I 
112TH CONGRESS 
1ST SESSION H. R. 2141 
To promote optimal maternity outcomes by making evidence-based maternity 
care a national priority, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 3, 2011 
Ms. ROYBAL-ALLARD introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committee 
on Ways and Means, for a period to be subsequently determined by the 
Speaker, in each case for consideration of such provisions as fall within 
the jurisdiction of the committee concerned 
A BILL 
To promote optimal maternity outcomes by making evidence- 
based maternity care a national priority, and for other 
purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Maximizing Optimal Maternity Services for the 21st 
Century’’ or the ‘‘MOMS for the 21st Century Act’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
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Sec. 1. Short title; table of contents. 
Sec. 2. Findings. 
TITLE I—HHS FOCUS ON THE PROMOTION OF OPTIMAL 
MATERNITY CARE 
Sec. 101. Additional focus area for the Office on Women’s Health. 
Sec. 102. Interagency Coordinating Committee on the Promotion of Optimal 
Maternity Outcomes. 
‘‘Sec. 229A. Interagency Coordinating Committee on the Promotion of Op-
timal Maternity Outcomes. 
Sec. 103. Consumer education campaign. 
Sec. 104. Bibliographic database of systematic reviews for care of childbearing 
women and newborns. 
TITLE II—RESEARCH AND DATA COLLECTION ON MATERNITY 
CARE 
Sec. 201. Maternity care health professional shortage areas. 
Sec. 202. Expansion of CDC Prevention Research Centers program to include 
Centers on Optimal Maternity Outcomes. 
Sec. 203. Expanding models to be tested by Center for Medicare and Medicaid 
Innovation to include maternity care models. 
TITLE III—ENHANCEMENT OF A GEOGRAPHICALLY, RACIALLY, 
AND ETHNICALLY DIVERSE INTERDISCIPLINARY MATERNITY 
WORKFORCE 
Sec. 301. Development of interdisciplinary maternity care provider core cur-
ricula. 
Sec. 302. Interdisciplinary training of medical students, residents, and student 
midwives in academic health centers. 
Sec. 303. Loan repayments for maternal care professionals. 
Sec. 304. Grants to professional organizations to increase diversity in maternity 
care professionals. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) Maternity expenditures in the United States 
surpass all other developed countries, but childbirth 
continues to carry significant risks for mothers in 
the United States, as demonstrated by the following: 
(A) More than two women die every day in 
the United States from pregnancy-related 
causes. 
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(B) More than one-third of all women who 
give birth in the United States (1,700,000 
women each year) experience some type of com-
plication that has an adverse effect on their 
health. 
(C) Severe complications that result in 
women nearly dying, known as a ‘‘near miss’’ 
or severe morbidity, increased by 25 percent be-
tween 1998 and 2005, to approximately 34,000 
cases a year. 
(D) African-American women have nearly 
a four times greater risk of dying from preg-
nancy-related complications than White women, 
and these disparities have not improved in 50 
years. 
(2) In spite of the considerable investment of 
the United States in maternity care, the United 
States is failing to ensure that all infants have a 
healthy start in life, as demonstrated by the fol-
lowing: 
(A) The national rate of pre-term birth in-
creased by 36 percent in the quarter-century 
from 1981 to 2006. Despite a very modest re-
duction in pre-term births between 2006 and 
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2008, rates remain 31 percent higher than in 
1981. 
(B) The proportion of low birth weight ba-
bies increased by 21 percent between 1981 and 
2008. 
(C) Non-Hispanic Black infants continue 
to experience significantly higher rates of both 
pre-term birth and low birthweight, two of the 
leading causes of infant mortality in this coun-
try. 
(3) Despite shortcomings in the United States 
statewide data collections systems, which make 
international comparisons more challenging, inter-
national health organizations have ranked the 
United States far behind almost all developed coun-
tries in important perinatal and maternal outcomes, 
as demonstrated by the following: 
(A) The World Health Organization identi-
fied 49 nations with lower rates of maternal 
deaths than the United States in 2008. 
(B) In the World Health Report 2005, the 
World Health Organization identified 35 na-
tions with lower early neonatal mortality rates 
(4/1,000 live births) and 33 with lower neonatal 
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mortality rates (5/1,000 live births) than the 
United States. 
(C) 
According 
to 
data 
from 
the 
Organisation for Economic Co-operation and 
Development (OECD), 26 countries (out of 29 
reporting) had low birthweight rates lower than 
that of the United States. 
(D) 21 OECD countries (out of 27 report-
ing) had lower cesarean section rates than the 
United States. 
