tv House Ways and Means Hearing on Maternal Health Mortality CSPAN May 16, 2019 8:37pm-12:01am EDT
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>> olympian and gold medalist track and field athlete allison felix was among a group of witnesses testifying about the need to address the racial disparities with maternal health care. this house ways and means committee hearing was convened to discuss the high rate of mothers dying to do causes related to pregnancy or childbirth in the u.s. >> the committee will come to order. with over 700 women in america dying of pregnancy -related deaths each year experts view the united states is one of the most difficult places in the industrialized world to give birth. this should not be the case. pregnancy should be one of the happiest times in a woman's life, not an experience, based on fear. cdc estimates three fifths of pregnancy related deaths in america are preventable. the stunning reality is that
this parity between mortality rate between women of color and non-hispanic white women with women of color notably less likely to survive. sadly, african-american women are three-four times more likely to die from pregnancy -related convocations than white women. this racial disparity plays out across women of all income and educational backgrounds. problem is so common that i need not look further at the male staff personal experience. at 32 years old african-american attorney who works for the committee became pregnant with her third child. initially she and her family were excited but their joy turned to worry. shortly after her first trimester she fainted falling down a flight of steps. in the emergency room specialist determine her painting was the result of cardiac and other issues and admitted her to the intermediate care unit. she remained there for some time and after being discharged was placed on extended bedrest with post monitoring via a specialist
including in-home nursing care. during a doctor's visit at 35 weeks another convocation was discovered and she was admitted to hospital with a high risk unit in icu. within days specialist determine her life is at risk and child it to be delivered early. her daughter was born preterm at 36 weeks. my staff member was fortunate to have access to quality health care and a team of specialists caring for both her and her new daughter. every woman should have the same opportunity. as a nation, despite money directed toward medical care is not seen a complement or a reduction in illness or improvement in the overall healthcare of many americans. ideally, medical treatment and care in the united states would be closer to being equal for all but the reality is medical care tends to favor some people over others and pregnant women of color are at risk for issues and many other women are not.
for too long policy makers have failed to properly account for a range of personal, social and economic factors known as social determinants of health. [inaudible] they are a clear example of this problem. tremendous amount of research across the country and help us to combat this problem. congress has the tools to make real change in maternity care and eradicate these disparities and lowered them attorney mortality rate to stabilize. i want to thank ms. felix and my staff for sharing their personal stories to help me progress on this issue. i welcome our distinguished witnesses and look forward to their testimonies. with that, i recognize the ranking member, mr. brady, for an opening statement. >> inc. you, chairman neil. welcoming a new child into this world should be one of the most rewarding times in a woman's life and it's nearly impossible to put into words the joy that comes from seeing a new baby for the first time.
sadly, u.s. is one of the countries globally where the maternal mortality rate is on the rise and in other words, getting worse. as it did state more dangerous to give birth in america then it was two decades ago but according to senators for disease control it has increased 26% from the year 2000-2014. this means that for all women today they are more at risk of dying when giving birth than their mothers are and the statistics are even more alarming for women of color. african-american women are three-four times more likely to experience pregnancy related deaths than caucasian women. it's not entirely clear why maternal mortality and severe mobility is increased in the last but we all know one thing for certain. this is unacceptable. our country should be the healthcare leader of the world and in every single month deserve to know it will be in
safe hands or giving birth. his wife last year republicans on this committee and i is german launched an investigation into this dilemma. goal of our investigation is to find out why his death are happening, where congress can take action and how as a nation we can reverse this trend. legislative, we, together for the first time in program history we authorized maternal infant early childhood home visiting program for five years and asks states review those resources are deployed in the best target to mom, babies at risk. as of october 1201929 states will draw down matching funds met only by their contributions and expanding the reach of this successful intervention.
i applaud chairman neil for continuing our efforts on this tragic national issue and while today's hearing will solve the problem entirely i'm looking forward to working together for bipartisan solutions to support america's moms. recent investigations from advocacy groups have highlighted this growing issue. it is the has determined over 50000 moms experienced serious injury during child birthing experience and the chairman said 700 women died of pregnancy related convocations in the u.s. 60% of these deaths are preventable. regardless of race and ethnicity and regardless of when they occur. this statistic should force us all to pause because the truth is we know these findings most likely only scratch the surface. as a work toward solutions you first have to acknowledge there is a shortage of information on this problem. u.s. is deficient of consistent data reporting across states and we lack an official u.s. maternal mortality rate. without such information is more
difficult to identify the causes of this national problem and more data is needed in order to develop the appropriate response to this growing crisis. i know this firsthand and in texas and state legislator because of local constraints they had a baby born without a brain and took on the cause of creating a texas for the fax registry because all we realize is if we don't know when and where these but the facts are occurring we can't identify the cause and now more than two decades later we have better chances of healthy babies because we started with what we needed most, the right information at the right time. we also recognize areas to improve in our current system, particularly access to affordable care and sometimes strained doctor-patient relationships and need to examine geographical disparities, returning regarding maternal health. pregnant women in rural america face significant challenges including high poverty rates,
more chronic conditions all with less access to healthcare providers and in fact, than half of all rural counties currently in the hospital exist to provide maternity care forcing men women to drive hours to get to the closest hospital. this makes it more challenging for a woman to go into labor to get to the hospital on time. on top of this research found black and hispanic women report receiving discriminatory practices in the course of their prenatal care. that is just wrong. these are big issues with congress needs to address. with all hands on deck effort we can work to ensure best practices to address this issue and make sure that our minds are getting the care they deserve. republicans, we are glad to initiate the effort to investigate why art countries maternal mortality rate is so high and what lawmakers can do to remedy this. let's work together and continue the investigation because as our witnesses will attest today there is much more work to be done and i'm hopeful the
chairman working together in a bipartisan manner we can tackle this every mom will be secure in knowing she will be safe while giving birth. you, chairman. >> without objection, all members opening statements will be made a part of the record. before we move to witness testimony on to advise members we expect today's hearing to go long and do not expect votes to be called until after 5:00 p.m. therefore in order to accommodate member complex and to give our witnesses a break we will recess shortly before noon and probably reconvene at 1:00 o'clock. let's proceed to hearing from two of our members of the house. or first two witnesses and we will have two panels again be accompanied by other distinguished witnesses as well. we welcome our college. robin kelly is a democrat from the second district of illinois and congresswoman jamie herrera
is a republican from the third district of washington. each of your statements will be made part of the record in its entirety and ask you summarize testimony in five minutes or less. congressman kelly, please begin. >> you would think i know how to do this by now. [laughter] >> you are usually on the side. >> good morning. to my colleagues, my deepest appreciation for granting me time to testify today to talk about the complex issue of naming solutions that drive the maternal mortality. in terms of maternal health as you have heard the united states suffers from an alarming rate of maternal mortality. 700-900 american moms die every year more than any other developed nation for women in the united states and risk of death during their pregnancies and childbirth. america is the only valid nation where the rates of women dying during childbirth 26.7 mothers
for every 100,000 birth and his writing. women of color for the brunt of burden across a myriad of health outcomes. this is especially with respect to maternal wellness, lack -- what at higher rates than any other mothers. they are 300-four 100% more likely to die from top of her pregnancy related convocations than their white counterparts. moms like carol johnson, daughter-in-law of judge hatchett, a mother who raced cars and planes and spoke five languages still died soon after giving birth to her second son, langston. mothers like doctor irving lieutenant command and the public health services core and epidemiologist who dedicated her career to studying the stresses associated with racism and she died weeks after giving birth to her daughter. preventable conditions such as hemorrhaging, preeclampsia and other conditions that these bright lights and that of others. what we do to answer this call
of this hearing? what we do to overcome racial disparities in social determinants in maternal mortality? i've had the pleasure of working alongside many of you in this room to put forth allegedly to remedy to protect the health of women who desire to become mothers. these efforts are strong and i believe it will change maternal care inside and outside of clinical settings. however, hard truth is no loss can legislate away racism or sexism and no laws contain the hearts and minds of people who operate on, deliver care to or look at women of people covered the lens of unconscious bias but our loss can change how care is delivered within our hospitals and i equip our providers with standardized emergency obstetrical protocols and our laws can support providers across their training and continue with tools that help them become more reflective about how their own biases play out in the care with women of color. our laws can extend cares
medicaid beneficiaries without the entire postpartum period and hour laws can support collection of consistent data about who dies on the weight of motherhood and why. this is a woman's health issue and women from all backgrounds, walks of life, classes, education levels and races are dying but as with all health disparities women of color especially black women are overly impacted. we can only do the very hard collaborative double work of a major we find out why and correct the situation. as chairwoman of the congressional black caucus and cochair of the congressional caucus on black women and girls of prime importance to me is equitable health care access and delivery and healthcare systems impact on those before the aca historically experience care whether costs, geographic isolation, insurance conference and due to egregious forms of exclusion such as race and the residuals of racism. in closing, i extend a happy
belated mother's day to all moms in the room and i wish my colleague locke is a ready to deliver any minute and to those were with us in spirit and in two days. as a mother my heart goes out to those families who have lost their moms and starting a family should not cost a mother of color or any mother or life. all moms deserve a chance to be a mom and together we can make sure this is always the case of black and brown women and for all women. thank you. i yield back. >> thank you. let me recognize jamie herrera butler from the state of washington for five minutes. >> thank you, chairman neil and ranking member brady. the privilege to be here in front of you all. i promise not to go into labor wide testifying. unless you get tired and it's a long day. [laughter] thank you for holding this hearing. the increasing maternal mortality crisis and that morbidity crisis in the u.s. and the racial disparities enrolled
disparities in those rates is truly alarming. charles johnson widowed father lives by the motto, wake up, make mommy proud, repeats. as a single father of two they strive to honor his late wife by raising awareness of maternal mortality rate in the u.s. his wife died hours after giving birth to a healthy baby. they chose the best hospital can find. as we were here today statistics are shocking and difficult to comprehend how this can happen right now 20% 20th century america where our technology sets the standard for the rest of the world. despite these technological advantages the u.s. ranks 47th in maternal mortality, 700-900 women a year die. this means or mothers die from pregnancy, childbirth and postpartum here in our nation than in any other developed nation in the entire world in maternal death rate increases
every year. perhaps the most heart-wrenching of all this is the cdc estimates 60% of those deaths can be prevented. i want to specifically take the committee for shedding light on the racial disparities that exist within maternal mortality rates and it's hard to come and but but mothers are three-four times more likely to die from pregnancy -related deaths than other women and depending on the state therein the number goes up. women in rural areas is higher than average death rates and need these disparities persist across all socioeconomic levels and as a citizen and a mother this alarms me i know we can do better as a country. is member of the committee are aware we know many conditions that contribute to all high rate such as hardy of ask litotes hemorrhage, hypotension dessert committing factors but however the reality is the ability to an attorney is inadequate and the
first question in mind is why and we can't answer that fully. working with key leaders in the field of maternal health as cochair of the maternal mortality caucus with my colleague all these leaders have come to us and pointed to state maternal mortality review committees are critical and the first step in combating this health crisis. these committees will investigate every single maternal death or pregnancy -related death and make recommendations for the future moms life to be saved. it will be a friend in each area and in region and instance and there's not a one size it all fixed. i'm proud to say congress has taken an important first step. the president signed into law might bipartisan preventable death act and i know a number of you were supportive in that effort and this bill is the largest step congress has taken to date to address this crisis.
it establishes state maternal mortality rate minis so that we can begin to understand why moms are dying and what is behind the racial and geographic disparities. it is exciting to me to see how this bill has incentivized state to take swift action. as a [inaudible] money into this and has been let out and momentum is building. for instance, new jersey and nevada both recently passed bills to establish maternal mortality rate and just last week, my own state enacted legislation of strengthen and expand maternal death investigations and reporting and this is critical. to close, i want to remind each of us that you either are a mom or have one this issue impacts you. everyone should care about the tragic reality of maternal mortality in the u.s. right here in our own communities others are dying. we must take action to save
them. america should be a safe and welcoming place for every woman to have a baby. it is well past time and stand up and advocate for women across our country who choose one of the highest calling, motherhood. with that, i go back. thank you. >> i think both of our witnesses and consistent with practice and respect for your schedules. [applause] out of respect for your schedules will not ask you to remain for question. i thank you for your time and work on this important issue. i let our next witnesses take their seats.
