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tv   House Ways and Means Hearing on Maternal Health Mortality  CSPAN  May 19, 2019 12:17pm-1:23pm EDT

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capitol hill this week, not to discuss the 2020 olympics in tokyo, but to speak about the rising maternal mortality rate in the u.s. we begin this part of the house ways and means committee hearing with the six time olympic gold medalist talking about her personal experience and the racial disparities in maternal health care. >> good morning. ranking member brady and members of the committee, my name is allison felix, and i am cameron's mom. that is a title i am most proud of. i have also represented our country in four olympic games and have won six olympic gold medals. i have surged side-by-side with president and this is obama and the fight against childhood obesity. i am the daughter of an element tree 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
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just how many other women just like me were experiencing those same fears and much worse. my hope is that by sharing my experience with you, it will continue a conversation that needs much more attention and support. 32 weeks into my pregnancy, i was going into a routine prenatal appointment and i thought everything was right on track. i thought i was healthy, and i thought my daughter was healthy. i noticed swelling in my feet, but i thought that was normal for pregnancy. right? i asked my mom and my aunt, who are both black mothers, if they experienced this as well. one had. one hadn't. doctorke told me to ask my at my next apartment, which was days away. no one seemed too concerned so i was not either. i trusted that my doctors would look out for a. i found comfort in knowing i was a professional athlete and continued to train and exercise throughout my pregnancy and was in great shape. when i walked into my
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appointment, i was met with a family smile and genuine care and concern about how i was feeling. i really am so fortunate i had such a thorough dr.. she took a look and check on cameron, but then she stepped out of the office for a while. those moments sitting in her office alone felt like one of those moments in life that are full of anxious anticipation. that people describe as time standing still, waiting to hear the voice at the other end of the phone tell you exactly why they are calling at 3:24 in the morning. those few moments lasted an eternity but the doctor finally came back in, and she told me i would need to go to the hospital. i did not quite understand the seriousness of her request. i said sure, but i have a photo shoot with espn immediately after this. so i would just run by, knock that out, and go to the hospital. i got into my car. the doctor let me know that was
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not going to be an option. i got into my car without any idea what was going on but knowing that something was not right. i called my husband, who was at work. i 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 1500 miles away. i felt alone because i thought i had done something wrong. i felt like i was one of very few women that something so unpredictable is happening to. that morning started like any other day, like every other day. but now i, was sitting at the hospital waiting to hear what s the doctors told me that not only was my baby at risk but i was at risk, too. all that i cared about at that moment was my daughter would survive, and i did not understand about my life as well. mothers do not die from childbirth, right? not in 2019.
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not professional athletes. not at one of the best hospitals in the country, and not certainly women who have a breathing plan lined up. i thought maternal health was solely 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 that i would need to be on bed rest for the rest of my pregnancy number which meant staying in the hospital for the next eight weeks. the thought of staying in bed for that amount of time was awful, but it would be ok because my baby would be ok. just as we started settling into our new home, the doctor came back in and gave us even worse news. she told me that i had a severe and if they did not act fast, it could prove fatal. i called my family and ask them to fight in and asked my doctor if they could wait until they got here. he told me he would do his best.
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10 hours later, i was being taken in for emergency c-section at 32 weeks. i kissed my husband goodbye not knowing what would happen. it all really happened so fast. i heard her cry. i could not see her. why wouldn't they let me see her? i strained and reached but my body did not really work. i could not see her. i could not hear her cry anymore. i clenched my husband's hand tighter. there she was. she was the most beautiful thing i had ever seen. she was not crying but she was rearing, and that is ok. than her for no more 15 seconds before they rushed her away and i close my eyes. the next month was spent in the nicu and i learned my story was not so uncommon. there were others like me, just like me, black like me, healthy like me, doing their best just like me. they faced death like me, too. researchthat i did my and the more other moms i
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talked to, i realized they had these experiences. i learned black women are nearly four times more likely to die from childbirth than white mothers are in the united states and that we suffer severe complications twice as often. the data was teaching me that risk is equally shared by all black women regardless of income, education, or geographical location. so all the ways that made me feel i was prepared and doing things the right way are not for black women. as this committee meets to discuss overcoming the racial disparities and the maternal mortality questions, i ask you to consider writing down a few names and keeping the list somewhere safe. please write down the name of my friend, serena williams, olympia's mom, and tennis champion. please write down the name of andrea mcbride, maribel's mom, half of the pacific american sister duo to establish and found a one company. these are a couple of names of
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women who are just like me. even though we may have entirely different backgrounds and lives, some have more access to resources than others. some are more healthy than others. but each of us have faced losing our lives and the lives of our unborn children. what i have 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 racial bias within our health care system that is troubling and will be difficult to tackle. that does not mean we shouldn't. racial bias is difficult because it is not as easy to spot as outright racism, but examples can be just as devastating. biasrch shows that racial is a number maternal health care system, includes things like provider spending less time with black mothers, underestimating the pain of their black patients, ignoring symptoms, and dismissing complaints. practical next steps are to look at ways we can provide women of color the access to do list and
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midwives. it helps educate women of color on pregnancies and healthy ways should be monitoring our bodies during this beautiful time. i believe we must also look at how we can support organizations committed to the work of lowering minority maternal mortality rates. our current health care system is not set up specifically to provide support for these at-risk women and the organizations that have taken up the cause are intentional 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, chairman neil, and to committee for hearing that story and for also encouraging me to learn even more about this very important problem. as a result, i have decided to further lend my voice to organizations who have taken up this work, and i hope i cannot only share my story but be intimately involved in this work and fight to make a difference. >> thank you, miss felix.
