,,ii  #aaf? ,,congress  #b;d ,session   
,s4 #dgfi  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,septemb] #cj          
7legislative day1 ,septemb] #bi71       
#bjbj,ms4 ,w>r5 7= h]self1 ,mr4 ,book]1 
,ms4 ,h>ris1 ,mrs4 ,gillibr&1 & ,ms4    
,smi?7 introduc$ ! foll[+ bill2 :i* 0   
read twice & ref]r$ to ! ,committee on  
,heal?1 ,education1 ,labor1 & ,p5sions  
,a ,,bill  ,to improve ! public heal?   
response to address+ mat]nal mortality &
 morbidity dur+ ! ,,covid-#ai public    
heal? em]g5cy4  #a4 ,%ort title ,?is    
,act may be cit$ z ! ,mat]nal ,heal?    
,p&emic ,response ,act ( #bjbj4  #b4    
,f9d+s ,congress f9ds z foll[s3 7#a7 ,! 
,_w ,heal? ,organization decl>$         
,,covid-#ai a ,public ,heal? ,em]g5cy ( 
,int]national ,conc]n on ,janu>y #cj1   
#bjbj4 ,by ! beg9n+ ( ,augu/ #bjbj1 !re 
h be5 ov] #ah1jjj1jjj confirm$ cases (1 
& ov] #gjj1jjj dea?s associat$ )1       
,,covid-#ai worldwide4  7#b7 ,9 ! ,unit$
 ,/ates1 ! numb] ( cases ( ,,covid-#ai  
has quickly surpass$ ! numb] ( su* cases

 9 e o!r nation1 & z ( ,augu/ #e1 #bjbj1
 ov] #d1jjj1jjj cases & #aef1jjj dea?s h
 be5 report$ by ! ,unit$ ,/ates alone4  
7#c7 ,long/&+ sy/emic heal? & social    
inequities h put communities ( color at 
increas$ risk ( contract+ ,,covid-#ai or
 exp]i5c+ sev]e illness2 age-adju/$     
hospitalization rates f ,,covid-#ai are 
highe/ = ,am]ican ,indian & ,alaska     
,native1 ,black1 & ,lat9x p4  7#d7      
,prior to ! />t ( ! ,,covid-#ai p&emic1 
! ,unit$ ,/ates 0 fac+ a mat]nal        
mortality & morbidity crisis1 9 :i* !   
,unit$ ,/ates has ! highe/ mat]nal      
mortality rate 9 ! develop$ _w1 & t rate
 is n improv+4  7#e7 ,m ?an #ej1jjj wom5
 9 ! ,unit$ ,/ates annually exp]i5ce    
sev]e mat]nal morbidity1 & mu* l>g]     
numb]s exp]i5ce m common h>mful         
*all5ges1 su* z pr5atal & po/p>tum      
anxiety & depression & lack ( support = 
meet+ brea/fe$+ goals4  7#f7 ,comp>$ to 
,:ite wom51 ,black & ,am]ican ,indian & 
,alaska ,native wom5 9 ! ,unit$ ,/ates  
are significantly m likely to die f     

pregnancy-relat$ complications1 & ,black
 & ,am]ican ,indian & ,alaska ,native   
wom5 suff] disproportionately high rates
 ( mat]nal morbidity4  7#g7 ,! causes ( 
mat]nal mortality & morbidity are       
complex & include racial1 e?nic1 &      
socioeconomic inequities2 racism1 bias1 
& discrim9ation2 comorbidities2 &       
inadequate access to ! heal? c>e sy/em1 
includ+ behavioral heal? c>e1 :i* are   
factors t h simil>ly contribut$ to !    
racial disp>ities se5 9 ,,covid-#ai     
outcomes4  7#h7 ,! burd5 ( morbidity &  
mortality 9 ! ,unit$ ,/ates = bo?       
,,covid-#ai & mat]nal heal? outcomes has
 also fall5 disproportionately on       
,black1 ,lat9x1 & ,am]ican ,indian &    
,alaska ,native communities1 :o suff] ! 
mo/ f great public heal? ne$s & are !   
mo/ m$ically und]s]v$4  7#i7 ,accord+ to
 ! ,c5t]s = ,disease ,control &         
,prev5tion1 pregnant p h *anges 9 _!    
bodies t may increase _! risk ( "s      
infections & pregnant p h _h a high]    
risk ( sev]e illness :5 infect$ )       

