(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
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. 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 INTERPROFESSIONAL MATERNITY 
WORKFORCE 
Sec. 301. Development of interprofessional maternity care educational models 
and tools. 
Sec. 302. Interprofessional training of medical students, residents, and student 
midwives in academic health centers and freestanding birth 
centers. 
Sec. 303. 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 and the maternal mortality rate in the 
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United States has roughly doubled in the past 
25 years. According to data released in 2010, 
the maternal mortality ratio was 12.7 percent 
as compared to 6.6 percent in 1987. 
(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: 
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(A) Despite five years of modest reduction 
in pre-term births between 2006 and 2011, the 
United States continues to lag behind most 
other countries in pre-term birth rates, ranking 
131 out of 184 countries, according to a 2011 
report by the March of Dimes and the World 
Health Organization. 
(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. 
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(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 
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 
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the United States in 2009, nearly one in four 
were childbearing women and newborns. 
(B) Combined mother and baby charges 
for hospitalization, which was $98,000,000,000 
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 
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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 
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 during pregnancy and exter-
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nal version to turn breech babies at term, have 
strong proven correlation with considerable improve-
ment in outcomes with no detrimental side effects, 
but are significantly underused in the United States. 
(9) There is a growing body of evidence that 
other non-invasive practices which are underused in 
current practice may also be associated with im-
proved outcomes. These non-invasive practices in-
clude group model prenatal care (such as the 
CenteringPregnancy model), continuous labor sup-
port, and non-supine positions for birth. 
(10) 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. 
(11) 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. 
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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 
(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 
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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 incorporating non-invasive, 
evidence-based practices that have documented 
correlation with considerable improvement in 
outcomes with no detrimental side effects, such 
as smoking cessation programs in pregnancy 
and proven models of group prenatal care that 
integrate health assessment, education, and 
support into a unified program; 
‘‘(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; 
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‘‘(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) high-quality, evidence-based child-
birth education that promotes a natural, 
healthy, and safe approach to pregnancy, child-
birth, and early parenting; is taught by certified 
educators, peer counselors, and health profes-
sionals; and promotes informed decisionmaking 
by childbearing women.’’. 
SEC. 102. INTERAGENCY COORDINATING COMMITTEE ON 
THE PROMOTION OF OPTIMAL MATERNITY 
OUTCOMES. 
(a) IN GENERAL.—Part A of title II of the Public 
Health Service Act (42 U.S.C. 202 et seq.) is amended 
by adding at the end the following new section: 
‘‘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-
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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 
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, 
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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 
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; 
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‘‘(iii) uncomplicated cesarean birth; 
and 
‘‘(iv) complicated cesarean birth. 
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated, in addition to such 
amounts authorized to be appropriated under section 
229(e), to carry out this section $1,000,000 for each of 
the fiscal years 2014 through 2018.’’. 
(b) CONFORMING AMENDMENTS.— 
(1) INCLUSION AS DUTY OF HHS OFFICE ON 
WOMEN’S HEALTH.—Section 229(b) of such Act (42 
U.S.C. 237a(b)), as amended by section 101, is 
amended— 
(A) in paragraph (7), at the end, by strik-
ing ‘‘and’’; 
(B) in paragraph (8), at the end, by strik-
ing the period and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
paragraph: 
‘‘(9) establish the Interagency Coordinating 
Committee on the Promotion of Optimal Maternity 
Outcomes in accordance with section 229A.’’. 
(2) TREATMENT OF BIENNIAL REPORTS.—Sec-
tion 229(d) of such Act (42 U.S.C. 237a(d)) is 
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amended by inserting ‘‘(other than under subsection 
(b)(9))’’ after ‘‘under this section’’. 
SEC. 103. CONSUMER EDUCATION CAMPAIGN. 
Section 229 of the Public Health Service Act (42 
U.S.C. 237a), as amended by sections 101 and 102, is 
further amended— 
(1) in subsection (b)— 
(A) in paragraph (8), at the end, by strik-
ing ‘‘and’’; 
(B) in paragraph (9), at the end, by strik-
ing the period and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
paragraph: 
‘‘(10) not later than one year after the date of 
the enactment of the MOMS for the 21st Century 
Act, develop and implement a 4-year culturally and 
linguistically appropriate multi-media consumer edu-
cation campaign to promote understanding and ac-
ceptance of evidence based maternity practices and 
models of care for optimal maternity outcomes 
among women of childbearing ages and families of 
such women and that— 
‘‘(A) highlights the importance of pro-
tecting, promoting, and supporting the innate 
capacities of childbearing women and their 
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newborns for childbirth, breast-feeding, and at-
tachment; 
‘‘(B) promotes understanding of the impor-
tance of using obstetric interventions when 
medically necessary and when supported by 
strong, high-quality evidence; 
‘‘(C) highlights the widespread overuse of 
maternity practices that have been shown to 
have benefit when used appropriately in situa-
tions of medical necessity, but which can expose 
women, infants, or both to risk of harm if used 
routinely and indiscriminately, including contin-
uous fetal monitoring, labor induction, epidural 
anesthesia, elective primary cesarean section, 
and repeat cesarean delivery; 
‘‘(D) emphasizes the non-invasive mater-
nity practices that have strong proven correla-
tion or may be associated with considerable im-
provement in outcomes with no detrimental side 
effects, and are significantly underused in the 
United States, including smoking cessation pro-
grams in pregnancy, group model prenatal care, 
continuous labor support, non-supine positions 
for birth, and external version to turn breech 
babies at term; 
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‘‘(E) educates consumers about the quali-
fications of licensed providers of maternity care 
and the best evidence about their safety, satis-
faction, outcomes, and costs; 
‘‘(F) informs consumers about the best 
available research comparing birth center 
births, planned home births, and hospital 
births, including information about each set-
ting’s safety, satisfaction, outcomes, and costs; 
‘‘(G) fosters participation in high-quality, 
evidence-based childbirth education that pro-
motes a natural, healthy, and safe approach to 
pregnancy, childbirth, and early parenting; is 
taught by certified educators, peer counselors, 
and health professionals; and promotes in-
formed decisionmaking by childbearing women; 
and 
‘‘(H) is pilot tested for consumer com-
prehension, cultural sensitivity, and acceptance 
of the messages across geographically, racially, 
ethnically, and linguistically diverse popu-
lations.’’. 
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SEC. 104. BIBLIOGRAPHIC DATABASE OF SYSTEMATIC RE-
VIEWS FOR CARE OF CHILDBEARING WOMEN 
AND NEWBORNS. 
(a) IN GENERAL.—Not later than one year after the 
date of the enactment of this Act, the Secretary of Health 
and Human Services, through the Agency for Healthcare 
Research and Quality, shall— 
(1) make publicly available an online biblio-
graphic database identifying systematic reviews, in-
cluding an explanation of the level and quality of 
evidence, for care of childbearing women and 
newborns; and 
(2) initiate regular updates that incorporate 
newly issued and updated systematic reviews. 
(b) SOURCES.—To aim for a comprehensive inventory 
of systematic reviews relevant to maternal and newborn 
care, the database shall identify reviews from diverse 
sources, including— 
(1) scientific peer-reviewed journals; 
(2) databases, including Cochrane Database of 
Systematic Reviews, Clinical Evidence, and Data-
base of Abstracts of Reviews of Effects; and 
(3) Internet Web sites of agencies and organi-
zations throughout the world that produce such sys-
tematic reviews. 
(c) FEATURES.—The database shall— 
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