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Maternal Health and Morbidity

Photo of Representative Louis Ruiz

Rep. Louis Ruiz (KS), NHCSL Healthcare Task Force Chair

Sponsored by Sen. Cristina Castro (IL)

Reported to the Caucus by the NHCSL Healthcare Task Force
Rep. Louis Ruiz (KS), Chair

Unanimously ratified by the Caucus on December 5, 2019

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WHEREAS, maternal death is when a woman dies during pregnancy or within 42 days after the end of pregnancy;[1] and,

WHEREAS, about 700 women die a year from complications during or shortly after a pregnancy in the United States;[2] and,

WHEREAS, black and American Indian/Alaska Native women in the United States are 3 times more likely to die from pregnancy-related causes than white women; and,

WHEREAS, Asian and Pacific Islander women have an annual average of 182 pregnancy-related deaths and a pregnancy-related mortality ration of 14.2;[3] and,

WHEREAS, “high-risk pregnancy” means a pregnancy in which the mother or baby is at increased risk of complications during pregnancy or childbirth.

WHEREAS, every year in the United States more than 50,000 women have severe pregnancy complications and one in four pregnancy-related deaths are related to heart conditions;[4] and,

WHEREAS, low income and first time mothers who are at risk for pregnancy complications can benefit and improve their chances for a healthy outcome by increasing collaboration with health care providers; [5]and,

WHEREAS, benefits of home-visitation programs include increased use of prenatal care, increased birth weight, decreased preterm labor and increased length of gestation, improved nutrition during pregnancy, increased attendance at childbirth classes, greater interest by fathers in pregnancy, and an increase in the number of labor room companions;[6] and,

WHEREAS, a 15-year follow-up study of families who received a mean of nine home visits by nurses during pregnancy and 23 home visits up to their child’s second birthday displayed the following long-term effects[7]-

  • Fewer subsequent pregnancies,
  • Reduced maternal criminal behavior,
  • Decrease in use of welfare,
  • Decrease in verified incidents of child abuse and neglect,
  • Less maternal behavioral impairment attributable to alcohol and drug abuse; and,

WHEREAS, benefits of doula services include[8]-

  • Breastfeeding support,
  • Help with emotional and physical recovery after birth,
  • Housekeeping,
  • Assistance with newborn care,
  • Sibling care,
  • Baby soothing techniques,
  • Referrals to local resources such as parenting classes, pediatricians, and lactation support; and,

WHEREAS, long-acting reversible contraceptive devices (LARCS) have been proven effective in reducing the rate of unintended pregnancies which have been tied to maternal illness and death according to the U.S Centers for Disease Control and Prevention (CDC);[9] and,

WHEREAS, the aforementioned services will decrease rates of maternal morbidity in minority communities and promote perinatal and maternal health by improving birth outcomes.

THEREFORE, BE IT RESOLVED, that the National Hispanic Caucus of State Legislators (NHCSL) urges state governments to expand and update maternal health programs to better serve any pregnant or postpartum woman whose pregnancy has been identified as high-risk by her primary care provider or according to the standards developed by the respective state agency tasked with overseeing public health; and,

BE IT FURTHER RESOLVED, that the National Hispanic Caucus of State Legislators advocates for a partnership and joint taskforce with the National Caucus of Native American State Legislators (NCNASL) , the National Black Caucus of State Legislators (NBCSL), and the National Asian Pacific American Caucus of State Legislators (NAPACSL) to address and increase accessibility of maternal healthcare to decrease maternal morbidity rates given the increased likelihood of pregnancy-related death in minority populations; and,

BE IT FURTHER RESOLVED, that services provided to pregnant and postpartum woman must by administered by a registered nurse, licensed social workers, or other staff with behavioral and medical training, as approved by the respective state agency tasked with overseeing public health; and,

BE IT FURTHER RESOLVED, that States should establish standard levels of maternal care in birthing facilities adhering to the criteria set forth by the American Congress of Obstetricians and Gynecologists;[10] and,

BE IT FURTHER RESOLVED, those providing services may collaborate with other providers including obstetricians, gynecologists, or pediatricians in treating a patient; and,

BE IT FURTHER RESOLVED, that the National Hispanic Caucus of State Legislators (NHCSL) recommends the establishment of an evidence-based, voluntary, nurse – home visitation program that improves the health and well-being of low-income, first-time pregnant women and their children. This nurse-family partnership shall include, but not limited to the following components:

  • Maternal health education includes but is not limited to, home visits to program participants, providing education, support, and guidance regarding pregnancy and maternal health, child health and development, parenting, the mother's life course development, and instruction on how to identify and use family and community supports.
  • Home visits to program participants regarding pre-natal and post-natal care shall begin on a weekly or biweekly basis starting on the 28th week of pregnancy and continuing until participants children reach the age of 2.

BE IT FURTHER RESOLVED, that the respective Department tasked with public health may work in collaboration with human services, healthcare and family services in addition to other key providers of maternal child health services to amend the state agency’s rules regarding high risk infant follow-up; and,

BE IT FURTHER RESOLVED, that high risk infant follow-up shall entail the use of current scientific, national, and State outcome data, to expand existing services to improve both maternal and infant outcomes and to reduce racial disparities when it comes to outcomes and services provided;[11] and,

BE IT FURTHER RESOLVED, that any group health insurance policy shall allow hospitals separate reimbursement for a long-acting reversible contraceptive device provided immediately postpartum before hospital discharge; and,

BE IT FURTHER RESOLVED, that any group health insurance policy shall provide coverage for medically necessary treatment for postpartum complications, including, but not limited to, infection, depression, and hemorrhaging, mental, emotional, nervous, or substance use disorder or conditions at in-network facilities for a pregnant or postpartum women up to one year after the woman has given birth to a child; and,

BE IT FURTHER RESOLVED, the participants eligible for medical assistance shall receive medical coverage for doula services by a certified doula during their pregnancy and during the 12-month period beginning on the last day of their pregnancy; and,

BE IT FURTHER RESOLVED, participants are also eligible for coverage of perinatal[12] depression screenings for the 12-month period beginning on the last day of their pregnancy; and,

BE IT FINALLY RESOLVED, that state governments shall endorse a state plan to expand medical coverage for family planning services to low-income pregnant women.



[1] https://www.marchofdimes.org/complications/pregnancy-related-death-maternal-death-and-maternal-mortality.aspx



Refer to the Pregnancy Mortality Surveillance System


Refer to the Section under Public Health Problem titled Pregnancy-Related Deaths

Refer to the Fast Facts section of the website on the right hand side.


Refer to the section titled Prenatal Effects


Refer to the section titled Long-term Effects


Refer to the section titled Duties of a Postpartum Doula



Standard levels of care include an early warning system that monitors mothers during pre and post-natal care.


[12] Relating to the time, usually a number of weeks, immediately before or after birth.