
        higher risk for intensive care unit admissions than nonpregnant 
        women due to COVID-19, and Latinx and Black pregnant people 
        have been disproportionately infected by COVID-19, as well as 
        more likely to experience severe disease.
            (11) Our understanding of the specific impact of COVID-19 
        on pregnant people has grown significantly. Pregnant and newly 
        delivered women are more susceptible to serious infection from 
        COVID-19, a direct impact. In addition, the COVID-19 pandemic 
        has further strained the health care system and decreased 
        access to preconception, prenatal, and postpartum care. The 
        lack of access to care, including mental health care, increases 
        the risks of maternal mortality and morbidity, pregnancy loss, 
        and infant mortality. It has also added another layer of fear 
        and vulnerability for pregnant people, with disproportionate 
        effects on people of color.
            (12) As of March 7, 2022, over 180,000 pregnant people in 
        the United States have tested positive for COVID-19 and 293 
        pregnant people have died as a result of COVID-19.
            (13) The World Health Organization states that everyone 
        ``has the right to safe and positive childbirth experience, 
        whether or not they have a confirmed COVID-19 infection, this 
        includes the right to respect and dignity, a companion of 
        choice, clear communication by maternity staff, pain relief 
        strategies, and mobility in labor when possible and the 
        position of choice''.
            (14) A COVID-19 public health response without concerted 
        Federal action and focus on maternal health care access and 
        quality, research, data collection, mitigation of negative 
        socioeconomic consequences of the pandemic, and protection of 
        the right to safe and positive childbirth experience has 
        exacerbated the maternal mortality and morbidity crisis. Risk 
        has also increased for pregnant women who have not been 
        provided with a continuum of respectful, responsive, and 
        empowering care from preconception through postpartum, during 
        the pandemic and beyond.

SEC. 3. DEFINITIONS.

    In this Act:
            (1) COVID-19 public health emergency.--The term ``COVID-19 
        public health emergency'' means the period beginning on the 
        date that the public health emergency declared by the Secretary 
        of Health and Human Services under section 319 of the Public 
        Health Service Act (42 U.S.C. 247d) on January 31, 2020, with 
        respect to COVID-19 took effect, and ending on the later of the 
        end of such public health emergency or January 1, 2023.
            (2) Culturally congruent.--The term ``culturally 
        congruent'', with respect to care or maternity care, means care 
        that is anti-racist and is in agreement with the preferred 
        cultural values, beliefs, worldview, and practices of the 
        health care consumer and other stakeholders.
            (3) Indian tribe, tribal organization, and urban indian 
        organization.--The terms ``Indian Tribe'' and ``Tribal 
        organization'' have the meanings given the terms ``Indian 
        tribe'' and ``tribal organization'', respectively, in section 4 
        of the Indian Self-Determination and Education Assistance Act 
        (25 U.S.C. 5304), and the term ``urban Indian organization'' 
        has the meaning given such term in section 4 of the Indian 
        Health Care Improvement Act (25 U.S.C. 1603).
            (4) Maternal mortality.--The term ``maternal mortality'' 
        means a death occurring during pregnancy or within one year of 
        the end of 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) Postpartum.--The term ``postpartum'' means the 1-year 
        period beginning on the last day of a person's pregnancy.
            (6) Respectful maternity care.--The term ``respectful 
        maternity care'' means care organized for, and provided to, all 
        pregnant and postpartum people in a manner that--
                    (A) is culturally congruent and linguistically 
                appropriate;
                    (B) maintains a person's dignity, privacy, and 
                confidentiality;
                    (C) ensures freedom from harm and mistreatment; and
                    (D) enables informed choice and continuous support 
                during labor, childbirth, and postpartum.
            (7) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (8) Severe maternal morbidity.--The term ``severe maternal 
        morbidity'' means an unexpected outcome caused by labor and 
        delivery that results in significant short-term or long-term 
        consequences to the health of the pregnant person.

