AMA advocacy to improve maternal health

The American Medical Association is committed to tackling the issues surrounding maternal mortality and morbidity. The U.S. has the highest maternal mortality rate among developed countries. A 2019 report by the Centers for Disease Control and Prevention (CDC) found that Black women are 3-4 times more likely to die from pregnancy-related causes than white women.

The AMA understands that there are a multitude of considerations necessary to address this epidemic, including:

• Lack of insurance or inadequate coverage prior to, during and after pregnancy.
• Closures of maternity units in many rural and urban communities.
• A lack of inter-professional teams trained in best practices.

There are concrete actions that should be taken to reduce and prevent rising rates of maternal mortality and serious or near-fatal maternal morbidity in the United States.

We urge policy makers to:

• Extend Medicaid and Children's Health Insurance Program (CHIP) coverage to 12 months postpartum.
• Increase support for maternal mortality review committees.
• Implement equitable standardized data collection methods.
• Expand access to medical and mental health care and social services for postpartum women.
• Continue to develop a health care workforce that is diverse in background and experience.
• Address shortcomings in our institutions.
• Adopt standards to ensure respectful, safe and quality care before, during and after delivery.

2024

• To bolster federal and state efforts and provide recommendations to improve maternal health outcomes, the AMA has worked collaboratively over the last year with a variety of members of the Federation of Medicine, including relevant specialty societies, state medical associations and physicians from rural areas. On Apil 11, the AMA released (PDF) a new set of concrete steps that the administration and Congress can take to improve maternal health outcomes in the United States. The AMA has also developed a comprehensive document (PDF) providing a more detailed explanation of the recommendations outlined in our April 11 correspondence to the federal government.
• The AMA voiced support for H. Res. 217 (PDF) and S. Res. 90 (PDF) to increase the endometriosis research that is desperately needed. The AMA believes that there should be increased endometriosis research that addresses health disparities in the diagnosis, evaluation and management of endometriosis as well as increased funding for endometriosis related research for patients of color.
• On Feb. 28, the AMA sent a letter to Administrator Brooks-LaSure recommending several steps the Center for Medicare and Medicaid Innovation (CMMI) can take to ensure the new Transforming Maternal Health (TMaH) program significantly improves birthing outcomes for pregnant and postpartum individuals and their babies.

• The AMA requested the ICD-10 Coordination and Maintenance Committee make revisions to the current International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) to remove derogatory language and adopt destigmatizing terminology. Specifically, the AMA noted the use of “elderly” and “young” in the context of pregnancy.
• On July 26, the AMA signed onto a letter in support of the bipartisan Preventing Maternal Deaths Reauthorization Act of 2023 (H.R.3838/S.2415). This legislation continues crucial federal support for the state-based maternal mortality review committees (MMRCs) that review pregnancy-related deaths to identify causes and make recommendations for the prevention of future mortalities.
• On Jan. 31, the AMA sent a letter commenting to the Centers for Medicare & Medicaid Services (CMS) on the Request for Information (RFI) on Essential Health Benefits (EHB) published in the Federal Register. Comments covered a number of topics including maternal health.
• On Feb. 21, the AMA commented on the proposed revisions to the "Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Food Packages." Overall, the AMA applauded the WIC program’s demonstrated success in improving the health of individual participants by increasing consumption of nutritious foods and decreasing food insecurity. Moreover, the AMA supported the primary goal of revising the program to align with the current Dietary Guidelines for Americans while providing flexibility in the variety and choice of foods and beverages. This flexibility will better reflect cultural and medical needs and personal preferences while adhering to the science associated with nutritional necessities that promote growth and health in pregnant, breastfeeding and non-breastfeeding postpartum individuals and children.
• On March 13, the AMA sent comments on the CMS Notice of Proposed Rule Making (NPRM) outlining proposals to advance interoperability and improve prior authorization (PA) in Medicare Advantage (MA) plans, state Medicaid agencies and Medicaid managed care plans, Children’s Health Insurance Program (CHIP) agencies and CHIP managed care entities and issuers of Qualified Health Plans (QHPs) on the Federally-Facilitated Exchanges (FFEs). A number of topics were covered including a request for information entitled: "Advancing Interoperability and Improving Prior Authorization Processes for Maternal Health." As such the AMA provided information on how to strengthen data collection and the prior authorization process for pregnant, birthing and postpartum individuals. 
• In a joint webinar, Manatt Health, the AMA and a panel of stakeholders shared key lessons for states seeking to innovate and expand access to evidence-based care for pregnant people with a substance use disorder (SUD) who are incarcerated or under judicial supervision.
• On the judicial front, the AMA signed on to an amicus brief in the State of Ohio v. Tara Hollingshead, which concerned a pregnant person who was sentenced to a lengthy prison term for using illicit drugs during the third trimester. The AMA strongly opposes criminalizing pregnant individuals who have substance-use disorders. The AMA joined seven other Ohio and national organizations to file an amicus brief that urged the court to overturn the verdict that would have sent the woman to prison for eight to 12 years. They were joined in the brief by 31 experts on maternal, fetal and neonatal health and the effects of drug use on pregnant people, pregnancies and babies. In May, the court vacated the conviction.

• On Jan. 16, 2024, the AMA signed onto a letter commenting on the U.S. Preventive Services Task Force (USPSTF) Draft Recommendation: High Body Mass Index in Children and Adolescents: Interventions.
• On May 16, 2023, the AMA commented on the U.S. Department of Agriculture (USDA) Food and Nutrition Service (FNS) on the “Special Supplemental Nutrition Program for Women, Infants, and Children (WIC): Online Ordering and Transactions and Food Delivery Revisions to Meet the Needs of a Modern, Data-Driven Program” proposed rule. By removing barriers to online ordering and internet-based transactions, harmonizing the near-complete transition to electronic benefit transfer (EBT), and modernizing regulations to support food delivery and minimize burden on WIC food suppliers, FNS will modernize the WIC program and increase accessibility so that WIC can meet the evolving needs of the millions who rely on the benefit.
• On April 10, 2023, the AMA commented on the U.S. Department of Agriculture’s (USDA or Department) Food and Nutrition Service (FNS) on the proposed revisions to the Child Nutrition Programs: Revisions to Meal Patterns Consistent with the 2020 Dietary Guidelines for Americans. Overall, the AMA applauded the Child Nutrition Program’s primary goal of revising the program to align with the current Dietary Guidelines for Americans (DGA) while providing flexibility in the variety and choices offered in school meals. However, the AMA provided more detailed comments and suggestions on improving the nutritional density and limiting the fat, added sugar, and sodium content in school-based food programs, accommodating food substitutions based on cultural and medical needs and preferences, and supporting initiatives to improve access to healthy, affordable foods and promoting lifelong healthy diet and lifestyle choices.
• On Feb. 21, 2023, the AMA commented on the proposed revisions to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Food Packages. Overall, the AMA supports the primary goal of revising the program to align with the current Dietary Guidelines for Americans while providing flexibility in the variety and choice of foods and beverages. This flexibility will better reflect cultural and medical needs and personal preferences while adhering to the science associated with nutritional necessities that promote growth and health in pregnant, breastfeeding, and non-breastfeeding postpartum individuals and children.

Learn more about the AMA’s earlier advocacy to improve maternal health (PDF).

• AMA recommendations to improve maternal health outcomes
• AMA initiatives to improve maternal health outcomes