>> thank you to our second panel of distinguished witnesses to take the time to appear before us today to discuss these important issues. first let me welcome ms. allison felix, united states track and field start nighttime polemic finalist and world champion who competes in 100, 200, 400-meter events. president-elect of the medical association and then doctor michael senior associate dean for faculty affairs at the school of public health at george washington university. doctor melanie is a maternal mortality projects coordinator and office of the chief medical examiner of virginia department of health.
doctor lauren robinson is deputy secretary of health promotion and disease prevention for the pennsylvania department of health. finally, the immediate president and interim ceo american college of obstetricians and gynecologists. each of your statements will be made part of the record in its entirety and i would ask you summarize your testimony in five minutes or less and to help at that time there's a timing light at her table. you have one minute left the light will switch from green to yellow and finally to read when the five minutes are up. felix, please begin. >> good morning, jim and neil. ranking member brady and members of the committee. my name is allison felix and i'm cameron's mom and that is a title i'm most proud of. i have also represented our country and for all of the games and have 16 olympic gold medals. i stood side-by-side with
president and mrs. obama in the fight against childhood obesity and proud african-american woman with the daughter of an elementary school teacher and minister but today i am simply cameron's mom. i would like to share the story of the two most terrifying days of my life. at the time i did not realize just how many other women like me were experiencing those same fears and much worse. my hope is by sharing my experience with you it will continue our conversation that is much more attention and support 32 weeks into my fancy i was going into a routine prenatal appointment and thought the meeting was right on track. i thought i was healthy and my daughter was healthy. i noticed swelling in my feet but thought that was normal for pregnancy, right? i asked my mom and aunt were both black mothers if they had experiences as well. one hat, one had not. they told me to ask my doctor and my next appointment which fortunately was a few days away. no one seemed to concerned so i was not either. i trusted that my doctors would have told me to look out for it and i found comfort in knowing
that i was a professional athlete and continued to train and exercise my pregnancy and was in great shape. when i walked into my appointment i was met with a friendly smile and genuine caring concern about how i was feeling. i am so fortunate i had such a thorough doctor and took a look and checked on cameron but she stepped out of the office for a little while in those moments sitting in her office alone felt like one of those moments in life that are full of anxious anticipation. one of those moments that people describe as time standing still and waiting to hear the voice on the other end of the phone tell you why they are calling it 3:2. those few moments lasted an eternity but the doctor came back and told me i would need to come to the hospital. i do not quite understand the seriousness of her class and
said sure but i have a photo shoot with espn immediately after this. i will run by, knock that out and head to the hospital. i got into my car without the doctor let me know that was not going to be an option but i got into my car without any idea of what was wrong but knowing that something was not right. i called my husband was at work and told him to meet me right away. i was scared. i felt alone. not just because my husband was at work and my family was 5900 way but i felt alone because i thought i had done nothing wrong. ... but i was at risk to all i cared
about in that moment is that my daughter would survive and i didn't really understand about my life as well. not that one of the best hospitals in the country and certainly not for women that have a birthing plan to wind up. i thought maternal health was about fitness, resources and care. if that was true, then why was this happening to me? i was doing everything right. my husband arrived at the hospital and my doctor told us i would need to be on bed rest the rest of my pregnancy which meant staying in the hospital the next eight weeks. the thought of staying in bed for that amount of time was awful but it would be okay because my baby would be okay. as we started settling into our new home, the doctor came back in and gave us even worse news. she told me i had a severe case of preeclampsia and if they
didn't act fast it could prove fatal. i called my family and asked them to fly in and asked my doctor if he could wait until they got here. he said he would do his best. ten hours later i was being taken in for an emergency c-section at 32 weeks. i kissed my husband goodbye not knowing what would happen next and all happened so fast. i heard her cry, i couldn't see her though. why wouldn't they let me see her? i reached my body didn't work. i couldn't hear her cry anymore. i clenched my husband's hand and there she was the most beautiful thing i have ever seen. she wasn't crying that she was breathing and that was okay. no more than 15 seconds before they rushed her away and i closed my eyes. the next month we spend in the nicu and there were others like me.
i'll be like me doing their best, just like me. and they faced death just like me, too. the more i did my research, and the more other moms i talked to i realized that they also had these experiences. i learned black women are nearly four times more likely to die in childbirth in white mothers ands and that we suffer severe complications twice as often. the data is teaching the risk is equally shared by all black women regardless of income education or geographical location. so all the ways that made me think i was prepared in doing things the right way, not for black women. we need to discuss overcoming the racial disparities in the crisis. i ask you to consider writing down a few names and keeping the best somewhere safe. please write down the name of my friend, serena williams, olympia's mom in tennis
championand tennischampion, thed andrea mcbride and half of the african-american sister duo that found and established a wine company. these are a couple of the names of women who are just like me. even though we have entirely different backgrounds, some have more access to resources than others. some are healthier than others but each of us have faced losing our lives and the lives of our unborn children. what i've learned is that there is something that we should be doing about this. we need to provide women of color with more support during their pregnancies. there is a level of bias in the system that is troubling and will be difficult to tackle but that doesn't mean that we shouldn't. research shows racial bias is in our maternal health care system including things like providers spending less time,
underestimating the pain, ignoring symptoms and dismissing complaints. the next steps are to look at how we can provide women of color the access to duelist and midwives this not only increase hionly increasessupport helps ef color on pregnancies in healthy ways we should be monitoring our bodies during this beautiful time. we also must look at how we can support organizations who are committed to the work of blubbering minority fertility rates. i have been learning that the current healthcare system is not set up specifically to provide support to those that have taken up the cost of our individual in their work. i came here to share my story. a story that i thought was unique but quickly learned was not. i'm grateful to you and the committee for hearing tha a heat story and also encouraging me to learn even more about this important problem. as a result i decided t to findy
voice to organizations have taken up this work and i hope i can not only share my story but intimately involved in this work and fight to make a difference. good morning chairman, ranking member brady and committee members. the medical association commends you for holding today's hearing. my name is doctor patrice harris and i am a practicing child and adolescent psychiatrist from atlanta and adjunct assistant professor in the department of psychiatry. thank you for the opportunity to testify today and i want to thank you for the advocates that have been working on this issue for many years. you have hurt the data on infant mortality in the u.s. that are
deeply disturbing. the u.s. is one of only three countries in the world where the rate of maternal death is rising. again you've heard the statistics and we'll hear more data today. most alarmingly, 67% of pregnancy related deaths are preventable. this is simply unacceptable when we know these ann what'll are unjust and unavoidable. what is causing these and why is it so much high here particularly from black and native women. among the factors that play a role are as follows although coverage has expanded, millions of women still lack insurance for have an adequate coverage prior to, during and after pregnancy. pregnancy. increased closures of the units both in the rural communities have reduced access to quality care. in addition, they are trained
and best practiceinbest practict from the quality of care. structural determinants of health which include public-policy laws, racism and in equities and the social determinants of health such as education, employment, housing and transportation. it exacerbates strength which can result in hypertension and heart disease and gestational diabetes during pregnancy and as we've heard black women are not being heard and clinicians and institutional biases can lead to missed warning signs and delayed diagnosis. so how do we move forward they are committed to ensuring health equity which we define as optimal health for all. our work in this area includes convening medical schools to create learning opportunities and integrate training in a social and structural determinants of health implicit biases and cultural humility is
the developing educational opportunities for practicing physicians on the social and structural determinants of health. working with united healthcare could utilize the diagnosis codes links to the social determinants of health which we believe will incentivize the physicians to screen for and provide the necessary referral to social services and community support and welcoming the officer who was initiating the health equity we support the expansion of the state mortality review committee. we support the act to improve data collection and to spread information on the intervention and expand access to healthcare and social services for the postpartum women. we encourage health systems to work with other partners to identify and adopt standards to
ensure safe quality of care at delivery and afterwards. the ama is committed to doing so. we are committed to building and continuing our path forward to a more holistically improved maternal health and advanced health equity. thank you. >> thank you member and members of the committee. i am currently and in july i will assume my role as the dean of public health at uc berkeley. the director of the bureau i'm pleased to have the opportunity to share with you today my views on what we must do as a nation
to eradicate mortality. let me start by saying that in 21st century america, the most powerful nation on earth no woman should ever die from pregnancy and childbirth. and get as we have heard more than 700 women die i and more tn 50,000 suffered a life-threatening complication. to shine a spotlight on the problem at times they make it seem like there isn't much we can do. in fact i believe that much can and must be done. i believe that we can cut the mortality in half by 2025 and eradicate the death in this country by 2050 by doing three things right. i won't say much about what you are about to hear but want to add what they are leaving to create a system of the review committees in every state we need to learn from the maternal
death so we can prevent it from happening to others. second to ensure the safety and quality for all. is this the low hanging fruit with the recent cdc report 60% are preventable. the results of the preparation to delay the diagnosis and effective treatment or the poor communication across the providers facilities. this is where the safety bundles come in of the best practices protocols and other resources for the quality and safety of care. these bundles work with public health professionals and we went around and it did in the
service. we engaged hospital ceos and to build a culture of safety. until about 2006, california controlled with the rest of the united states and it kept going up. the implementation of these decreased by 50% in six years and then it was also cut in half. when i became the director of the health bureau we worked with many of the other public and private partners to launch the alliance for innovation to spread to other states. the idea is if we can get them through every single good and hospital in the united states i believe we can cut it by half by 2025. the third and most important thing we must do this improve the health of girls and women in the country. we can start by assuring access
for all women not only during pregnancy but beyond pregnancy. many low income women lose their coverage of 60 days postpartum and postpartum extending coverage to up to one year could be an important step for reducing the maternal death. health care is important and so are the social determinants of violence against girls linked to chronic health problems. for those in low-income households can take a toll on their long-term health. experience of racism in the likes of men and women of color can lead to accelerating which can contribute to the high rates of conditions as well as the intent or to java become top ofn
college-educated african-american women. health jurisdiction over a number of income support programs which could buffer against these determinants took up the child poverty in half in the next decade the combination to expand tax credits exemplify the kind of evidence-based policy approaches that can go a long way to improving health in this country. last but they close by giving a shout out to my mom and wish her a belated happy mother's day. my mom hasn't gotten a lot of public shout outs in her life because she never got to go to college or high school or even junior high. my mom was 11 when her father died this i was the oldest girln the family she had to drop out in fifth grade to go work at the factory. she and my dad worked hard all their lives to put food on the table and their four children
through college. in one generation for youngest son is about to become a dean dn the greatest public university in the world with all the love and sacrifice that she has shown me and that played out nearly 43.5 million times every day in this nation. america can do better by our mothers. >> thank you. chairman, ranking member brady and members of the ways and means committee ten q. for the opportunity to testify at this hearing. i am the maternal practice coordinator in the department of health office of the chief medical examiner and i would like to commend you for holding this hearing on this important topic. the markup of the review team was established in 2002 as a partnership between the department of health offices of the chief medical examiner and family health services.