SEC. 4. EMERGENCY FUNDING FOR FEDERAL DATA COLLECTION, SURVEILLANCE, 
              AND RESEARCH ON MATERNAL HEALTH OUTCOMES DURING THE 
              COVID-19 PUBLIC HEALTH EMERGENCY OR A FUTURE PUBLIC 
              HEALTH EMERGENCY.

    To conduct or support data collection, surveillance, and research 
on maternal health as a result of the COVID-19 public health emergency 
or a future public health emergency, including support to assist in the 
capacity building for State, Tribal, territorial, and local public 
health departments to collect and transmit racial, ethnic, and other 
demographic data related to maternal health, there are authorized to be 
appropriated--
            (1) $100,000,000 for the Surveillance for Emerging Threats 
        to Mothers and Babies program of the Centers for Disease 
        Control and Prevention, to support the Centers for Disease 
        Control and Prevention in its efforts to--
                    (A) work with public health, clinical, and 
                community-based organizations to provide timely, 
                continually updated guidance to families and health 
                care providers on ways to reduce health risks to 
                mothers and babies and tailor interventions to improve 
                their long-term health;
                    (B) partner with more State, Tribal, territorial, 
                and local public health programs in the collection and 
                analysis of clinical data on the impact of COVID-19 and 
                future public health emergencies on pregnant and 
                postpartum patients and their newborns, including among 
                pregnant people of color; and
                    (C) establish regionally based centers of 
                excellence to offer medical, public health, and other 
                knowledge to ensure communities, especially communities 
                of color, rural communities, and other underserved 
                communities can help pregnant and postpartum patients 
                and infants get the care they need;
            (2) $30,000,000 for the Enhancing Reviews and Surveillance 
        to Eliminate Maternal Mortality program (commonly known as the 
        ``ERASE MM program'') of the Centers for Disease Control and 
        Prevention, to support the Centers for Disease Control and 
        Prevention in expanding its partnerships with States and Indian 
        Tribes and provide technical assistance to existing Maternal 
        Mortality Review Committees;
            (3) $45,000,000 for the Pregnancy Risk Assessment 
        Monitoring System (commonly known as the ``PRAMS'') of the 
        Centers for Disease Control and Prevention, to support the 
        Centers for Disease Control and Prevention in its efforts to--
                    (A) create a COVID-19 supplement to its PRAMS 
                questionnaire;
                    (B) add questions around experiences of respectful, 
                responsive, and empowering maternity care in prenatal, 
                intrapartum, and postpartum care;
                    (C) conduct a rapid assessment of COVID-19 
                awareness, impact on care and experiences, and use of 
                preventive measures among pregnant, laboring and 
                birthing, and postpartum people during the COVID-19 
                public health emergency; and
                    (D) work to transition the survey to an electronic 
                platform and expand the survey to a larger population, 
                with a special focus on reaching underrepresented 
                communities and underserved communities, and with 
                sensitivity to individuals who lack access to such a 
                platform; and
            (4) $15,000,000 for the National Institute of Child Health 
        and Human Development, to conduct or support research for 
        interventions to mitigate the effects of the COVID-19 public 
        health emergency on pregnant and postpartum people, including 
        Black, Latinx, Asian-American and Pacific Islander, and 
        American Indian and Alaska Native people, as well as people 
        living in areas with limited maternity care.

SEC. 5. COVID-19 MATERNAL HEALTH DATA COLLECTION AND DISCLOSURE.

    (a) Data Collection.--The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention and the Administrator of 
the Centers for Medicare & Medicaid Services, shall make publicly 
available, on the website of the Centers for Disease Control and 
Prevention, pregnancy and postpartum data collected across all 
surveillance systems relating to COVID-19, disaggregated by race, 
ethnicity, primary language, disability status, gender identity, sexual 
orientation, immigration status, insurance status, and State and Tribal 
location, including the following:
            (1) Data related to all COVID-19 diagnostic testing, 
        including the number of pregnant people and postpartum people 
        tested and the number of positive cases.
            (2) Data related to all suspected cases of COVID-19 in 
        pregnant, birthing, and postpartum people who did not undergo 
        testing.
