I 

117TH CONGRESS 

1ST SESSION H. R. 1212 

To end preventable maternal mortality and severe maternal morbidity in 

the United States and close disparities in maternal health outcomes, 

and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 23, 2021 

Ms. ADAMS (for herself, Ms. UNDERWOOD, Mr. KHANNA, Ms. VELA ́ZQUEZ, 

Mrs. MCBATH, Mr. SMITH of Washington, Ms. SCANLON, Mr. LAWSON

of Florida, Mrs. HAYES, Mr. BUTTERFIELD, Ms. MOORE of Wisconsin, 

Ms. STRICKLAND, Mr. RYAN, Mr. SCHIFF, Mr. JOHNSON of Georgia, Mr. 

HORSFORD, Ms. WASSERMAN SCHULTZ, Ms. BARRAGA ́N, Mr. DEUTCH, 

Mr. BLUMENAUER, Mr. MOULTON, Mr. SOTO, Mr. NADLER, Mr. TRONE, 

Ms. CLARKE of New York, Ms. SCHAKOWSKY, Ms. BASS, Ms. PRESSLEY, 

Mr. EVANS, Ms. BLUNT ROCHESTER, Ms. CASTOR of Florida, Ms. SEWELL, and Ms. WILLIAMS of Georgia) introduced the following bill; which 

was referred to the Committee on Energy and Commerce 

A BILL 

To end preventable maternal mortality and severe maternal 

morbidity in the United States and close disparities in 

maternal health outcomes, 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 ‘‘Kira Johnson Act’’. 


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1 SEC. 2. INVESTMENTS IN COMMUNITY-BASED ORGANIZA2 TIONS TO IMPROVE BLACK MATERNAL 

3 HEALTH OUTCOMES. 

4 (a) AWARDS.—Following the 1-year period described 

5 in subsection (c), the Secretary of Health and Human 

6 Services (in this section referred to as the ‘‘Secretary’’) 

7 shall award grants to eligible entities to establish or ex8 pand programs to prevent maternal mortality and severe 

9 maternal morbidity among Black pregnant and 

10 postpartum individuals. 

11 (b) ELIGIBILITY.—To be eligible to seek a grant 

12 under this section, an entity shall be a community-based 

13 organization offering programs and resources aligned with 

14 evidence-based practices for improving maternal health 

15 outcomes for Black pregnant and postpartum individuals. 

16 (c) OUTREACH AND TECHNICAL ASSISTANCE PE17 RIOD.—During the 1-year period beginning on the date 

18 of enactment of this Act, the Secretary shall— 

19 (1) conduct outreach to encourage eligible enti20 ties to apply for grants under this section; and 

21 (2) provide technical assistance to eligible enti22 ties on best practices for applying for grants under 

23 this section. 

24 (d) SPECIAL CONSIDERATION.— 


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1 (1) OUTREACH.—In conducting outreach under 

2 subsection (c), the Secretary shall give special con3 sideration to eligible entities that— 

4 (A) are based in, and provide support for, 

5 communities with high rates of adverse mater6 nal health outcomes or significant racial and 

7 ethnic disparities in maternal health outcomes, 

8 to the extent such data are available; 

9 (B) are led by Black women; and 

10 (C) offer programs and resources that are 

11 aligned with evidence-based practices for im12 proving maternal health outcomes for Black 

13 pregnant and postpartum individuals. 

14 (2) AWARDS.—In awarding grants under this 

15 section, the Secretary shall give special consideration 

16 to eligible entities that— 

17 (A) are described in subparagraphs (A), 

18 (B), and (C) of paragraph (1); 

19 (B) offer programs and resources designed 

20 in consultation with and intended for Black 

21 pregnant and postpartum individuals; and 

22 (C) offer programs and resources in the 

23 communities in which the respective eligible en24 tities are located that— 


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1 (i) promote maternal mental health 

2 and maternal substance use disorder treat3 ments and supports that are aligned with 

4 evidence-based practices for improving ma5 ternal mental and behavioral health out6 comes for Black pregnant and postpartum 

