I 

111TH CONGRESS 

2D SESSION H. R. 6318 

To amend the Public Health Service Act to ensure a national, coordinated 

approach to improving maternal and infant health. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 29, 2010 

Mrs. CAPPS (for herself, Ms. ROYBAL-ALLARD, and Mr. MURPHY of Connecticut) introduced the following bill; which was referred to the Committee on Energy and Commerce 

A BILL 

To amend the Public Health Service Act to ensure a national, coordinated approach to improving maternal and 

infant health. 

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 ‘‘Maternity Care Im5 provement Act of 2010’’. 

6 SEC. 2. TABLE OF CONTENTS. 

7 The table of contents of this Act is as follows: 

Sec. 1. Short title. 

Sec. 2. Table of contents. 

TITLE I—ENHANCED REPORTING, RESEARCH, AND EVALUATION 


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Sec. 101. National registry of maternal and infant health data. 

TITLE II—STRENGTHENING THE MATERNITY CARE WORKFORCE 

Sec. 201. Maternal and infant health workforce education and training. 

Sec. 202. Report on creation of a uniform maternity care core curriculum. 

Sec. 203. Demonstration projects to promote use of core curriculum and interdisciplinary team teaching in maternity care health professions 

education. 

Sec. 204. Report on maternity care workforce. 

Sec. 205. Allocation of funds for maternity care workforce development. 

TITLE III—ADDRESSING MATERNAL HEALTH DISPARITIES 

Sec. 301. CDC Centers for Research and Demonstration of Health Promotion 

and Disease Prevention. 

Sec. 302. Grants to support a diversified maternity care workforce. 

TITLE IV—COORDINATION OF MATERNITY CARE 

Sec. 401. Maternal health coordinator. 

1 TITLE I—ENHANCED REPORT2 ING, RESEARCH, AND EVAL3 UATION 

4 SEC. 101. NATIONAL REGISTRY OF MATERNAL AND INFANT 

5 HEALTH DATA. 

6 Title III of the Public Health Service Act is amended 

7 by inserting after section 317L of such Act (42 U.S.C. 

8 247b–13) the following: 

9 ‘‘SEC. 317L–1. IMPROVEMENT OF MATERNAL AND INFANT 

10 HEALTH THROUGH ENHANCED REPORTING, 

11 RESEARCH, AND EVALUATION. 

12 ‘‘(a) NATIONAL REGISTRY.— 

13 ‘‘(1) IN GENERAL.—The Secretary shall estab14 lish and maintain a national registry of maternal 

15 and infant health information (in this section re16 ferred to as the ‘Registry’). 


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1 ‘‘(2) CONTENTS.—The Registry shall include 

2 information on maternal and infant health, including 

3 any such information submitted to the Secretary 

4 through the Pregnancy Risk Assessment Monitoring 

5 System. The Secretary shall disaggregate informa6 tion in the Registry by race and ethnicity. 

7 ‘‘(3) STANDARDIZATION.—In carrying out this 

8 subsection, the Secretary shall ensure that informa9 tion is collected and maintained pursuant to stand10 ardized measures of maternal health, including a 

11 standardized definition of maternal death. 

12 ‘‘(b) REPORTING AND COLLECTION OF INFORMA13 TION.—The Secretary shall expand, enhance, and ensure 

14 the coordination of programs of the Department of Health 

15 and Human Services relating to the reporting and collec16 tion of information on maternal and infant health. Activi17 ties under this subsection may include— 

18 ‘‘(1) expansion of the Pregnancy Risk Assess19 ment Monitoring System to include standardized re20 porting, including core questions and any additional 

21 State-added information reporting by all States; 

22 ‘‘(2) expansion of programs to assist and en23 courage vital registration systems in each State to 

24 use enhanced, standardized electronic birth certifi25 cates; and 


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1 ‘‘(3) disaggregation of information by race and 

2 ethnicity. 

3 ‘‘(c) ELECTRONIC BIRTH AND DEATH SYSTEMS.— 

4 The Secretary shall award grants to vital records jurisdic5 tions for the development and implementation of electronic 

6 birth and death systems— 

7 ‘‘(1) to collect 2003 standard certificate data; 

8 and 

9 ‘‘(2) for the training of individuals responsible 

10 for completing birth and death certificates. 

11 ‘‘(d) ANALYSIS OF PROGRAMS THAT MITIGATE MA12 TERNAL MORBIDITY AND MORTALITY.—The Secretary 

13 shall enter into an agreement with the Institute of Medi14 cine of the National Academies under which the Institute 

15 will— 

16 ‘‘(1) conduct an in-depth analysis, including 

17 funding histories, of Federal, State, and local pro18 grams (both governmental and private) across the 

19 Nation that mitigate maternal mortality and mor20 bidity; and 

21 ‘‘(2) not later than 12 months after the date of 

22 the enactment of this section, submit a report to the 

23 Secretary and the Congress on the results of such 

24 analysis. 


