II 

116TH CONGRESS 

2D SESSION S. 3826 

To require the Secretary of Defense to provide additional resources, including 

doula support, for pregnant beneficiaries under the TRICARE program, 

and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MAY 21, 2020 

Mr. BLUMENTHAL (for himself and Mrs. GILLIBRAND) introduced the following bill; which was read twice and referred to the Committee on 

Armed Services 

A BILL 

To require the Secretary of Defense to provide additional 

resources, including doula support, for pregnant beneficiaries under the TRICARE program, and for other 

purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘TRICARE Coverage 

5 for Doula Support Act’’. 


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1 SEC. 2. ADDITIONAL RESOURCES, INCLUDING DOULA SUP2 PORT, FOR PREGNANT BENEFICIARIES 

3 UNDER THE TRICARE PROGRAM. 

4 (a) FINDINGS.—Congress finds the following: 

5 (1) In 2018, 52,535 members of the Armed 

6 Forces and their dependents gave birth at military 

7 medical treatment facilities or civilian hospitals 

8 where the Department of Defense purchased care. 

9 (2) As required pursuant to the House report 

10 accompanying H.R. 5515, 115th Congress (House 

11 Report 115–874), under the heading ‘‘Report on rate 

12 of maternal mortality among members of the Armed 

13 Forces’’ under the heading ‘‘LEGISLATIVE PROVI14 SIONS NOT ADOPTED’’, the report submitted by the 

15 Secretary of Defense titled ‘‘Maternal and Infant 

16 Mortality Rates in the Military Health System’’ 

17 showed that rates of maternal and infant mortality 

18 in the military health system are lower than national 

19 averages but also recommended expanding available 

20 resources for prenatal, childbirth, and postnatal 

21 communication, as well as education for pregnant 

22 beneficiaries under the TRICARE program. 

23 (3) Doula support, which includes continuous 

24 non-clinical one-to-one emotional, physical, and in25 formational support around the time of birth, as well 


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1 as support during pregnancy and postpartum, could 

2 be one such resource for pregnant beneficiaries. 

3 (4) Studies have shown that doula support can 

4 decrease maternal anxiety and depression that can 

5 contribute to postpartum depression, and also that 

6 doula support reduces the likelihood of consequential 

7 and costly interventions, such as cesarean birth and 

8 epidural pain relief. 

9 (5) Research has also shown that doula support 

10 increases the likelihood of a shorter labor, a sponta11 neous vaginal birth, higher Apgar scores for babies, 

12 and a positive childbirth experience, which subse13 quently lowers the cost of maternity care while im14 proving the health of women and infants. 

15 (6) The Expert Panel on Improving Maternal 

16 and Infant Health Outcomes in Medicaid and the 

17 Children’s Health Insurance Program of the Centers 

18 for Medicare & Medicaid Services recommends pro19 viding coverage for continuous doula support during 

20 labor. 

21 (7) Members of the Armed Forces and military 

22 spouses are uniquely positioned to maximize the ben23 efits of doula support due to the nature of training, 

24 deployments, frequent permanent changes of station, 

25 and other mission requirements that can contribute 


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1 to isolation during pregnancy and birth, or prevent 

2 birthing partners from being present during child3 birth. 

4 (8) Members of the Armed Forces who are sin5 gle, members of the Armed Forces and military 

6 spouses with deployed birthing partners, and minor7 ity women who face racial bias in access to health 

8 care might find doula support particularly beneficial. 

9 (9) There are currently no specific programs of 

10 the Department of Defense for labor support, but 

11 the My Career Advancement Account program of the 

12 Department provides funding for military spouses to 

13 receive training to become doulas. 

14 (b) ADDITIONAL RESOURCES FOR PREGNANT

15 TRICARE BENEFICIARIES.— 

16 (1) IN GENERAL.—In providing maternity care 

17 for pregnant beneficiaries under the TRICARE pro18 gram under chapter 55 of title 10, United States 

19 Code, the Secretary of Defense shall provide to such 

20 beneficiaries additional resources for prenatal and 

21 postnatal communication and education, including 

22 doula support. 

23 (2) PROHIBITION ON COST SHARING.—The Sec24 retary shall not require a beneficiary under the 

25 TRICARE program to pay any fee or other costVerDate Sep 11 2014 04:08 Jun 14, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S3826.IS S3826

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1 sharing requirement for the receipt of additional re2 sources under paragraph (1). 

3 (3) IMPLEMENTATION.—Not later than one 

4 year after the date of the enactment of this Act, the 

5 Secretary shall finalize implementation of the provi6 sion of additional resources required under para7 graph (1). 

8 (c) ADVISORY COMMITTEE.— 

9 (1) IN GENERAL.—Not later than 180 days 

10 after the date of the enactment of this Act, the Sec11 retary of Defense shall establish an advisory com12 mittee to assist the Department of Defense in car13 rying out the requirements under this section. 

14 (2) SELECTION OF MEMBERS.—The Secretary 

15 shall select the members of the advisory committee 

16 required under paragraph (1), which shall include 

17 the selection of— 

18 (A) members who are racially and eth19 nically diverse; 

20 (B) members who are trained doulas; and 

21 (C) members who are members of the 

22 Armed Forces or family members of members 

23 of the Armed Forces. 