(4) Maternity care is a major component of the 
escalating health care costs in the United States, as 
demonstrated by the following: 
(A) With 4,000,000 deliveries yearly, the 
vast majority of which occur in hospitals, ma-
ternity care for mothers and their newborns is 
the number one reason for hospitalization in the 
United States, exceeding such prevalent condi-
tions as pneumonia, cancer, fracture, and heart 
disease. Of those discharged from hospitals in 
the United States in 2008, nearly one in four 
were childbearing women and newborns. 
(B) Combined mother and baby charges 
for hospitalization, which was $98,000,000,000 
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in 2008, far exceeded charges for any other 
hospital condition in the United States. 
(5) Maternity care also accounts for a signifi-
cant proportion of expenditures under the Medicaid 
program, which covers 42 percent of births in this 
country, as demonstrated by the following: 
(A) In 2008, 26 percent of all hospital 
charges for which payment was made under the 
Medicaid program (totaling $41,000,000,000) 
was for birthing women and newborns. 
(B) The two most common conditions for 
which payments were made under the Medicaid 
program in 2007 were pregnancy and childbirth 
(constituting 28 percent of such payments) and 
newborns (constituting 26 percent of such pay-
ments), which together accounted for 53 per-
cent of hospital discharges billed to Medicaid. 
(C) The two most costly conditions for 
which payment was made under the Medicaid 
program in 2008 were ‘‘mother’s pregnancy and 
delivery’’ and care for ‘‘newborn infants’’, which 
together accounted for 26 percent of all Med-
icaid expenditures. 
(6) Maternity care facility charges vary signifi-
cantly by setting and type of birth. Part of the 
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charge differentials between facilities are attrib-
utable to high overhead of hospitals— 
(A) in 2008, the average charge for a hos-
pital cesarean birth with complications was 
$20,080, 
and 
without 
complications 
was 
$14,900; 
(B) in 2008, the average charge for a hos-
pital vaginal birth with complications was 
$11,410, 
and 
without 
complications 
was 
$8,920; and 
(C) in 2010, the average charge for a birth 
center vaginal birth was $2,277. 
(7) The procedure-intensity of birth-related hos-
pital stays also helps to explain the high costs of 
such hospital stays. In 2008, 6 of the 10 most com-
monly performed hospital procedures for all patients 
with all diagnoses involved childbirth and newborn 
care. Cesarean section was the most common oper-
ating room procedure. 
(8) Two non-invasive maternity practices, smok-
ing cessation programs in pregnancy and external 
version to turn breech babies at term, have strong 
proven correlation with considerable improvement in 
outcomes with no detrimental side effects, but are 
significantly underused in the United States. Other 
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non-invasive practices which are underused in cur-
rent practice and may be associated with improved 
outcomes include group model prenatal care, contin-
uous labor support, and non-supine positions for 
birth. 
(9) The growing shortage of maternity health 
care professionals and childbirth facilities is creating 
a serious obstacle to timely and adequate maternity 
health care for women, particularly in rural areas 
and the inner cities. 
(10) There are significant racial and ethnic dis-
parities across the maternity care workforce creating 
additional access barriers to culturally and linguis-
tically competent maternity services. 
TITLE I—HHS FOCUS ON THE 
PROMOTION OF OPTIMAL MA-
TERNITY CARE 
SEC. 101. ADDITIONAL FOCUS AREA FOR THE OFFICE ON 
WOMEN’S HEALTH. 
Section 229(b) of the Public Health Service Act (42 
U.S.C. 237a(b)) is amended— 
(1) in paragraph (6), at the end, by striking 
‘‘and’’; 
(2) in paragraph (7), at the end, by striking the 
period and inserting ‘‘; and’’; and 
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(3) by adding at the end the following new 
paragraph: 
‘‘(8) facilitate policy makers, health system 
leaders and providers, consumers, and other stake-
holders in their understanding optimal maternity 
care and support for the provision of such care, in-
cluding the priorities of— 
‘‘(A) protecting, promoting, and supporting 
the innate capacities of childbearing women and 
their newborns for childbirth, breast-feeding, 
and attachment; 
‘‘(B) using obstetric interventions only 
when such interventions are supported by 
strong, high-quality evidence, and minimizing 
overuse of maternity practices that have been 
shown to have benefit in limited situations and 
that can expose women, infants, or both to risk 
of harm if used routinely and indiscriminately, 
including continuous electronic fetal monitoring, 
labor induction, epidural analgesia, primary ce-
sarean section, and routine repeat cesarean 
birth; 
‘‘(C) reliably providing beneficial practices 
with no or minimal evidence of harm that are 
underused, including smoking cessation pro-
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grams in pregnancy, group model prenatal care, 
continuous labor support, non-supine positions 
for birth, and external version to turn breech 
babies at term; 
‘‘(D) a shared understanding of the quali-
fications of licensed providers of maternity care 
and the best evidence about the safety, satisfac-
tion, outcomes, and costs of their care, and ap-
propriate deployment of such caregivers within 
the maternity care workforce to address the 
needs of childbearing women and newborns and 
the growing shortage of maternity caregivers; 
‘‘(E) a shared understanding of the results 
of the best available research comparing hos-
pital, birth center, and planned home births, in-
cluding information about each setting’s safety, 
satisfaction, outcomes, and costs; and 
‘‘(F) informed decisionmaking by child-
bearing women.’’. 