a multidisciplinary group of representatives from academic institutions, behavioral health agencies, hospital associations, professional associations and also violence prevention agencies. we have representatives from forensics pathology, maternal fetal medicine, nursing delivery, obstetrics, pharmacy attrition, psychiatry, patient safety and public health all participating. the team collects data and reviews all of the presidents who were pregnant within a year of their death regardless of the cause or outcome of the pregnancy. we refer to these as pregnancy associated deaths. we use the decision-making to determine the community, patient facility and provider factors contributed in each case. and then to determine whether or not they were related to the
pregnancy and whether it was presentable. it would be able to be prevented we discussed ways they could have been made and ended up with a better outcome. between 2004 and 2013 in virginia, 462 women died of pregnancy associated deaths. the number of deaths vary from year to year and if there was no sign whether it was increasing or decreasing our preliminary numbers for 2015 and 2016 suggests that those continue to increase. overall approximately 53% of the pregnancy associated deaths were due to natural causes. accidental deaths represented the next largest number among pregnancy associated at 26% among the leading causes were cardiac disorder, accidental overdoses, motor vehicle
accidents, homicides and suicides. nearly 55% of these occur 43 or more days following the end of the pregnancy. there are several identified in virginia the most prevalent of these are chronic mental illness, substance abuse and chronic medical condition. over 25% of the decisions in virginia they'd been diagnosed with depression or approximately 20% had been diagnosed with anxiety at some point in their life. nearly 25% of the maternal were found to have a comic substance abuse issue. throughout the years we noticed a significant racial disparity. the causes of death and the manner of death that contributes the disparities have been found to cause all socioeconomic
status and educational background. in general the rate for black women is over twice as high as it is for white women and when we look at the specifics in the later cases black women die at a rate three times higher. there's also been significant difference is found by was foue in regards to the manner of death black women are more likely to die from natural causes whereas white women are likely to die from accidental deaths. in addition to the disparities that we found we also found between urban and rural areas now they are the leading cause from violent causes including motor vehicle accidents which have accounted for approximately 20% of all in the rural areas. followed by homicide and accidental overdoses. in our urban areas the leading cause of death is cardiac disorder followed by homicide.
additionally. the mortality of the state and national level has been increasing over the last two decades. the review team's offer the opportunity to review these to determine the factors that contributed to this and make a recommendation for the intervention and policies that can improve maternal health outcomes. they pregnancy associated deaths is associated to the need for the system of affordable, coordinated and standardized care in the united states as a cultural value group and a standard and human rights. the provider level, facility level and system-level.
within the pennsylvania department of health i am a physician trained in both internal medicine and pediatri pediatrics. i'd like to thank the chairman, ranking member brady and all members of the committee for the invitation to address issues surrounding the importance of women's health and healthcare and wellness for mothers during perhaps some of the most vulnerable. her life but i'd also like to thank ms. felix for giving her testimony today because so much of my story over the last one has reflected her work. three weeks ago i was promoted to the right of other of myself and it is thanks to my mother watching my son today that i can be here. in pennsylvania we've outlined programming to federal outcome measures to increase access to quality, prenatal to postpartum care all of which are critical to reducing pregnancy related complications and be morbidity and mortality. while many people know
pennsylvania and what philadelphia and pittsburgh. the narrative of the mortality has different faces across the commonwealth and also bear the brunt of the health care disparities we talked about today. the epidemic has caused significant impacts the maternal and infant morbidity and mortality in the rural areas and small to medium-sized cities the committee started to rally and organize to implement practices that are saving lives. these efforts haven't been enough to overcome the disparities in outcomes were not in the minority women especially black women. the complex interplay of
individuals, relationships, community and societal factors necessitate addressing issues across the range of factors to authorize the health of the black women and the health of their children. prenatal care is recognized as a practice acclaimed to the health outcomes while the general trend in accessing adequate prenatal care is increasing for all races in pennsylvania black women are less likely to have received early and adequate prenatal care with only 65% of black women as compared to 79%. the healthy people 2020 target and the 78% receiving early and adequate prenatal care. although prenatal care is important, it may be received too late or not enough to positively impact the outcomes. preconception and health as indicated can provide opportunities to promote the
health of girls and women before they become pregnant. state governments have incredible convening power even while there are restrictions on how, when and with whom the dollars can be spent by bringing together the community organizations, insurance companies, large academic healthcare systems and smaller community-based hospitals the state governments can be the bridge to the exchange. exchange. the imperative that comes from the exchange is the creation of the policy programs that reach the communities that have typically not yet benefited from federal funding and programming. in pennsylvania the department of human services administers both the social service block grant and maternal home visiting program. currently over 6,000 individuals representing 3200 households were served with a total of 40,000 home visits being conducted in 2017. and while the programs provide services for many, the department of health often fills
the gaps for support and home visits for families who may not qualify for the above-mentioned program. the implementation promoted the progress in reversing the trend of maternal mortality. i'm proud to say in pennsylvania in may of 2019 the governor enacted the law which creates a pennsylvania infant or child of the review committee. the language of the act was modeled off of a particular test in the home state of massachusetts. it's now got a thrill within three years of its first meeting last october. for the collaborative another practice that is flourishing in states such as north carolina and massachusetts but will the collaborative is a network of
teams that work to improve the access and quality of care for both mothers and babies across prenatal newborn and postpartum services. these teams identify processes that need to be improved and quickly adopt best practices to achieve the collective aims. in closing ways that we can move forward and address the mortality currently to preventing maternal death act is providing applications or an opportunity to apply funding to create as a next step in as we look forward to the act introduced by congresswoman robin kelly one year ago this month identifies priorities we can address and achieve first by expanding medicaid access to cover the postpartum period up to one year most importantly to
improve access to culturally competent care by addressing institutional racism and the training of hospitals and communities health providers on the needs of all american authors. we continue to follow and be thankful and our elected officials on washington. i'd like to thank you for your time this morning and look forward to working together to improve thank you for inviting me to speak today. with a membership of more than 58,000 a58,000 is the leading pn organization dedicated to advancing women's health. key to the mission is the core values all women should have access to affordable high-quality safe healthcare.
i am an ob/gyn specializing in high risk obstetrics and dedicated my career to improving the health of my patients. you've already heard the united states has a property crisis and the disparities are unacceptable. we are committed to eliminating preventable deaths, and we are eager to continue our strong partnership with you to achieve this important goal. we applauded the passage of the congresswoman's bill last year. have you heard they are best positioned to understand the causes and contribute in factors of maternal to identify the opportunities for prevention launched in 2015, the program and send it through a cooperative agreement.
the goal of the voluntary program is to eliminate preventable mortality and morbidity in every facility. the data identifies gaps for improvement, collaboratives to assist with implementation and providing the programs that get us to our goal. the reduction in morbidity between 2015 and 2018 california had a 21% reduction in severe complications from hemorrhage. and in illinois, timely achievement as hypertension rose from 41% to 85% the team is now
in 27 states applied to about 75% as a total u.s. population to help achieve that, they are working with our partners on the boy says that the equity is a project funded by the robert johnson foundation to incorporate patient voices and lived experiences and the patient safety work. black women's feedback must be the driver for quality improvement initiatives. it also supports the actions for safe maternity care initiatives with a goal of empowering and equipping mothers to obtain respectful person centered care. we and all providers have work to do and we are committed to addressing the bias and increasing the provision of culturally competent care to the
patients. these are parts in my home state of texas that this issue in the national spotlight. it helped ensure we have both an accurate accounting of mortality which was lower than initially reported and his understanding of the causes in our state. our latest report noted the leading causes for cardiovascular conditions, obstetric hemorrhage and cardiomyopathy. we found black women bared the greatest risk for death and that risk exists regardless of income, marital status or other factors. these findings and recommendations such as the promotion of the culture of safety through the implementation of the best practices like those developed by the program committee and increased efforts to eliminate health disparities. in addition i was the cochair of the harris county community plan to improve maternity health to address the rate of maternal morbidity. i encourage others to consider
this partnership model. as congress considers the next step, we urge you to advance initiatives to accelerate evidence-based patient safety changes and authorize the program to support the efforts to end the disparities in the outcomes and extend medicaid coverage. we are making meaningful progress on the path to better outcomes and look forward to working together with you to eliminate mortality. >> we will now proceed to questions under the five-minute rule consistent with the practice i will wreck it is those present at the time of the gavel in order of seniority. let me begin by recognizing myself. would you like to convey to como expecting mothers who may be watching this hearing especially african-american women who might
not always feel included in such conversations your feelings? >> i would'v >> i would definitely want them to know to be a lawyer. i wasn't aware. i didn't know i was at a greater risk to advocate you can be intimidated sometimes how can we better and consistently collected data so that we can make informed of progress and yield better results in this country who rely upon the hospitals for safe delivery put
your microphone on, please. >> the review committees collected a lot of data on social determinants of health. i think we also need to be better tracking at least 50 to 75 women di didn't die but suffd a life-threatening complication and there's a lot of things we could be learning on these morbidity is. we also need to be giving a better job monitoring the quality and safety of care which begs for performance measures on the impatient side or the outpatient side. we also need to be doing a better job in terms of listening to mothers, and especially in
terms of understanding their birthing experience whether they feel listened to, disrespected, discriminated against any possible way of doing that is to expand the cbc plans in terms of capturing their pregnancy experience. let me recognize ranking member brady for five minutes. >> thank you for hosting this hearing. the reason republicans on the committee lost the investigation last year was that this problem has been growing for more than 30 years especially when they
have done everything right as you did. we have to get to the root causes of the mortality and get serious about it. medical factors play a role and obesity is higher in some how hypertension the same. diabetes, the same, all of which lead to early births and c-sections all of which can help drive mortality from all need we can't accept that as genetics we have to go to the causes and assaulted a.
in identifying the better data we understand it as they all identify certain better practices all of which i think helped along the way. what do agree that we need a national comprehensive strategy to eliminate deaths that were. one of the things we have seen across all of our efforts is collaboration.