viruses f ! same family z ,,covid-#ai & 
o!r viral respiratory infections1 su* z 
influ5za4  7#aj7 ,z ( ,june #be1 #bjbj1 
! late/ in=mation f ! ,c5t]s = ,disease 
,control & ,prev5tion indicates t       
pregnant wom5 are m likely to be        
hospitaliz$ & are at high] risk =       
int5sive c>e unit admissions ?an        
nonpregnant wom5 due to ,,covid-#ai1 &  
,lat9x & ,black pregnant p h be5        
disproportionately infect$ by           
,,covid-#ai4  7#aa7 ,our und]/&+ ( !    
specific impact ( ,,covid-#ai on        
pregnant p is limit$1 9 "p due to a lack
 ( robu/ data collection1 b !           
,,covid-#ai p&emic has fur!r /ra9$ !    
heal? c>e sy/em & add$ ano!r lay] ( fe> 
& vuln]ability = pregnant p1 )          
disproportionate effects on p ( color4  
7#ab7 ,z ( ,july #cj1 #bjbj1 ov] #ad1jjj
 pregnant p 9 ! ,unit$ ,/ates h te/$    
positive = ,,covid-#ai & #ce pregnant p 
h di$ z a result ( ,,covid-#ai4  7#ac7  
,! ,_w ,heal? ,organization /ates t     
ev]yone has ! "r to safe & positive     

*ildbir? exp]i5ce1 :e!r or n !y h a     
confirm$ ,,covid-#ai infection1 ?is     
includes ! "r to respect & dignity1 a   
companion ( *oice1 cle> communication by
 mat]nity /aff1 pa9 relief /rategies1 & 
mobility 9 labor :5 possible & !        
position ( *oice4  7#ad7 ,a ,,covid-#ai 
public heal? response )\t conc]t$ ,f$]al
 action & focus on mat]nal heal? c>e    
access & quality1 rese>*1 data          
collection1 mitigat+ negative           
socioeconomic consequ5ces ( ! p&emic1 & 
safegu>d+ ! "r to safe & positive       
*ildbir? exp]i5ce w risk exac]bat+ !    
mat]nal mortality & morbidity crisis4   
#c4 ,def9itions ,9 ?is ,act3 7#a7       
,,covid-#ai public heal? em]g5cy ,! t]m 
,,covid-#ai public heal? em]g5cy means !
 p]iod beg9n+ on ! date t ! public heal?
 em]g5cy decl>$ by ! ,secret>y ( ,heal? 
& ,human ,s]vices "u section #cai ( !   
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #bdg;d7 on ,janu>y #ca1 #bjbj1
 ) respect to ,,covid-#ai took effect1 &
 end+ on ! lat] ( ! end ( su* public    

heal? em]g5cy or ,janu>y #a1 #bjbc4     
7#b7 ,culturally congru5t ,! t]m        
culturally congru5t1 ) respect to c>e or
 mat]nity c>e1 means c>e t is anti-raci/
 & is 9 agreem5t ) ! pref]r$ cultural   
values1 beliefs1 worldview1 & practices 
( ! heal? c>e consum] & o!r /akehold]s4 
7#c7 ,indian tribe1 tribal organization1
 & urban ,indian organization ,! t]ms   
,indian ,tribe & ,tribal organization h 
! mean+s giv5 ! t]ms ,indian tribe &    
tribal organization1 respectively1 9    
section #d ( ! ,indian                  
,self-,det]m9ation & ,education         
,assi/ance ,act 7#be ,u4,s4,c4 #ecjd71 &
 ! t]m urban ,indian organization has ! 
mean+ giv5 su* t]m 9 section #d ( !     
,indian ,heal? ,c>e ,improvem5t ,act    
7#be ,u4,s4,c4 #afjc74  7#d7 ,mat]nal   
mortality ,! t]m mat]nal mortality means
 a dea? occurr+ dur+ pregnancy or )9 "o 
ye> ( ! end ( pregnancy1 f a pregnancy  
complication1 a *a9 ( ev5ts initiat$ by 
pregnancy1 or ! aggravation ( an        
unrelat$ condition by ! physiologic     

effects ( pregnancy4  7#e7 ,po/p>tum ,! 
t]m po/p>tum means ! #a-ye> p]iod beg9n+
 on ! la/ day ( a p]son's pregnancy4    
7#f7 ,respectful mat]nity c>e ,! t]m    
respectful mat]nity c>e ref]s to c>e    
organiz$ =1 & provid$ to1 all pregnant &
 po/p>tum p 9 a mann] t is culturally   
congru5t1 ma9ta9s _! dignity1 privacy1 &
 confid5tiality1 ensures fre$om f h>m & 
mi/reatm5t1 & enables in=m$ *oice &     
cont9u\s support dur+ labor1 *ildbir?1 &
 po/p>tum4  7#g7 ,secret>y ,! t]m       
,secret>y means ! ,secret>y ( ,heal? &  
,human ,s]vices4  7#h7 ,sev]e mat]nal   
morbidity ,! t]m sev]e mat]nal morbidity
 means an unexpect$ outcome caus$ by    
labor & deliv]y t results 9 significant 
%ort-t]m or long-t]m consequ5ces to !   
heal? ( ! pregnant p]son4  #d4 ,em]g5cy 
fund+ = ,f$]al data collection1         
surveillance1 & rese>* on mat]nal heal? 
outcomes dur+ ! ,,covid-#ai public heal?
 em]g5cy ,to conduct or support data    
collection1 surveillance1 & rese>* on   
mat]nal heal? z a result ( ! ,,covid-#ai

