II 

116TH CONGRESS 

2D SESSION S. 4769 

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 

SEPTEMBER 30 (legislative day, SEPTEMBER 29), 2020 

Ms. WARREN (for herself, Mr. BOOKER, Ms. HARRIS, 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. 

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 ‘‘Maternal Health Pan5 demic Response Act of 2020’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds as follows: 

8 (1) The World Health Organization declared 

9 COVID–19 a ‘‘Public Health Emergency of InterVerDate Sep 11 2014 00:30 Oct 18, 2020 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S4769.IS S4769

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1 national Concern’’ on January 30, 2020. By the be2 ginning of August 2020, there have been over 

3 18,000,000 confirmed cases of, and over 700,000 

4 deaths associated with, COVID–19 worldwide. 

5 (2) In the United States, the number of cases 

6 of COVID–19 has quickly surpassed the number of 

7 such cases in every other nation, and as of August 

8 5, 2020, over 4,000,000 cases and 156,000 deaths 

9 have been reported by the United States alone. 

10 (3) Longstanding systemic health and social in11 equities have put communities of color at increased 

12 risk of contracting COVID–19 or experiencing se13 vere illness; age-adjusted hospitalization rates from 

14 COVID–19 are highest for American Indian and 

15 Alaska Native, Black, and Latinx people. 

16 (4) Prior to the start of the COVID–19 pan17 demic, the United States was facing a maternal mor18 tality and morbidity crisis, in which the United 

19 States has the highest maternal mortality rate in the 

20 developed world, and that rate is not improving. 

21 (5) More than 50,000 women in the United 

22 States annually experience severe maternal mor23 bidity, and much larger numbers experience more 

24 common harmful challenges, such as prenatal and 


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1 postpartum anxiety and depression and lack of sup2 port for meeting breastfeeding goals. 

3 (6) Compared to White women, Black and 

4 American Indian and Alaska Native women in the 

5 United States are significantly more likely to die 

6 from pregnancy-related complications, and Black 

7 and American Indian and Alaska Native women suf8 fer disproportionately high rates of maternal mor9 bidity. 

10 (7) The causes of maternal mortality and mor11 bidity are complex and include racial, ethnic, and so12 cioeconomic inequities; racism, bias, and discrimina13 tion; comorbidities; and inadequate access to the 

14 health care system, including behavioral health care, 

15 which are factors that have similarly contributed to 

16 the racial disparities seen in COVID–19 outcomes. 

17 (8) The burden of morbidity and mortality in 

18 the United States for both COVID–19 and maternal 

19 health outcomes has also fallen disproportionately on 

20 Black, Latinx, and American Indian and Alaska Na21 tive communities, who suffer the most from great 

22 public health needs and are the most medically un23 derserved. 

24 (9) According to the Centers for Disease Con25 trol and Prevention, ‘‘pregnant people have changes 


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1 in their bodies that may increase their risk of some 

2 infections’’ and ‘‘pregnant people have had a higher 

3 risk of severe illness when infected with viruses from 

4 the same family as COVID–19 and other viral res5 piratory infections, such as influenza’’. 

6 (10) As of June 25, 2020, the latest informa7 tion from the Centers for Disease Control and Pre8 vention indicates that pregnant women are more 

9 likely to be hospitalized and are at higher risk for 

10 intensive care unit admissions than nonpregnant 

11 women due to COVID–19, and Latinx and Black 

12 pregnant people have been disproportionately in13 fected by COVID–19. 

14 (11) Our understanding of the specific impact 

15 of COVID–19 on pregnant people is limited, in part 

16 due to a lack of robust data collection, but the 

17 COVID–19 pandemic has further strained the health 

18 care system and added another layer of fear and vul19 nerability for pregnant people, with disproportionate 

20 effects on people of color. 

21 (12) As of July 30, 2020, over 14,000 pregnant 

22 people in the United States have tested positive for 

23 COVID–19 and 35 pregnant people have died as a 

24 result of COVID–19. 


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1 (13) The World Health Organization states 

2 that everyone ‘‘has the right to safe and positive 

3 childbirth experience, whether or not they have a 

4 confirmed COVID–19 infection, this includes the 

5 right to respect and dignity, a companion of choice, 

6 clear communication by maternity staff, pain relief 

7 strategies, and mobility in labor when possible and 

8 the position of choice’’. 