            (3) Data related to all COVID-19 serologic testing, 
        including the number of pregnant and postpartum people tested 
        and the number of such serologic tests that were positive.
            (4) Data related to treatment for COVID-19, including 
        hospitalizations, emergency room, and intensive care unit 
        admissions of pregnant, birthing, and postpartum people related 
        to COVID-19.
            (5) Data related to COVID-19 outcomes, including total 
        fatalities and case fatality (expressed as the proportion of 
        people who were infected with COVID-19 and died from the virus) 
        of pregnant and postpartum people.
            (6) Data related to pregnancy and infant health outcomes 
        for pregnant people with confirmed or suspected COVID-19, which 
        may include stillbirths, maternal mortality and morbidity, 
        infant mortality, preterm births, low-birth weight infants, and 
        cesarean section births.
            (7) Data related to all long-term effects of COVID-19 
        related to cases contracted during the pregnancy or postpartum 
        period.
    (b) Timeline.--The Secretary shall update the data made available 
under this section not less frequently than monthly, during the COVID-
19 public health emergency and for at least one month after the end of 
the COVID-19 public health emergency.
    (c) Privacy.--In publishing data under this section, the Secretary 
shall take all necessary steps to protect the privacy of people whose 
information is included in such data, including by complying with--
            (1) privacy protections under the regulations promulgated 
        under section 264(c) of the Health Insurance Portability and 
        Accountability Act of 1996 (42 U.S.C. 1320d-2 note); and
            (2) protections from all inappropriate internal use by an 
        entity that collects, stores, or receives the data, including 
        use of such data in determinations of eligibility (or continued 
        eligibility) in health plans, and from inappropriate uses.
    (d) Indian Health Service.--The Director of the Indian Health 
Service and Director of the Centers for Disease Control and Prevention 
shall consult with Indian Tribes and confer with urban Indian 
organizations on data collection and reporting for purposes of this 
section.
    (e) Data Collection Guidance.--The Secretary shall issue guidance 
to States and local public health departments to ensure that all 
relevant demographic data, including pregnancy and postpartum status, 
are collected and included when sending COVID-19 testing specimen to 
laboratories, and State and local health departments and Indian Tribes 
are disaggregating data on COVID-19 status in data on maternal and 
infant morbidity and mortality. The Secretary shall ensure that the 
guidance is developed in consultation with Indian Tribes to ensure that 
it includes Tribally developed best practices on reducing 
misclassification of American Indian and Alaska Native people in 
Federal, State, and local public health surveillance systems.

SEC. 6. PUBLIC HEALTH COMMUNICATION REGARDING MATERNAL CARE DURING 
              COVID-19.

    (a) Public Health Campaign.--The Director of the Centers for 
Disease Control and Prevention shall undertake a robust public health 
education effort to enhance access by pregnant people, their employers, 
and their providers to accurate, evidence-based health information 
about COVID-19 and pregnancy, safety, and risk, with a particular focus 
on reaching pregnant and postpartum people in underserved communities.
    (b) Emergency Temporary Standard.--
            (1) In general.--In consideration of the grave risk 
        presented by COVID-19 and the need to strengthen protections 
        for employees, pursuant to section 6(c)(1) of the Occupational 
        Safety and Health Act of 1970 (29 U.S.C. 655(c)(1)) and 
        notwithstanding the provisions of law and the executive order 
        described in paragraph (3), not later than 7 days after the 
        date of enactment of this Act, the Secretary of Labor shall 
        promulgate an emergency temporary standard to protect all 
        employees at occupational risk from occupational exposure to 
        SARS-CoV-2.
            (2) Pregnant and postpartum employees.--The emergency 
        temporary standard promulgated under this subsection shall 
        include consideration of the risks and needs specific to 
        pregnant and postpartum employees.