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dr. harris is recognized. would you put your microphone on, please? >> thank you. good morning, chairman neil. wrecking member brady and .ommittee members my name is dr. patrice harris, and i am the president elect of the ama. i'm a practicing child psychiatrist from atlanta and adjunct assistant professor in the department of psychiatry. i think you for the opportunity to testify today. and i also want to thank all the advocates who have been working on this issue for many years. you have heard the data, and the data on maternal mortality in the u.s. are deeply disturbing. the u.s. is one of only three countries in the world where the is rising.rnal death again, you have heard the statistics and we'll hear more
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data this morning. but most alarmingly, 60% of pregnancy-related deaths are preventable. this is simply on acceptable when we know -- undetectable when we know the end agrees are unjust and avoidable. what is causing this and why is the rate so much higher particularly for black and native american women? factors that play a role are as follows. although coverage has extended under the aca, millions of women have lacked insurance or have inadequate coverage during pregnancy. increased closures of maternity units in urban and rural committees have reduced access to quality care. in addition, the lack of interpersonal and interprofessional teams, traits, and best practices also impact quality of care. structural determinants of health, which include public policies, laws, racism, produce
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inequities in the social determinants of health such as education, employment, housing, and transportation. discrimination and racism exacerbates stress, which can result in hypertension, heart disease, and gestational diabetes during pregnancy. as we heard, black women are not being heard. clinician and institutional biases can lead to missed warning signs and delayed diagnoses. how do we move forward? the ama is 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, to integrate training in a social and structural determinants of health, implicit biases, and cultural humility, developing educational opportunities for practicing physicians on the social and structural determinants of health, working with united health care to utilize diagnoses
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linked to the social determine determinants of health, which can screen for and provide the necessary referrals to social services and community support, and welcoming dr. maybank as the ama's first chief health equity officer who is initiating our new and explicit path to advance health equity. regarding specific solutions to address maternal death and morbidity, we are expanding the review committee. we support improving data collection for information on effective intervention and expand access to health care and social services for postpartum women. we encourage health systems to work with other partners to identify and adopt standards, to ensure safe and quality of care at delivery and afterwards. it will certainly take all of us working together in partnership to address this issue.
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the ama is committed to doing so. we are committed to building and continuing our path forward to a more holistically and effectively improve maternal health and advanced health equity. thank you. >> thank you, dr. harris. let me recognize dr. lou. >> chairman neil, ranking member brady, and numbers of the committee, my name is dr. michael lou. i am at george washington university. in july, i will assume my new role as the dean of the school of public health at uc berkeley. ofm formerly the director the health bureau and am pleased to have this opportunity to share with you today my personal views on what we must do to eradicate maternal mortality. let me start by saying that in 21st century america, the most powerful nation on earth, no woman should ever die from
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pregnancy and childbirth. everys we have heard, year more than 700 women die and more than 50,000 women suffer a life-threatening complication. recent media stories have shined a spotlight on the problem, but at times they make it seem mike there is not much we can do. in fact, i believe that much can and must be done. i believe we can cut maternal mortality in half by 2025 and eradicate maternal death in this country by 2050 by doing three things right. first is to learn from every maternal death. much of what you are about to hear, support the work that the cdc is leading to create a national system of maternal mortality review committees in every state. we need to learn from every maternal death so we can prevent it from happening to other mothers. second is to ensure the quality and safety of maternal care for all women. this is a low hanging fruit.
