Among the 11 wealthiest nations, the United States ranks poorly in several measures of women's health, notably in maternal care and outcomes. A 2018 analysis by the Commonwealth Fund found that U.S. women had the highest rate of death from pregnancy and childbirth complications-14 per 100,000 live births. Most of the comparison countries had half that rate or lower; Sweden had the least with four per 100,000 live births. The maternal health crisis in the United States has been worsening for decades, and the data reveal deep racial, ethnic, and socioeconomic differences, with black women dying from pregnancy-related complications at up to four times more often than white women. Until now, a comprehensive approach addressing the factors behind these disparate outcomes has been elusive.

Figure. Rep. Lauren Underwood (D-IL) and colleagues introduce a historic legislative package on March 10 to address the U.S. maternal health crisis. Photo courtesy of Lauren Underwood / Twitter.

New legislation aims to change this grim picture by targeting gaps in current health policy. The Black Maternal Health Momnibus Act of 2020, which encompasses nine individual bills, was introduced in March in the House of Representatives by members of the Black Maternal Health Caucus. The legislation takes a multipronged approach to put a stop to preventable maternal deaths and address racial and socioeconomic disparities in pregnancy and postpartum outcomes. Among the proposals are investments in community-based organizations; improvements to transportation, housing, and other social determinants of health; programs to address maternal mental health; and digital tools to improve access to telehealth. The bills also seek to expand the perinatal workforce and data collection, improve payment models and maternal care for incarcerated women, and promote the study of women veterans' maternal health risks.

Illinois representative Lauren Underwood, a nurse and one of the sponsors of the legislation, is also a founder of the Black Maternal Health Caucus. "The black maternal health crisis demands immediate attention and serious action from all of us, and nurses are an essential part of the solution," she told AJN. "The Black Maternal Health Momnibus includes robust funding to grow and diversify the perinatal nursing workforce in America-a critical step to ensure that all moms have access to the high-quality, culturally competent maternity care they deserve."

As we went to press, the legislation was undergoing committee review.-Corinne McSpedon, senior editor