by working together and organizations, patient groups, advocacy groups to work for a single goal we have made significant progress specifically in the work that we did, we had a wonderful opportunity to bring together the leaders in our local government, private entities, hospital systems, insurance providers and working together we are able to come up with a strategic plan that had multiple different prongs to address the problems that were specific to harris county. >> a proven perspective, the county in america very diverse, has a broad range of the factors that impact maternal mortality. do we need a comprehensive strategy here? >> it'is important to be able to work collaboratively across all
of our groups so that we do not have duplication of that and we are working together. i would like to pose a question to my colleagues today. is there any reason we can't all support a national strategy to address and eliminate maternal mortality come and furthermore i would suggest we work together to continue the investigation as the committee that we started last fall. we've got some bright people on the committee but are absolutely dedicated to this and i bet you we can make a difference. with that, i yield back. >> mr. lewis. >> thank you very much mr. chairman. first of all, i want to thank you for holding this hearing. this panel is one of the most
diverse panels as i've been on the committee and i want to thank you again. i would like to thank each and every one of you for taking the time to share your stories and expertise with us. we faced a crisis and i've like to enter into the record georgia ranked last in the nation on this matter. >> so ordered. i'd also like to express my gratitude. she shared her story of the challenges of trying to access service as a woman of color. thank you for being here. i am so glad we have a doctor
which the local and community-based solutions can arise. again earlier we talked about supporting the act and making sure that there is funding. several panelists mentioned the importance of maternal mortality in the review committee. in order to develop solutions, we need to first identify the problems. we can't always identify those problems without the accurate data. so, funding to make sure that the review committees are adequately occupational and will be key. the other issue you mentioned depression and i think i would be reminiscent i didn't mention the fact that we see women suffering increased levels of postpartum depression, and we see that at even higher rates in african american women. and unfortunately, the infrastructure for mental health and substance abuse disorders
have been woefully underfunded for several years. funding a basic infrastructure for treatment for mental illness in postpartum depression will be the key as well so those are just a few suggestions. >> thank you for your courage and for being here today. i know you are a great athlete. why would you want to tell your story and be so personal? >> thank you so much. it was important for me to be here. for a living i get to do what i'm passionate about, and that brings me much joy. but to me, there is no more important issue than what we are talking about today. i consider having my daughter my greatest achievement, and it was
such an eye-opening experience what i went through. i wasn't aware. i was completely not educated on the topic and so i wasn't happy to go through what i went through, but i'm thankful that i was able to learn so much because now i feel like with the platform i do have i could use my voice to try to have an impact so i'm happy to be here and share my story today. >> let me recognize the gentleman from nebraska mr. smith. >> thank you to all the panelists your stories and professional perspectives we certainly appreciate. it's clear that seeing the rise in the mortality is a challenge that needs to be addressed. when i chaired the subcommittee ways and means committee in the last congress we acknowledged to
work on the challenges faced by pregnant and new mothers and we authorized the main program because of the benefits of the program provides to at-risk mothers i pushed for a five-year reauthorization to ensure mothers and children get appropriate support they wouldn't otherwise be able to access. it included in language the jobs for success to allow them to recognize the need by using dollars to words. mothers in rural districts such as mine often face difficulties a problem exacerbated by the closure and consolidation of the hospitals and clinics. one avenue for providing the testing as well as the postpartum care new mothers need to through the rural health clinics. the nearest source of primary care for those in rural america. in fact because of the importance of the health clinics in the position of the
preventative care and the rurall areas to begin introducing the health care clinic modernization act a bipartisan package that will help stabilize the health clinics and extend the recent tide of closures. another aspect of overcoming the challenges including maternal mortality is the adoption of innovative approaches to transform care to the rural populations. what healthcare challenges would you say your observations with included in terms of noticing pregnant and new mothers and their experiences in rural areas? >> the access to maternity care is of critical importance in our organization is working with the american academy of physician sent national health association to come together to find
solutions they can put into place that will enhance the access to care in maternity areas so that women have access to the same quality care regardless of where they live. we urge you to get acces accessd print up your minds as you are considering future implementation so that we can ensure women have access to safe and high-quality care. >> do you see ~ health as being an option in the delivery of healthcare? >> the american college of obstetricians and gynecologists convened a task force last year and have been working to come up with recommendations on best practices for our membership and we look forward to the publication of a report in the coming months. >> anything else that you would wish to add relating to that?
doctor robinson would you be able to elaborate on your perspective on the delivery of healthcare certainly to rural areas it doesn't even have to be the areas that benefit from to let health of urban areas as well can you reflect on that? >> i think especially if you think about just the wait for the doctor in urban areas i think that it could play a significant role. it helps for triage so when a pregnant woman has a concern and as i'm sure it's something that requires them to go to the hospital or have a question, tele- health provides the opportunity to have a face-to-face consultation and the other piece of stuff that's important that we think about the social determinants what is it a mother is in need of it may not be she needs to go to the hospital but maybe she's having
a concern about accessing childcare or how to access child care so she can go to her provider appointment and how to access transportation. in pennsylvania and a lot of various transportation is a big issue. there's communities that don't have sidewalks if we talk about safe areas to walk, live and play through to let health we can have those consultations to figure out what a specific woman is facing and figure out it may not just be her so that there is a lot of the same concerns in one community that allows us to say how do we leverage resources we have in existence to address the concerns that may be in a particular community and if we don't have those resources how do we call on our federal partners to say this is what we are seeing in our state and program funding allows us to do this but we need to be able to do this. are we able to do that. >> what they recognize the gentleman from texas. >> i appreciate your valuable insight.
as the chairman of the health subcommittee, i think that this is a very good place to start. but recognizing that we need a more in-depth explanation across-the-board and health care disparities that affect people in all conditions and all ages and genders i think it's important that we look at the reforms that have been outlined in legislation failed last session fofiled lastsession fory accountability act by mr. lewis. representative gomes and blumenauer from this committee. there's much more work to do about the broad issue of health care disparities. in texas your zip code is such a strong predictor of the health of mother and child. in san antonio which i represent they are really stark overall
they have the highest mortality rate in the state they have the second largest in almost 40% of the live births involve women who do not receive any prenatal care or received only very late in her pregnancy. the numbers show why giving the state of texas more responsibility by block granting medicaid would be such a terrible mistake, and the harm that has already been caused by the state's failure to accept available federal funds to expand medicaid as well as its continued outrageous attacks on planned parenthood even for those women who received medicaid coverage during pregnancy i am pleased with your testimony in the work that's ths
being done at the legislature now to try to extend that 60 day period to a more reasonable level but overall, while it's very important to work on the data, and i want to inquire more about that, we need good care and we need it for all. this is economically disadvantaged to address the issues of disparities. bringing a child into the world as a combination of joy and stress that it is enhanced when the women who travel through the health care system don't see many medical professionals that look like them and so we need to work on our work force and healthcare system as well as one way of addressing this matter. in san antonio, a nurse is one of those groups working to address this whole issue and to
empower moms and break through the cultural barriers. the san antonio express has editorialized the number of times about the data problems because we had a declaration that texas had the highest maternal mortality rate in the world, but it turned out that the data had been inflated in the entire process and interfereinterferes with our abo get at this problem. there are so many other groups that are in coalition in dare county working together to try to address this problem. i want to ask the doctor robinson and doctor harris about what else we need to do to get the care to help address this problem. >> thank you so much for that question. i think i would start by saying training providers on what
systematic institutionalism is it is the first step. so often we talk about race or racism and it's about a personal attack and when we think about the system there are very few people who would argue that any policy that's geared towards keeping a group of people down needs to stay in existence. sometimes those are things we just don't know about and only have training and can understand there are things that have been in place for generations we can all work together across states and idols to address once we know what they are. that is the first piece of it. the hospital an hospital and hem level is important, and for some of the other panelists talking about the community organizations when we think about the nurses, midwives and to do was aching sure people can get care where they are that there is coverage for that because services are not cheap t cheap or covered by insurance and then.
there is a better chance we can work to eliminate the mortality. >> thank you very much. our time is up and we welcome additional submissions from any of the witnesses on these issues. >> we recognize the gentleman from pennsylvania. >> thank you all for being here today. first of all, thank you so much for being here. you are totally irrelevant and the fact that you were willing to come forward and talk about your story, what i am puzzled with is in your case it wasn't a matter of not having proper care or a matter of not being in great shape for so many different things, and yet i've got to tell you in my life we were blessed with four children 15 number one and number two, we had an ectopic pregnancy and no
one would have known it if it hadn't been for visits to the doctor's office. i had no idea at that time within ectopic pregnancy was that we went on to have three children after. it just puzzles me because i'm trying to understand you have the best care you could possibly have and the vitamins you were taking, everything you were getting ready to burst and still have this problem. it puzzles me. but again i want to thank you for knowing -- my daughter was a long-distance runner and it's incredible the role that you play and voice that you have. so what else could you have done differently? ..
health workers and been thinking about as women get closer to deliver a web service is absolutely have to be delivered at the hospital to help women understand when you see any of these things you need to get to a hospital and we have policies and procedures in place to help them get there and that's the piece we need to communicate because so many of this is a long nine months. we need to reduce the mortality. >> anything we can do it but altogether there's nobody on this panel. thank you so much.
>> thank you very much for putting on this important hearing and to all the witnesses. you've done an outstanding job. this is other witnesses as stated before and colleagues on the panel stated as a woman's health issue but i think it's important to point out that it's also community health issue. it's something that affect us all of us and do a better handle the debt, the more our entire community is going to benefit from this. i think someone else mentioned it also talkealso talked about f california has had, and i want to focus on it a little bit. we started making our progress in 2006 when we established. seven years after that program was started, our maternal went out of the race and before you was cut in half.
