Lamaze International’s call for increased advocacy joins a chorus of stakeholders, maternity care providers, and policymakers seeking to improve maternal health outcomes. This is taking place on many different fronts, through increased awareness, dialogue, partnerships—and legislative action. Since the inaugural Lamaze Advocacy Summit in 2017, the number of maternal health-related bills introduced in the U.S. Congress have tripled.

Initiatives to identify and address causes and contributors to maternal mortality and morbidity have prompted a deeper dive into maternal healthcare in United States—and growing number of different bills introduced each year reflects the progression from discussion to action. The uptick of maternal health bills in just a few short years is a positive step toward improving maternal health outcomes.

Tracking so many different bills, though, can be overwhelming. One can now argue that the issue area has reached a saturation point for legislation. Most maternal-health bills introduced will not become law—and a majority will not advance far in the legislative process. This is not bad news. Their existence shows that more policymakers are paying attention to this issue and want to carve out a sub-topic within this initiative to champion. This is a positive indicator of progress—and a promising step for Lamaze efforts to find a champion for evidence-based childbirth education and certified childbirth educators.

A quick overview of the legislative process below may help Lamaze members track legislation and discern among the many existing bills related to maternal-health outcomes. Understanding the steps each bill must take to reach the House or Senate floor will help Lamaze members navigate the onslaught of maternal-health legislation and track promising bills.

A bill’s introduction is the result of many hours over the course of months—and sometimes years— of conversations, outreach, lobbying, research, draft-development, and draft review among Congressional staff, stakeholders, experts, and advocates. Each bill needs a Congressional champion—a member of Congress who introduces the bill and gathers colleagues’ support. The likelihood of a bill’s success requires bipartisan support—sponsorship from both Democrats and Republican members of Congress.

Upon introduction, a bill receives assignment to a Congressional committee that has jurisdiction over a topic area. For maternal-health bills, this usually means the Energy & Commerce Committee or the Ways & Means Committee in the House of Representatives, and the Finance Committee or the Health, Education, Labor, and Pensions Committee in the Senate.

Once assigned to a committee, most bills receive no further action. Every two years, Congress permanently adjourns (at the end of even-numbered years) and Congress resets its legislative slate. Colloquially referred to as “dying in committee,” any bill sitting in a committee, regardless of its support, disappears from the committee docket.

The 117^th Congress, which began in January 2021, will run through adjournment in December 2022. In just over four months of the 117^th Congress, close to 4,000 bills now sit in House committees and over 2,000 bills sit in Senate committees. Most will not receive any additional consideration and will disappear at the end of 2022. This disappearance can be permanent or temporary. Members of Congress often re-introduce their bills from the previous Congress early in a new Congress. The uptick of legislation in the first few months of a new Congress (e.g. 2021) reflects these re-introductions—many of which will sit in committee until that Congress adjourns in 2022.

If a bill is bipartisan at the outset and receives support from both Democrat and Republican members within its assigned committee, it has a higher likelihood of receiving additional consideration through committee hearings and bill markups. Committee hearings enable subject-matter experts, advocates, and stakeholders to testify before committee members, who in turn, ask these individuals questions about the bill and the issue area. Hearings inform a bill’s committee markup, which precedes a committee vote to advance the bill to the entire House or Senate (depending on the specific chamber) for consideration. 

Bills that make it out of a committee must pass out of either the House or the Senate and receive consideration in the opposite chamber. Most bills do not get to this point as stand-alone measures. Larger legislative initiatives often pick up smaller, bipartisan bills that have are either cost-savers or politically viable for both Democrats and Republicans. This can happen quickly—and often late at night.

Bipartisan maternal-health bills are good candidates for larger legislative vehicles. Thus, the disappointment of seeing so many worthwhile bills ignored in committees can be offset when practical, good-sense bills succeed. One recent example is the Medicaid coverage extension from 3 to 12-months postpartum. Several stand-alone bills called for this extended coverage, and the concept proved viable in the COVID-19 relief bill that became law in early 2021.

This quick addition to the COVID-relief bill, long in the making for advocates, will have a tremendous impact on maternal health coverage for many in year following birth. Countless lives will be saved and many more will have access to healthcare and support to help set them up for success in the earlier years of parenting.

Advocacy is a long-term, but continuous effort. And input, support, and expertise on all levels is essential to achieving results and seeing positive change. Lamaze believes in this change and the steps—however long—it takes to see improved childbirth and maternal-health outcomes. Increasing access to evidence-based childbirth education and certified childbirth educators contributes to these improved outcomes and Lamaze is there every step of the way.

The Lamaze advocacy team does this with your expertise, guidance, and outreach. The 2021 Lamaze Advocacy Summit will provide Lamaze members opportunities to meet with Congressional representatives and advocate for the profession, themselves, and for effective change. We look forward to seeing you there.

About Molly Giammarco, MMP

Molly Giammarco has consulted for professional healthcare associations for more than eight years. As Lamaze International’s Senior Manager for Policy & Government Relations, Molly monitors legislation regulations related to maternal and child health, as well as advises the Lamaze Advocacy + Collaboration Committee.

Molly received her undergraduate degree from Smith College in Northampton, Massachusetts and her master’s degree in public policy from the George Washington University in Washington, D.C.  She currently lives in Washington, D.C.

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