April 15, 2022

Warren, Moore, Booker, Casey Introduce Mamas First Act to Combat Maternal Mortality Crisis

Legislation Would Help Address the Maternal Mortality Crisis that Hits Black and Brown Moms Hardest

Bill Text (PDF)

Washington, D.C. – Today, during Black Maternal Health Week, Senator Elizabeth Warren (D-Mass.) and Representative Gwen Moore (D-Wis.), along with Senators Cory Booker (D-N.J) and Bob Casey (D-Pa.), and Representatives Deborah Dingell (D-Mich.), Ayanna Pressley (D-Mass.), Lauren Underwood (D-Ill.), and Alma Adams (D-N.C.) introduced the Mamas First Act, vital legislation to address the maternal mortality crisis by expanding Medicaid to include doula, midwifery, and tribal midwifery care. In the Senate, this legislation is cosponsored by Senators Alex Padilla (D-Calif.), Bernie Sanders (I-Vt.), Tammy Duckworth (D-Ill.), and Richard Blumenthal (D-Conn.).

“The U.S. maternal mortality and morbidity crisis is shameful, and it hits Black and Brown people the hardest. My colleagues and I are introducing this bill to increase access to doulas, midwives, and tribal midwives in Medicaid to help combat disparities and systemic racism in our health care system – expanding access to these services is powerfully important,” said Senator Warren.

“Medicaid covers 40 percent of all births and 65 percent of Black mothers’ births. As Black mothers continue to bear the burden of our maternal health crisis, dying at three to five times the rate of white mothers, making these investments will have an immediate impact on the most vulnerable mothers. Mothers who have access to doulas and midwives are more likely to have healthier outcomes and deliveries free of complications for them and their babies. I am so thrilled to join Senators Elizabeth Warren and Cory Booker, co-chairs of the Black Maternal Health Caucus, Representatives Lauren Underwood and Alma Adams, and Congresswomen Debbie Dingell, and Ayanna Pressley in introducing this essential legislation,” said Representative Moore.

“The United States is facing a maternal mortality crisis that disproportionately impacts Black and Indigenous communities, which has only been exacerbated by the COVID-19 pandemic,” said Senator Booker. “Building upon my past work on this critical issue, including the MOMMIES Act, I am proud to join this bicameral effort that would expand Medicaid services to cover doulas and midwives, helping our nation take steps to improve health care outcomes for all birthing people.” 

“Every mother deserves to be cared for and supported—before, during and after giving birth, but too often, this is not the case. The maternal health crisis, which disproportionately affects Black and Brown women, must be addressed. I am proud to introduce this legislation to ensure that Medicaid covers the support so many mothers and infants rely upon and I will work with my colleagues to get this bill across the finish line,” said Senator Bob Casey.

The U.S. has been experiencing a maternal mortality and morbidity crisis since prior to the COVID-19 pandemic. People in the U.S. die as a result of pregnancy and childbirth at a higher rate than in any other developed country, and the U.S. is the only country among developed nations with a rising maternal mortality rate. This crisis disproportionately affects women of color, who, in many hospital settings, face systematic barriers and racial biases, including delays in recognizing symptoms, disregard for the patient's pain, failure to clarify treatment options, and higher rates of C-sections. 

Increasing access to doulas and midwives has been shown to reduce these disparities in maternal health outcomes, yet Medicaid does not currently cover services provided by doulas or midwives.  

The Mamas First Act would change that by amending the Social Security Act to allow doulas, midwives, and tribal midwives to be reimbursed by Medicaid, which covers almost half of all births in the U.S. each year. This would significantly expand access to doulas and midwife services, increase the focus on culturally-competent and patient-centered care, and improve health outcomes for mothers and babies in under-served and under-resourced communities.

“We celebrate the reintroduction of the Mamas First Act, which allows doulas, midwives, and tribal midwives to be reimbursed by Medicaid,” said Angela D. Aina, MPH, co-founding Executive Director of Black Mamas Matter Alliance. “If passed, this bill would directly support Black perinatal workers in our Alliance, as well as Black women and birthing people seeking holistic maternity care. Particularly as we commemorate the fifth annual Black Maternal Health Week, this bill exemplifies the policy action we need to end the maternal health crisis in the United States. BMMA commends Representative Gwen Moore, Senator Elizabeth Warren, and their co-sponsors for championing policies that advance Black maternal health, rights, and justice.”