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1 ‘‘(e) COMPARATIVE EFFECTIVENESS OF CLINICAL

2 PRACTICES RELATED TO CHILDBIRTH.— 

3 ‘‘(1) IN GENERAL.—The Secretary shall con4 duct or support research on the comparative effec5 tiveness of clinical practices related to childbirth, in6 cluding home birth and other out-of-hospital birth, 

7 vaginal birth after cesarean, vaginal breech, multiple 

8 gestation, elective induction, and caesarian section 

9 without indication. 

10 ‘‘(2) CONSIDERATION OF LIABILITY CON11 CERNS.—The research under paragraph (1) shall 

12 take into consideration the liability concerns of 

13 health care providers. 

14 ‘‘(3) COORDINATION.—The Secretary shall en15 sure the coordination of research under this section 

16 with comparative effectiveness research of the De17 partment of Health and Human Services under sec18 tion 1181 of the Social Security Act or other provi19 sions of law. 

20 ‘‘(f) REPORT TO CONGRESS.—Not later than 12 

21 months after the date of the enactment of this section, 

22 the Secretary shall submit a report to the Congress on 

23 programs and activities under this section, including an 

24 analysis of progress in improving the quality and outcomes 

25 of maternity care and infant health. 


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

2 carry out this section, there are authorized to be appro3 priated such sums as may be necessary.’’. 

4 TITLE II—STRENGTHENING THE 

5 MATERNITY CARE WORKFORCE 

6 SEC. 201. MATERNAL AND INFANT HEALTH WORKFORCE 

7 EDUCATION AND TRAINING. 

8 (a) HEALTH PROFESSIONALS.—Part D of title VII 

9 of the Public Health Service Act (42 U.S.C. 294 et seq.) 

10 is amended by adding at the end the following: 

11 ‘‘SEC. 760. EDUCATION AND TRAINING RELATING TO MA12 TERNAL AND INFANT HEALTH. 

13 ‘‘The Secretary shall, with respect to maternal and 

14 infant health education and training, carry out services 

15 and programs equivalent (as determined by the Secretary) 

16 to the services and programs under section 753 with re17 spect to maternal and infant health education and train18 ing.’’. 

19 (b) NURSING.—Title VIII of the Public Health Serv20 ice Act (42 U.S.C. 296 et seq.) is amended by adding at 

21 the end the following: 


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1 ‘‘PART J—COMPREHENSIVE MATERNAL AND 

2 INFANT HEALTH PROFESSIONS EDUCATION 

3 ‘‘SEC. 861. COMPREHENSIVE MATERNAL AND INFANT 

4 HEALTH PROFESSIONS EDUCATION. 

5 ‘‘(a) PROGRAM AUTHORIZED.—The Secretary shall 

6 award grants to eligible entities to develop and implement, 

7 in coordination with programs under section 760, pro8 grams and initiatives to train and educate individuals in 

9 providing evidence-based maternal and infant health care. 

10 ‘‘(b) USE OF FUNDS.—An eligible entity that receives 

11 a grant under subsection (a) shall use funds under such 

12 grant to— 

13 ‘‘(1) provide training to individuals who will 

14 provide maternal and infant health care; 

15 ‘‘(2) develop and disseminate core curricula for 

16 all maternity care providers that emphasizes health 

17 promotion and disease prevention; 

18 ‘‘(3) train faculty members in maternal and in19 fant health care; 

20 ‘‘(4) provide continuing education to individuals 

21 who provide maternal and infant health care; or 

22 ‘‘(5) establish traineeships for individuals who 

23 are preparing for advanced education nursing de24 grees deemed appropriate by the Secretary. 

25 ‘‘(c) APPLICATION.—An eligible entity desiring a 

26 grant under subsection (a) shall submit an application to 


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1 the Secretary at such time, in such manner, and con2 taining such information as the Secretary may reasonably 

3 require. 

4 ‘‘(d) ELIGIBLE ENTITY.—For purposes of this sec5 tion, the term ‘eligible entity’ includes a school of nursing, 

6 a health care facility, a program leading to certification 

7 as a certified nurse assistant, a partnership of such a 

8 school and facility, a partnership of such a program and 

9 facility, or a nonprofit entity that issues continuing nurs10 ing education.’’. 