9 (14) A COVID–19 public health response with10 out concerted Federal action and focus on maternal 

11 health care access and quality, research, data collec12 tion, mitigating negative socioeconomic consequences 

13 of the pandemic, and safeguarding the right to safe 

14 and positive childbirth experience will risk exacer15 bating the maternal mortality and morbidity crisis. 

16 SEC. 3. DEFINITIONS. 

17 In this Act: 

18 (1) COVID–19 PUBLIC HEALTH EMERGENCY.— 

19 The term ‘‘COVID–19 public health emergency’’ 

20 means the period beginning on the date that the 

21 public health emergency declared by the Secretary of 

22 Health and Human Services under section 319 of 

23 the Public Health Service Act (42 U.S.C. 247d) on 

24 January 31, 2020, with respect to COVID–19 took 


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1 effect, and ending on the later of the end of such 

2 public health emergency or January 1, 2023. 

3 (2) CULTURALLY CONGRUENT.—The term ‘‘cul4 turally congruent’’, with respect to care or maternity 

5 care, means care that is anti-racist and is in agree6 ment with the preferred cultural values, beliefs, 

7 worldview, and practices of the health care consumer 

8 and other stakeholders. 

9 (3) INDIAN TRIBE, TRIBAL ORGANIZATION, AND

10 URBAN INDIAN ORGANIZATION.—The terms ‘‘Indian 

11 Tribe’’ and ‘‘Tribal organization’’ have the meanings 

12 given the terms ‘‘Indian tribe’’ and ‘‘tribal organiza13 tion’’, respectively, in section 4 of the Indian Self14 Determination and Education Assistance Act (25 

15 U.S.C. 5304), and the term ‘‘urban Indian organiza16 tion’’ has the meaning given such term in section 4 

17 of the Indian Health Care Improvement Act (25 

18 U.S.C. 1603). 

19 (4) MATERNAL MORTALITY.—The term ‘‘mater20 nal mortality’’ means a death occurring during preg21 nancy or within one year of the end of pregnancy, 

22 from a pregnancy complication, a chain of events 

23 initiated by pregnancy, or the aggravation of an un24 related condition by the physiologic effects of preg25 nancy. 


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1 (5) POSTPARTUM.—The term ‘‘postpartum’’ 

2 means the 1-year period beginning on the last day 

3 of a person’s pregnancy. 

4 (6) RESPECTFUL MATERNITY CARE.—The term 

5 ‘‘respectful maternity care’’ refers to care organized 

6 for, and provided to, all pregnant and postpartum 

7 people in a manner that is culturally congruent, 

8 maintains their dignity, privacy, and confidentiality, 

9 ensures freedom from harm and mistreatment, and 

10 enables informed choice and continuous support dur11 ing labor, childbirth, and postpartum. 

12 (7) SECRETARY.—The term ‘‘Secretary’’ means 

13 the Secretary of Health and Human Services. 

14 (8) SEVERE MATERNAL MORBIDITY.—The term 

15 ‘‘severe maternal morbidity’’ means an unexpected 

16 outcome caused by labor and delivery that results in 

17 significant short-term or long-term consequences to 

18 the health of the pregnant person. 

19 SEC. 4. EMERGENCY FUNDING FOR FEDERAL DATA COL20 LECTION, SURVEILLANCE, AND RESEARCH 

21 ON MATERNAL HEALTH OUTCOMES DURING 

22 THE COVID–19 PUBLIC HEALTH EMERGENCY. 

23 To conduct or support data collection, surveillance, 

24 and research on maternal health as a result of the 

25 COVID–19 public health emergency, including support to 


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1 assist in the capacity building for State, Tribal, territorial, 

2 and local public health departments to collect and trans3 mit racial, ethnic, and other demographic data related to 

4 maternal health, there are authorized to be appro5 priated— 

6 (1) $100,000,000 for the Surveillance for 

7 Emerging Threats to Mothers and Babies program 

8 of the Centers for Disease Control and Prevention, 

9 to support the Centers for Disease Control and Pre10 vention in its efforts to— 

11 (A) work with public health, clinical, and 

12 community-based organizations to provide time13 ly, continually updated guidance to families and 

14 health care providers on ways to reduce risk to 

15 mothers and babies and tailor interventions to 

16 improve their long-term health; 

17 (B) partner with more State, Tribal, terri18 torial, and local public health programs in the 

