Sec. 2. Findings

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Congress finds the following: Maternity expenditures in the United States surpass all other developed countries, but childbirth continues to carry significant risks for mothers in the United States, as demonstrated by the following: More than two women die every day in the United States from pregnancy-related causes and the maternal mortality rate in the United States has roughly doubled in the past 25 years. According to data released in 2010, the maternal mortality ratio was 12.7 percent as compared to 6.6 percent in 1987.

More than one-third of all women who give birth in the United States (1,700,000 women each year) experience some type of complication that has an adverse effect on their health. Severe complications that result in women nearly dying, known as a near miss or severe morbidity, increased by 25 percent between 1998 and 2005, to approximately 34,000 cases a year. African-American women have nearly a four times greater risk of dying from pregnancy-related complications than White women, and these disparities have not improved in 50 years.

In spite of the considerable investment of the United States in maternity care, the United States is failing to ensure that all infants have a healthy start in life, as demonstrated by the following: Despite five years of modest reduction in pre-term births between 2006 and 2011, the United States continues to lag behind most other countries in pre-term birth rates, ranking 131 out of 184 countries, according to a 2011 report by the March of Dimes and the World Health Organization.

The proportion of low birth weight babies increased by 21 percent between 1981 and 2008. Non-Hispanic Black infants continue to experience significantly higher rates of both pre-term birth and low birthweight, two of the leading causes of infant mortality in this country. Despite shortcomings in the United States statewide data collections systems, which make international comparisons more challenging, international health organizations have ranked the United States far behind almost all developed countries in important perinatal and maternal outcomes, as demonstrated by the following:

The World Health Organization identified 49 nations with lower rates of maternal deaths than the United States in 2008. In the World Health Report 2005, the World Health Organization identified 35 nations with lower early neonatal mortality rates (4/1,000 live births) and 33 with lower neonatal mortality rates (5/1,000 live births) than the United States. According to data from the Organisation for Economic Co-operation and Development (OECD), 26 countries (out of 29 reporting) had low birthweight rates lower than that of the United States. 21 OECD countries (out of 27 reporting) had lower cesarean section rates than the United States.

Maternity care is a major component of the escalating health care costs in the United States, as demonstrated by the following: With 4,000,000 deliveries yearly, the vast majority of which occur in hospitals, maternity care for mothers and their newborns is the number one reason for hospitalization in the United States, exceeding such prevalent conditions as pneumonia, cancer, fracture, and heart disease. Of those discharged from hospitals in the United States in 2009, nearly one in four were childbearing women and newborns.

Combined mother and baby charges for hospitalization, which was $98,000,000,000 in 2008, far exceeded charges for any other hospital condition in the United States. Maternity care also accounts for a significant proportion of expenditures under the Medicaid program, which covers 42 percent of births in this country, as demonstrated by the following: In 2008, 26 percent of all hospital charges for which payment was made under the Medicaid program (totaling $41,000,000,000) was for birthing women and newborns.

The two most common conditions for which payments were made under the Medicaid program in 2007 were pregnancy and childbirth (constituting 28 percent of such payments) and newborns (constituting 26 percent of such payments), which together accounted for 53 percent of hospital discharges billed to Medicaid. The two most costly conditions for which payment was made under the Medicaid program in 2008 were mother’s pregnancy and delivery and care for newborn infants , which together accounted for 26 percent of all Medicaid expenditures.

Maternity care facility charges vary significantly by setting and type of birth. Part of the charge differentials between facilities are attributable to high overhead of hospitals— in 2008, the average charge for a hospital cesarean birth with complications was $20,080, and without complications was $14,900; in 2008, the average charge for a hospital vaginal birth with complications was $11,410, and without complications was $8,920; and in 2010, the average charge for a birth center vaginal birth was $2,277.

The procedure-intensity of birth-related hospital stays also helps to explain the high costs of such hospital stays. In 2008, 6 of the 10 most commonly performed hospital procedures for all patients with all diagnoses involved childbirth and newborn care. Cesarean section was the most common operating room procedure. Two non-invasive maternity practices, smoking cessation programs during pregnancy and external version to turn breech babies at term, have strong proven correlation with considerable improvement in outcomes with no detrimental side effects, but are significantly underused in the United States.

There is a growing body of evidence that other non-invasive practices which are underused in current practice may also be associated with improved outcomes. These non-invasive practices include group model prenatal care (such as the CenteringPregnancy model), continuous labor support, and non-supine positions for birth. The growing shortage of maternity health care professionals and childbirth facilities is creating a serious obstacle to timely and adequate maternity health care for women, particularly in rural areas and the inner cities.

There are significant racial and ethnic disparities across the maternity care workforce creating additional access barriers to culturally and linguistically competent maternity services.