11 SEC. 202. REPORT ON CREATION OF A UNIFORM MATER12 NITY CARE CORE CURRICULUM. 

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

14 Human Services shall seek to enter into an arrangement 

15 with the Institute of Medicine of the National Academies 

16 to prepare a report on the creation of a uniform maternity 

17 care core curriculum to foster a shared knowledge base 

18 among maternity care professionals. At a minimum, the 

19 report shall address ways in which such core curriculum 

20 can support— 

21 (1) preventing and treating complications in 

22 pregnancy and childbirth; 

23 (2) physiologic pregnancy, birth, and early par24 enting; 

25 (3) psychosocial aspects of pregnancy and birth; 


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1 (4) woman- and family-centered care; 

2 (5) cultural competence; 

3 (6) collaborative practice; 

4 (7) shared decisionmaking between childbearing 

5 women and clinicians; 

6 (8) avoiding overuse of maternity interventions 

7 in low-risk women and newborns; 

8 (9) improved systemic approaches to maternity 

9 care; and 

10 (10) eliminating disparities in maternal care 

11 and maternal outcomes. 

12 (b) CONSULTATION.—The arrangement under sub13 section (a) shall require the Institute of Medicine, in pre14 paring the report, to consult with consumer and advocacy 

15 representatives and with each of the following organiza16 tions and their associated educational, accrediting, and 

17 certification bodies: 

18 (1) The American College of Obstetricians and 

19 Gynecologists. 

20 (2) The American Academy of Family Physi21 cians. 

22 (3) The American College of Nurse-Midwives. 

23 (4) The National Association of Certified Pro24 fessional Midwives. 


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1 (5) The Association of Women’s Health, Ob2 stetric, and Neonatal Nurses. 

3 (6) The Accreditation Council for Graduate 

4 Medical Education. 

5 (7) The American Academy of Pediatrics. 

6 (8) The Society for Maternal-Fetal Medicine. 

7 (c) SUBMISSION OF REPORT.—The arrangement 

8 under subsection (a) shall provide for completion of the 

9 report and the submission of the report to the Congress 

10 within 18 months after the date of the enactment of this 

11 Act. 

12 SEC. 203. DEMONSTRATION PROJECTS TO PROMOTE USE 

13 OF CORE CURRICULUM AND INTERDISCIPLI14 NARY TEAM TEACHING IN MATERNITY CARE 

15 HEALTH PROFESSIONS EDUCATION. 

16 (a) IN GENERAL.—Beginning not later than the 

17 deadline specified in section 202(c) for completion and 

18 submission of the report under section 202, the Secretary 

19 shall, on a competitive basis and pursuant to a peer review 

20 process, make available grants to eligible entities or con21 sortia to carry out demonstration projects in academic 

22 educational programs to develop, implement, and evalu23 ate— 

24 (1) a uniform core maternity care curriculum 

25 recommended in the report under section 202; and 


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1 (2) interdisciplinary team teaching and learning 

2 in maternity care education. 

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

4 under this section, an entity or consortium shall be or in5 clude— 

6 (1) a health professions school; 

7 (2) an academic health sciences center; or 

8 (3) another type of institution specified by the 

9 Secretary. 

10 (c) APPLICATION.—To seek a grant under subsection 

11 (a) for a demonstration project, an entity or consortium 

12 shall submit to the Secretary an application that in13 cludes— 

14 (1) a plan for developing and implementing the 

15 demonstration project, including by— 

16 (A) developing collaborative programs in 

17 all maternity care program settings to allow 

18 students of all relevant disciplines to observe 

19 different practice styles, collaborate, and learn 

20 together from faculty including a full range of 

21 maternity care providers; 

22 (B) offering a mix of teaching modalities 

23 including cognitive, hands-on, and simulation 

24 training; 

25 (C) using— 


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1 (i) acute hospital settings; and 

2 (ii) community health centers, public 

3 health department clinics, freestanding 

4 birth clinics, or other sites determined ap5 propriate by the Secretary; and 

6 (D) using an interdisciplinary teaching 

7 team approach involving multiple disciplines, 

8 which approach may include teaching by an ob9 stetrician, family physician, a nurse-midwife, a 

10 nurse, a doula, a mental health professional, 

11 and other providers specified by the Secretary; 

12 (2) an agreement to provide for the collection of 

13 data regarding the effectiveness of the demonstra14 tion project; and 

15 (3) an agreement to provide matching funds in 

16 accordance with subsection (d). 

17 (d) MATCHING FUNDS.— 

18 (1) IN GENERAL.—The Secretary may award a 

19 grant to an entity or consortium under this section 

20 only if the entity or consortium agrees to make 

21 available non-Federal contributions toward the costs 

22 of the demonstration program to be funded under 

23 the grant in an amount that is not less than $1 for 

24 each $5 of Federal funds provided through the 

25 grant. 