SEC. 102. INTERAGENCY COORDINATING COMMITTEE ON 
THE PROMOTION OF OPTIMAL MATERNITY 
OUTCOMES. 
(a) IN GENERAL.—Part B of title II of the Public 
Health Service Act is amended by adding at the end the 
following new section: 
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‘‘SEC. 229A. INTERAGENCY COORDINATING COMMITTEE ON 
THE PROMOTION OF OPTIMAL MATERNITY 
OUTCOMES. 
‘‘(a) IN GENERAL.—The Secretary of Health and 
Human Services, acting through the Deputy Assistant 
Secretary for Women’s Health under section 229 and in 
collaboration with the Federal officials specified in sub-
section (b), shall establish the Interagency Coordinating 
Committee on the Promotion of Optimal Maternity Out-
comes (referred to in this subsection as the ‘ICCPOM’). 
‘‘(b) OTHER AGENCIES.—The officials specified in 
this subsection are the Secretary of Labor, the Secretary 
of Defense, the Secretary of Veterans Affairs, the Surgeon 
General, the Director of the Centers for Disease Control 
and Prevention, the Administrator of the Health Re-
sources and Services Agency, the Administrator of the 
Centers for Medicare & Medicaid Services, the Director 
of the Indian Health Service, the Administrator of the 
Substance Abuse and Mental Health Services Administra-
tion, the Director of the National Institute on Child 
Health and Development, the Director of the Agency for 
Healthcare Research and Quality, the Assistant Secretary 
for Children and Families, the Deputy Assistant Secretary 
for Minority Health, the Director of the Office of Per-
sonnel Management, and such other Federal officials as 
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the Secretary of Health and Human Services determines 
to be appropriate. 
‘‘(c) CHAIR.—The Deputy Assistant Secretary for 
Women’s Health shall serve as the chair of the ICCPOM. 
‘‘(d) DUTIES.—The ICCPOM shall guide policy and 
program development across the Federal Government with 
respect to promotion of optimal maternity care, provided, 
however, that nothing in this section shall be construed 
as transferring regulatory or program authority from an 
Agency to the Coordinating Committee. 
‘‘(e) CONSULTATIONS.—The ICCPOM shall actively 
seek the input of, and shall consult with, all appropriate 
and interested stakeholders, including State Health De-
partments, public health research and interest groups, 
foundations, childbearing women and their advocates, and 
maternity care professional associations and organiza-
tions, reflecting racially, ethnically, demographically, and 
geographically diverse communities. 
‘‘(f) ANNUAL REPORT.— 
‘‘(1) IN GENERAL.—The Secretary, on behalf of 
the ICCPOM, shall annually submit to Congress a 
report that summarizes— 
‘‘(A) all programs and policies of Federal 
agencies (including the Medicare program 
under title XVIII of the Social Security Act and 
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the Medicaid program under title XIX of such 
Act) designed to promote optimal maternity 
care, focusing particularly on programs and 
policies that support the adoption of evidence 
based maternity care, as defined by timely, sci-
entifically sound systematic reviews; 
‘‘(B) all programs and policies of Federal 
agencies (including the Medicare program 
under title XVIII of the Social Security Act and 
the Medicaid program under title XIX of such 
Act) designed to address the problems of mater-
nal mortality and infant mortality, prematurity, 
and low birth weight; 
‘‘(C) the extent of progress in reducing 
maternal mortality and infant mortality, low 
birth weight, and prematurity at State and na-
tional levels; and 
‘‘(D) such other information regarding op-
timal maternity care as the Secretary deter-
mines to be appropriate. 
The information specified in subparagraph (C) shall 
be included in each such report in a manner that 
disaggregates such information by race, ethnicity, 
and indigenous status in order to determine the ex-
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