            (3) Inapplicable provisions of law and executive order.--
        The requirements of chapter 6 of title 5, United States Code 
        (commonly referred to as the ``Regulatory Flexibility Act''), 
        subchapter I of chapter 35 of title 44, United States Code 
        (commonly referred to as the ``Paperwork Reduction Act''), the 
        Unfunded Mandates Reform Act of 1995 (2 U.S.C. 1501 et seq.), 
        and Executive Order 12866 (58 Fed. Reg. 190; relating to 
        regulatory planning and review) shall not apply to the standard 
        promulgated under this subsection.
    (c) Task Force on Birthing Experience and Safe, Respectful, 
Responsive, and Empowering Maternity Care During Pandemics and Other 
Public Health Emergencies.--
            (1) Establishment.--The Secretary, in consultation with the 
        Director of the Centers for Disease Control and Prevention and 
        the Administrator of the Health Resources and Services 
        Administration, shall convene a task force to develop Federal 
        recommendations regarding respectful, responsive, and 
        empowering maternity care, including safe birth care and 
        postpartum care, during public health emergencies.
            (2) Duties.--The task force established under paragraph (1) 
        shall develop, publicly post, and update Federal 
        recommendations in multiple languages to ensure quality, 
        provide nondiscriminatory maternity care, promote positive 
        birthing experiences, and improve maternal health outcomes 
        during the COVID-19 public health emergency and future public 
        health emergencies, with a particular focus on outcomes for 
        communities of color and rural populations. Such guidelines and 
        recommendations shall--
                    (A) address, with particular attention to ensuring 
                equitable treatment on the basis of race and 
                ethnicity--
                            (i) measures to facilitate respectful, 
                        responsive, and empowering maternity care;
                            (ii) measures to facilitate telehealth 
                        maternity care for pregnant people who cannot 
                        regularly access in-person care;
                            (iii) strategies to increase access to 
                        specialized care for those with high-risk 
                        pregnancies or pregnant individuals with 
                        elevated risk factors;
                            (iv) diagnostic testing for pregnant and 
                        laboring patients;
                            (v) birthing without one's chosen 
                        companions, with one's chosen companions, and 
                        with smartphone or other telehealth connection 
                        to one's chosen companions;
                            (vi) newborn separation after birth in 
                        relation to maternal infection status;
                            (vii) breast milk feeding in relation to 
                        maternal infection status;
                            (viii) licensure, training, scope of 
                        practice, and Medicaid and other insurance 
                        reimbursement for certified midwives, certified 
                        nurse-midwives, certified professional 
                        midwives, in a manner that facilitates 
                        inclusion of midwives of color and midwives 
                        from underserved communities;
                            (ix) financial support and training for 
                        perinatal health workers who provide non-
                        clinical support to people from pregnancy 
                        through the postpartum period, such as a doula, 
                        community health worker, peer supporter, 
                        lactation consultant, nutritionist or 
                        dietitian, social worker, home visitor, or a 
                        patient navigator in a manner that facilitates 
                        inclusion from underserved communities;
                            (x) strategies to ensure and expand doula 
                        coverage under State Medicaid programs;
                            (xi) how to identify, address, and treat 
                        prenatal and postpartum mental and behavioral 
                        health conditions, such as anxiety, substance 
                        use disorder, and depression, which may have 
                        arisen or increased during the COVID-19 public 
                        health emergency, and how to mitigate the 
                        impact of future public health emergencies on 
                        maternal mental health;
                            (xii) how to identify and address instances 
                        of intimate partner violence during pregnancy 
                        which may arise or intensify during public 
                        health emergencies, and how to mitigate the 
                        impact of future public health emergencies on 
                        maternal mental health;
                            (xiii) strategies to address hospital 
                        capacity concerns in communities with a surge 
                        in infectious disease cases and to provide 
                        childbearing people with options that reduce 
                        potential for cross-contamination and increase 
                        the ability to implement their care preferences 
                        while maintaining safety and quality, such as 
                        the use of auxiliary maternity units and 
                        freestanding birth centers;
                            (xiv) provision of child care services 
                        during prenatal appointments for mothers whose 
                        children are unable to attend as a result of 
                        restrictions relating to the public health 
                        emergencies;
                            (xv) how to identify and address racism, 
                        bias, and discrimination in the delivery 