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1 (2) NON-FEDERAL CONTRIBUTIONS.—Non-Fed2 eral contributions under paragraph (1) may be in 

3 cash or in-kind, fairly evaluated, including equip4 ment or services. Amounts provided by the Federal 

5 Government, or services assisted or subsidized to 

6 any significant extent by the Federal Government, 

7 may not be included in determining the amount of 

8 such contributions. 

9 (e) EVALUATION.—The Secretary shall take such ac10 tion as may be necessary to— 

11 (1) evaluate the projects funded under this sec12 tion; and 

13 (2) make publicly available, publish, and dis14 seminate the results of such evaluation as widely as 

15 practicable. 

16 (f) REPORTS.—Not later than 2 years after the date 

17 of the enactment of this Act, and annually thereafter, the 

18 Secretary shall submit to the Committee on Health, Edu19 cation, Labor, and Pensions and the Committee on Fi20 nance of the Senate and the Committee on Energy and 

21 Commerce and the Committee on Ways and Means of the 

22 House of Representatives a report that— 

23 (1) describes the specific projects supported 

24 under this section; and 


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1 (2) contains recommendations to Congress 

2 based on the evaluation conducted under subsection 

3 (e). 

4 (g) DEFINITION.—In this section, the term ‘‘Sec5 retary’’ means the Secretary of Health and Human Serv6 ices. 

7 SEC. 204. REPORT ON MATERNITY CARE WORKFORCE. 

8 (a) ASSESSMENT.—The National Health Care Work9 force Commission (established by section 5101 of the Pa10 tient Protection and Affordable Care Act (Public Law 

11 111–148)) shall conduct an assessment of current and 

12 projected workforce needs for achieving the optimal deliv13 ery of maternity care services. At a minimum, the assess14 ment shall include an evaluation of— 

15 (1) an appropriate volume of maternity care 

16 providers; 

17 (2) an appropriate geographic distribution of 

18 maternity care providers; 

19 (3) an appropriate number of maternity care 

20 providers in various health care disciplines to meet 

21 the maternity care needs of women with both low22 and high-risk pregnancies; 

23 (4) an appropriate sociodemographic diversity 

24 of the maternity care workforce; 


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1 (5) demographic composition and trends of 

2 childbearing families; and 

3 (6) demographic composition and trends (in4 cluding total hours worked per week, number of 

5 years of providing maternity care, and willingness to 

6 provide care at night and on weekends) of the work7 force that serves childbearing families. 

8 (b) REPORT.—Not later than 18 months after the 

9 date of the enactment of this Act, the National Health 

10 Care Workforce Commission shall complete the assess11 ment under subsection (a) and submit a report on the re12 sults of such assessment to the Congress. 

13 SEC. 205. ALLOCATION OF FUNDS FOR MATERNITY CARE 

14 WORKFORCE DEVELOPMENT. 

15 Section 740 of the Public Health Service Act (42 

16 U.S.C. 293d) is amended— 

17 (1) by redesignating subsection (d) as sub18 section (e); and 

19 (2) by inserting after subsection (c) the fol20 lowing: 

21 ‘‘(d) ACTIVITIES RELATING TO MATERNITY CARE

22 WORKFORCE.—Of the amounts made available to carry 

23 out sections 737, 738, and 739 for fiscal year 2013 and 

24 each succeeding fiscal year, the Secretary shall allocate a 

25 percentage (to be determined by the Secretary) of such 


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1 amounts for activities relating to maternity care workforce 

2 development under such sections.’’. 

3 TITLE III—ADDRESSING MATER4 NAL HEALTH DISPARITIES 

5 SEC. 301. CDC CENTERS FOR RESEARCH AND DEMONSTRA6 TION OF HEALTH PROMOTION AND DISEASE 

7 PREVENTION. 

8 Paragraph (2) of section 1706(b) of the Public 

9 Health Service Act (42 U.S.C. 300u–5(b)) is amended— 

10 (1) in subparagraph (B), by striking ‘‘and’’ at 

11 the end; 

12 (2) in subparagraph (C) by striking the period 

13 at the end and inserting ‘‘; and’’; and 

14 (3) by adding at the end the following: 

15 ‘‘(D) community-based participatory re16 search on maternal and infant health, focusing 

17 on disparities in maternal and infant health.’’. 