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because as you heard, according to a recent cdc report from 60% of deaths ar maternal deaths are preventable. a like diagnosis, printable treatment, or pork medication or coronation across providers and facilities. this is where the maternal safety bundles come in. these are bundles of past practices, toolkits, protocols, , and, solutions an other things designed to improve maternal care. these bundles work. i saw it work firsthand in california. i was part of a small group of doctors, nurses, and public of professionals who piloted these bundles. we went around the state hospital by hospital. service for labor and delivery staff. we engage hospital ceo in quality improvement initiatives and built a culture of safety. in 2006, california's maternal
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mortality was trending high in the united states. it kept going up. with the limitation of these bundles, california's mortality decreased by 60% in six years and african-american mortality was also cut in half. when i became the director, we worked with many of the other public and private partners to launch the alliance for innovation in maternal health or aim to spread california's success to other states. the idea is if we can get these we can cutes, maternal mortality by half by 2025. the third and probably the most import thing we can do is improve the health of girls and women in our country across their life force. we can start by certain quality of health care to women not -- today,nancy but
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low-income women lose their medicare coverage. one in eight maternal deaths days between 42 and 365 postpartum, extending medicaid coverage up to one year postpartum is an important first step for reducing late maternal death. health care is important. but so are social determinants. average childhood experiences and violence against girls and women have been linked to chronic health problems. poverty for girls and low-income households can take a physiological toll on their long-term health. experience of racism in the lives of many women of color can lead to weathering or accelerating agents which contribute to higher rates of chronic health conditions as well as maternal mortality among even college-educated african-american women. your committee has jurisdiction over a number of tax and income support programs which can buffer against the impact of the social determinants. cuts propertyls
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in half in the next decade to accommodation of a span of tax credits through stamps and housing vouchers example fight a timed evidence-based policy that can go a long way to improving maternal health in the country. lastly, i want to close by a shout out to my mom. i wish her a belated happy mother's day. lot ofhas not got a full public shout outs in her life because she never got to go to college or high school or even junior high. my mom was only 11 when her father died. so is the oldest girl in the family, she had to drop out of fifth-grade to go work in a sewing factory. she and my dad worked hard all their lives to put food on the table and put their children through college. about toer son is become a dean in the greatest public university in the world.
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a testament to all the love and sacrifice she has shown me. nearly 43.5 out by million times every day in this nation. america can do better by our mothers. >> thank you. dr. ross. memberrman neil, ranking brady, and members of the ways and means committee, thank you for the opportunity to testify at this hearing. i'm dr. melanie ross, maternity mortality coordinator in virginia deferment of health, office of the chief medical examiner, and i would like to commend you for holding this hearing on this important topic. virginias maternal mortality review team was established in 2002 as a partnership between the department of health offices of chief medical examiner and family health services. it is a multidisciplinary group of representatives from academic institutions, behavioral health agencies, hospital associations,
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chapters of professional associations, and also violence prevention agencies. we have representatives from forensic pathology, maternal medicine, obstetrics, pharmacy, nutrition psychiatry, patient health allnd public participating in our team. the team collects data on and reviews the death of all virginia residents who were pregnant within a year of their death, regardless of the cause of death or the outcome of the pregnancy. we refer to these deaths as pregnancy-associated deaths. we use consensus decisionmaking to determine the community, patient, facility, and provider factors that were contributed to the mortality in each case. and then the team also assists in determining whether or not the death was related specifically to the pregnancy and whether or not it was preventable. for death that we determined to were able to be prevented, we suggest ways it could have been made and ended up in a better outcome instead of a death.
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between 2004 and 2014 in 2013 in virginia, 462 women died of pregnancy associated death. the number of deaths and the rates of death varied from year to year and there was no clear signs whether it was increasing or decreasing. our preliminary numbers for 2015 and 2016 suggest those rates are continuing to increase. overall approximately 53% of our , pregnancy associated deaths were due to natural causes. accidental deaths represented the next largest manner of death among pregnancy associated death in virginia at 26%. among the leading causes of death were cardiac disorders followed by accidental overdoses, motor vehicle accidents, homicides, and then suicides. nearly 55% of these deaths occurred 43 or more days following the end of the pregnancy.
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there are several risk factors that have been identified in pregnancy associated deaths in virginia. the most prevalent of these risk factors are chronic mental illness, chronic substance abuse , and chronic medical conditions. over 25% of maternal deceased in virginia had been diagnosed with depression, and approximately 20% had been diagnosed with anxiety at some point in their life. nearly 25% of the maternal decedents were found to have a chronic substance abuse issue. throughout the years, the maternal mortality review in virginia, we noticed the significant racial disparities. there have been disparities identified in the rates, causes of death, as well as the manners of death in contributors to these. the disparities have been found to extend all across socioeconomic status and educational backgrounds. in general, the maternal mortality rate for black women is over twice as high as it is for white women, and when we look at specific to the
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pregnancy of later cases, black women die at a rate three times higher than white women. there's also been significant differences found by race in regards to the manner of death. black women were more likely to die from natural causes whereas white women were more likely to die from accidental deaths. in addition to the racial and ethnic disparities we found, we also found disparities between urban and rural areas. in our rural areas, the leading causes of death were typically from violent causes, including motor vehicle accidents which accounted for approximately 20% of all of our deaths in rural areas. this was followed by homicides and then accidental overdoses. in our urban areas, the leading cause of death was cardiac disorders followed by homicides. additionally, motor vehicle accidents and overdoses were prevalent in our urban areas at approximately 10%. maternal mortality at the state
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and national level have been increasing over the last two decades. maternal mortality review teams offer an opportunity to review these deaths to determine factors that contributed to the death and to make a recommendation for intervention and policies that can improve maternal health outcomes. the teams review pregnancy associated death in virginia has demonstrated a system of affordable, coordinated, and standardized care in the united states as a cultural value, a medical standard, and a human right. improving the health and outcomes of and postpartum women involves changes at all levels, including the community, provider level, the facility level, and a system level. mr. neal: thank you, dr. rouse. dr. robinson. dr. robinson: good morning. i'm dr. loren robinson, the deputy secretary for health promotion and disease promotion -- prevention within the pennsylvania department of health. i'm a physician trained in both internal medicine and