seven years, cut in half and that's pretty incredible if you think about that. the other thing is in the rest of the country o their rates skyrocketed during the same seven years, so we've done well in california but we have a long way to go. in particular the gains we've made in california haven't been shared equally. the mortality rate for african-american mothers in california is still three or four times greater than it is for white women. what are some of the lessons congress and other states can take from our experience in california and how can we make sure the benefits of our efforts are equitable that women of color are not left behind? >> first of all the key lesson is quality matters and safety
matters. we are able to show that kind of revolt because we create a culture of quality and safety throughout, and that's kind of the idea as we try to spread the culture of safety across all hospitals in the united states. the other important thing for congress to be aware of is the social determinants of health. improving quality and safety to zero, but if we truly want to eradicate mortality in this country we have to work on improving the health of women and girls and that has a lot to do with creating the kind of social conditions in which girls, women and families are to be healthy and why i'm so
excited that this committee is holding a hearing on this it is also clear there is a link between the socia social factor, unemployment, education level income, social support, etc.. in one of my counties others without a high school degree experience food insecurity and other related issues. doctor harris, what can hold care providers due to better incorporate the social factors into their work? >> i think we continue to do the work we are currently doing at the partnership with united healthcare incentivizing physicians, developing diagnoses and codes that link higher
reimbursements to address these issues. it's important to identify the issues as you just mentioned. iissues around the lack of transportation and access to healthy nutritious foods, lack of access to the quality built environment. those are all of the social determinants of health that do impact healthcare. you and someone on the panel mentioned that the zip code and we know that again we need to address the quality and address healthcare with 80% of what impacts health is beyond healthcare so we have to address those issues and it is job training and workforce development and looking at the built environment and making sure we don't have food deserts. so all of those issues are critical in addressing the social determinants of health and then on the other side we
certainly have to start their own input and biases. we all have implicit biases but first we have to name them into some of the training we will be doing this to have folks named the implicit biases and then move forward on how and knowing how that impacts care. >> thank you all very much. >> what we recognize the gentleman from south carolina to inquire. >> this is certainly eye-opening and shocking that in this age of expanding technology and more people being covered by healthcare and all these things we are experiencing a terrible trend. implicit biases play such a large role on this. i'm looking at the trends and they are frightening in terms of
its gotten worse every year the number of deaths per 100,000 people since the 80s so where i struggle with what you're saying is do you think that the implicit biases are higher. the number of deaths are skyrocketing its way up. why is that? >> i don't think we've measured that before. we are just beginning to have that conversation around implicit biases and how they affect care. we are just beginning to get the data just on a related issue but we know some clinicians believe that african-americans feel painless the thing that makes me
have you all learned that floodplains of this increase is from the epidemic? >> we certainly need more data. >> doctor robinson have you looked at what portion of this increase we don't have the data available that we will look at it. >> have you looked at what percentage this does to the epidemic? >> they are gaining the data to be able to do that type of assessment. >> i think the gentleman. whawe recognize the gentleman fm connecticut to inquire. thank you for holding this hearing and thanks to the witnesses. i work for the record like to submit an article mothers are dying in childbirth why isn't anyone talking about it like susan campbell and christine
stewart. it's what's taken place in alabama and so i appreciate the witnesses and the desire and i want to go back to something mr. brady said the goal here should be to eliminate and the cdc issued a report that said these could be reduced by 60% of them in my mind that means that there is 40% more than this is impacting that we can't get our arms around and it's this incrementalism that disturbs me as much as anybody here and i'm wondering because i know there may not be a silver bullet
because certainly there's got to be the following steps that need to be taken immediately to eradicate and eliminate this. do we have steps that we can take immediately? >> i think the first step is for you all to call for a national strategy which i think is long overdue. >> for example having a national task force that was dedicated and focused on this with all the nations leading expert to say the goal is we are going to eliminate this. a woman in my district has three times the chance of dying than a person in the united kingdom or canada and even people in china or saudi arabia fare better than
americans do. if this isn't a call to arms, i don't know what is, and instead of focusing on eliminating the affordable care act we ought to be talking about how we can provide more health care and better access to people. is that part of the solution? >> i do think starting with the national strategy and making sure to resource with a strategy i remember reading about the crisis in this country in the wealthiest nation on earth this problem has been going on for such a long time and getting worse over time and we are now finally in that moment where the nations are coming together to finally do something about infant mortality. it's important to call for a national strategy to make sure that we have the first ever come
preemptive national strategy to eliminate and eradicate infant mortality in our generation. >> i agree with the national strategy but i agree that we can do some things right now. you heard folks talk about the gamaim for the review committeeo we could know immediately what is causing the problem to the particular and try to address those. what would you recommend? >> i agree with my colleagues on the panel and i would say also the extending of medicaid provision of two one-year postpartum for women to make sure after that 60 days or 40 today's women are still able to get care to help prevent those deaths that we know of her and of postpartum period.
>> implement the program in all 50 states and all of the hospitals so that everyone is implementing best practices. >> absolute we implementing the infant mortality and all of the states that we are able to assess what the problem is. once we know what the problem is, we can work to address it. >> you should be the national face of this. >> the only one appear that isn't a doctor. i have to agree with all of them. [laughter] >> good answers. thank you and i yield back. >> i recognize the gentleman from arizona. >> i want to get a few seconds to mr. brady because he wanted to put something in the record. >> when neglecting to say my family and i have cheered you on from the living room so it's fun to do from the hearing room. thank you for being here. >> that means a lot. >> what is the direction because
that is a serious issue. a study found implicit bias has decreased. 17%. it is exported by 37% again, but the answer is zero. no bias is accepted in medical treatment or time spent on a person, period. the other point of that is supposed and grace will tell us to. will you help us identify why we are losing those moms, i think that your testimony as well as our state and local communities can help us do that. thank you for yielding. >> a long 15 seconds. >> almost no hearing i've been involved in that in some ways has weighed heavily on the staff and myself because we are used to being able to slam through it
and have it say something to us. in many ways, your documents were most helpful to us, but still you struggled because there's still so much noise in the data. you want something to pop up and say this person with this ethnic background from this area and this zi zip code database of hypertension so this outcome and i can see a percentage and i know the population data is still too thin. thank you for what you're doing in virginia, but we desperately need more because somehow we are also going to have to balance what is happening out there with national trend is, the age of a first birth as we have seen in the society is getting much older. is that affecting our math?
if we can find out where we had a genuine problem we can put the policy resources to it. we are struggling right now trying to say where we put the policy resources. i was going to bounce a personal story off of you. i have the worlds greatest little girl. he three and a half year old and she is the best -- a 28-year-old mother, not a single visit on prenatal care. only enrolled in our state access system which is the majority of births in arizona. at the medicaid system. in the discussion with her and some of the medical professionals around her, it turned out that wasn't uncommon. in their case they said that it was just a transportation issue. but we all have the button on the phone, whether it be left or guber or something else, and in
a weird way that isn't a medical disorder can access to modern life and technology and resource concept that i'm hoping over time we see the data. maybe we can fix that with a transportation or telephone there is one that i really struggled with and a the only way we can get a population is to have a culture racism decision-making on the medical professionals when this population to get their medical advice from an algorithm from
something that's had a nonhuman decision-making so that it doesn't have a and i know that is controversial in the medical world but unless you have that test we will never know an honest baseline so i encourage you and it is a culturally difficult thing for the organization saying maybe we need to turn to the algorithms. we are very involved in looking at what we call assisted intelligence. it is augmented intelligence.
i will say the one thing there are people developing the software in the program and those people have biases so i think we have to keep that in mind. >> it's hard to augment. i know it's controversial but thank you for at least letting me go through that because i see no other path other than to test something of that nature. >> the chair would recognize mr. blumenauer says kelly putting a personal face on this and evidenced by some of the witnesses here today. we've had one of our other colleagues from illinois, members of congress with i think to nursing degrees who was
recently in my district and was part of the visit and made a very powerful presentation on this issue. it's very profound, and i think it illustrates some of the complexities and dysfunction of the health care system. it's no secret we spend more by about a factor of two than any other country in the world. we've too many outcomes that are troubling and some of us have access to the finest health care in the world and the communities that we are falling short on the very important markers that you are sharing with us today. and it's not just economics. we are watching some of the outcomes. there's stuff going on here. i deeply appreciate in
particular some of you sharing personal stories, and it seems to me that this is a subject for new and expectant mothers that is personal, that is perhaps they are not used to talking about or entirely comfortable, and we are having the appropriate staff training the diversity would make a big difference. so i would hope that any of you that want to dive in here to just talk a little bit about what difference that will make in terms of getting our arms around better answers to being able to seize on what was a bipartisan note of interest concern and willingness to work together. could you talk about the personal dimension? >> i could definitely speak
briefly about it. for someone who was really excited to be pregnant and did a lot of research and read so many books, i can say that i was not aware that i was more at risk. and i think that is -- that says a lot. it's not really talked about. even among my friends when you are chatting it's not something that is very cheerful when you first find out that you're pregnant if yo that you want tog up, but it is a real issue. maybe i would have had better questions to ask. maybe when i first saw my swollen feet i would have rushed in instead of thinking this is a common issue that everyone experiences. so i think that you were absolutely right in that awareness that can make a difference. just to be on the alert of things to look at. >> i would follow-up to say that
i think it's important for providers, like we said it's uncomfortable to talk about race and racism in the country and there is a definite piece of race and racism around the mortality, but i think that we have to be able to talk to patients about it. for me being a physician and being healthy i was at the top of my game and was going to kind of sale through this. obviously, i am still learning, not sleeping. when i talked to my doctor about the concerns i had that i was rapidly reassured without kind of some follow-up testing, so i think it's important that the providers listen to older patients, but especially when we know that black women are more at risk of maternal mortality between this in to black women
and that it's better to have been air on the side of caution as it relates to trying to makee sure that we have positive outcomes but also listening to patients and addressing what could be biases among the providers around thinking the patient for two healthy. listening to the patient is the key and did we learn about that in med school that is a gentle reminder talking to patients about what they may be at risk for. >> i noticed that the opposite of the hearing we will now recess and promptly reconvene at 1 p.m.. the committee stands in recess.
>> the i want to thank doctor harris she's been in my office prior to visit with me so i do want to thank you for the expert testimony. it is very valuable. with that let me recognize the gentle lady from indiana and the ranking member of the committee. >> welcome to this historic moment. thanks mr. chairman. i just think it's interesting and i've been thinking about it even during the recess listening to all of you on the panel again i'm so thankful that you are here, but i think it is interesting you are hearing us as members talk about how horrible our state is. my state of arizona has one of the strongest economies in the country and we are third from the bottom on this issue. listening to my colleagues in the world sitting here saying this is such a big issue and i can't help but think a couple of things. number one that when we look at the success of the program.
i think it is really interesting one of the things that is an advantage here is a bipartisan bill so everybody out here is onboard also funded to 2022 now, but i'm wondering if we are talking about finding a solution at the same time because i'm sitting here thinking to myself i could be looking at a potential expansion of this in the future because one of the things it relies on. establish the most vulnerable people and start funneling all
those resources into vulnerable people groups and start their end of an expanded out of there and one of the advantages we are talking about is people looking like people and the other advantage is a lot of the people that actually are the trainers are right out of the program. somebody came in and trained them and when they had their kids and were successful and healthy they go back into the same homes because they live in the same neighborhoods and it is really almost a friend of a friend kind of relationship. but i think that i'm very interested i did some investigations in the state of indiana as well as to why do we have the strongest economy, one of the strongest and why are we third in the nation on this problem and a lot of the local organizations on the frontline but i talked to talk about just the pandemic in our area, so i just want to addres wanted to au
the question as you look at these numbers and as we continue to talk about this and i look at this as a great optimism i think we could certainly start quickly with expanding the program or looking at putting our attention on the program, but there is an article in the american journal of obstetrics and gynecology about the fact between 2006 and 2017 it's more than doubled and i think you've said you've had reports on the problem but one model of the treatment what have you seen to be the most effective in helping a pregnant woman with a substance abuse disorder get healthy and stay clean? is there anything you've seen so far that could land that wisdom to us? >> medication assisted treatment is one of the best ways to address the order for pregnant women. there is also a recent study
looking at maternal mortality from drug overdose in the state of massachusetts, and they provide some very interesting information that talks about a year after delivery being a vulnerable period. for the obstetric care and opioid abuse disorder one of the important things about this particular bundle is it extends participation outside of the hospital system into the clinical care and addresses care during pregnancy and not just at the time of delivery.