19 collection and analysis of clinical data on the 

20 impact of COVID–19 on pregnant and 

21 postpartum patients and their newborns, includ22 ing among pregnant people of color; and 

23 (C) establish regionally based centers of 

24 excellence to offer medical, public health, and 

25 other knowledge to ensure communities, espeVerDate Sep 11 2014 00:30 Oct 18, 2020 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S4769.IS S4769

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1 cially communities of color, can help pregnant 

2 and postpartum patients and infants get the 

3 care they need; 

4 (2) $30,000,000 for the Enhancing Reviews 

5 and Surveillance to Eliminate Maternal Mortality 

6 program (commonly known as the ‘‘ERASE MM 

7 program’’) of the Centers for Disease Control and 

8 Prevention, to support the Centers for Disease Con9 trol and Prevention in expanding its partnerships 

10 with States and Indian Tribes and provide technical 

11 assistance to existing Maternal Mortality Review 

12 Committees; and 

13 (3) $45,000,000 for the Pregnancy Risk As14 sessment Monitoring System (commonly known as 

15 the ‘‘PRAMS’’) of the Centers for Disease Control 

16 and Prevention, to support the Centers for Disease 

17 Control and Prevention in its efforts to— 

18 (A) create a COVID–19 supplement to its 

19 PRAMS questionnaire; 

20 (B) add questions around experiences of 

21 respectful maternity care in prenatal, 

22 intrapartum, and postpartum care; 

23 (C) conduct a rapid assessment of 

24 COVID–19 awareness, impact on care and ex25 periences, and use of preventive measures 


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1 among pregnant, laboring and birthing, and 

2 postpartum people during the COVID–19 pub3 lic health emergency; and 

4 (D) work to transition the survey to an 

5 electronic platform and expand the survey to a 

6 larger population, with a special focus on reach7 ing underrepresented communities; 

8 (4) $15,000,000 for the National Institute of 

9 Child Health and Human Development, to conduct 

10 or support research for interventions to mitigate the 

11 effects of the COVID–19 public health emergency on 

12 pregnant and postpartum people, including Black, 

13 Latinx, Asian-American and Pacific Islander, and 

14 American Indian and Alaska Native people. 

15 SEC. 5. COVID–19 MATERNAL HEALTH DATA COLLECTION 

16 AND DISCLOSURE. 

17 (a) DATA COLLECTION.—The Secretary, acting 

18 through the Director of the Centers for Disease Control 

19 and Prevention and the Administrator of the Centers for 

20 Medicare & Medicaid Services, shall make publicly avail21 able, on the website of the Centers for Disease Control 

22 and Prevention, pregnancy and postpartum data collected 

23 across all surveillance systems relating to COVID–19, 

24 disaggregated by race, ethnicity, State, and Tribal location 

25 including the following: 


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1 (1) Data related to all COVID–19 diagnostic 

2 testing, including the number of pregnant people 

3 and postpartum people tested and the number of 

4 positive cases. 

5 (2) Data related to all suspected cases of 

6 COVID–19 in pregnant, birthing, and postpartum 

7 people who did not undergo testing. 

8 (3) Data related to all COVID–19 serologic 

9 testing, including the number of pregnant and 

10 postpartum people tested and the number of such 

11 serologic tests that were positive. 

12 (4) Data related to treatment for COVID–19, 

13 including hospitalizations, emergency room, and in14 tensive care unit admissions of pregnant, birthing, 

15 and postpartum people related to COVID–19. 

16 (5) Data related to COVID–19 outcomes, in17 cluding total fatalities and case fatality (expressed 

18 as the proportion of people who were infected with 

19 COVID–19 and died from the virus) of pregnant 

20 and postpartum people. 

21 (6) Data related to pregnancy and infant health 

22 outcomes for pregnant people with confirmed or sus23 pected COVID–19, which may include stillbirths, 

24 maternal mortality and morbidity, infant mortality, 


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1 preterm births, low-birth weight infants, and cesar2 ean section births. 

3 (b) TIMELINE.—The Secretary shall update the data 

4 made available under this section not less frequently than 

5 monthly, during the COVID–19 public health emergency 

6 and for at least one month after the end of the COVID– 

7 19 public health emergency. 