                        treatment and support to pregnant and 
                        postpartum people, including evaluating the 
                        value of training for hospital staff on 
                        implicit bias and racism, respectful, 
                        responsive, and empowering maternity care, and 
                        demographic data collection;
                            (xvi) how to address the needs of 
                        undocumented pregnant women and new mothers who 
                        may be afraid or unable to seek needed care 
                        during the COVID-19 public health emergency;
                            (xvii) how to address the needs of 
                        uninsured pregnant women who have historically 
                        relied on emergency departments for care;
                            (xviii) how to identify women at risk for 
                        depression, anxiety disorder, psychosis, 
                        obsessive-compulsive disorder, and other 
                        maternal mood disorders before, during, and 
                        after pregnancy, and how to treat those 
                        diagnosed with a postpartum mood disorder;
                            (xix) how to effectively and 
                        compassionately screen for substance abuse 
                        during pregnancy and postpartum and help moms 
                        find support and effective treatment; and
                            (xx) such other matters as the task force 
                        determines appropriate;
                    (B) identify barriers to the implementation of the 
                guidelines and recommendations;
                    (C) take into consideration existing State and 
                other programs that have demonstrated effectiveness in 
                addressing pregnancy, birth, and postpartum care during 
                the COVID-19 public health emergency; and
                    (D) identify policies specific to COVID-19 that 
                should be discontinued when safely possible and those 
                that should be continued as the public health emergency 
                abates.
            (3) Membership.--The task force established under paragraph 
        (1) shall be comprised of--
                    (A) representatives of the Department of Health and 
                Human Services, including representatives of--
                            (i) the Secretary;
                            (ii) the Director of the Centers for 
                        Disease Control and Prevention;
                            (iii) the Administrator of the Health 
                        Resources and Services Administration;
                            (iv) the Administrator of the Centers for 
                        Medicare & Medicaid Services;
                            (v) the Director of the Agency for 
                        Healthcare Research and Quality; and
                            (vi) the Director of the Indian Health 
                        Service;
                    (B) at least 3 State, local, or territorial public 
                health officials representing departments of public 
                health, who shall represent jurisdictions from 
                different regions of the United States with relatively 
                high concentrations of historically marginalized 
                populations, to be appointed by the Secretary;
                    (C) at least 1 Tribal public health official 
                representing departments of public health;
                    (D) 1 or more representatives of a community-based 
                organization that addresses adverse maternal health 
                outcomes with a specific focus on racial and ethnic 
                inequities in maternal health outcomes, appointed by 
                the Secretary, with special consideration given to 
                organizations led by a person of color or from 
                communities with significant minority populations;
                    (E) 1 or more obstetrician-gynecologist or other 
                physician who provides obstetric care, with special 
                consideration for physicians who are from, or work in, 
                communities experiencing, or that have experienced, the 
                highest rates of COVID-19 mortality and morbidity;
                    (F) 1 or more nurse, such as a certified nurse-
                midwife, women's health nurse practitioner, or other 
                nurse who provides obstetric care, with special 
                consideration for nurses who are from, or work in, 
                communities experiencing, or that have experienced, the 
                highest rates of COVID-19 mortality and morbidity;
                    (G) 1 or more perinatal health workers who provide 
                non-clinical support to people from pregnancy through 
                postpartum period, such as a doula, community health 
                worker, peer supporter, lactation consultant, 
                nutritionist or dietitian, social worker, home visitor, 
                or patient navigator;
                    (H) 1 or more patients who were pregnant or gave 
                birth during the COVID-19 public health emergency;
                    (I) 1 or more patients who contracted COVID-19 and 
                later gave birth;
                    (J) 1 or more patients who have received support 
                from a perinatal health worker who provides prenatal 
                and postpartum support, such as a doula, community 
                health worker, peer supporter, lactation consultant, 
                nutritionist or dietitian, social worker, home visitor, 
                or a patient navigator, or a spouse or family member of 
                such patient; and
                    (K) racially and ethnically diverse representation 
                from at least 3 independent experts with knowledge or 
                field experience with racial and ethnic disparities in 
                public health, women's health, or maternal mortality 
                and severe maternal morbidity.