7 individuals; 

8 (ii) address social determinants of ma9 ternal health for pregnant and postpartum 

10 individuals; 

11 (iii) promote evidence-based health lit12 eracy and pregnancy, childbirth, and par13 enting education for pregnant and 

14 postpartum individuals; 

15 (iv) provide support from perinatal 

16 health workers to pregnant and 

17 postpartum individuals; 

18 (v) provide culturally congruent train19 ing to perinatal health workers; 

20 (vi) conduct or support research on 

21 maternal health issues disproportionately 

22 impacting Black pregnant and postpartum 

23 individuals; 

24 (vii) provide support to family mem25 bers of individuals who suffered a pregVerDate Sep 11 2014 04:28 Mar 20, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1212.IH H1212

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1 nancy-associated death or pregnancy-re2 lated death; 

3 (viii) operate midwifery practices that 

4 provide culturally congruent maternal 

5 health care and support, including for the 

6 purposes of— 

7 (I) supporting additional edu8 cation, training, and certification pro9 grams, including support for distance 

10 learning; 

11 (II) providing financial support 

12 to current and future midwives to ad13 dress education costs, debts, and 

14 other needs; 

15 (III) clinical site investments; 

16 (IV) supporting preceptor devel17 opment trainings; 

18 (V) expanding the midwifery 

19 practice; or 

20 (VI) related needs identified by 

21 the midwifery practice and described 

22 in the practice’s application; or 

23 (ix) have developed other programs 

24 and resources that address community-spe25 cific needs for pregnant and postpartum 


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1 individuals and are aligned with evidence2 based practices for improving maternal 

3 health outcomes for Black pregnant and 

4 postpartum individuals. 

5 (e) TECHNICAL ASSISTANCE.—The Secretary shall 

6 provide to grant recipients under this section technical as7 sistance on— 

8 (1) capacity building to establish or expand pro9 grams to prevent adverse maternal health outcomes 

10 among Black pregnant and postpartum individuals; 

11 (2) best practices in data collection, measure12 ment, evaluation, and reporting; and 

13 (3) planning for sustaining programs to prevent 

14 maternal mortality and severe maternal morbidity 

15 among Black pregnant and postpartum individuals 

16 after the period of the grant. 

17 (f) EVALUATION.—Not later than the end of fiscal 

18 year 2026, the Secretary shall submit to the Congress an 

19 evaluation of the grant program under this section that— 

20 (1) assesses the effectiveness of outreach efforts 

21 during the application process in diversifying the 

22 pool of grant recipients; 

23 (2) makes recommendations for future outreach 

24 efforts to diversify the pool of grant recipients for 

25 Department of Health and Human Services grant 


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1 programs and funding opportunities related to ma2 ternal health; 

3 (3) assesses the effectiveness of programs fund4 ed by grants under this section in improving mater5 nal health outcomes for Black pregnant and 

6 postpartum individuals, to the extent practicable; 

7 and 

8 (4) makes recommendations for future Depart9 ment of Health and Human Services grant programs 

10 and funding opportunities that deliver funding to 

11 community-based organizations that provide pro12 grams and resources that are aligned with evidence13 based practices for improving maternal health out14 comes for Black pregnant and postpartum individ15 uals. 

16 (g) AUTHORIZATION OF APPROPRIATIONS.—To carry 

17 out this section, there is authorized to be appropriated 

18 $10,000,000 for each of fiscal years 2022 through 2026. 

19 SEC. 3. INVESTMENTS IN COMMUNITY-BASED ORGANIZA20 TIONS TO IMPROVE MATERNAL HEALTH OUT21 COMES IN UNDERSERVED COMMUNITIES. 

22 (a) AWARDS.—Following the 1-year period described 

23 in subsection (c), the Secretary of Health and Human 

24 Services (in this section referred to as the ‘‘Secretary’’) 

25 shall award grants to eligible entities to establish or exVerDate Sep 11 2014 04:28 Mar 20, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1212.IH H1212

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1 pand programs to prevent maternal mortality and severe 

2 maternal morbidity among underserved groups. 