8 (c) PRIVACY.—In publishing data under this section, 

9 the Secretary shall take all necessary steps to protect the 

10 privacy of people whose information is included in such 

11 data, including by complying with— 

12 (1) privacy protections under the regulations 

13 promulgated under section 264(c) of the Health In14 surance Portability and Accountability Act of 1996 

15 (42 U.S.C. 1320d–2 note); and 

16 (2) protections from all inappropriate internal 

17 use by an entity that collects, stores, or receives the 

18 data, including use of such data in determinations of 

19 eligibility (or continued eligibility) in health plans, 

20 and from inappropriate uses. 

21 (d) INDIAN HEALTH SERVICE.—The Director of the 

22 Indian Health Service and Director of the Centers for Dis23 ease Control and Prevention shall consult with Indian 

24 Tribes and confer with urban Indian organizations on data 

25 collection and reporting for purposes of this section. 


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1 (e) DATA COLLECTION GUIDANCE.—The Secretary 

2 shall issue guidance to States and local public health de3 partments to ensure that all relevant demographic data, 

4 including pregnancy and postpartum status, are collected 

5 and included when sending COVID–19 testing specimen 

6 to laboratories, and State and local health departments 

7 and Indian Tribes are disaggregating data on COVID–19 

8 status in data on maternal and infant morbidity and mor9 tality. The Secretary shall ensure that the guidance is de10 veloped in consultation with Indian Tribes to ensure that 

11 it includes tribally developed best practices on reducing 

12 misclassification of American Indian and Alaska Native 

13 people in Federal, State, and local public health surveil14 lance systems. 

15 SEC. 6. INCLUSION OF PREGNANT PEOPLE AND LACTATING 

16 PEOPLE IN VACCINE AND THERAPEUTIC DE17 VELOPMENT FOR COVID–19. 

18 (a) IN GENERAL.—The Director of the National In19 stitutes of Health shall— 

20 (1) support and advance the responsible inclu21 sion of pregnant and lactating people in COVID–19 

22 therapeutic and vaccine clinical trials when safe and 

23 appropriate; 

24 (2) prioritize the implementation of final rec25 ommendations made by the Task Force on Research 


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1 Specific to Pregnant Women and Lactating Women 

2 to improve the inclusion of pregnant and lactating 

3 people in clinical research when safe and appro4 priate, particularly as these recommendations apply 

5 to the development and issuance of safe and effective 

6 COVID–19 therapeutics and vaccines; and 

7 (3) ensure that at least one COVID–19 vaccine 

8 developed and made available for use in the United 

9 States is suitable for pregnant people and lactating 

10 people. 

11 (b) REQUIREMENTS.— 

12 (1) REPORTING REQUIREMENTS.—The Director 

13 of the National Institutes of Health shall collect in14 formation from every developer of a drug or biologi15 cal product for the treatment or prevention of 

16 COVID–19 in the clinical stages of development that 

17 received Federal funding from the Department of 

18 Health and Human Services and its subagencies re19 garding— 

20 (A) how evidence is being generated to 

21 evaluate the safety, efficacy, and appropriate 

22 dosing of the drug or biological product among 

23 pregnant people and lactating people; 

24 (B) plans for the systematic collection of 

25 data from people who are inadvertently exposed 


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1 to the drug or biological product while pregnant 

2 or lactating; 

3 (C) plans for the inclusion of pregnant 

4 people and lactating people, including racial and 

5 ethnic minorities disproportionately affected by 

6 COVID–19, in clinical trials or the rationale for 

7 exclusion; and 

8 (D) plans for performing Developmental 

9 and Reproductive Toxicology studies, or the ra10 tionale for not performing such studies. 

11 (2) DRUG APPROVALS AND BIOLOGICAL PROD12 UCT LICENSING.—The Commissioner of Food and 

13 Drugs shall require a drug or biological product de14 veloper submit, as part of an application for ap15 proval of a drug under section 505 of the Federal 

16 Food, Drug, and Cosmetic Act (21 U.S.C. 355) or 

17 licensing of a biological product under section 351 of 

18 the Public Health Service Act (42 U.S.C. 262) for 

19 the treatment or prevention of COVID–19— 

20 (A) an adequate representation of the ef21 fect of the drug or biological product on preg22 nant people and lactating people, either through 

23 the inclusion of pregnant people and lactating 

24 people in clinical trials when safe and appro25 priate or other research, or through a scientific 


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1 and ethical justification as to why pregnant 

2 people or lactating people were not included in 

3 clinical trials; and 

4 (B) a comprehensive plan for the collection 

5 of additional evidence of safety and efficacy for 

6 pregnant and lactating people after approval 

7 under such section 505 or licensure under such 

8 section 351, or after issuance of an emergency 

9 use authorization under section 564 of the Fed10 eral Food, Drug, and Cosmetic Act (21 U.S.C. 