so, implementation of the bundle is something that could be recommended. >> i just want to say to all of you that are in this fight, thanks for your expertise. i think that the program as it is right now is a hope for us in the future. .. for teish up such an important issue, and as timing would have it. it was a very pertinent and good article that appeared in the "new york times" dated may 7, 2019 and it's titled huge disparities linked to pregnancy. and the subtitle is women are three times more likely to die
from cause related to pregnancy compared to white women. mr. chairman i'd ask unanimous consent to have the article inserted in the record at this time. >> so ordered and now we will move from 2-1. >> i want to yield to my colleague from wisconsin. i want to thank ms. felix for your personal testimony and sharing a personal story. it brought back a flood of memories and the tough pregnancies my wife and i went through with our two boys. the first one being so un expected and predictable, and scary at the same time. we thought, like you, that we were doing all the right things, checking all the right boxes, doing lamaze. we read "what to expect when you're expecting." and we were live to do our doctors, we thought we were doing everything right and when it came time for the delivery it was game on, we're ready for
this let's deliver a boy. and we went in and things went bad real fast. it was extremely difficult delivery. fetal heart monitor started plummeting. the oxygen intake monitor all the fetal distress signs were spiking and we heard the fateful words we need to do an emergency c section now. we were whisked away our heads spinning going into an operating room, and a moment of probably the most terror i've experienced and i was fearful i would a lose my wife and baby at the same time, only to be followed with the most happy moments of my life, i was holding a healthy baby at the end of the day, but they put that screen up across my wife's chest, and i was hold ing her hands, and i was standing next to the doctor so i could watch the procedure. it was amazing they could do it as quickly as well as they did.
and having a baby boy she was so heavily sedated she couldn't remember much of it. i took johnny to get cleaned up, and she wanted me to fill in what happened, and being the guy i am giving an honest response i said to her, well you know dear, having stood there and watch this doctor perform the c section i really think that if we're in a pinch i could do this procedure now. she looked at me and said what? that's what you got from this. having said that let me remind yield the remainder of my time to my friend from wisconsin. >> i miss this young man johnny and the most terrifying part of it is he looks just like you ronny. oh, but that's a happy ending and i just wanted to lean into some of the questions maybe i'll just make a statement with this short amount of time. i want you guys to think about the structural racism part, and
many of you have said well we don't have much data on this. we don't have much information on this. and i'm thinking so much of what we know about healthcare is based on the framing model. and there hasn't been enough return done on women and black women, hispanic women, so that allison, you know when you ask your momma and your aunties was this common in your family. what you may not have realized at that point is that african americans are very predisposed to high blood pressure because of the middle passage. those africans who made it to the shore were the ones who retained water and so ergo we have propensity towards higher blood pressure. so if an african american woman presents herself pregnant that
is although a risk factor. our genetics and our background and so you're absolutely right. more information is needed. so i just to wanted to use this short time to say that i think that r & d is very important. i have also introduced yesterday a duala bill. we had doulla's and they provided services to black and white women. but when we had our institution al hospital care, mid wives and doulla's were put town we need to reintroduce that kind of care. i'll yield back the gentleman's testimony, and i can't wait until my time comes. >> let me recognize the gentleman from illinois, mr. davis to inquire. >> thank you mr. chairman, and i was sitting here thinking that my colleague from new jersey was next, so -- but. >> you know what i think he probably was, but it's too late,
you're recognized, we'll go right back to him. >> let me just thank you for this incredible hearing. and i certainly want to thank you all of our witnesses who have simply been outstanding trying to get at this issue, i represent a unity bellwood illinois. it's a working class suburban area. neat bung allows align the street. they have a good town well-run. i just love going out there for town hall meetings, and that kind of thing. low and behold they had 65.4
deaths per 10,000 deliveries in 2016 and 2017. not a poverty town. not a whole lot of social problems. not a lot of street gangs. people have jobs, they go to work. and, yet, this they had the highest rate in the whole area. as a great university medical center right there. liola university. as a great big veterans administration hospital right there. and there are other hospitals
there are physicians. and so, it's an area that you wouldn't necessarily expect this kind of mortality and morbidity. we've talked a freight deal about a number of things. my colleague from wisconsin just injected the whole idea of research. and that's kind of where i'm going with my questions. since there is so much that we don't know, in trying to figure out these are not poverty-strick en people. i mean, this is the good town. it's a great community. and yet, we have this problem. do you think that there is a
role or research to try and help us to better understand the why of the issue we're discussing? and why don't i just start with you and go right down the line. and thank you so much. >> i will definitely have to refer all of my new doctor friends. but i would think of course the research would definitely play a part in helping the problem so that when you get to people like me, who are the patients, and you know your everyday person who is coming into care that all of that would be able to help better than the situation. >> so i'm all about research, and i didn't -- when you have african american women with more
than 16 years of schooling, you have high memortality rates, and white women with less than 12 years of schooling. so we're talking about african american lawyers, and business executives and they saw higher maternal mortality rates than white women who are high school drop outs. now the leading hypothesis around chronic stress, and maybe it's stress from the structural racism, and equal treatment they experience in healthcare and other areas but i do think a lot more research needs to be done in terms of understanding why but also more importantly, what can our nation do about it. >> research is absolutely one of the most important things we can do at this point. even amongst states that already have maternal review teams we need to expand the scope of what we're looking at. when we look at our data we end up with more questions.
we need to be more in-depth and have a broader scope when we research these cases. >> i agree with my copanelist, and i would also say in addition to doing the research we have to disseminate the findings so that folks who were on the ground who are doing the research is aware of what is being found in the research and what they can do about it in our community setting. >> we do need to expand the data we're collecting in the maternal tests so we can understand what factors it is in the communities that are putting women at risk. >> thank you mr. chairman, i yield back. >> thank the gentleman, and let me recognize dr. wis. >> thank you, i served on isn't that board of health and one of the things we engaged in was infant mortality because we recognized our numbers were going up in infant mortality and
we started looking at things like zip codes and race that seemed to be factors or common denominators, anyway. and the problem, and what was interesting too is we're looking at things, we're saying well why is this happening, is it because of access, is it because of education? is it because of lack of peri natal care. we found some of the mothers didn't come in to see a doctor until the month before they were do you. then you really recognize we've got a problem here. so there is so many factors. dr. -- just said the more data we get the more we have to look at. and there's not everything is medical. it's transportation, it's a lot of things that go on. and i think we have to look at that and ms. felix, i was struck you said i was unaware the risk. and you know i think in this age of liability, and we always get
a consent it's kind of amazing that we're not doing that. that someone's not saying by the way you're african american so there's a higher risk for pre-eclampsia. i want you to be aware of that. i think it's important that we do that, and obviously we have to look at co morbidities and other factors. or is a patient are they smoking are there drugs involved? nutrition adequate? obesity? is their home safe. all of these things come into play. so, when i got elected i not only had a rural area but an urban area. there was a priest in my
district who was a family practice dock. he had two perishes, and a full- time family practice and he did the deliveries and all the high-risk deliveries. and in our area it was a lot of the drug addicts, he was the example of trying to make sure everything was done. i had a car dealer tell me this guy comes in and buys used cars for the mothers so that they can get to their appointments. but you see he recognized this is more than just one component it's all these factors in coming into play in dealing with hot a great example. and i was grad i got to know this doctor before he passed a way. and in certainly i'm from a large orthopedic group and we don't want to do readmissions. we're penalized from re admissions but we're doing surgery most of the time. you're getting a knee, a hip, this and that. so one of the things we started doing is you're going to stop
smoking before you do your certainly, your going to lose weight. we're going to do physical therapy beforehand, and we're going to do everything so that the outcome is at it's best. delivering a baby is not an elective procedure. so you don't have that. i'm thinking outside the box. how do we embrace all of these factors, try to bring it together so we optimize our results, that we make people aware of their risks. if you're not aware, then it's hard to stop it. so there's a lot of things we can bring together and i'm looking forward to work on all of this with you. i think the medical hospital in columbus, we make sure they're healthy and get their vaccinations. we'll go to their house if we have to do make sure they get taken care of. how do we do this in this environment and what are your thoughts on that prospect?
we're talking in the right track and we do more. whoever wants to weight in on that. doctor felix? >> if you don't mind i'd like to speak to that briefly. we have a very similar model with a medicaid health plan working with our facility and have a pregnancy medical home model with that same goal. when moms are healthy or when they children are healthier, the entire system works better. and that model has definitely shown improved outcomes for pregnant women and their children reduced rates of nicu utilization, and better outcomes using care coordination, increased touches with tele phonic and in person. so the model you mentioned is something that could be useful. >> thank you all very much. >> thank you, doctor. with that let me recognize the
gentleman from new jersey, mr. pasquell to inquire. >> mr. chairman i was interested in remarks from my good friend from ohio. and i'm going to ask you a question to begin with in that spirit. dr. lou, when you work at a great university, you're an obstetrician, you have a lot to offer here as all the other panelists have. but i want to ask you something. there was the report from the institute of medicine back in 2003, and it was regarding un equal treatment and racial and ethnic disparities. so providers are on the front lines of ensuring the healthcare is equitable. what are physicians doing?
because you do a lot of education with our residents. that to improve their acknowledge of social determinants, in health equity in order to provide better care. what are physicians doing? doctor lou? >> yeah, right. they have decades of research in equal treatment in various areas of healthcare but it took someone like serena williams to actually call it out and bring public attention to this. i think we can definitely do better in terms of training the next generation of physicians. . . .
encouraged to take classes in communication and psychology and anthropology which made me a better dr.. in my political training we spend that first year doing home visiting. i still remember visiting the elderly couple in san francisco and they were the nicest people. they love to tell me their life stories so i learned to listen very well to see how the environment really impacts our patient's health. some of those things are important to standardize the medical training to make sure the future's doctors are kept more aware of implicit bias of
social determinants. >> we know individual health is influenced by many factors including the race, ethnicity, socioeconomic status and geographic locations. and that's just the start. in the past i've introduced legislation called the reduce act standing for reducing disparities using care models and education. it works to reduce health disparities. i'm going to introduce it again very soon. working on it, bringing it up-to-date. the bill which will work to provide updated data on the most vulnerable population giving states and localities schools to
better understand malls and projects that impact public health. i think this is critical to the issue rating with the testimony said. for two very different districts have to do with the major problem here? individuals long-term health status at the risk factors with limited access to care and get many of the cases there isn't a problem of access to care. it is painful because it should be preventable. women are more likely to die inf childbirth and pregnancy related causes and women in high income
countries. we've heard that many times today. 50% more likely to die in childbirth. that simply is not acceptable to any of us. but in order to say that, then what are you going to do about it? we are very poor responding to the problems and getting something changed for the better. thank you. the chair recognizes herself for five minutes. let me start by saying what a privilege it is to serve on a committee house ways and means committee that is taking seriously such an issue that affects disproportionately women of color, and i'm honored that the chairman was so gracious to yield his seat to me for a
little bit of time so that i could just say how profoundly important it is that we have women of color in every position but especially as researchers and it's critically important to have as lawmakers and policymakers as well. on the screen there is a map i would like to point your attention to. i represent the district in alabama. the district includes the city of birmingham, montgomery, tuscaloosa as well as parts of selma alabama which is my hometown. for the labor and delivery services 30 fewer than did in 1980. so, if you look at the map and showing, 1980 shows the number of labor and delivery services
and in 2008, 31 rural counties that inhabit and in 2017, 38 rural communities in the state of alabama do not provide labor and delivery services, so over the years less and less companies for having labor and delivery services. throughout my district people have to drive one or two hours of a. can you imagine if you in your state of preeclampsia had to drive an hour and a half or two hours with those women have to go to in order to have a baby. i am aware of the social
determinants of health disparities in the country. when i think about the fact that transportation, just one economic condition that affects one's health care and delivery of healthcare but so does poverty and unemployment and lack of food deserts and nutritional foods. so, we have a lot of work to do, but i think that when we have come to realize this committee and this day there is bipartisan support to do something about maternity mortality in this nation. you heard the ranking member talk about the investigation that began on the republicans watch and now you see it is being furthered by chairman neil. i think what we need, and i'm honored to be sitting here now with my republican who is also a medical or from ohio. we need to do something about this and i think a good start was made by having the approval
of congress women between also need to go further i think and consider the act by congresswoman kelly. i wanted to just say to you honored to watch you on television but more important to watch you here today in this hearing to get you give your te, your personal testimony. and i would like for you to remark on what you think is the biggest learning experience that you had from this whole episode. it is a crisis but i think that your voice is such an important place i would love to hear your thoughts about what advice he would give to other women. >> i would say the biggest lessonlesson that i learned in f my experience was being aware and educated on this.