3 (b) ELIGIBILITY.—To be eligible to seek a grant 

4 under this section, an entity shall be a community-based 

5 organization offering programs and resources aligned with 

6 evidence-based practices for improving maternal health 

7 outcomes for pregnant and postpartum individuals. 

8 (c) OUTREACH AND TECHNICAL ASSISTANCE PE9 RIOD.—During the 1-year period beginning on the date 

10 of enactment of this Act, the Secretary shall— 

11 (1) conduct outreach to encourage eligible enti12 ties to apply for grants under this section; and 

13 (2) provide technical assistance to eligible enti14 ties on best practices for applying for grants under 

15 this section. 

16 (d) SPECIAL CONSIDERATION.— 

17 (1) OUTREACH.—In conducting outreach under 

18 subsection (c), the Secretary shall give special con19 sideration to eligible entities that— 

20 (A) are based in, and provide support for, 

21 communities with high rates of adverse mater22 nal health outcomes or significant racial and 

23 ethnic disparities in maternal health outcomes, 

24 to the extent such data are available; 


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1 (B) are led by individuals from racially, 

2 ethnically, and geographically diverse back3 grounds; and 

4 (C) offer programs and resources that are 

5 aligned with evidence-based practices for im6 proving maternal health outcomes for pregnant 

7 and postpartum individuals. 

8 (2) AWARDS.—In awarding grants under this 

9 section, the Secretary shall give special consideration 

10 to eligible entities that— 

11 (A) are described in subparagraphs (A), 

12 (B), and (C) of paragraph (1); 

13 (B) offer programs and resources designed 

14 in consultation with and intended for pregnant 

15 and postpartum individuals from underserved 

16 groups; and 

17 (C) offer programs and resources in the 

18 communities in which the respective eligible en19 tities are located that— 

20 (i) promote maternal mental health 

21 and maternal substance use disorder treat22 ments and support that are aligned with 

23 evidence-based practices for improving ma24 ternal mental and behavioral health outVerDate Sep 11 2014 04:28 Mar 20, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H1212.IH H1212

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1 comes for pregnant and postpartum indi2 viduals; 

3 (ii) address social determinants of ma4 ternal health for pregnant and postpartum 

5 individuals; 

6 (iii) promote evidence-based health lit7 eracy and pregnancy, childbirth, and par8 enting education for pregnant and 

9 postpartum individuals; 

10 (iv) provide support from perinatal 

11 health workers to pregnant and 

12 postpartum individuals; 

13 (v) provide culturally congruent train14 ing to perinatal health workers; 

15 (vi) conduct or support research on 

16 maternal health outcomes and disparities; 

17 (vii) provide support to family mem18 bers of individuals who suffered a preg19 nancy-associated death or pregnancy-re20 lated death; 

21 (viii) operate midwifery practices that 

22 provide culturally congruent maternal 

23 health care and support, including for the 

24 purposes of— 


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1 (I) supporting additional edu2 cation, training, and certification pro3 grams, including support for distance 

4 learning; 

5 (II) providing financial support 

6 to current and future midwives to ad7 dress education costs, debts, and 

8 other needs; 

9 (III) clinical site investments; 

10 (IV) supporting preceptor devel11 opment trainings; 

12 (V) expanding the midwifery 

13 practice; or 

14 (VI) related needs identified by 

15 the midwifery practice and described 

16 in the practice’s application; or 

17 (ix) have developed other programs 

18 and resources that address community-spe19 cific needs for pregnant and postpartum 

20 individuals and are aligned with evidence21 based practices for improving maternal 

22 health outcomes for pregnant and 

23 postpartum individuals. 


