I 118th CONGRESS 1st Session H. R. 6746 IN THE HOUSE OF REPRESENTATIVES December 13, 2023 Ms. Caraveo (for herself, Ms. Budzinski , Ms. Sewell , Ms. Clarke of New York , Ms. Pettersen , Mr. Carter of Louisiana , Mr. Grijalva , Mr. Davis of North Carolina , and Mr. García of Illinois ) introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To amend the Public Health Service Act to provide for a public awareness campaign with respect to iron deficiency.

1. Short title This Act may be cited as the Iron Deficiency Education and Awareness Act . 2. Findings Congress finds the following: (1) Iron deficiency occurs when there are insufficient amounts of iron in the body. Without enough iron, the body cannot produce sufficient amounts of hemoglobin, which is the protein that enables red blood cells to carry oxygen. (2) Menstrual bleeding and pregnancy are major reasons for lower levels of iron in the body. The symptoms of iron deficiency include fatigue, cold extremities, hair loss, cognitive issues, shortness of breath, headaches, and sleep disorders. (3) Iron deficiency often goes undiagnosed due to difficulty recognizing symptoms and lack of urgency in diagnosing. When left untreated, the condition can progress to iron-deficiency anemia. This may increase the risk of developing organ complications, such as an abnormally fast heartbeat, or tachycardia, and heart failure. (4) Among pregnant women, iron deficiency and iron-deficiency anemia has been linked to increased maternal illness, premature birth and low birth weight among babies, and intrauterine growth restriction. (5) Approximately 35 percent of women of reproductive age in the United States do not have a sufficient amount of iron in their bodies. Additionally, nearly 40 percent of girls and young women ages 12 to 21 are affected by iron deficiency, and 6 percent are iron-deficient anemic. (6) Children under the age of two are at a high risk for iron deficiency. About 6 percent of children ages 1–2 have iron deficiency. (7) Eliminating barriers to awareness, education, and screening will assist in preventing and treating iron deficiency, iron deficiency anemia, and related health issues among women and children under the age of two. 3. Iron deficiency awareness campaign (a) In general Section 317 of the Public Health Service Act ( 42 U.S.C. 247b ) is amended by adding at the end the following: (o) Iron deficiency public awareness campaign (1) In general The Secretary shall carry out a national campaign to— (A) increase awareness of the importance of iron deficiency screening; (B) combat misconceptions about iron deficiency, including misconceptions in diagnosis and management of iron deficiency; (C) increase awareness about missed diagnoses due to inadequate screening tests; and (D) increase iron deficiency screening among women and children under the age of two. (2) Consultation In carrying out the national campaign required by paragraph (1), the Secretary shall consult with the National Academy of Medicine, health care providers, public health associations, nonprofit organizations, State and local public health departments, and institutions of higher education to solicit advice on evidence-based information for policy development and program development, implementation, and evaluation. (3) Requirements The national campaign required by paragraph (1) shall— (A) include the use of evidence-based media and public engagement; (B) be carried out through competitive grants or cooperative agreements awarded to 1 or more private, nonprofit entities with a history developing and implementing similar campaigns; (C) include the development of culturally and linguistically competent resources that shall be tailored for— (i) women who are pregnant, recently gave birth, or are breastfeeding; (ii) women who menstruate, especially if menstrual periods are heavy; (iii) women who have undergone major surgery or physical trauma; (iv) women with limited English proficiency; (v) women with gastrointestinal diseases, such as Celiac disease and inflammatory bowel diseases such as ulcerative colitis and Crohn’s disease; (vi) women with peptic ulcer disease; (vii) populations with a high prevalence of iron deficiency (such as Black and Hispanic women); (viii) parents with children under the age of two; (ix) rural communities; and (x) such other communities as the Secretary determines appropriate; (D) include the dissemination of iron deficiency information and communication resources to health care providers and health care facilities (including pediatricians, primary care providers, community health centers, dentists, obstetricians, and gynecologists), State and local public health departments, elementary and secondary schools, child care centers, and colleges and universities; (E) be complementary to, and coordinated with, any other Federal efforts with respect to iron deficiency awareness; (F) include message testing to identify culturally competent and effective messages for behavioral change; and (G) include the award of grants or cooperative agreements to State, local, and Tribal public health departments to engage with— (i) communities specified in subparagraph (C); (ii) local educational agencies; (iii) health care providers; (iv) community organizations; or (v) other groups the Secretary determines are appropriate to develop and deliver effective strategies to decrease iron deficiency rates. (4) Options for dissemination of information The national campaign required by paragraph (1) may— (A) include the use of— (i) social media, television, radio, print, the internet, and other media; (ii) in-person or virtual public communications; and (iii) recognized, trusted figures; (B) be targeted to specific communities specified in paragraph (3)(C); and (C) include the dissemination of information highlighting— (i) appropriate screening for iron deficiency, including the recommended populations to be screened by age range or other criteria; (ii) the prevalence of iron deficiency; (iii) symptoms of iron deficiency; and (iv) mechanisms of preventing and managing iron deficiency. (5) Authorization of appropriations There is authorized to be appropriated to carry out this subsection $7,000,000 for each of fiscal years 2024 through 2028. . (b) Report to Congress (1) In general Not later than the end of fiscal year 2027, the Secretary of Health and Human Services shall submit to the Committee on Energy and Commerce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate a report on the campaign under section 317(o) of the Public Health Service Act, as added by subsection (a). (2) Qualitative assessment The report under paragraph (1) shall include a qualitative assessment of— (A) the overall campaign under section 317(o) of the Public Health Service Act, as added by subsection (a); and (B) the impacts of the activities conducted through the campaign, including such impacts on iron deficiency, and iron deficiency anemia, among women and children under the age of two.