Republicans are not always associated with the fight to end maternal mortality, but on the eve of a GOP trifecta in Washington, maternal health advocates say they will need to find a way to get more conservative members on board with their agenda.
The U.S. has one of the highest rates of maternal mortality in the developed world — about 22 deaths per 100,000 live births (and nearly 50 deaths among Black women), according to data from the Commonwealth Fund. There are lots of reasons for this, according to experts, including economic stability, racial disparities in health care and postpartum treatment options. In the wake of the post-Roe reproductive landscape, restrictive abortion laws may mean patients have been less likely to seek emergency care or doctors have been less likely to give it out of fear of prosecution.
Getting Republican buy-in to tackle any of those underlying issues is a difficult task, to say the least. But Democratic Rep. Robin Kelly has high hopes that at least one piece of legislation could have wider bipartisan appeal. She said that in her conversations with Republican colleagues, they often bring up how to fund policy solutions, but they’re unified in their desire to find some.
Kelly is one of the major congressional proponents of policies to make birth less dangerous in the U.S. In an interview with NOTUS, she said she’s concerned about what kind of progress might be made — and what might be rolled back — under the new Trump administration.
She currently works with Republican Rep. Young Kim as the co-chair of the bipartisan Maternity Care Caucus. She said that she and Kim may not always see eye to eye, but they have found a way toward common ground.
“I may have to use different words sometimes, you know, but I think she truly cares about women being able to have what they need to have healthy babies,” said Kelly. “And I think it comes from personal experience with her own family, too, that, you know, she sees how women have struggled and wants to make sure that things are smooth for women.” (Kim’s office did not respond to a request for comment.)
Advocates generally emphasize policy solutions that more closely monitor maternal deaths, diversify the provider workforce and provide better access to maternal health care for low-income and rural populations.
The last of the three stands a chance of getting through a Republican-controlled Congress. A bipartisan bill introduced earlier this year in the House and Senate, the Rural Obstetrics Readiness Act, taps into the parties’ mutual interest in their rural constituents. The House version was launched by Kelly and Kim, with Republican Rep. Dan Meuser and Democratic Rep. Kim Schrier, and the identical Senate version was introduced by Democrats Maggie Hassan and Tina Smith and Republicans Susan Collins and Katie Britt.
“The Rural Obstetrics Act is just a great example of members looking at what’s going on in their districts and coming together, regardless of what letter sits behind their name,” said Tina Sherman, national director of the Maternal Justice campaign at MomsRising, an advocacy group.
That legislation would create an obstetric emergency training program for rural hospitals, fund obstetric equipment, direct the Department of Health and Human Services to study the causes of maternal care “deserts” and set up a pilot program for regional networks of teleconsulting that would give rural patients better access to informed care.
Meuser acknowledged that Republicans aren’t usually inclined to spend more federal funding on this kind of thing. But in districts like his, a rural swath of northeastern Pennsylvania, he said there’s a need for government health care spending.
“Funding, pay-fors, try not to do any increases. But in this case, it’s critical,” Meuser told NOTUS. “From funding for rural hospitals, nursing shortages to the unfairness that comes with it, our doctors and our funding is just as expensive as they are in the city. Yet we get less.”
Rep. Nikki Budzinski, another Democratic co-sponsor, was less optimistic that something could get done, especially in the hyperpartisan Congress.
“I think bipartisan efforts like that have the best chance,” she said. “But I don’t hold out.”
Data from another Commonwealth study also suggests that fewer OB-GYNs are choosing to work in states that have enacted abortion restrictions, contributing to a deficit of maternal health care in some parts of the country.
In a statement, Britt said she’s committed to the Rural Obstetrics Act as well as other pieces of bipartisan legislation she’s led to get maternal mortality the attention it deserves, like the NIH IMPROVE Act, which would support more research of maternal mortality causes.
“One of my top priorities in the Senate is to make sure moms feel supported throughout all stages of motherhood, from pregnancy through the prenatal and childhood development stages,” she said. “These critical pieces of legislation will be a priority of mine in the 119th Congress, and I look forward to continuing to gain support from my colleagues on both sides of the aisle to find commonsense solutions for this pressing issue.”
Another spot for potential bipartisan policy efforts: maternal mortality review committees. Forty-nine states, plus D.C., New York City, Philadelphia and Puerto Rico, have committees or boards that review pregnancy-related and/or pregnancy-associated deaths and provide recommendations on how to stop them. Georgia announced last month that it was dismissing all members of its MMRC after ProPublica reported on the details of two deaths of women the board determined were preventable, but care was likely delayed due to the state’s abortion ban. The state will be replacing the board members, but Sherman said that’s a “concerning trend.”
Rachel Gandell Tetlow, senior director of government and political affairs at the American College of Obstetricians and Gynecologists, told NOTUS in an email that her organization is prepared to work with a Republican Congress to ensure that support continues for MMRCs. She mentioned that the last time MMRCs were broadly supported by Congress was under a similar Republican trifecta in 2018.
Republicans had mixed messaging on abortion rights during the campaign trail and moved away from talking about abortion bans to focus on a more “pro-family” message. While Democrats hit back hard on the GOP’s anti-abortion platform, maternal health advocates are actually using similar pro-family language to appeal to a broader coalition.
“We need to do better by our families, our moms and moms-to-be,” Kelly said. “When you think about younger people saying they don’t want to have kids, that’s kind of scary. We need people coming into the world. And some people don’t want to have kids, that’s fine, but the people that do should feel like they still have that right.”
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Helen Huiskes is a NOTUS reporter and an Allbritton Journalism Institute fellow.