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1 (e) TECHNICAL ASSISTANCE.—The Secretary shall 

2 provide to grant recipients under this section technical as3 sistance on— 

4 (1) capacity building to establish or expand pro5 grams to prevent adverse maternal health outcomes 

6 among pregnant and postpartum individuals from 

7 underserved groups; 

8 (2) best practices in data collection, measure9 ment, evaluation, and reporting; and 

10 (3) planning for sustaining programs to prevent 

11 maternal mortality and severe maternal morbidity 

12 among pregnant and postpartum individuals from 

13 underserved groups after the period of the grant. 

14 (f) EVALUATION.—Not later than the end of fiscal 

15 year 2026, the Secretary shall submit to the Congress an 

16 evaluation of the grant program under this section that— 

17 (1) assesses the effectiveness of outreach efforts 

18 during the application process in diversifying the 

19 pool of grant recipients; 

20 (2) makes recommendations for future outreach 

21 efforts to diversify the pool of grant recipients for 

22 Department of Health and Human Services grant 

23 programs and funding opportunities related to ma24 ternal health; 


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1 (3) assesses the effectiveness of programs fund2 ed by grants under this section in improving mater3 nal health outcomes for pregnant and postpartum 

4 individuals from underserved groups, to the extent 

5 practicable; and 

6 (4) makes recommendations for future Depart7 ment of Health and Human Services grant programs 

8 and funding opportunities that deliver funding to 

9 community-based organizations that provide pro10 grams and resources that are aligned with evidence11 based practices for improving maternal health out12 comes for pregnant and postpartum individuals. 

13 (g) DEFINITION.—In this section, the term ‘‘under14 served groups’’ refers to pregnant and postpartum individ15 uals— 

16 (1) from racial and ethnic minority groups (as 

17 such term is defined in section 1707(g)(1) of the 

18 Public Health Service Act (42 U.S.C. 300u– 

19 6(g)(1))); 

20 (2) whose household income is equal to or less 

21 than 150 percent of the Federal poverty line; 

22 (3) who live in health professional shortage 

23 areas (as such term is defined in section 332 of the 

24 Public Health Service Act (42 U.S.C. 254e(a)(1))); 


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1 (4) who live in counties with no hospital offer2 ing obstetric care, no birth center, and no obstetric 

3 provider; or 

4 (5) who live in counties with a level of vulner5 ability of moderate-to-high or higher, according to 

6 the Social Vulnerability Index of the Centers for 

7 Disease Control and Prevention. 

8 (h) AUTHORIZATION OF APPROPRIATIONS.—To carry 

9 out this section, there is authorized to be appropriated 

10 $10,000,000 for each of fiscal years 2022 through 2026. 

11 SEC. 4. RESPECTFUL MATERNITY CARE TRAINING FOR ALL 

12 EMPLOYEES IN MATERNITY CARE SETTINGS. 

13 Part B of title VII of the Public Health Service Act 

14 (42 U.S.C. 293 et seq.) is amended by adding at the end 

15 the following new section: 

16 ‘‘SEC. 742. RESPECTFUL MATERNITY CARE TRAINING FOR 

17 ALL EMPLOYEES IN MATERNITY CARE SET18 TINGS. 

19 ‘‘(a) GRANTS.—The Secretary shall award grants for 

20 programs to reduce and prevent bias, racism, and dis21 crimination in maternity care settings and to advance re22 spectful, culturally congruent, trauma-informed care. 

23 ‘‘(b) SPECIAL CONSIDERATION.—In awarding grants 

24 under subsection (a), the Secretary shall give special con25 sideration to applications for programs that would— 


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1 ‘‘(1) apply to all maternity care providers (as 

2 defined in section 8 of the Kira Johnson Act) and 

3 any employees who interact with pregnant and 

4 postpartum individuals in the provider setting, in5 cluding front desk employees, sonographers, sched6 ulers, health care professionals, hospital or health 

7 system administrators, security staff, and other em8 ployees; 

9 ‘‘(2) emphasize periodic, as opposed to one10 time, trainings for all birthing professionals and em11 ployees described in paragraph (1); 

12 ‘‘(3) address implicit bias, racism, and cultural 

13 humility; 

14 ‘‘(4) be delivered in ongoing education settings 

15 for providers maintaining their licenses, with a pref16 erence for trainings that provide continuing edu17 cation units; 