11 360bbb–3). 

12 SEC. 7. PUBLIC HEALTH COMMUNICATION REGARDING MA13 TERNAL CARE DURING COVID–19. 

14 (a) PUBLIC HEALTH CAMPAIGN.—The Director of 

15 the Centers for Disease Control and Prevention shall un16 dertake a robust public health education effort to enhance 

17 access by pregnant people, their employers, and their pro18 viders to accurate, evidence-based health information 

19 about COVID–19 and pregnancy, safety, and risk, with 

20 a particular focus on reaching pregnant people in under21 served communities. 

22 (b) EMERGENCY TEMPORARY STANDARD.— 

23 (1) IN GENERAL.—In consideration of the grave 

24 risk presented by COVID–19 and the need to 

25 strengthen protections for employees, pursuant to 


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1 section 6(c)(1) of the Occupational Safety and 

2 Health Act of 1970 (29 U.S.C. 655(c)(1)) and not3 withstanding the provisions of law and the Executive 

4 order listed in paragraph (3), not later than 7 days 

5 after the date of enactment of this Act, the Sec6 retary of Labor shall promulgate an emergency tem7 porary standard to protect all employees at occupa8 tional risk from occupational exposure to SARS– 

9 CoV–2. 

10 (2) PREGNANT AND POSTPARTUM EMPLOY11 EES.—The emergency temporary standard promul12 gated under this subsection shall include consider13 ation of the risks and needs specific to pregnant and 

14 postpartum employees. 

15 (3) INAPPLICABLE PROVISIONS OF LAW AND

16 EXECUTIVE ORDER.—The requirements of chapter 6 

17 of title 5, United States Code (commonly referred to 

18 as the ‘‘Regulatory Flexibility Act’’), subchapter I of 

19 chapter 35 of title 44, United States Code (com20 monly referred to as the ‘‘Paperwork Reduction 

21 Act’’), the Unfunded Mandates Reform Act of 1995 

22 (2 U.S.C. 1501 et seq.), and Executive Order 12866 

23 (58 Fed. Reg. 190; relating to regulatory planning 

24 and review), as amended, shall not apply to the 

25 standard promulgated under this subsection. 


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1 (c) TASK FORCE ON BIRTHING EXPERIENCE AND

2 SAFE, RESPECTFUL MATERNITY CARE IN RESPONSE TO

3 THE COVID–19 PUBLIC HEALTH EMERGENCY.— 

4 (1) ESTABLISHMENT.—The Secretary, in con5 sultation with the Director of the Centers for Dis6 ease Control and Prevention and the Administrator 

7 of the Health Resources and Services Administra8 tion, shall convene a task force to develop Federal 

9 recommendations regarding respectful maternity 

10 care, including safe birth care and postpartum care, 

11 during the COVID–19 public health emergency. 

12 (2) DUTIES.—The task force established under 

13 paragraph (1) shall develop, publicly post, and up14 date Federal recommendations in multiple languages 

15 to ensure quality, provide nondiscriminatory mater16 nity care, promote positive birthing experiences, and 

17 improve maternal health outcomes during the 

18 COVID–19 public health emergency, with a par19 ticular focus on outcomes for communities of color 

20 and rural populations. Such guidelines and rec21 ommendations shall— 

22 (A) address, with particular attention to 

23 ensuring equitable treatment on the basis of 

24 race and ethnicity— 


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1 (i) measures to facilitate respectful 

2 maternity care; 

3 (ii) strategies to increase access to 

4 specialized care for those with high-risk 

5 pregnancies or pregnant individuals with 

6 elevated risk factors; 

7 (iii) COVID–19 diagnostic testing for 

8 pregnant and laboring patients; 

9 (iv) birthing without one’s chosen 

10 companions, with one’s chosen companions, 

11 and with smartphone or other telehealth 

12 connection to one’s chosen companions; 

13 (v) newborn separation after birth in 

14 relation to maternal COVID–19 status; 

15 (vi) breast milk feeding in relation to 

16 maternal COVID–19 status; 