18 SEC. 302. GRANTS TO SUPPORT A DIVERSIFIED MATERNITY 

19 CARE WORKFORCE. 

20 (a) IN GENERAL.—The Secretary may award grants 

21 to eligible entities or consortia to carry out demonstration 

22 projects to increase recruitment of underrepresented mi23 norities into the maternity care professions. Such awards 

24 shall be made on a competitive basis and pursuant to peer 

25 review. 


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1 (b) ELIGIBILITY.—To be eligible to receive a grant 

2 under this section, an entity or consortium shall be or in3 clude— 

4 (1) a health professions school; 

5 (2) an institution with a graduate medical edu6 cation program; 

7 (3) a hospital; 

8 (4) a community health center; 

9 (5) a freestanding birth center; 

10 (6) a public health department clinic; 

11 (7) a nonprofit professional organization; or 

12 (8) another type of institution specified by the 

13 Secretary. 

14 (c) APPLICATION.—To seek a grant under subsection 

15 (a) for a demonstration project, an entity or consortium 

16 shall submit to the Secretary an application that includes 

17 each of the following: 

18 (1) A plan for carrying out the demonstration 

19 project, including by performing one or more of the 

20 following: 

21 (A) Strengthening recruitment, education, 

22 retention, and mentoring of underrepresented 

23 minorities. 


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1 (B) Increasing the racial, ethnic, geo2 graphic, linguistic, and socioeconomic diversity 

3 of the maternity care workforce. 

4 (C) Engaging in early outreach to students 

5 in elementary and secondary schools in dis6 parity communities about maternity care ca7 reers. 

8 (D) Creating assistance programs in com9 munity colleges and other institutions of higher 

10 learning to support low-income students and 

11 students from underrepresented backgrounds 

12 who wish to become maternity caregivers. Such 

13 assistance programs may include the provision 

14 of grants, scholarships, housing stipends, health 

15 insurance for students and their families, and 

16 childcare services for student-parents. 

17 (E) Establishing community-based doula, 

18 childbirth educator, and peer breastfeeding 

19 counselor training programs for women in un20 derserved communities. 

21 (2) An agreement to provide for the collection 

22 of data regarding the effectiveness of the demonstra23 tion project. 

24 (3) An agreement to provide matching funds in 

25 accordance with subsection (d). 


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1 (d) MATCHING FUNDS.— 

2 (1) IN GENERAL.—The Secretary may award a 

3 grant to an entity or consortium under this section 

4 only if the entity or consortium agrees to make 

5 available non-Federal contributions toward the costs 

6 of the project to be funded under the grant in an 

7 amount that is not less than $1 for each $5 of Fed8 eral funds provided through the grant. 

9 (2) NON-FEDERAL CONTRIBUTIONS.—Non-Fed10 eral contributions under paragraph (1) may be in 

11 cash or in-kind, fairly evaluated, including equip12 ment or services. Amounts provided by the Federal 

13 Government, or services assisted or subsidized to 

14 any significant extent by the Federal Government, 

15 may not be included in determining the amount of 

16 such contributions. 

17 (e) EVALUATION.—The Secretary shall take such ac18 tion as may be necessary to— 

19 (1) evaluate the projects funded under this sec20 tion; and 

21 (2) make publicly available, publish, and dis22 seminate the results of such evaluation as widely as 

23 practicable. 

24 (f) REPORTS.—Not later than 2 years after the date 

25 of enactment of this section, and annually thereafter, the 


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1 Secretary shall submit to the Committee on Health, Edu2 cation, Labor, and Pensions and the Committee on Fi3 nance of the Senate and the Committee on Energy and 

4 Commerce and the Committee on Ways and Means of the 

5 House of Representatives a report that— 

6 (1) describes the specific projects supported 

7 under this section; and 

8 (2) contains recommendations for Congress 

9 based on the evaluation conducted under subsection 

10 (e). 

11 (g) DEFINITION.—In this section, the term ‘‘Sec12 retary’’ means the Secretary of Health and Human Serv13 ices. 

14 TITLE IV—COORDINATION OF 

15 MATERNITY CARE 

16 SEC. 401. MATERNAL HEALTH COORDINATOR. 

17 Title III of the Public Health Service Act is amend18 ed— 

19 (1) by redesignating section 317K (42 U.S.C. 

20 247b–12) as section 317K–1; and 

21 (2) by inserting after section 317J the fol22 lowing: 


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1 ‘‘SEC. 317K. COORDINATION OF MATERNAL HEALTH PRO2 GRAMS AND ACTIVITIES. 

3 ‘‘The Secretary shall designate an official within the 

4 Office of the Secretary whose primary responsibility shall 

5 be to coordinate the programs and activities of the Depart6 ment of Health and Human Services relating to maternal 

7 health.’’. 

Æ 


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