18 ‘‘(5) include trauma-informed care best prac19 tices and an emphasis on shared decision making be20 tween providers and patients; 

21 ‘‘(6) include antiracism training and programs; 

22 ‘‘(7) be delivered in undergraduate programs 

23 that funnel into health professions schools; 

24 ‘‘(8) be delivered in settings that apply to pro25 viders of the special supplemental nutrition program 


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1 for women, infants, and children under section 17 of 

2 the Child Nutrition Act of 1966; 

3 ‘‘(9) integrate bias training in obstetric emer4 gency simulation trainings or related trainings; 

5 ‘‘(10) include training for emergency depart6 ment employees and emergency medical technicians 

7 on recognizing warning signs for severe pregnancy8 related complications; 

9 ‘‘(11) offer training to all maternity care pro10 viders on the value of racially, ethnically, and profes11 sionally diverse maternity care teams to provide cul12 turally congruent care; or 

13 ‘‘(12) be based on one or more programs de14 signed by a historically Black college or university or 

15 other minority-serving institution. 

16 ‘‘(c) APPLICATION.—To seek a grant under sub17 section (a), an entity shall submit an application at such 

18 time, in such manner, and containing such information as 

19 the Secretary may require. 

20 ‘‘(d) REPORTING.—Each recipient of a grant under 

21 this section shall annually submit to the Secretary a report 

22 on the status of activities conducted using the grant, in23 cluding, as applicable, a description of the impact of train24 ing provided through the grant on patient outcomes and 

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1 uals from racial and ethnic minority groups and their fam2 ilies. 

3 ‘‘(e) BEST PRACTICES.—Based on the annual reports 

4 submitted pursuant to subsection (d), the Secretary— 

5 ‘‘(1) shall produce an annual report on the find6 ings resulting from programs funded through this 

7 section; 

8 ‘‘(2) shall disseminate such report to all recipi9 ents of grants under this section and to the public; 

10 and 

11 ‘‘(3) may include in such report findings on 

12 best practices for improving patient outcomes and 

13 patient experience for pregnant and postpartum in14 dividuals from racial and ethnic minority groups and 

15 their families in maternity care settings. 

16 ‘‘(f) DEFINITIONS.—In this section: 

17 ‘‘(1) The term ‘postpartum’ means the one-year 

18 period beginning on the last day of an individual’s 

19 pregnancy. 

20 ‘‘(2) The term ‘culturally congruent’ means in 

21 agreement with the preferred cultural values, beliefs, 

22 world view, language, and practices of the health 

23 care consumer and other stakeholders. 


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1 ‘‘(3) The term ‘racial and ethnic minority 

2 group’ has the meaning given such term in section 

3 1707(g)(1). 

4 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—To 

5 carry out this section, there is authorized to be appro6 priated $5,000,000 for each of fiscal years 2022 through 

7 2026.’’. 

8 SEC. 5. STUDY ON REDUCING AND PREVENTING BIAS, RAC9 ISM, AND DISCRIMINATION IN MATERNITY 

10 CARE SETTINGS. 

11 (a) IN GENERAL.—The Secretary of Health and 

12 Human Services shall seek to enter into an agreement, 

13 not later than 90 days after the date of enactment of this 

14 Act, with the National Academies of Sciences, Engineer15 ing, and Medicine (referred to in this section as the ‘‘Na16 tional Academies’’) under which the National Academies 

17 agree to— 

18 (1) conduct a study on the design and imple19 mentation of programs to reduce and prevent bias, 

20 racism, and discrimination in maternity care settings 

21 and to advance respectful, culturally congruent, 

22 trauma-informed care; and 

23 (2) not later than 24 months after the date of 

24 enactment of this Act— 

25 (A) complete the study; and 


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1 (B) transmit a report on the results of the 

2 study to the Congress. 