17 (vii) licensure, training, scope of prac18 tice, and Medicaid and other insurance re19 imbursement for certified midwives, cer20 tified nurse-midwives, certified professional 

21 midwives, in a manner that facilitates in22 clusion of midwives of color and midwives 

23 from underserved communities; 

24 (viii) financial support for perinatal 

25 health workers who provide non-clinical 


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1 support to people from pregnancy through 

2 the postpartum period, such as a doula, 

3 community health worker, peer supporter, 

4 lactation consultant, nutritionist or dieti5 tian, social worker, home visitor, or a pa6 tient navigator in a manner that facilitates 

7 inclusion from underserved communities; 

8 (ix) how to identify, address, and 

9 treat prenatal and postpartum mental and 

10 behavioral health conditions, such as anx11 iety, substance use disorder, and depres12 sion, which may have arisen or increased 

13 during the COVID–19 public health emer14 gency; 

15 (x) strategies to address hospital ca16 pacity concerns in communities with a 

17 surge in COVID–19 cases and to provide 

18 childbearing people with options that re19 duce potential for cross-contamination and 

20 increase the ability to implement their care 

21 preferences while maintaining safety and 

22 quality, such as the use of auxiliary mater23 nity units and freestanding birth centers; 

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1 ery treatment and support to pregnant and 

2 postpartum people, including evaluating 

3 the value of training for hospital staff on 

4 implicit bias and racism, respectful mater5 nity care, and demographic data collection; 

6 and 

7 (xii) such other matters as the task 

8 force determines appropriate; 

9 (B) identify barriers to the implementation 

10 of the guidelines and recommendations; 

11 (C) take into consideration existing State 

12 and other programs that have demonstrated ef13 fectiveness in addressing pregnancy, birth, and 

14 postpartum care during the COVID–19 public 

15 health emergency; and 

16 (D) identify policies specific to COVID–19 

17 that should be discontinued when safely possible 

18 and those that should be continued as the pub19 lic health emergency abates. 

20 (3) MEMBERSHIP.—The task force established 

21 under paragraph (1) shall be comprised of— 

22 (A) representatives of the Department of 

23 Health and Human Services, including rep24 resentatives of— 

25 (i) the Secretary; 


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1 (ii) the Director of the Centers for 

2 Disease Control and Prevention; 

3 (iii) the Administrator of the Health 

4 Resources and Services Administration; 

5 (iv) the Administrator of the Centers 

6 for Medicare & Medicaid Services; 

7 (v) the Director of the Agency for 

8 Healthcare Research and Quality; and 

9 (vi) the Director of the Indian Health 

10 Service; 

11 (B) at least 3 State, local, or territorial 

12 public health officials representing departments 

13 of public health, who shall represent jurisdic14 tions from different regions of the United 

15 States with relatively high concentrations of 

16 historically marginalized populations, to be ap17 pointed by the Secretary; 

18 (C) at least 1 Tribal public health official 

19 representing departments of public health; 

20 (D) 1 or more representatives of a commu21 nity-based organization that addresses adverse 

22 maternal health outcomes with a specific focus 

23 on racial and ethnic inequities in maternal 

24 health outcomes, appointed by the Secretary, 

25 with special consideration given to organizations 


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1 led by a person of color or from communities 

2 with significant minority populations; 

3 (E) 1 or more obstetrician-gynecologist or 

4 other physician who provides obstetric care, 

5 with special consideration for physicians who 

6 are from, or work in, communities experiencing 

7 the highest rates of COVID–19 mortality and 

8 morbidity; 

9 (F) 1 or more nurse, such as a certified 

10 nurse-midwife, women’s health nurse practi11 tioner, or other nurse who provides obstetric 

12 care, with special consideration for nurses who 

13 are from, or work in, communities experiencing 

14 the highest rates of COVID–19 mortality and 

15 morbidity; 

16 (G) 1 or more perinatal health workers 

17 who provide non-clinical support to people from 

18 pregnancy through postpartum period, such as 

19 a doula, community health worker, peer sup20 porter, lactation consultant, nutritionist or die21 titian, social worker, home visitor, or patient 

22 navigator; 

23 (H) 1 or more patients who were pregnant 

24 or gave birth during the COVID–19 public 

25 health emergency; 


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1 (I) 1 or more patients who contracted 

2 COVID–19 and later gave birth; 

3 (J) 1 or more patients who have received 

4 support from a perinatal health worker who 

5 provides prenatal and postpartum support, such 

6 as a doula, community health worker, peer sup7 porter, lactation consultant, nutritionist or die8 titian, social worker, home visitor, or a patient 

9 navigator, or a spouse or family member of 

10 such patient; and 

11 (K) racially and ethnically diverse rep12 resentation from at least 3 independent experts 

13 with knowledge or field experience with racial 

14 and ethnic disparities in public health, women’s 

15 health, or maternal mortality and severe mater16 nal morbidity. 

