retary shall, through a contract with an inde-
pendent research organization, conduct a study 
on strategies to address— 
(i) racism or bias on the basis of race, 
ethnicity, or another protected class in the 
delivery of maternity care services; and 
(ii) successful implementation of re-
spectful care initiatives. 
(B) COMPONENTS OF STUDY.—The study 
shall include the following: 
(i) An assessment of the reports sub-
mitted to the Secretary from the respectful 
maternity care compliance programs pur-
suant to subsection (b)(5). 
(ii) Based on such assessment, rec-
ommendations for potential accountability 
mechanisms related to cases of racism or 
bias on the basis of race, ethnicity, or an-
other protected class in the delivery of ma-
ternity care services at hospitals and other 
birth settings. Such recommendations shall 
take into consideration medical and non- 
medical factors that contribute to adverse 
patient experiences and maternal health 
outcomes. 
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(C) REPORT.—The Secretary shall submit 
to the Congress and make publicly available a 
report on the results of the study under this 
paragraph. 
(d) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there is authorized to be appropriated 
such sums as may be necessary for fiscal years 2022 
through 2027. 
SEC. 7. GAO REPORT. 
(a) IN GENERAL.—Not later than 2 years after the 
date of enactment of this Act and annually thereafter, the 
Comptroller General of the United States shall submit to 
the Congress and make publicly available a report on the 
establishment of respectful maternity care compliance pro-
grams within hospitals, health systems, and other mater-
nity care settings. 
(b) MATTERS INCLUDED.—The report under para-
graph (1) shall include the following: 
(1) Information regarding the extent to which 
hospitals, health systems, and other maternity care 
settings have elected to establish respectful mater-
nity care compliance programs, including— 
(A) which hospitals and other birth set-
tings elect to establish compliance programs 
and when such programs are established; 
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(B) to the extent practicable, impacts of 
the establishment of such programs on mater-
nal health outcomes and patient and family ex-
periences in the hospitals and other birth set-
tings that have established such programs, es-
pecially for patients from racial and ethnic mi-
nority groups and their families; 
(C) information on geographic areas, and 
types of hospitals or other birth settings, where 
respectful maternity care compliance programs 
are not being established and information on 
factors contributing to decisions to not establish 
such programs; and 
(D) recommendations for establishing re-
spectful maternity care compliance programs in 
geographic areas, and types of hospitals or 
other birth settings, where such programs are 
not being established. 
(2) Whether the funding made available to 
carry out this section has been sufficient and, if ap-
plicable, recommendations for additional appropria-
tions to carry out this section. 
(3) Such other information as the Comptroller 
General determines appropriate. 
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SEC. 8. DEFINITIONS. 
In this Act: 
(1) CULTURALLY CONGRUENT.—The term ‘‘cul-
turally congruent’’, with respect to care or maternity 
care, means care that is in agreement with the pre-
ferred cultural values, beliefs, worldview, language, 
and practices of the health care consumer and other 
stakeholders. 
(2) MATERNITY
CARE
PROVIDER.—The term 
‘‘maternity care provider’’ means a health care pro-
vider who— 
(A) is a physician, physician assistant, 
midwife who meets at a minimum the inter-
national definition of the midwife and global 
standards for midwifery education as estab-
lished by the International Confederation of 
Midwives, nurse practitioner, or clinical nurse 
specialist; and 
(B) has a focus on maternal or perinatal 
health. 
(3) MATERNAL MORTALITY.—The term ‘‘mater-
nal mortality’’ means a death occurring during or 
within a one-year period after pregnancy, caused by 
pregnancy-related or childbirth complications, in-
cluding a suicide, overdose, or other death resulting 
from a mental health or substance use disorder at-
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tributed to or aggravated by pregnancy-related or 
childbirth complications. 
(4) PERINATAL HEALTH WORKER.—The term 
‘‘perinatal health worker’’ means a doula, commu-
nity health worker, peer supporter, breastfeeding 
and lactation educator or counselor, nutritionist or 
dietitian, childbirth educator, social worker, home 
visitor, language interpreter, or navigator. 
(5) POSTPARTUM AND POSTPARTUM PERIOD.— 
The terms ‘‘postpartum’’ and ‘‘postpartum period’’ 
refer to the 1-year period beginning on the last day 
of the pregnancy of an individual. 
(6) 
PREGNANCY-ASSOCIATED
DEATH.—The 
term ‘‘pregnancy-associated death’’ means a death of 
a pregnant or postpartum individual, by any cause, 
that occurs during, or within 1 year following, the 
individual’s pregnancy, regardless of the outcome, 
duration, or site of the pregnancy. 
(7) PREGNANCY-RELATED
DEATH.—The term 
‘‘pregnancy-related death’’ means a death of a preg-
nant or postpartum individual that occurs during, or 
within 1 year following, the individual’s pregnancy, 
from a pregnancy complication, a chain of events 
initiated by pregnancy, or the aggravation of an un-
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related condition by the physiologic effects of preg-
nancy. 
(8) RACIAL AND ETHNIC MINORITY GROUP.— 
The term ‘‘racial and ethnic minority group’’ has the 
meaning given such term in section 1707(g)(1) of 
the Public Health Service Act (42 U.S.C. 300u– 
6(g)(1)). 
(9) SEVERE MATERNAL MORBIDITY.—The term 
‘‘severe maternal morbidity’’ means a health condi-
tion, including mental health conditions and sub-
stance use disorders, attributed to or aggravated by 
pregnancy or childbirth that results in significant 
short-term or long-term consequences to the health 
of the individual who was pregnant. 
(10) SOCIAL
DETERMINANTS
OF
MATERNAL 
HEALTH DEFINED.—The term ‘‘social determinants 
of maternal health’’ means non-clinical factors that 
impact maternal health outcomes, including— 
(A) economic factors, which may include 
poverty, employment, food security, support for 
and access to lactation and other infant feeding 
options, housing stability, and related factors; 
(B) neighborhood factors, which may in-
clude quality of housing, access to transpor-
tation, access to child care, availability of 
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healthy foods and nutrition counseling, avail-
ability of clean water, air and water quality, 
ambient temperatures, neighborhood crime and 
violence, access to broadband, and related fac-
tors; 
(C) social and community factors, which 
may include systemic racism, gender discrimi-
nation or discrimination based on other pro-
tected classes, workplace conditions, incarcer-
ation, and related factors; 
(D) household factors, which may include 
ability to conduct lead testing and abatement, 
car seat installation, indoor air temperatures, 
and related factors; 
(E) education access and quality factors, 
which may include educational attainment, lan-
guage and literacy, and related factors; and 
(F) health care access factors, including 
health insurance coverage, access to culturally 
congruent health care services, providers, and 
non-clinical support, access to home visiting 
services, access to wellness and stress manage-
ment programs, health literacy, access to tele-
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health and items required to receive telehealth 
services, and related factors. 
Æ 
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