107th Congress

Safe Motherhood Act for Research and Treatment (Smart Mom Act)

S. 2328/H.R. 4602

Background

According to statistics released by the National Center for Health Statistics in May 2001, 3,193 pregnancy-related deaths occurred in the United States from 1991 through 1997. In 1998, the rate of maternal deaths was 7.1 per 100,000 live births. (See Healthy People 2010, objective 16-4.) Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native women suffer a significantly higher risk of pregnancy-related mortality than non-Hispanic white women, while African-American women continue to have the highest risk of all these racial and ethnic groups. One of the goals of Healthy People 2010 is to reduce significantly both maternal mortality associated with pregnancy and maternal illness and complications due to pregnancy. In 1998, there were 31.2 maternal complications for every 100 deliveries. (See Healthy People 2010, objective 16-5.) Such complications included miscarriage, ectopic pregnancy, excessive vomiting, diabetes, hemorrhage, infection, preeclampsia, preterm labor, and the need for a cesarean section.

To address these issues, Senator Tom Harkin (D-IA) and several cosponsors, including Senators Edward M. Kennedy (D-MA), Barbara A. Mikulski (D-MD), and Christopher J. Dodd (D-CT), introduced S. 2328, the Safe Motherhood Act for Research and Treatment, known as the SMART Mom Act. The companion bill, H.R. 4602, was introduced by Representative John D. Dingell (D-MI). S. 2328 was introduced in an effort to promote the understanding and treatment of complications that women suffer during pregnancy and ensure that women receive the information and services they need to have safe, healthy pregnancies. In Senator Harkin's press release accompanying the introduction of the bill, he stated, "the legislation calls for making research of pregnancy—and providing women reliable pregnancy information—a priority for the Federal Government's efforts to address women's health." He also stated that "experts agree that the rate of death and complications could be decreased by half with improved research and treatment." Senator Mikulski stated in her own press release that "the United States ranks below 29 other countries in pregnancy-related deaths, including Cyprus, Singapore, and Malta. We have not had a decline in U.S. maternal death rate in the last 20 years." In general, the bill was intended to 1) increase research efforts relating to pregnancy, 2) ensure that women understand the effect that medication and medical devices have on pregnant women, and 3) provide one-stop shopping for comprehensive pregnancy-related information via a new Government Web site.

Provisions of the Legislation/Impact on NIH

As reported by the Senate Health, Education, Labor and Pensions (HELP) Committee on September 17, 2002, the bill contained the following key provisions of interest to the National Institutes of Health (NIH):

• The bill would have required the creation of an Interagency Coordinating Committee on Safe Motherhood (Coordinating Committee), which would have included the Director of NIH and representatives from other U.S. Department of Health and Human Services (DHHS) agencies. The Coordinating Committee would also have included the Secretary of Labor; representatives of other Federal Government agencies that serve women; representatives of women's health care advocacy and grassroots organizations; health care providers, including providers of specialty care; and researchers to be appointed by the DHHS Office of Women's Health.
• The bill would have required the Coordinating Committee to develop a coordinated Federal research plan for safe motherhood. The Coordinating Committee would have been required to consult with the Directors of NIH, the Centers for Disease Control and Prevention, and the Agency for Healthcare Research and Quality to determine key indicators of maternal health and sources of data to be included in a biannual report to Congress entitled "American's Mothers: Key Indicators of Well Being."
• The bill would have required the Secretary of Health and Human Services, acting in consultation with the Coordinating Committee, to develop a national public education and health promotion campaign, including the maintenance of an Internet site.
• The bill would have required the Director of NIH to enhance and expand research into the leading causes of pregnancy-related death and complications of pregnancy, including research on preterm labor, postpartum health conditions, and health disparities.
• The bill would have required the Director of NIH to expand research concerning the impact of chronic conditions, physical impairments, and mental health problems on the health of women during their pregnancy. In carrying out this section, the bill would have required the Director of the National Institute of Child Health and Human Development to collaborate with other NIH components.
• The bill would have codified the existing Maternal Fetal Medicine Units Network.

S. 2328 was introduced by Senator Harkin on April 25, 2002, and referred to the Senate HELP Committee. The companion bill, H.R. 4602, was introduced by Representative Dingell on April 25, and referred to the House Energy and Commerce Committee. H.R. 4602 did not receive any action in the House. S. 2328 was reported favorably by the HELP Committee (Senator Kennedy, Chairman) on September 17. As amended, S. 2328 also included several other pending women's health bills, which affect agencies other than NIH. Although there was no further action on this legislation during the 107th Congress, many of the supporters of the bill have indicated that they will introduce similar legislation when the 108th Congress convenes.

For information on other women's health bills, see the article entitled "Women's Health."

• The bill would have required NIH to expand the longitudinal children's health study required under Section 1004 of the Children's Health Act (42 U.S.C. 285g note) to include a research study of mothers to determine the effects of pregnancy on women's health.
• The bill would have required the Director of NIH, in consultation with the Food and Drug Administration, to identify materials used in devices which come in contact with the body and for which there is insufficient information to assess their safety for persons and fetuses. The Director of NIH would have been responsible (resources permitting) for funding such studies.

Status and Outlook