Oversight Committee and Black Maternal Health Caucus Leaders Release New GAO Report Examining Maternal Health and Access to Midwife Care

May 8, 2023
Press Release
Report Shows Financial, Training, and Assessment Barriers to Expanding Access to Midwifery Care Across the Country

Washington, D.C. (May 8, 2023)—Today, Rep. Jamie Raskin, Ranking Member of the Committee on Oversight and Accountability, in partnership with Rep. Lauren Underwood and Rep. Alma S. Adams, Ph.D., Co-Chairs of the Black Maternal Health Caucus; Rep. Robin Kelly, Chair of the Congressional Black Caucus Health Braintrust; Oversight Committee Members Rep. Cori Bush, Rep. Shontel Brown, Rep. Summer Lee, Rep. Jasmine Crockett and Rep. Robert Garcia; along with Rep. Gwen Moore, issued the following statement after the Government Accountability Office (GAO) released a report examining midwifery health care coverage, midwifery education programs, and midwifery workforce effects on the maternal health outcomes in the U.S.:

 

“Today’s report sheds light on the various barriers to obtaining midwifery care and education despite the practice’s significant benefits in improving maternal health outcomes.  At a time when maternal death rates are rising across the country, increasing access to midwifery care is vital to keeping patients safe and thriving.  It’s evident from GAO’s report that Congress must invest in affordable, high-quality education, and expand insurance coverage, including Medicaid to ensure midwives can offer the best possible care to patients regardless of race or income,” said Ranking Member Jamie Raskin. 

 

“Everyone deserves access to high-quality care and robust support during and after pregnancy, no matter where they live.  But in too many communities across our country, families are struggling to access maternity care,” said Rep. Lauren Underwood.  “This report, which then-Chairwoman Carolyn Maloney and I commissioned, sheds light on the barriers that prevent families from accessing midwifery care, including coverage gaps and midwifery workforce shortages.  Evidence shows that midwives provide personalized, high-quality care that leads to great outcomes for moms and babies, and we must advance legislation to ensure every family who wants a midwife can access one.  The Black Maternal Health Momnibus Act makes historic investments to grow and diversify the midwifery and broader perinatal workforce, and Congress must pass this legislation immediately.”

 

“Last week, we observed the International Day of the Midwife because they provide crucial care to mothers and newborns,” said Rep. Alma Adams.  “This report makes it clear midwives improve the quality of maternal care, improve maternal outcomes, and are an essential part of solving our country’s maternal health crisis.”

 

“This report confirms what so many mothers already know, we need more birthing professionals, like midwives, trained and certified to support families before, after, and during childbirth.  As Chair of the CBC Health Braintrust and Co-Chair of the Maternity Care Caucus, I know that supporting and training midwives is key to improving maternal health outcomes and reducing racial bias in maternal care,” said Rep. Robin Kelly.  “Congress must take a comprehensive approach to address the maternal mortality crisis, which needlessly claims thousands of lives and disproportionately affects Black mothers.  My legislation, the MOMMA’S Act, provides holistic solutions to the complex challenges that contribute to maternal mortality and explicitly includes workforce development provisions meant to support providers like midwives and doulas.  We must act now; we cannot afford to wait.”

 

“This report only validates the heartbreaking truth policymakers already knew— over the pandemic, the effects of the Black maternal health crisis only worsened.  Black mamas and our babies deserve to grow old, yet our loved ones continue to die at the hands of preventable policy failure,” said Rep. Cori Bush.  “Decades of policy violence must be met with future decades of investment in Black lives.  I will continue to advance legislative action focused on ending this crisis and am grateful to have the support of my Democratic colleagues on the House Oversight and Accountability Committee, the Black Maternal Health Caucus, and the Equal Rights Amendment Caucus.  Together we must prioritize the health and prosperity of all pregnant people.”

 

“The rise in maternal mortality, especially among Black women, is inexcusable in one of the wealthiest nations on Earth,” said Rep. Shontel Brown.  “With American maternal mortality rates at their highest level since 1965, and at a time when access to reproductive care is constantly under attack, it is imperative that we acknowledge and urgently address the disparities and inequities in maternal health.  As a member of the Democratic Women’s Caucus, Pro-Choice Caucus, and Black Maternal Health Caucus, I stand with my colleagues on the Oversight Committee in this necessary request to the Government Accountability Office.”

 

“Representing Pittsburgh, where Black women are 3 times more likely to die from childbirth than white women and are more likely to die during pregnancy than in 97% of other cities, these findings make clear the atrocious reality of maternal health in this country and the bold action necessary to end the maternal mortality crisis,” said Rep. Summer Lee.  “Every mother deserves access to safe maternal and reproductive health services, and we must act with urgency because the lives of millions of babies and mothers depends on it.”