3 (b) POSSIBLE TOPICS.—The agreement entered into 

4 pursuant to subsection (a) may provide for the study of 

5 any of the following: 

6 (1) The development of a scorecard or other 

7 evaluation standards for programs designed to re8 duce and prevent bias, racism, and discrimination in 

9 maternity care settings to assess the effectiveness of 

10 such programs in improving patient outcomes and 

11 patient experience for pregnant and postpartum in12 dividuals from racial and ethnic minority groups and 

13 their families. 

14 (2) Determination of the types and frequency of 

15 training to reduce and prevent bias, racism, and dis16 crimination in maternity care settings that are dem17 onstrated to improve patient outcomes or patient ex18 perience for pregnant and postpartum individuals 

19 from racial and ethnic minority groups and their 

20 families. 

21 SEC. 6. RESPECTFUL MATERNITY CARE COMPLIANCE PRO22 GRAM. 

23 (a) IN GENERAL.—The Secretary of Health and 

24 Human Services (referred to in this section as the ‘‘Sec25 retary’’) shall award grants to accredited hospitals, health 


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1 systems, and other maternity care settings to establish as 

2 an integral part of quality implementation initiatives with3 in one or more hospitals or other birth settings a respect4 ful maternity care compliance program. 

5 (b) PROGRAM REQUIREMENTS.—A respectful mater6 nity care compliance program funded through a grant 

7 under this section shall— 

8 (1) institutionalize mechanisms to allow pa9 tients receiving maternity care services, the families 

10 of such patients, or perinatal health workers sup11 porting such patients to report instances of racism 

12 or evidence of bias on the basis of race, ethnicity, or 

13 another protected class; 

14 (2) institutionalize response mechanisms 

15 through which representatives of the program can 

16 directly follow up with the patient, if possible, and 

17 the patient’s family in a timely manner; 

18 (3) prepare and make publicly available a 

19 hospital- or health system-wide strategy to reduce 

20 bias on the basis of race, ethnicity, or another pro21 tected class in the delivery of maternity care that in22 cludes— 

23 (A) information on the training programs 

24 to reduce and prevent bias, racism, and dis25 crimination on the basis of race, ethnicity, or 


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1 another protected class for all employees in ma2 ternity care settings; 

3 (B) information on the number of cases re4 ported to the compliance program; and 

5 (C) the development of methods to rou6 tinely assess the extent to which bias, racism, 

7 or discrimination on the basis of race, ethnicity, 

8 or another protected class are present in the de9 livery of maternity care to patients from racial 

10 and ethnic minority groups; and 

11 (4) develop mechanisms to routinely collect and 

12 publicly report hospital-level data related to patient13 reported experience of care; and 

14 (5) provide annual reports to the Secretary with 

15 information about each case reported to the compli16 ance program over the course of the year containing 

17 such information as the Secretary may require, such 

18 as— 

19 (A) de-identified demographic information 

20 on the patient in the case, such as race, eth21 nicity, gender identity, and primary language; 

22 (B) the content of the report from the pa23 tient or the family of the patient to the compli24 ance program; 


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1 (C) the response from the compliance pro2 gram; and 

3 (D) to the extent applicable, institutional 

4 changes made as a result of the case. 

5 (c) SECRETARY REQUIREMENTS.— 

6 (1) PROCESSES.—Not later than 180 days after 

7 the date of enactment of this Act, the Secretary 

8 shall establish processes for— 

9 (A) disseminating best practices for estab10 lishing and implementing a respectful maternity 

11 care compliance program within a hospital or 

12 other birth setting; 

13 (B) promoting coordination and collabora14 tion between hospitals, health systems, and 

15 other maternity care delivery settings on the es16 tablishment and implementation of respectful 

17 maternity care compliance programs; and 

18 (C) evaluating the effectiveness of respect19 ful maternity care compliance programs on ma20 ternal health outcomes and patient and family 

21 experiences, especially for patients from racial 

22 and ethnic minority groups and their families. 

