Oct 30, 2019, 1:00 PM ETPanel, Conference Presentation

Sexual, Reproductive, and Maternal Health in America

Panelists: The session features Dr. Michael Liu (Dean, UC Berkeley School of Public Health; former HHS MCH Bureau Director), Christy Turlington Burns (Founder, Every Mother Counts), Dr. Lena Nguyen (Former CEO, Planned Parenthood; Visiting Professor, Milken Institute), and Rep. Lauren Underwood (Co-Chair, Black Maternal Health Caucus).
Moderator Note: Rep. Underwood must depart 10–15 minutes prior to the session's conclusion, necessitating an early start to the Q&A segment.

In the 21st century United States, more than 700 women die annually from pregnancy and childbirth-related complications.
Over 50,000 women experience life-threatening complications during pregnancy or postpartum each year.
The maternal mortality rate has increased by 50% over the last 20 years, making a woman 50% more likely to die from pregnancy than her mother.
African American women are more than three times as likely to die from pregnancy-related causes compared to non-Hispanic white women, a disparity that has remained stagnant for over 30 years even when controlling for income, education, and insurance status.
Cardiovascular disease, hemorrhage, infection, and preeclampsia (formerly toxemia) account for approximately 50% to 75% of all maternal deaths.
Approximately one-third of maternal deaths occur during labor and delivery, while two-thirds occur at other points, including the postpartum period.
Clinical data indicates that at least half of all maternal deaths in the U.S. are completely preventable through improved quality and safety protocols.

Rep. Underwood and Rep. Alma Adams founded the Black Maternal Health Caucus in April to address racial disparities and the lack of national reporting or federal goals regarding maternal mortality.
The caucus launched with 50 members, including three Republicans, and has grown to 86 members, maintaining a bipartisan composition.
Legislative Wins (First 6 Months):
- Secured new funding in the Labor, Health and Human Services House Appropriations Bill to tackle maternal mortality.
- Introduced a suite of legislation extending Medicaid coverage to 12 months postpartum for all women.
- Advocated for robust funding and standards for state-level morbidity and mortality review committees.
The "MOMnibus": A collective term for multiple bills introduced in May addressing various aspects of maternal health, including fertility preservation and comprehensive care.
Funding Specifics: The House passed a bill allocating $50 million specifically for research on maternal mortality and disparities, a figure that Rep. Underwood notes has received insufficient public coverage.
The caucus is engaging external stakeholders, including private industry (e.g., Uber, Lyft) and insurance companies, to partner on transport and care models.
Rep. Underwood reports that while 90% of solutions are bipartisan, legislation regarding abortion access and Medicaid expansion linked to the Affordable Care Act remains politically polarized.

Provider Training & Protocols: Dr. Liu highlights the implementation of "safety bundles" (checklists, drills, simulations) which reduced California's maternal mortality by 60% between 2006 and 2012.
Scale-Up Status: The Alliance for Innovation on Maternal Health has deployed safety bundles in over 1,000 hospitals across 20+ states, aiming to cover every U.S. hospital to halve mortality rates.
Over-medicalization: Excessive interventions, such as unnecessary C-sections, lead to complications like placenta accreta, which are difficult to treat and often require specialized, scarce providers.
Postpartum Care Gaps: The traditional six-week postpartum visit is considered outdated; the American College of Obstetricians and Gynecologists now recommends immediate follow-up within the first week.
Mental Health: Postpartum depression is frequently missed due to stigma, lack of screening, and the archaic timing of visits; pediatricians are increasingly used as a conduit for maternal screening.
Implicit Bias: Systemic racism and implicit bias in medical care are identified as primary drivers of the racial mortality gap, necessitating mandatory bias training for providers seeking Medicare/Medicaid accreditation.

Telemedicine Limitations: Dr. Nguyen and Rep. Underwood express skepticism regarding telemedicine as a "panacea," noting it is cheaper to fund screens than to train and retain human providers in rural areas.
Risk of Widening Disparities: There is concern that new technologies (wearables, sensors, AI) could exacerbate health inequities if access is differential or if design incorporates implicit bias.
High-Tech/High-Touch Integration: Experts advocate combining technology with "high touch" care, such as group prenatal care and home visiting nurses, to address nutrition, sleep, stress, and environmental exposures.
Data Utilization: Proposed use of continuous data from wearables and AI to predict risks and triage patients to appropriate care levels (e.g., home visits vs. specialist care).
Primary Care Integration: A low-tech, high-impact proposal involves primary care providers asking women of reproductive age if they plan to be pregnant in the next year to facilitate proactive screening for hypertension, diabetes, and mental health.

Political Strategy: Dr. Nguyen and Rep. Underwood advocate for finding common ground on prevention, universal care access, and maternal survival, separating these from partisan debates on abortion to secure broader support.
Grassroots Momentum: The panel attributes the current surge in attention to celebrity stories (e.g., Serena Williams), media investigations (e.g., ProPublica), and the "Black Moms Matter" movement, though they note the need for sustained, mass grassroots advocacy beyond individual anecdotes.
Systemic Reform Goal: The ultimate objective is to treat women's health not as a siloed issue but as an integral part of the broader healthcare system, addressing social determinants like paid leave, income tax credits, and food security.
Workforce Development: Urgent calls to address the pipeline crisis in mental health professionals and to expand funding for training in nursing, midwifery, and clinical psychology.
Stress as a Clinical Factor: Recognition that chronic stress from societal pressures (racism, economic insecurity) acts as a physiological burden on women's health, requiring interventions that build community resilience.