 

“North Texas has one of the highest maternal health disparities in America.  As representative for this region, I remain deeply concerned with how recent attacks on access to reproductive health impact the ongoing Black maternal health crisis in Texas and across the entire country,” said Rep. Jasmine Crockett.  “Oversight Committee Democrats commissioned this report because we believe that facts should guide our policy solutions to this crisis—not the other way around.  If Republican lawmakers want to pass laws restricting mothers’ access to life-saving care for miscarriage and pregnancy complications, then they should have to reckon with the consequences of their laws, particularly the loss of life for mothers, sisters, daughters, and friends.  I hope my colleagues on both sides of the aisle will read this report with the intent to use its findings to address this crisis, rather than utilizing the extremist rhetoric and outright lies that have come to characterize the Republican attitude on reproductive care.”

“More needs to be done to improve the maternal health care system, but these findings point us in the right direction to address this pressing issue,” said Rep. Robert Garcia.  “Midwifery has the power to transform maternal health outcomes in our communities.  By expanding coverage for maternal care, investing in midwifery education programs, and strengthening the midwifery workforce, we can improve access to high-quality, patient-centered care that is tailored to the needs of everyone.”

 

“As a lawmaker with a personal commitment to tackling the maternal health crisis, these findings are vital and lay bare the barriers that mothers, maternal health professionals and prospective providers face in providing and accessing care,” said Rep. Gwen Moore.  “Addressing these challenges is part of my mission.  My legislation, including the Perinatal Workforce Act and the Mamas First Act, will diversify the pipeline of nurse midwives with federal grants and expand Medicaid to include doulas and midwives, which will help our maternal health care system better support mothers and their babies.”

 

During the Committee Democrats’ May 6, 2021, hearing examining America’s Black maternal health crisis, then-Chairwoman Maloney announced that the Members commissioned three new GAO studies to examine the effect of the coronavirus pandemic on maternal mortality and morbidity, the state of America’s perinatal workforce, and the disproportionate impact of the Black maternal health crisis on people who are incarcerated.

 

On October 19, 2022, the Members released the first of three GAO reports that examined the impact of COVID-19 on maternal health, showing COVID-19 contributed to more than one-quarter of maternal deaths during 2020 and 2021.

 

According to today’s GAO report, midwives provide a range of health care services and can serve a critical role in improving the negative maternal care outcomes like those outlined in previous reports.

 

Below are findings from GAO’s new report:

 

Health Care Coverage and Challenges to Obtaining Midwifery Care

 

  • Insurance companies and Medicaid reimburse midwives at a lower rate than physicians who provide the same services.  As a result, low rates of reimbursement make it more difficult for midwives to serve low-income communities.  In addition, Medicaid’s low payment rates for midwives can force them to take on more clients than desired just to maintain their practices.

 

  • A 2014 study of insurance companies found that 47% of insurers did not cover birthing centers, leaving pregnant people to pay high out-of-pocket costs or to seek other forms of birthing care. 

 

  • The same study found that 20% of insurance plans did not include certified nurse-midwives, 60% of plans did not include certified midwives, and 65% of plans did not include certified professional midwives in their provider networks.

 

  • In addition to financial barriers, GAO’s report cites lack of knowledge, limited location access, and lack of diverse providers as challenges to obtaining midwifery care.

 

Midwifery Education Barriers

 

  • Despite an increase in midwifery students from 2016 to 2021, GAO’s report shows that cost is a challenge to students pursuing a career in the field.  According to a survey of underrepresented people wishing to become midwifes, 58% of respondents reported the cost of tuition as a barrier to completing their studies.

 

  • As a result of limited federal funding, the insufficient number of training centers and educators was also cited as a barrier to meeting education requirements.  One director told GAO that enrolled students can wait up to one year for a clinical spot, delaying their graduation date and causing financial hardship.

 

  • A survey of underrepresented people who were interested in becoming midwives reported that 38% of respondents felt discouraged from entering a training program because of the lack of midwives matching their racial identity.

 

Barriers to Measuring the Quality of Midwifery Care

 

  • The same challenges to tracking the quality of maternal care in general also apply to assessing the quality of midwifery care, including attributing care to a specific provider and lacking patient experience measures.

 

  • Throughout pregnancy and delivery, a patient will interact with multiple providers, including a midwife.  This makes it challenging to attribute specific health and maternal outcomes to a specific provider.  This challenge is exacerbated when a birth takes place outside of a traditional hospital setting.

 

  • According to researchers interviewed by GAO, maternal quality measures do not account for patient experience, including whether the patient was treated with dignity and respect.

 

###

Issues: 
118th Congress