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pediatrics. i want to thank chairman neal and ranking member brady and the members of the committee for the invitation to address issues surrounding women's health, health care, and wellness for matters in one of the most vulnerable periods of their lives. i'd also like to thank ms. felix for giving her testimony today because so much of my story over the last month has been reflected in her words. just three weeks ago i was , promoted to the rank of mother myself. thank you. it's thanks to my mother who is watching my son today that i can be here. in pennsylvania, we have aligned 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 maternal morbidity and mortality. while many people know pennsylvania and know about philadelphia and pittsburgh, our state is also made up of a rich collection of small and mid-sized cities such as erie, pennsylvania, and vast rural areas that contribute much to our nation's rich agricultural
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markets. the narrative of maternal mortality has different faces across the commonwealth and women in our rural areas are also bearing the brunt of these health care disparities we talked about today. the opioid epidemic has caused significant impact in both maternal and infant morbidity and mortality in our rural and small to mid-sized cities. these communities have started to rally and organize to implement practices that are saving lives. such as linking home visiting services to our centers of excellence, which provide treatment and counseling for the disease of addiction. however, these efforts have not yet been enough to overcome the grave disparities and outcomes borne by minority women, especially black women. the complex interplay of individual, relationship, community, and societal factors necessitates addressing issues across the range of factors to optimize the health of black women and the health of their children as the choices a person
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makes are shaped by the choices that a person has, which are themselves shaped by structural policies and processes. prenatal care is widely recognized as a practice claim to help maternal and infant outcomes. while the general trend and access in 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% of white women. the healthy people 2020 target is 78% of women receiving early and adequate prenatal care. and although prenatal care is important, it may be received too late or not be enough to positively impact pregnancy outcomes. preconception and health, as dr. lu 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 for whom our federal dollars can be spent. by bringing together our
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community organizations, payers, insurance companies, large academic health care systems, and smaller community-based hospitals, state governments can be the bridge for idea exchange. the imperative that comes from such an exchange is the creation of interdisciplinary policy and programs that reach communities that have typically not yet benefited from federal funding and programs. - programming. in pennsylvania, the department of human services administers both the social services block grant and the maternal infant and early childhood home visiting program. currently, over 6,000 individuals representing 3,200 households are served through this program with a total of 40,000 home visits being conducted in 2017. and while these programs provide services for many pennsylvanians, the department of health often fills the gap for support and home visiting for families who may not qualify for the above-mentioned programs. the implementation of mmrc has promoted progress in reversing the trend of maternal mortality.
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i'm proud to say that in pennsylvania in may of 2017, governor wolf signed act 24 into law, which created the pennsylvania maternal mortality review committee. the language of this act was modeled off of important work that was passed in chairman neal's home state of massachusetts where their mmrc has been in place for over 20 years. pennsylvania is now equipped with an mmrc that will produce a report within three years of its first meeting, which was last october. examples of ways to implement changes and recommendations of maternal mortality review committees are through organizations known as perinatal quality collaborative policies, collaboratives, or p.q.c.'s. in states like north carolina and massachusetts, a collaborative is a network of teams that works to improve the access and quality of care for both mothers and babies across prenatal, labor and birth, newborn, and postpartum services. these teams can identify processes that can be improved.
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and quickly adopt best practices to achieve their collective aims. in closing, ways that we can move forward and address maternal mortality. currently, the preventing maternal death act is providing applications or an opportunity for states to apply for funding to create their mmrc's. as a next step and as we look forward, the mama act, which was introduced by congresswoman robin kelly just one year ago this month, identifies priorities that we can address and achieve. first, by expanding medicaid access to cover the postpartum period up to one year as opposed to the routine 42 to 60 days across states. second, to ensure the sharing of best practices across these perinatal quality collaborative practices and across hospital systems. third, establishing and enforcing our national emergency obstetric protocols, and lastly, and possibly most importantly, to improve access to culturally competent care by addressing institutional racism and the
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training of hospitals and community health providers on the needs of all american mothers. we continue to follow and be thankful for the dedicated time and energy of this committee and our elected officials here in washington. i would like to thank you for your time this morning and i look forward to working together to improve the health of mothers of our great nation. thank you. mr. neal: thank you, dr. robinson. dr. hollier. dr. hollier: chairman neal, ranking member brady, and distinguished members of the committee, thank you for inviting me to speak with you today. acog, with a membership of more than 58,000, is the leading physician organization dedicated to advancing women's health. key to the action is our core value that all women have access to affordable health care. i'm an ob-gyn and i dedicated my career to improving the health of my patients. you've already heard the united states has a maternal mortality
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crisis and the disparities in mortality are unacceptable. acog is dedicated to eliminating maternal deaths and we are eager to continue our strong partnership with you to achieve this important goal. we applaud the passage of congresswoman herrera beutler's bill last year. as you've heard, mmrc's are best positioned to understand the causes and contributing factors of maternal deaths and to identify opportunities for prevention. the alliance for innovation on maternal health, or the aim program, is helping to translate maternal mortality review committee findings and recommendations into action. launched in 2015, the aim nrogram is funded through a agreement with acog. the goal of aim, a voluntary program, is to eliminate preventable maternal mortality and morbidity in every birthing
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facility. mmrc data identifies gaps for improvements, collaboratives assessed with implementation and aim provides the programs which gets us to our goal. aim promotes a culture in of safety in hospitals through best practices called bundles hemorrhage, severe hypertension, opioid use disorder, and the reduction of racial and ethnic disparities. early evidence shows that aim is shifting culture. initial aim states including illinois, florida, and michigan observed a 7% to 21% reduction in severe maternal morbidity between 2015 and 2018. california had a 21% reduction in severe complications from hemorrhage. and in illinois, timely treatment of severe hypertension rose from 41% to 85%. aim is now in 27 states, applied to about 75% of the total u.s. birthing population, and with your support, we hope to reach all 50 states.