17 SEC. 8. GAO REPORT ON MATERNAL HEALTH AND PUBLIC 

18 HEALTH EMERGENCY PREPAREDNESS. 

19 Not later than 1 year after the end of the public 

20 health emergency declared by the Secretary of Health and 

21 Human Services under section 319 of the Public Health 

22 Service Act (42 U.S.C. 247d) on January 31, 2020, with 

23 respect to COVID–19, the Comptroller General of the 

24 United States shall submit to the appropriate committees 

25 of Congress a report on maternal health and public health 


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1 emergency preparedness, including prenatal, labor and de2 livery, and postpartum care during the COVID–19 public 

3 health emergency, including the following: 

4 (1) A review of the prenatal, labor and delivery, 

5 and postpartum experiences of people during the 

6 COVID–19 public health emergency, which shall— 

7 (A) identify barriers to accessing preg8 nancy, birth, and postpartum care during a 

9 pandemic; 

10 (B) assess the extent to which public and 

11 private insurers were providing coverage for 

12 maternal health care during the public health 

13 emergency, including for telehealth services; 

14 (C) to the extent practicable, analyze ma15 ternal and infant health outcomes by race and 

16 ethnicity (including quality of care, mortality, 

17 morbidity, cesarean section rates, preterm birth, 

18 prevalence of prenatal and postpartum anxiety 

19 and depression) during the COVID–19 public 

20 health emergency and the impact of Federal 

21 and State policy changes made in response to 

22 the COVID–19 pandemic on such outcomes; 

23 (D) identify contributors to population24 based disparities seen in COVID–19 outcomes, 

25 such as racial profiling of, and bias and disVerDate Sep 11 2014 00:30 Oct 18, 2020 Jkt 019200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 E:\BILLS\S4769.IS S4769

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•S 4769 IS

1 crimination against Black, American Indian 

2 and Alaska Native, Latinx, and Asian-American 

3 and Pacific Islander people; and 

4 (E) review the impact of increased unem5 ployment, paid family leave, changes in health 

6 care coverage, and other social determinants of 

7 health for pregnant and postpartum people dur8 ing the public health emergency. 

9 (2) Consultation with maternity care providers, 

10 maternal mental and behavioral health care special11 ists, researchers who specialize in women’s health or 

12 maternal mortality and severe maternal morbidity, 

13 people who experienced pregnancy or childbirth dur14 ing the COVID–19 public health emergency, rep15 resentatives from community-based organizations 

16 that address maternal health, and perinatal health 

17 workers who provide nonclinical support to pregnant 

18 and postpartum people (such as a doula, community 

19 health worker, peer support, certified lactation con20 sultant, nutritionist or dietician, social worker, home 

21 visitor, or navigator). 

22 (3) Recommendations to improve the public 

23 health emergency response and preparedness efforts 

24 of the Federal Government specific to maternal 


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27 

•S 4769 IS

1 health, with a particular focus on outcomes for mi2 nority women, including— 

3 (A) ways to improve research, surveillance, 

4 and data collection of the Federal Government 

5 related to maternal health; 

6 (B) ways for the Federal Government to 

7 factor maternal health outcomes and disparities 

8 into decisions regarding distribution of re9 sources, including COVID–19 tests, personal 

10 protective equipment, and emergency funding; 

11 (C) the extent to which guidelines and rec12 ommendations of the Federal Government re13 lated to maternal health care during the 

14 COVID–19 public health emergency were cul15 turally congruent and linguistically competent 

16 for minority women; and 

17 (D) ways to improve the distribution of 

18 public health funds, data, and information to 

19 Indian Tribes and Tribal organizations with re20 gard to maternal health during the COVID–19 

21 public health emergency. 

Æ 


kjohnson on DSK79L0C42PROD with BILLS