if i don't know someone that i felt like to do research and was excited and talk to a lot of people who a lot of my friends don't know agai begin shreddingf the great questions to to ask and what to look out for. i think across the medical specialty so we definitely need black women as nurses and midwives. i was stunned to find out there's one black certified nurse for the holy city of philadelphia. whole city of philadelphia.
there is work that we need to do and great programs. the program that helps train people to go into the dough is very important so we need to expand on those programs the chair noticed that she's out of time. i would like to put in the record several articles about alabama and its effect on maternal mortality. next, ms. chu from california. >> thank you. and it's so momentous on this critical topic i think it is clear maternal health is in the state of crisis i am so dismayed
to find that this statistic today we are talking about the impact of maternal mortality on women of color and there is an effect on this population as well. i was dismayed to find that women are twice as likely to die from pregnancy related causes as white women according to the center for american progress and they also have a higher infant mortality rate in the general population which is 7.4 per 1,000 compared to 1.6 for the general population. also, i was stunned to find that in california there's the
highest rate of c-sections of any ratio or ethnic group that 45%. in practical terms this means half on medicaid and the preceding c-sections, which is 60% higher than those with private insurance. what is the consequence to having such a high c-section rate? >> that is a great question and something that as you said nothing but data and information we need to know as mother and women going into care i think it's important to understand the benefits and risks to any procedure, whether it is normal delivery, or vaginal delivery or c-section. educating parents about the risks that can go a long with having a surgical procedure, any surgical procedure there is a risk of infection but understanding that i think from
the beginning gives an understanding of the risk of going into childbirth and having a social procedure. i think one of the things peachy alliance can do is address misconceptions around the c-sections said people are aware of the benefit of that can be because they are so afraid of having a c-section because they think it is wrong but sometimes it's the only way to ensure a safe delivery so i think the goal is to have safe deliveries and to let women and providers know how on a one-on-one basis but then i'm a population health level. in the higher mortality are there areas for women like language access barriers with the groups that speak over 100 languages. >> there hasn't been a whole lot
of research for the populations. we do know that the women have higher rates and they are worth a study that showed they were more likely to be respected in healthcare settings compared to based on their language status. the other thing i just want to point out also is often the overall number of may mask certain problems and groups of the experience that we know that it is twice as high as filipino americans and native hawaiians s
and it is among chinese americans. so, i do think that when it comes to the data we can hope for precisely address the issues of the community. >> then i would like to ask whether better family planning can lead to better pregnancy outcomes and the reason i ask that is most of them women and women in general get family planning funds that bee these he been under attack from the trump administration under restrictions and orders on physicians and so for him since, is it true doctors recommend that women space out their pregnancies by at least 18 months to ensure the most healthy pregnancy outcomes? >> yes ma'am. can you say why? >> the first of approximately 18
in subsequent pregnancies improves outcomes for women and improves outcomes for their newborns as well. >> thank you. i yield back. >> the gentle lady from wisconsin for five minutes. >> thank you so much madam chair and i just want to thank the distinguished panel for the insights provided. we don't have research on that or data. we don't know. we don't have research. folks, we need to research this and i have introduced a bill that i hope gets passed that would also help us lean into why there is a disproportionate amount of sudden infant death syndrome and unexpected among women of color as well. as i indicated in the time i
think research and development is at the root of this and i think that a lot of our resistance to really funding the research and development we want to blame the victim they must have been on drugs. and we want to deny the structural barriers to the structural racism but it's involved. things like nutrition for example when you cut the food stamps and budgets i know, i run a household. food costs a lot of money. good food costs even more money. i do whenever my daughter whispering on the phone when she
had her first child and was breast-feeding. i've never eaten so well in my life and i was spending a fortune on food. when you start talking about the macmax that the gentle lady from alabama showed us, if you have a travel 15 miles there is no post that gets out there you might ignore swollen feet and just take it from your mama that all of us had swollen feet as long as he can remember and when you think about stuff like diabetes. these are structural things that
we are not leaning into. and i guess cardiac disease. i have the good fortune becoming good friends with a black woman cardiologist. you may not feel the pain coming up your arm indicating you in the chest because women don't resist the same way. we want you all -- environmental factors. my first attack shoveling coal into a furnace. so if your results and women in the city you get asthma and roaches in the house. these are factors that we need to research and that is what you -- i want you to agree with me in my last one minute and 30 seconds. >> we've got to do the research
and pin this down because it's not just that women don't care about environmental factors have structural problems and access to health care and the environment. there's nutrition and we need to end access to birth control and not having people tell us that we cannot space our pregnancies. we need to make sure that we take some of the elements of structural racism held in if we were to do the research, we would find out that these things are predominantly the factors. anybody have anything to say in 30 seconds? i just wanted to thank you again because the thing is you are a middle-class woman and the history of black women
reported deaths doubled when they closed the clinics and cut funding to planned parenthood. if texas was a country at the highest ratthat hasthe highest y developed world in the country. in the connection to the mortality i can speak to the data from the state of texas when the committee analyzed the data from 2012 we identified that there was significant reporting based on the death certificate data that was inaccurate and so than the actual fertility rate in that year was not as high as it was previously reported so we are looking at a rate closer to 18
then the 38. we don't have the data from prior years to compare it to post a detaile the detailed anan that year from 2012. it's important however to mention that restricting access to the practice of space medicine interferes with the patient physician relationship and our organization is very concerned about that i'm thrilled to have somebody from the city here thank you for serving our great commonwealth. the only healthcare interaction is maternity care and so we realize with the provision it's
been since roe v. wade and to intervene to kill the affordable care act and i'd just like to know how you talk about the importance of the affordable care act and obamacare to the maternal mortality. >> it's absolutely been important and what we found is women have had an adequate. following delivery so having access to care is extremely important if not the only solution is a big piece of.
>> to lead the act that got a couple of votes on the house floor because as you know, the cms is trying to make the plans available that would eliminate protection from pre-existing conditions or make it incredibly unaffordable and i bring that up here because so many people considered it a pre-existing condition. >> with that, mr. lewis is asked to have items include the itemsn the record without objection. but they recognize you to inquire. >> thank you for giving us all this opportunity to have a discussion. i want to thank the entire panel
tear that didn't show up in someone's life as a chronic disease or as an adverse health outcomes, so that's generally speaking what it is. when we talk about maternal health and infant health and the negative impact of weathering we see those but for all of the reason this seems like they would be healthy and can present to care on time and get all the care that is prescribed and recommended and still have a negative health outcomes. as difficult as i think several membermembers testified here tod said it's difficult to measure the impact of weathering because there are so many other factors but then there is a negative
outcome that is something we need to consider to say what is it that we could have been them differently here if all other things considered this woman is healthy and her child should be healthy she had a negative outcome that isn't related to simple medical diagnosis. >> i would like to follow up for the entire panel became that you just heard what do you think we can do to fill that gap? it's been described but described to me what you think we can do on the entire panel you had this opportunity to tell congress what do you think we can do? >> this is a good start, being heard. that means a lot to me. i feel like i have a voice that is very similar and just being
here and for you to listen to my story that definitely means a lot. >> it has a lot to do with the impact on your biology and then you think of some of the sources of stress and whether it's to have to work harder than anybody else just to prove to yourself, those are all sources of weathering. i rollcall on jurisdiction but that programs in addressing whether it is housing vouchers
these are all the programs that could reduce the stress on the women of color. >> when we look at weathering it is impacted by multiple factors on different levels so it's going to take a cooperative effort to address all of these issues that occur on multiple levels. >> it addresses the issue and the providers whether it is a nurse practitioner or family practitioner will be aware of what it is and start to have those conversations with their patients about it and what they can hope to do to address it together. >> i would add to the continuation to the provided services to women we have heard a lot about the nurse family partnership and visitation of another visitation program before important and then to optimize the best care within
the hospital system i would recommend authorization of the program. >> thank you, mr. chairman. i yield back. >> thank you, mr. chairman. i ask for unanimous consent a letter signed by health professionals affiliated with the public health and national association of certified professional midwives and the orange county women's health project. like why the gynecologists and obstetrics called it the benefit of women in medicaid expansion through the affordable care act. >> let me recognize the gentleman from illinois. >> thank you mr. chairman. think you for what you do
everyday and the work that you are pursuing to make sure everyone in the community has the health care they deserve and every mother can have the life she expects and deserves with her family. first, thank you for what you do representing the nation we are proud of you and as you mentioned the greatest pride we have is the title appearance there's nothing like it. as you talked about your story especially you said you'd ask yourself a question what did i do wrong, no one in your situation chipperfield question. no mother or father should ask that question what did i do wrong. we need to make sure we have a healthcare system that provides prenatal and postpartum care that leads to healthy families and all of our interest. i know in my own experience with my oldest son, my wife had an other option and it was a
serious condition. she got excellent care. i had no idea what was happening. she lost half of her blood volume, but she got up here and we now have two sons, 26 and 24. i couldn't be more proud of them and i wish the same for you and your daughter. i want to thank my colleagues for their tireless work to improve maternal health and in particular the excellent bill i'm very impressed to cosponsor and especially representative underwood leaving the caucus and a wonderful way but i also want to express my frustration as we think about the state within the richest country and we have some of the most extraordinary healthcare facilities and most wonderful healthcare professionals and medical advances and yet our maternal mortality and morbidity rates continue to rise. we are in the unpleasant company. the two countries have rise as
noted earlier, afghanistan and sudan. we can't get around the fact that we are -- my question as time is moving on into this may not have an easy answer to anyone on the panel, what makes our country unique grappling with this and bringing out the part of the way over the last 20 to 30 years has the rate increased? >> no one wants to answer. anyone? >> i think it is a combination of all of the things we've been talking about today. it's not any one of them, but it's all of them. and everything is intertwined. so, we are seeing the effect of the social determinants and how
we are seeing the effect of the factors that have been in play for quite some time and policies that don't often enhance when the end. i think it is a combination of all of the things that we've talked about here today. >> doctor lou. >> it is a complicated question without the answers. but i do think one possible answer is other countries invest so much more on the social determinants then perhaps the entire nation does. we spend more money on health care than the others and we are not getting the outcomes that we want to see, and i do think as we think about the national strategy towards eradicating but make sure that we pay attention
to the social determinants. going back to the jurisdiction of the committee, that's why i also think about the past policies and programs and so forth that this committee has an important leadership role to play in this country. >> i will make the observation with celebrating the 50th anniversary of landing a man on the moon and returning him home we can handle conflicts problems that we need to handle complex problems and the idea that every mother in this country whether she lives in the city or in the country or comes from a wealthy background or poor background. whether she's black, white or otherwise we need to make sure every mother has the care she needs and the care deserved it but no child is left without a mother because they didn't get the care the richest nation in the world should be able to deliver. i am out of time for any more questions but i think the chair man for having this hearing and i look forward to working on it.