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work on the aim disparities bundle is working in real time , and we are working to incorporate mechanisms to address disparities in all of our aim bundles. to help achieve that, acog is working with our partners on mothers voices driving birth equity, a project funded by the robert wood johnson foundation to incorporate patient voices and lived experiences in our patient safety work. black women's feedback must be a driver for quality improvement initiatives. acog also supports black mothers - the action for safety care initiative with equipping black mothers to obtain respectful patient-centered , care. we and all care providers have work to do t. news reports that the maternal mortality rate in my home state of texas is in the national spotlight. our mmrc up to ensure we have
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an accurate accounting of mortality, which was lower than initially recorded, and an understanding of the causes and overstate. a release report noted cardiovascular conditions, hemorrhage, infection, and cardiomyopathy. we found black women bared the greatest risk for maternal death and that risk exists regardless of income, marital status, or other health factors. these finally informed -finely informed recommendations such as the promotion of a culture of safety through the implementation of best practices like those developed by the aim program and increased efforts to eliminate health disparate. in addition i was also co-chair , of the harris county community plan to address harris county's high rate of maternal morbidity. i encourage other cities to consider this public-private partnership model. as congress considers its next encourages you to
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four initiatives. to accelerate evidence based safety changes. authorize the aim program. and extend medicaid coverage to 12 months post paragraph tell. thank you for opportunity to share our work with you today. we are truly making meaningful progress on the path to better maternal outcomes and a look and weak look forward to work together with you to eliminate maternal mortality. thank you. chairman neal: thank you. we'll now proceed to questioning under the five-minute rule. consistent with committee practice i will first recognize those members present at the time of the gavel in order of seniority. let me begin my recognizing myself. miss felix, would you like to convey mothers who may be watching this hearing, especially african-american women who might not always feel included in such conversations , your feelings. ms. felix: yes. i would definitely want them to know first of all to be aware.
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i was not aware. i didn't know that i was at a greater risk. really, to advocate for yourself. you can be intimidated sometimes in a doctor's office, but if something does not feel right, you need to speak up. we need to be heard. and i would just encourage them to do that. i hope that in the future this problem is not as great as it is now. until then, i just really encourage african-american mothers to have a voice and to really use it. chairman neal: thank you. dr. lu, how can we better and consistently collect data as you have outlined on social determinants of health and risk factors so we can make informed improvements that yield better results for millions of minority women in this country who rely upon our hospitals for safe delivery? put your microphone on, please. dr. lu: first things first, make - let's make sure we get
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mortality review committee in every state. they do collect a lot of data on social determinance of health. i think we also need to be better tracking severe maternal morbidity. for every single maternal death , there are 50 to 75 near misses. women did not die but suffered a life threatening complication. i think there are a lot of things we could be learning from severe maternal morbidities. i also think we need to be doing a better job in terms of monitoring the quality and safety of hospital care which begs for performance measures on the inpatient side or the outpatient side. lastly and probably most importantly, we need to do a better job in terms of listening to mothers and especially in terms of understand their birthing experience, whether they feel listened to. whether they felt disrespected. discriminated against. one possible way of doing that
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is to expand the c.d.c.'s plans , which is the cdc survey of mothers across the country in terms of capturing their pregnancy experience. chairman neal: thank you. let me recognize ranking member brady for five minutes. mr. brady: chairman, thank you for hosting this hearing. the reason republicans on this committee launched a investigation last year was that this problem's been growing for more than 30 years. from about the time ms. felix, you were two years old. the question is, why hasn't this been addressed before? why has this gone on so long? a woman shouldn't have to fear giving birth. especially when they have done everything right, as you did. what i think is important is that washington likes tock
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- to be simplistic. it's really important we're not. we have to get to the root causes of this mortality and get serious about it. medical factors do play a role. obesity is higher in some races than others. hypertension the same. , diabetes, the same. all which lead to early births and c-sections, all which can help, unfortunately, drive mortality for moms. we can't just accept that as genetics. we have to go to the root causes and solve it and make it better for them. socioeconomic factors matter, poverty is a risk factor, mental health is a risk factor. overdoses in texas and suicides in texas and around the world. so it is really important we go deep here. i have been encouraged by the investigation as we launched by how many local communities, states, including texas, responded. they are identifying better data so we understand it.