23 (2) STUDY.— 

24 (A) IN GENERAL.—Not later than 2 years 

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1 retary shall, through a contract with an inde2 pendent research organization, conduct a study 

3 on strategies to address— 

4 (i) racism or bias on the basis of race, 

5 ethnicity, or another protected class in the 

6 delivery of maternity care services; and 

7 (ii) successful implementation of re8 spectful care initiatives. 

9 (B) COMPONENTS OF STUDY.—The study 

10 shall include the following: 

11 (i) An assessment of the reports sub12 mitted to the Secretary from the respectful 

13 maternity care compliance programs pur14 suant to subsection (b)(5). 

15 (ii) Based on such assessment, rec16 ommendations for potential accountability 

17 mechanisms related to cases of racism or 

18 bias on the basis of race, ethnicity, or an19 other protected class in the delivery of ma20 ternity care services at hospitals and other 

21 birth settings. Such recommendations shall 

22 take into consideration medical and non23 medical factors that contribute to adverse 

24 patient experiences and maternal health 

25 outcomes. 


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1 (C) REPORT.—The Secretary shall submit 

2 to the Congress and make publicly available a 

3 report on the results of the study under this 

4 paragraph. 

5 (d) AUTHORIZATION OF APPROPRIATIONS.—To carry 

6 out this section, there is authorized to be appropriated 

7 such sums as may be necessary for fiscal years 2022 

8 through 2027. 

9 SEC. 7. GAO REPORT. 

10 (a) IN GENERAL.—Not later than 2 years after the 

11 date of enactment of this Act and annually thereafter, the 

12 Comptroller General of the United States shall submit to 

13 the Congress and make publicly available a report on the 

14 establishment of respectful maternity care compliance pro15 grams within hospitals, health systems, and other mater16 nity care settings. 

17 (b) MATTERS INCLUDED.—The report under para18 graph (1) shall include the following: 

19 (1) Information regarding the extent to which 

20 hospitals, health systems, and other maternity care 

21 settings have elected to establish respectful mater22 nity care compliance programs, including— 

23 (A) which hospitals and other birth set24 tings elect to establish compliance programs 

25 and when such programs are established; 


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1 (B) to the extent practicable, impacts of 

2 the establishment of such programs on mater3 nal health outcomes and patient and family ex4 periences in the hospitals and other birth set5 tings that have established such programs, es6 pecially for patients from racial and ethnic mi7 nority groups and their families; 

8 (C) information on geographic areas, and 

9 types of hospitals or other birth settings, where 

10 respectful maternity care compliance programs 

11 are not being established and information on 

12 factors contributing to decisions to not establish 

13 such programs; and 

14 (D) recommendations for establishing re15 spectful maternity care compliance programs in 

16 geographic areas, and types of hospitals or 

17 other birth settings, where such programs are 

18 not being established. 

19 (2) Whether the funding made available to 

20 carry out this section has been sufficient and, if ap21 plicable, recommendations for additional appropria22 tions to carry out this section. 

23 (3) Such other information as the Comptroller 

24 General determines appropriate. 


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1 SEC. 8. DEFINITIONS. 

2 In this Act: 

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

5 care, means care that is in agreement with the pre6 ferred cultural values, beliefs, worldview, language, 

7 and practices of the health care consumer and other 

8 stakeholders. 

9 (2) MATERNITY CARE PROVIDER.—The term 

10 ‘‘maternity care provider’’ means a health care pro11 vider who— 

12 (A) is a physician, physician assistant, 

13 midwife who meets at a minimum the inter14 national definition of the midwife and global 

15 standards for midwifery education as estab16 lished by the International Confederation of 

17 Midwives, nurse practitioner, or clinical nurse 

18 specialist; and 

19 (B) has a focus on maternal or perinatal 

20 health. 

21 (3) MATERNAL MORTALITY.—The term ‘‘mater22 nal mortality’’ means a death occurring during or 

23 within a one-year period after pregnancy, caused by 

24 pregnancy-related or childbirth complications, in25 cluding a suicide, overdose, or other death resulting 

26 from a mental health or substance use disorder atVerDate Sep 11 2014 04:28 Mar 20, 2021 Jkt 019200 PO 00000 Frm 00026 Fmt 6652 Sfmt 6201 E:\BILLS\H1212.IH H1212

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1 tributed to or aggravated by pregnancy-related or 

2 childbirth complications. 