“Commonsense Childbirth and the National Perinatal Task Force fully support and endorse the Mamas First Act and remain committed to strengthening and deploying a diverse perinatal workforce where community-based midwives and doulas are recognized and reimbursed by Medicaid for their service. These essential community health workers continue to address and redress the unjust health disparities disproportionately experienced by Black Americans and Native Americans, and therefore must be supported through this important and timely legislation,” said Jennie Joseph, LM, CPM, Founder and President of Commonsense Childbirth.

“Across the country, African American, American Indian, and Alaskan Native mothers are dying at rates three to four times that of white mothers. In addition, we are seeing expanding maternity care deserts in cities and rural areas across the U.S. where seven million women live, and nearly 150,000 babies are being born, who have no or limited access to maternity care.  Expanding access to care, by increasing access to doulas and midwives, is a key component to reversing these alarming trends.  With 42% of pregnant women utilizing Medicaid for coverage, the Mamas First Act would take a major step in the right direction in getting pregnant women the access to care they need and ensure that their infants have the best start to life possible,” said Stacey D. Stewart, President and CEO of the March of Dimes.

“The Mamas First Act is a step in expanding access to culturally humble care and addressing a serious gap for birthing people and new parents. Through access to midwives and doulas we are not just telling the community that we are here to help but showing them what it means to show up for future generations in a meaningful and tangible way,” said Chanel L. Porchia- Albert CD, CPD, CLC, CHHC Founder & CEO of Ancient Song Doula Services.

“Doulas and midwives can play a key role in supporting Black birthing people who are also survivors of domestic and sexual violence. Because their models of care allow for more time with birthing people, doulas and midwives are able to build the trust that is needed for survivors to feel comfortable reaching out to them for support. Mamas First will help create a patient-centered care team that increases access to domestic violence advocacy programs, and other community based supports to increase safety,” said Virginia Duplessis, MSW Associate Director, Health/Director, National Health Resource Center on Domestic Violence.

The Mamas First Act is endorsed by Black Mamas Matter Alliance (BMMA), The National Partnership, National Birth Equity Collaborative, March of Dimes, Center for Reproductive Rights, Futures Without Violence, National Indian Health Board (NIHB), Commonsense Childbirth Inc. and the National Perinatal Task Force, Ancient Song Doula Services, Restoring Our Own Through Transformation (ROOTT), Mamatoto Village, National Association of Certified Professional Midwives (NACPM), the What to Expect Project, and the African American Breastfeeding Network.

Senator Warren has consistently fought to lower maternal mortality rates and tackle racial disparities in maternal health outcomes. 

  • Senator Warren co-sponsored Senator Booker and Representative Underwood's Black Maternal Health Momnibus Act of 2021, a series of 12 bills to save moms’ lives and end racial and ethnic disparities in maternal health outcomes.
  • In April 2020, Senator Warren and Patty Murray (D-Wash.) released a GAO report underscoring the need to address the maternal mortality crisis. 
  • In August 2020, Senator Warren and Representative Underwood introduced the Maternal Health Pandemic Response Act to improve research and data collection, safeguard the health of pregnant and postpartum individuals, and dedicate resources to combat the maternal mortality and morbidity crisis during the COVID-19 pandemic. 
  • In February 2021, Senator Warren and Representative Underwood led their colleagues in sending a letter to Senate and House leadership urging the inclusion of provisions of the Maternal Health Pandemic Response Act in an upcoming COVID-19 relief package.  
  • Senator Warren is also a co-sponsor of Senator Booker's Black Maternal Health Week Resolution, Senators Jeff Merkley (D-Ore.) and Bill Cassidy’s (R-La.) Maternal and Child Health Stillbirth Prevention Act, Senator Booker’s MOMMIES Act, and Senator Richard Durbin's (D-Ill.) Mothers and Offspring Mortality and Morbidity Awareness (MOMMA) Act.