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dr. lu, they are identifying certain better practices, best practices, all of which i think help along the way. and i want to point out, dr. lu, i was pleased to see in your testimony you highlighted the need for a national strategy to help accomplish eliminating, that should be our goal, eliminating moms dying in birth. dr. hollier, do you agree that we need a national comprehensive strategy to eliminate deaths at birth? and in your community plan in harris county in our backyard, what was working to lead us toward that? dr. hollier: one of the things that we have seen work best across all of our efforts is collaboration. by working together, by organizations, patient groups, advocacy groups all coming together to work for a single goal to eliminate maternal mortality. we have made significant
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progress. specifically in that the harris county work that we did we had a wonderful opportunity to bring together leaders in our local government, private entities, hospital systems, insurance providers, and in working together we were able to come up with a strategic plan that had multiple different prongs to address the problems specific to harris county. that collaboration. rep that collaboration. brady, harris county third largest county in america. very diverse, a broad range of these factors that impact maternal mortality. do you agree we need a national comprehensive strategy here? dr. hollier: i think again it's very important for us to be able to work collaboratively across all of our groups so that we do not have duplication of effort. and we're working together.
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rep. brady: thank you, mr. chairman, i would like to pose a question to my colleagues today. is there any reason why we can't all support a national strategy to address maternal -- eliminate maternal mortality? further, i would suggest we all work together to continue our investigation as a committee that we started last fall. we've got some bright people on this committee who are absolutely dedicated to this. i bet you we can make a difference. with that, i yield back, mr. chairman. >> thank you. let me recognize the gentleman , mr. lewis, to inquire. mr. lewis: thank you very much, mr. chairman. mr. chairman, first of all i want to thank you for holding this hearing. this panel, in my estimation, may be one of the most diverse panel that i have witnessed
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since i have been a member of this committee. i want to thank you again, mr. chairman. i would like to thank each and every one of you for taking the time to share your stories and your expertise with us. mr. chairman, in my home state of georgia we face a crisis and i would like to enter into the record a news article about why georgia ranked last in the nation on this matter. chairman neal: so ordered. mr. lewis: i would also like to express my gratitude for miss reed from atlanta, georgia. she shared her story with me about the reality postpartum depression and the challenges of trying to access health service as a woman of color. dr. harris, thank you for being here. i am so glad we have a doctor from atlanta, georgia. we need more like you. you are well aware of the crisis in georgia.
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it is worse in our state than any other. we're far behind. we need to do better. we need to catch up. what should the congress do to encourage better maternity care for women of color? what should we do? dr. harris: thank you for your words. congressman lewis, i think there are many things that congress can do. i would say at a basic level it's funding and infrastructure. congressman brady talked about a national road map congress.
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and at the national level can develop funding for a infrastructure from which local and community based solutions can arise. again earlier we talked about supporting the momma act. we talked about making sure that there is funding several panelists have mentioned the importance of maternal mortality he review committees. in order to develop solutions, we need to first identify the problems. and we can't always identify those problems without the accurate data. so funding to make sure that these review committees are adequately operationalized will be key.
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the other issue, and you mentioned depression, as a psychiatrist i think i would be he remiss if 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. unfortunately, the infrastructure for mental health and substance abuse disorders have been woefully underfunded for several years. so funding a basic infrastructure for treatment for mental illness for postpartum depression will be key can as well. those are a few suggestions. mr. lewis: thank you for your courage. thank you for being here today. i know you are a great athlete. can run very fast. why would you want to come in and tell your story and be so personal. why? ms. felix: thank you so much. it was very 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're talking about today. i consider having my daughter, my greatest achievement. it was such an eye opening experience what i went through. i was not aware. i was completely not educated on this topic.
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so i am -- i wasn't happy to go through what i went through, but i am thankful that i was able to come out and learn so much because now i feel like with the platform that i do have i could use my voice to try to have an impact. so i am extremely happy to be here and to share my story today. mr. lewis: thank you for being here. yield back. chairman neal: let me recognize the gentleman from nebraska, mr. smith, to inquire. mr. smith: thank you, mr. chairman. and thank you to our panelists. your personal stories and professional perspectives. we appreciate. it is clear the increasing rates of maternal mortality represent a major national challenge that needs to be addressed. when i chaired the human resources subcommittee of the ways and means committee in the last congress, we acknowledged and worked to address the challenges faced by pregnant and new mothers during our work re-authorizing the miechv program.