3 (4) PERINATAL HEALTH WORKER.—The term 

4 ‘‘perinatal health worker’’ means a doula, commu5 nity health worker, peer supporter, breastfeeding 

6 and lactation educator or counselor, nutritionist or 

7 dietitian, childbirth educator, social worker, home 

8 visitor, language interpreter, or navigator. 

9 (5) POSTPARTUM AND POSTPARTUM PERIOD.— 

10 The terms ‘‘postpartum’’ and ‘‘postpartum period’’ 

11 refer to the 1-year period beginning on the last day 

12 of the pregnancy of an individual. 

13 (6) PREGNANCY-ASSOCIATED DEATH.—The 

14 term ‘‘pregnancy-associated death’’ means a death of 

15 a pregnant or postpartum individual, by any cause, 

16 that occurs during, or within 1 year following, the 

17 individual’s pregnancy, regardless of the outcome, 

18 duration, or site of the pregnancy. 

19 (7) PREGNANCY-RELATED DEATH.—The term 

20 ‘‘pregnancy-related death’’ means a death of a preg21 nant or postpartum individual that occurs during, or 

22 within 1 year following, the individual’s pregnancy, 

23 from a pregnancy complication, a chain of events 

24 initiated by pregnancy, or the aggravation of an unVerDate Sep 11 2014 04:28 Mar 20, 2021 Jkt 019200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\H1212.IH H1212

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1 related condition by the physiologic effects of preg2 nancy. 

3 (8) RACIAL AND ETHNIC MINORITY GROUP.— 

4 The term ‘‘racial and ethnic minority group’’ has the 

5 meaning given such term in section 1707(g)(1) of 

6 the Public Health Service Act (42 U.S.C. 300u– 

7 6(g)(1)). 

8 (9) SEVERE MATERNAL MORBIDITY.—The term 

9 ‘‘severe maternal morbidity’’ means a health condi10 tion, including mental health conditions and sub11 stance use disorders, attributed to or aggravated by 

12 pregnancy or childbirth that results in significant 

13 short-term or long-term consequences to the health 

14 of the individual who was pregnant. 

15 (10) SOCIAL DETERMINANTS OF MATERNAL

16 HEALTH DEFINED.—The term ‘‘social determinants 

17 of maternal health’’ means non-clinical factors that 

18 impact maternal health outcomes, including— 

19 (A) economic factors, which may include 

20 poverty, employment, food security, support for 

21 and access to lactation and other infant feeding 

22 options, housing stability, and related factors; 

23 (B) neighborhood factors, which may in24 clude quality of housing, access to transpor25 tation, access to child care, availability of 


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1 healthy foods and nutrition counseling, avail2 ability of clean water, air and water quality, 

3 ambient temperatures, neighborhood crime and 

4 violence, access to broadband, and related fac5 tors; 

6 (C) social and community factors, which 

7 may include systemic racism, gender discrimi8 nation or discrimination based on other pro9 tected classes, workplace conditions, incarcer10 ation, and related factors; 

11 (D) household factors, which may include 

12 ability to conduct lead testing and abatement, 

13 car seat installation, indoor air temperatures, 

14 and related factors; 

15 (E) education access and quality factors, 

16 which may include educational attainment, lan17 guage and literacy, and related factors; and 

18 (F) health care access factors, including 

19 health insurance coverage, access to culturally 

20 congruent health care services, providers, and 

21 non-clinical support, access to home visiting 

22 services, access to wellness and stress manage23 ment programs, health literacy, access to teleVerDate Sep 11 2014 04:28 Mar 20, 2021 Jkt 019200 PO 00000 Frm 00029 Fmt 6652 Sfmt 6201 E:\BILLS\H1212.IH H1212

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1 health and items required to receive telehealth 

2 services, and related factors. 

Æ 


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