>> is that with me recognize the gentleman from texas. >> thank you mr. chairman and thank you all for spending a good part of your day answering questions. it's clear you are very passionate about this and very knowledgeable. i always appreciate a great panel of folks that can help us try to solve problems. so, mr. chairman, it has been a very productive committee hearing and i've learned a lot. i had to step out. so i'm getting reoriented in my notes because i was taking copious notes throughout the presentations. i represent a swath of rules in west texas, and i refer to as the third fiber capital of the united states. a lot of farmers and ranchers and energy producers.
a lot of folks think of us as ththis asthe largest oil patch e country but we are also the largest wind farm and produce more wind energy than even the entire state of california. so, in order for these small towns to be sustainable, we need access to healthcare. basic care. even when it is offered often times i have the data only 6% of these hospitals have ob/gyn care access and yet represent 20% of the country. so, the hospital's going away since 2010 almost half are operating at a loss so we have a real crisis in health care in small town usa. i remember doctor robinson in
your testimony it seems like yesterday but we've done a few things since then. how do we get there. can we use technology to do it? can you talk about the rural aspect of this and i recognized again for listening and taking notes that we have a lot more to dig into and a lot more to learn before we are really smart and responsible about solving the problem because we want to be very focused and very responsible with the taxpayer money. i heard that you all are working in partnership with the community groups and local provider groups and some states are getting involved.
what role and ho roll and how de encourage other partners to participate. would you talk a little bit about the aspect to maternal mortality and how we address that? >> we can drill down and get the data to show exactly what's going on because that is going to be the next wave of headlines in terms of what it looks like in the rural communities. i think that ways we can start to address that sometimes it is a great benefit but sometimes it starts from the ground up. it is incredibly resilient through the theft only god can throw at you.
to think about ways that we do in pennsylvania when of the areas we have a program called centering pregnancy where it is a group provision meaning they come together in a group and can share their stories and concerns and to get their care and get those things and get the concerns answered. but then it also creates a support network, which women really need but only during pregnancy but in the postpartum period. but those types of programs and supporting those home visit programs and the use of community health workers is a way we can turn the tide in the community. >> in my remaining time, but we say to the ranking member, i commend you for investigating this.
it's more dangerous to have a baby than it was 20 years ago and could be on the short list is unacceptable in this country. and i'm going to work with the chairman and colleagues on both sides to try to solve this. god bless you and i yield back. >> thank you very much, mr. chairman. thank you for holding the hearing again on the impact that helps the care for all women but especially women of color and the opening testimonies by the witnesses here today as well as congresswoman kelly. your stories are powerful and i appreciate very much you being willing to share them with us today. thank you for leading the caucus with which i a i'm a member andi also want to recognize a home state of nevada that recently
signed legislation for a committee. the assistant majority leader in the assembly was the sponsor of the legislation and it's very important to us. i would like to enter into the record written testimony from the executive directo director e center of health disparities research and a professor of social and behavioral health. thank you. in her research, she identifies contributed factors of pregnancy related deaths and found that it is one clear challenge. a healthcare workforce shortage.
according to the resources and the administration, all 17 counties in nevada faced a primary healthcare shortage. the workforce shortage is compounded. nevada simply has too few. data from the charitable trust shows up from 2016 there were only 259 ob/gyn's in the entire state of nevada. even before addressing the quality of care that the scarcity and number of providers threatens the health and well-being of expectant mothers. doctor robinson, what do you recommend we do to address the severe workforce shortage areas that exist? >> thank you for the question. there are several programs that exist that helped to end the
device young students and their medical training to go into different fields. there've been specifically in primary care there've been loan repayment programs that have been in place for years but have been shown to be successful which helps us to address the issue of keeping women healthier before they become pregnant. ob/gyn is a specialty field and discipline sometimes you may not qualify for the single in the colleaguand thecolleague that ga primary care specialty does and that makes it a little bit harder and so there are if you look at the urban areas, there's definitely a higher concentration and i think that as we think about the rural areas the states where we have that health profession shortage we do need to train not only more physicians in general who can deliver our babies and keep our mother safe but we also need to make sure that our medical students that we have that diversity across the service
professions for medical care to ensure that. >> i know this committee will be looking at medical education and we also need to be looking at loans for business and debt elimination for the students pursuing these critical shortage areas. another way we can combat and prevent the death of others is through expanding programs like the maternal infant and early childhood home visiting progra programs. i'd like to ask i understand you previously helped oversee the program during the tenure. can you explain how this can help promote better outcomes? i'd like to thank you for your support of the home visiting program. there are different models but the idea that you have the only educator that visit the woman
and her family in their home during pregnancy in the first few years of the child life goes relationships can teach him on the adult self-care for families and help detect problems early on, problems with substance abuse and so on. there was a study published in 2014 that followed predominantly african-american women in memphis and found that when men that received home visiting in the first couple of years in their child's life were about three times less likely to die from any cause over the next two decades and eight times less likely to die from external causes such as homicide, suicide
and so i appreciate the support this committee has given and i do hope that you continue to expand the program so that more families can benefit from them. >> lengthy recognize the gentleman from florida. >> thank you all for sitting through a long hearing today. we certainly appreciate the work thayou are doing in this area. two questions for you. number one, and i will ask you this. it's very a lot of underlining research looking at the correlation between underlining health issues and this mortality rate? and what i'm getting at, do we
know, is there a correlation in those health diseases that are normally associated or are we coordinating that is looking at that in the same twenty-year period that we are looking at the mortality? >> we do see an association with chronic medical conditions and maternal mortality. so, when we look at women and compared to those that do not they are more than likely to have had another medical condition like chronic high blood pressure or diabetes. >> do we see an increase in those conditions, can we correlate that and do we know that that is happening as well?
we see increases in those conditions specifically it almost seems to me that if we are going to be more effective dealing with this, one of the things we need to look at is reducing those underlying medical conditions, better treatment, their access, awareness, blood pressure, diabetes, hypertension. is there any effort there were any kind of cause and effect or research to be done to say if we did a better job of preventing those may be we would see a better outcome on the other side. it makes sense, but are we looking at it through the flame is? >> if we had better health care and if we are able to present the development, pregnancy
related diabetes that can go away. if we are able to intervene and prevent subsequent diabetes that does remove the subsequent risk. i can't speak to the specifics that are saying it's reducing the reduced mortality that the health of women is incredibly important. but tying period if such a small parpart that we have to really e thinking about her health prior to pregnancy and intervene throughout the lifespan to ensure it's hoping women throughout the entire lifespan because we can't change it just overnight. >> one of the other challenges that we've got in rural america, and i have heard each of you kind of mentioned this it is
even tougher in rural america to address this issue. we talk about th talked about tf providers and access to cater. food deserts that exist in these communities where the families may not have access to the healthier choices. all of those kind of things play into it. we have to change the dynamic and how it is delivered in the role america and the deployment of broadband into these areas as such a critical component so we can connect patients back to the providers and medical centers where otherwise they may not have access to it. i want to make sure we are focusing on the mother's health before she becomes pregnant because we need to coordinate that and look back at that same twenty-year period and look at the overall health of these young women prior to the
pregnancy to see if we can correlate the health conditions that play a significant role. if that is the case then we need to put more emphasis on their hope sooner rather than very tight timeline in the individual finds out that she's pregnant. >> lengthy recognize the gentleman from georgia for a point of personal privilege. >> i want to recognize a member of the panel but thank each of you for being here. a graduate of spellbound college in the heart of my district.
health system and the social determinants of health that shape the quality of life. these issues are too big for just one hearing. they shape the future of health care in the 21st century. i represent central los angeles for the immigrant communities like the one i represent, language barriers between doctors and patients can be a problem and a major source of health disparities without language access and culturally competent care many health outcomes are measurably worse. what can we do to improve the access and care settings where it is most needed?
is a key component to the discussions between a healthcare professional and the patient that they are caring for her. there needs to be a good understanding of all of the information that's being conveyed. switching topics a little bit, you have achieved a zero maternal death to improving women's health not only during pregnancy but also across their life course. that is a direct quote from you. i am also proud to stand up for women's health especially those that rely on the safety net and that is why i will be reintroducing the investing women's health act after a
former staffer the bill would create a grant program and demonstration program to ensure all women have access to preventative care. this question can you tell me that the correlation that the preventative health screenings and maternal october the? -- mortality? is to identify when in so that we can ensure women at higher risk get appropriate care for example we've talked about how cardiovascular disease is the leading cause of mortality and so screening would give us an
opportunity to identify a woman who may have pre-existing cardiovascular disease to receive the appropriate care throughout her life and caring are pregnant the. >> one of the questions that came to me when i was listening to my colleagues is that people assume like the aca and maternal mortality are not connected are taking a shot in the dark is there any correlation between medicaid expansion and lower fertility rates in the state's? i can throw that out to the panel. >> in virginia we recently expanded medicaid and it's one of the recommendations i've seen made previously. we are looking forward to seeing what the data shows when it gets
going to see how it is going to be impacted. i just did a quick search and found the american journal of managed care that have medicaid expansion linked to the mortality rates. when people say they care about lowering the rates they also have to care about expanded medicare to the states that needed. i thank you for all your testimony and being strong. people need to be more outraged about this issue than they currently are. thank you and i will be healed back. >> i want to thank the witnesses or their testimony today. you've got two weeks to submit questions to be answered in writing and those questions and answers will be made part of a formal hearing record i thought it was important today and the witnesses did a terrific job.
when you're some questions about a new law passed in alabama. the governor recently signed a law making performing abortion a felony punishabl punishable by n life unless the mother's life is at risk. that is a topic on the campaign trail. the mayor of indiana and 2020 presidential candidate responded to the wall during a campaign event in chicago that's why this campaign must be about freedom. we think of freedom and liberty coming at you think of who you would expect it to be on in the
political world today and you think of people from the right. people think of our conservative friends that are preoccupied with making sure the government doesn't restrain our freedom too much. for the regulations that supposed to permit is the opposite of freedom, the less government and more freedom. it turns out that there are some exceptions to this rule. some in the american south today. i come from indiana. there are people i love, people i trust, people who support the politically who view this issues issue differently than i do. but i must say i don't think that you are free in this country if reproductive health can be criminalized.
[applause] this is not an easy choice for anybody to face, and i would be loath to tell anybodloathe to tg the situation with the right thing to do is. but that is exactly the point. i am a government official. i don't view myself as belonging in that conversation. to see in alabama that if someone is raped and seeks an abortion, the doctor who treats her will be penalized with a longer prison term and her rapist. it makes me question whether the discussion about freedom in the country has gone off the rails.