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because of the proven benefits this program provides to at-risk mothers, i pushed for a five-year re-authorization, the longest re-authorization of its kind, to ensure mothers and children get appropriate support they would otherwise be able to access. we also included language in the jobs for success act last year which would have allowed states to recognize this need by using tanf dollars toward home visiting in miechv. mothers in rural districts such as mine often face the greatest difficulties in accessing maternal care, a problem exacerbated by the closure and consolidation of rural hospitals and clinics. one avenue for providing pregnancy testing and care mothers need is through rural health clinics. frequently the nearest source of primary care for those in rural america. in fact, because of the importance of rural health clinics and the provision of necessary primary and preventive care in rural areas, today i'm introducing the rural health care clinic modernization act, a bipartisan package which will help stabilize rural health clinics and stem the recent tide of closures.
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another important aspect of overcoming rural health challenges, including maternal mortality, is the adoption of innovative approaches to transport deliver toy rural population. dr. hollier, what health care challenges would you say your observations would include in terms of noticing pregnant and new mothers and their experiences in rural areas? dr. hollier: acog believes that access to maternity care in rural areas is of critical importance. and our organization is working with the american academy of family physicians and the national rural health association to come together to find solutions that we can put into place that will enhance the access to care for women in maternity areas so that women have access to the same care, say quality care regardless of where they live.
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we urge you to keep access in the front of your minds as you are considering future implementation sews that we can ensure that women have access to safe high quality care. mr. smith: do you see telehealth being an option in this delivery of health care? dr. hollier: the american college of obstetricians and gynecologists convened a task force last year. they have been working to come up with recommendations on best practices for our membership. we look forward to the publication of that report in the coming months. mr. smith: anything else you wish to add relating to that? dr. robinson, would you be able to elaborate on telehealth and your perspective on the delivery of health care certainly to rural areas.
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it doesn't have to be just rural areas that could benefit from telehealth, but urban areas as well. can you respect on that? dr. robinson: sure. i think especially as we think about telehealth and just the wait for a doctor even in urban areas, i think that telehealth could play a significant role. it helps for triage. when a woman or pregnant woman has a concern and isn't sure this is something that requires them to go to the hospital or just have a question like ms. felix referred to, telehealth provides that opportunity to have a face-to-face consultation via the internet or telehealth. i think the other piece of that
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that's important and contributes is that we can think about telehealth as it relates to social determinance. what is it she's in need of? she may not need to go to a hospital but concern about accessing childcare, trying to figure out how she can access childcare so she can go to her provider appointment, how can she access transportation? in pennsylvania and a lot of our rural areas transportation is a big issue. there are communities that don't have sidewalks. we talk about safe areas to walk, live, and play, we want to be sure we can have those consultation, figure out what specific challenges a woman is facing and find out it may not be here. if there are a lot of these same concerns from one community, that allows us as a state how can we leverage our resources to address the concerns that may be in a particular community f we don't have those resources, how do we call on our federal partners to say this is what we're seeing in our state and our current funding allows us to do x, what we need to do is y, a and are we able to do that? mr. smith: thank you. chairman neal: let me recognize the gentleman from texas, mr. doggett, to inquire. mr. doggett: thank you so much. i appreciate your valuable insights. as chairman the health subcommittee, i think this is a very good place to start but recognize that we need a more in-depth exploration across the board of health care disparities that affect people in all conditions and in all ages and in both genders.
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i think it's particularly important that we look at the reforms that have been outlined in legislation that a was filed last session. the health equity and accountability act by mr. lewis, ms. sanchez, ms. sewell from this committee, ms. chu, representative davis, gomez, from this committee. there is much more work to do here about the broader issue of health care disparities. in texas, your skip code is such a strong predictor of the health of mother and child. in san antonio, bear county, which i reap, the disparities are stark. overall bear county has the highest infant mortality rate in the state. and the greater san antonio region has the second highest maternal mortality rate. almost 40% of the live births involve women who do not receive
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any prenatal care or received it only very late in their 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 texas women who receive medicaid coverage during pregnancy, coverage as dr. hollier pointed out, it has been terminated at 60 days after childbirth under the state's very stingy medicaid program. i'm pleased with your testimony, doctor, and the work being done in the texas legislature now to try to extend that 60 day period to a more reasonable level.