24 (3) DUTIES.—The duties of the advisory com25 mittee established under paragraph (1) are to guide 


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1 the Department of Defense through the implementa2 tion of the requirements under this section by pro3 viding recommendations to the Department on the 

4 following items: 

5 (A) Expansion of the TRICARE program 

6 to cover doula support. 

7 (B) Identification of appropriate certifi8 cations to qualify an individual to provide doula 

9 support under the TRICARE program. 

10 (C) Establishment of reimbursement rates 

11 for doula support under the TRICARE pro12 gram. 

13 (D) Outreach to beneficiaries under the 

14 TRICARE program to educate those bene15 ficiaries on the benefits of doula support and 

16 the availability of such support. 

17 (d) SURVEY AND REPORT.— 

18 (1) SURVEY.—Not later than one year after the 

19 date of the enactment of this Act, and annually 

20 thereafter, the Secretary shall administer a survey to 

21 determine— 

22 (A) how many members of the Armed 

23 Forces or spouses of such members give birth 

24 while their spouse or birthing partner is unable 


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1 to be present due to deployment, training, or 

2 other mission requirements; 

3 (B) how many single members of the 

4 Armed Forces give birth alone; and 

5 (C) how many members of the Armed 

6 Forces or spouses of such members use doula 

7 support, or are interested in using doula sup8 port, during pregnancy and childbirth. 

9 (2) MATTERS COVERED BY THE SURVEY.—The 

10 survey administered under paragraph (1) shall in11 clude an identification of the following: 

12 (A) The race, ethnicity, age, sex, relation13 ship status, military service, military occupa14 tion, and rank, as applicable, of each individual 

15 surveyed. 

16 (B) The service- or mission-specific reason 

17 the member of the Armed Forces was not 

18 present during the birth, if applicable. 

19 (C) If individuals surveyed were members 

20 of the Armed Forces or the spouses of such 

21 members, or both. 

22 (D) The length of advanced notice received 

23 by individuals surveyed that the member of the 

24 Armed Forces would be unable to be present 

25 during the birth, if applicable. 


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1 (E) Any resources or support that the indi2 viduals surveyed found useful during the preg3 nancy and birth process, including doula sup4 port. 

5 (3) REPORT.—The Secretary shall submit to 

6 the congressional defense committees an annual re7 port on the results of the survey administered under 

8 paragraph (1) for the year covered by the report. 

9 (e) DEFINITIONS.—In this section: 

10 (1) CONGRESSIONAL DEFENSE COMMITTEES.— 

11 The term ‘‘congressional defense committees’’ has 

12 the meaning given that term in section 101(a)(16) 

13 of title 10, United States Code. 

14 (2) DOULA.— 

15 (A) IN GENERAL.—The term ‘‘doula’’ 

16 means an individual who is trained as described 

17 in subparagraph (B) to provide non-medical ad18 vice, information, emotional support, and phys19 ical comfort to an individual during the individ20 ual’s pregnancy, childbirth, and postpartum pe21 riod by an organization that has been estab22 lished for not less than five years and that re23 quires the completion of continuing education. 

24 (B) TRAINING DESCRIBED.—Training de25 scribed in this subparagraph is training in naVerDate Sep 11 2014 04:08 Jun 14, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S3826.IS S3826

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1 tionally recognized core doula competencies, 

2 which may include competency in reproductive 

3 and birth justice frameworks, race equity, cul4 tural humility, home visiting skills, and knowl5 edge of social services. 

6 (3) TRICARE PROGRAM.—The term 

7 ‘‘TRICARE program’’ has the meaning given that 

8 term in section 1072 of title 10, United States Code. 

9 SEC. 3. EXPANSION OF EVALUATION ON EFFECTIVENESS 

10 OF TRICARE PROGRAM TO INCLUDE DATA ON 

11 BIRTHS AT MILITARY MEDICAL TREATMENT 

12 FACILITIES AND CIVILIAN HOSPITALS UNDER 

13 THE TRICARE PROGRAM. 

14 Section 717(a) of the National Defense Authorization 

15 Act for Fiscal Year 1996 (Public Law 104–106; 10 U.S.C. 

16 1073 note) is amended— 

17 (1) in paragraph (2), by striking ‘‘; and’’ and 

18 inserting a semicolon; 

19 (2) in paragraph (3)(B)(v), by striking the pe20 riod at the end and inserting ‘‘; and’’; and 

21 (3) by adding at the end the following new 

22 paragraph: 

23 ‘‘(4) assess data relating to births at each mili24 tary medical treatment facility or civilian hospital 


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1 under the TRICARE program during the one-year 

2 period preceding the evaluation, including— 

3 ‘‘(A) the number of births, disaggregated 

4 by military service and rank of the individual 

5 giving birth or their spouse, as appropriate; 

6 ‘‘(B) whether the individual giving birth is 

7 a member of the Armed Forces, a spouse of 

8 such a member, or other dependent of such a 

9 member; 

10 ‘‘(C) the race, ethnicity, age, and relation11 ship status of the individual giving birth; 

12 ‘‘(D) any effects of implicit or explicit bias 

13 in maternal health care under the TRICARE 

14 program, or evidence of racial or socioeconomic 

15 barriers to such care; and 

16 ‘‘(E) such other demographic information 

17 about the individual giving birth as the Sec18 retary considers appropriate.’’. 

Æ 


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