SEC. 7. GAO REPORT ON MATERNAL HEALTH AND PUBLIC HEALTH EMERGENCY 
              PREPAREDNESS.

    Not later than 1 year after the end of the public health emergency 
declared by the Secretary of Health and Human Services under section 
319 of the Public Health Service Act (42 U.S.C. 247d) on January 31, 
2020, with respect to COVID-19, the Comptroller General of the United 
States shall submit to the appropriate committees of Congress a report 
on maternal health and public health emergency preparedness, including 
prenatal, labor and delivery, and postpartum care during the COVID-19 
public health emergency, including the following:
            (1) A review of the prenatal, labor and delivery, and 
        postpartum experiences of people during the COVID-19 public 
        health emergency, which shall--
                    (A) identify barriers to accessing preconception, 
                pregnancy, birth, and postpartum care during a 
                pandemic, including maternal behavioral health care;
                    (B) assess the extent to which public and private 
                insurers were providing coverage for maternal health 
                care during the public health emergency, including for 
                telehealth services and out-of-hospital births;
                    (C) review the impact of the continuous enrollment 
                condition included in the Families First Coronavirus 
                Response Act (Public Law 116-127) had on enrollment of 
                postpartum people in State Medicaid programs and 
                analyze health care services utilized by this 
                population in the postpartum period;
                    (D) to the extent practicable, analyze maternal and 
                infant health outcomes by race and ethnicity (including 
                quality of care, mortality, morbidity, cesarean section 
                rates, preterm birth, prevalence of prenatal and 
                postpartum anxiety and depression, and other mood 
                disorders) during the COVID-19 public health emergency 
                and the impact of Federal and State policy changes made 
                in response to the COVID-19 pandemic on such outcomes;
                    (E) identify contributors to population-based 
                disparities seen in COVID-19 outcomes, such as racial 
                profiling of, and bias and discrimination against, 
                Black, American Indian and Alaska Native, Latinx, and 
                Asian-American and Pacific Islander people;
                    (F) review the impact of increased unemployment, 
                paid family leave, changes in health care coverage, and 
                other social determinants of health for pregnant and 
                postpartum people during the public health emergency, 
                including intimate partner violence; and
                    (G) assess the impact of the lack of inclusion of 
                pregnant and lactating people in clinical trials for 
                COVID-19 therapeutics and vaccines.
            (2) Consultation with maternity care providers, maternal 
        behavioral health care specialists, researchers who specialize 
        in women's health or maternal mortality and severe maternal 
        morbidity, people who experienced pregnancy or childbirth 
        during the COVID-19 public health emergency, representatives 
        from community-based organizations that address maternal 
        health, and perinatal health workers who provide nonclinical 
        support to pregnant and postpartum people (such as a doula, 
        community health worker, peer support, certified lactation 
        consultant, nutritionist or dietician, social worker, home 
        visitor, or navigator).
            (3) Recommendations to improve the public health emergency 
        response and preparedness efforts of the Federal Government 
        specific to maternal health, with a particular focus on 
        outcomes for minority women, including--
                    (A) ways to improve research, surveillance, and 
                data collection of the Federal Government related to 
                maternal health;
                    (B) ways for the Federal Government to factor 
                maternal health outcomes and disparities into decisions 
                regarding distribution of resources, including COVID-19 
                tests, personal protective equipment, and emergency 
                funding;
                    (C) the extent to which guidelines and 
                recommendations of the Federal Government related to 
                maternal health care during the COVID-19 public health 
                emergency were culturally congruent and linguistically 
                competent for minority women;
                    (D) ways to improve the distribution of public 
                health funds, data, and information to Indian Tribes 
                and Tribal organizations with regard to maternal health 
                during public health emergencies; and
                    (E) opportunities to incentivize or require 
                sponsors to include safety data on pregnant and 
                lactating people for therapeutics and vaccines in 
                emergency use authorization submissions.
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