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overall, while it's very important to work on the data, and i want to inquire more about that, we need not only good data but good care. and we need it for all economically disadvantaged texans and particularly to address this issue of disparities. the -- bringing a child into the world is a combination of joy and stress, but that stress is enhanced when the women who travel through our health care system don't see many medical professionals that look like them. so we need to work on our work force in the health care system as well as one way of addressing this matter. in san antonio, a nurse, veronica, and group called latch support, is one of those groups that is working to address this whole issue and to empower moms and break through some of the cultural barriers. the san antonio express has editorialized a number of times about 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 and that entire process
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really interfered with our ability to get at this problem. there are so many other groups that are in coalition in bear county working to try to address this problem, but i want to ask dr. robinson and dr. harris, given your comments about institutional racism, about what else we need to do to get the care there to help address this problem. >> thank you so much for that question, mr. doggett. i would start by saying training providers on systemic institutional racism is the first step. so often we talk about race or racism this country, it's about personal attack. i think when we think about systemic racialism, there are
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few people who would argue that any policy that's geared toward keeping a group of people down needs to stay in existence. sometimes we 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, we can work across straits, aisles, to address once we know what they are. that's the first piece. we can think about providers at the hospital and health system level which is important. then as ms. felix and other panelists said, talking about some of our community organizations. we think about nurse midwives and doula's, making sure people get care where they are. there is coverage for that because those services are not cheap and not currently covered by insurance. when patients understand that piece of it and understand how to access service answer met with the health system that supports them and understands how institutional racism play as a role, there is a better chance we can work to eliminate maternal mortality.
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mr. doggett: we welcome additional written submissions from any of the witnesses on these issues. chairman neal: recognize the gentleman from pennsylvania, mr. kelly, to inquire. mr. kelly: thank you for being here today. first of all, cameron's mom, ms. felix, thank you for being here. you are totally relevant in this. and i think the fact you are willing to come forward and talk about your story, what i'm puzzled with, though, is in your case it wasn't a matter of not having proper care, it wasn't a matter of nothing being in great shape, it wasn't a matter of so many different things, yet you encountered this. i got to tell in you my life, we have been blessed with four children, between number one and number two, we had an atopic pregnancy. never would have known it if it hadn't been for visits to the doctor's office. hi absolutely no idea what an atopic pregnancy was.
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my wife went through that. then we went on to have three children after it. it just puzzles me because i'm trying to understand. you had the best care you could possibly have. you were aware of everything in your life. what you ate, your vitamins, everything ready to give birth but you still had this problem. what else can we do? i want to thank you for doing that. you have got to be a -- my daughter was a long distance runner. but i got to tell you, it is incredible the role that you play and the voice that you have. what else could you have done differently? ms. felix: i'm puzzled as well. i think that's the problem. for me as an athlete, like you said, i know how to be healthy. i know all of the things, i know how to take care of my body. i did do everything right. i think that is really what's scary.
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that i was still at a higher risk and went through all these complications and wish i can could give you an answer. i don't know. but i know that this conversation is a great place to start and hopefully we can actually come up with some answers. i think the fact that i did do everything right and i know how to be healthy, but still face this is very, very alarming. mr. kelly: the role you are playing is important. i want to talk to dr. robinson. pennsylvania's been described as philadelphia in the east, pittsburgh in the west, and alabama in the middle. because we face -- the reason i bring this up is because of the fact that so much of our state is rural. i wonder sometimes as i look, because the role you are playing in pennsylvania right now and governor wolf signing a piece of legislation we're getting more involved with this, you talked about sharing data. when we talk about health care, and we talk about the access to health care and the availability of health care providers, in pennsylvania, what we're trying to do, we see that, we see that all at the time where people just don't have access to the providers they need to have, the question becomes, why can't they?
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a lot of cases there is no way to get there from where they are. what else can we do looking at where is it we're going? we started this in the last session and moving it forward right now. we're aware of it. mr. lewis and i first talked at the beginning of this session, one thing we want to start right away on oversight was about the mortality and mothers because i couldn't believe in the united states of america we had that problem. but we share the same interest and beliefs. there is no greater role in america than to be a mother and take care of our future generations. doctor, what else can we do and data he we can share? all states are facing probably a
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lot of the same situations. what can we do differently or need to do differently or going forwarder what have you seen? dr. robinson: thank you very much, mr. kelly. i think our first piece is getting the data. you have heard a lot of data. when you look headlines everyone is talking about what's going on with black women. that's so important. as a black woman i78' glad we're a headline and paying attention, you don't know what you haven't studied. i can't give you data about rural versus urban areas in pennsylvania.
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we won't know that until we study it. we talk about diagnoses like pre-eclampsia. and then start doing research about how early can we detect it, how can we prevent it, how can we get moms look for signs earlier than their swollen feet? those are the things we need data on. we think about our rural areas. some of the things that can help are community health workers. early in the pregnancy a lot of the visits are about eating well, not a lot of medical tests but checking in on a regular basis. so when we have community health workers who can do some of that work, when we have nurse midwives who can go out in the communities and can do some of the work that our ob-gyn's have done and share in that work and thinking about as women get closer to delivery what services absolutely have to be delivered
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out of the hospital and help women understand when you see any of these things, you need to get to a hospital. we've got policies and procedures in place to help them get there. that's the piece that we need to communicate. so much of this period -- it's a long nine months and there is a lot of knowns but still a lot of unknowns. reassuring moms they know their bodies and if something is different, who do they call and where do they go are ways we can make sure we can reduce maternal mortality. mr. kelly: there is nobody on this panel that's looking at what's going on and saying, you know what, it's not a problem. it's a huge problem, we have to


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