 public heal? em]g5cy1 includ+ support  
to assi/ 9 ! capacity build+ = ,/ate1   
,tribal1 t]ritorial1 & local public     
heal? dep>tm5ts to collect & transmit   
racial1 e?nic1 & o!r demographic data   
relat$ to mat]nal heal?1 !re are        
au?oriz$ to be appropriat$-- 7#a7       
#ajj1jjj1jjj = ! ,surveillance = ,em]g+ 
,?reats to ,mo!rs & ,babies program ( ! 
,c5t]s = ,disease ,control & ,prev5tion1
 to support ! ,c5t]s = ,disease ,control
 & ,prev5tion 9 its ef=ts to-- 7,a7 "w )
 public heal?1 cl9ical1 & community-bas$
 organizations to provide timely1       
cont9ually updat$ guidance to families &
 heal? c>e provid]s on ways to r$uce    
risk to mo!rs & babies & tailor         
int]v5tions to improve _! long-t]m      
heal?2  7,b7 p>tn] ) m ,/ate1 ,tribal1  
t]ritorial1 & local public heal?        
programs 9 ! collection & analysis (    
cl9ical data on ! impact ( ,,covid-#ai  
on pregnant & po/p>tum pati5ts & _!     
newborns1 includ+ among pregnant p (    
color2 &  7,c7 e/abli% regionally bas$  

c5t]s ( excell5ce to (f] m$ical1 public 
heal?1 & o!r k to ensure communities1   
especially communities ( color1 c help  
pregnant & po/p>tum pati5ts & infants   
get ! c>e !y ne$2  7#b7 #cj1jjj1jjj = ! 
,enhanc+ ,reviews & ,surveillance to    
,elim9ate ,mat]nal ,mortality program   
7commonly kn[n z ! ,,erase ,,mm program7
 ( ! ,c5t]s = ,disease ,control &       
,prev5tion1 to support ! ,c5t]s =       
,disease ,control & ,prev5tion 9 exp&+  
its p>tn]%ips ) ,/ates & ,indian ,tribes
 & provide te*nical assi/ance to exi/+  
,mat]nal ,mortality ,review ,committees2
 &  7#c7 #de1jjj1jjj = ! ,pregnancy     
,risk ,assessm5t ,monitor+ ,sy/em       
7commonly kn[n z ! ,,prams7 ( ! ,c5t]s =
 ,disease ,control & ,prev5tion1 to     
support ! ,c5t]s = ,disease ,control &  
,prev5tion 9 its ef=ts to-- 7,a7 create 
a ,,covid-#ai supplem5t to its ,,prams  
que/ionnaire2  7,b7 add que/ions ar\nd  
exp]i5ces ( respectful mat]nity c>e 9   
pr5atal1 intrap>tum1 & po/p>tum c>e2    
7,c7 conduct a rapid assessm5t (        

,,covid-#ai aw>5ess1 impact on c>e &    
exp]i5ces1 & use ( prev5tive measures   
among pregnant1 labor+ & bir?+1 &       
po/p>tum p dur+ ! ,,covid-#ai public    
heal? em]g5cy2 &  7,d7 "w to transition 
! survey to an electronic plat=m & exp& 
! survey to a l>g] population1 ) a      
special focus on rea*+ und]repres5t$    
communities2  7#d7 #ae1jjj1jjj = !      
,national ,in/itute ( ,*ild ,heal? &    
,human ,developm5t1 to conduct or       
support rese>* = int]v5tions to mitigate
 ! effects ( ! ,,covid-#ai public heal? 
em]g5cy on pregnant & po/p>tum p1       
includ+ ,black1 ,lat9x1 ,asian-,am]ican 
& ,pacific ,isl&]1 & ,am]ican ,indian & 
,alaska ,native p4  #e4 ,,covid-#ai     
mat]nal heal? data collection &         
disclosure  7a7 ,data collection ,!     
,secret>y1 act+ ?r\gh ! ,director ( !   
,c5t]s = ,disease ,control & ,prev5tion 
& ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e   
,m$icaid ,s]vices1 %all make publicly   
available1 on ! website ( ! ,c5t]s =    
,disease ,control & ,prev5tion1         

pregnancy & po/p>tum data collect$      
across all surveillance sy/ems relat+ to
 ,,covid-#ai1 disaggregat$ by race1     
e?nicity1 ,/ate1 & ,tribal location     
includ+ ! foll[+3 7#a7 ,data relat$ to  
all ,,covid-#ai diagno/ic te/+1 includ+ 
! numb] ( pregnant p & po/p>tum p te/$ &
 ! numb] ( positive cases4  7#b7 ,data  
relat$ to all suspect$ cases (          
,,covid-#ai 9 pregnant1 bir?+1 &        
po/p>tum p :o did n und]go te/+4  7#c7  
,data relat$ to all ,,covid-#ai s]ologic
 te/+1 includ+ ! numb] ( pregnant &     
po/p>tum p te/$ & ! numb] ( su* s]ologic
 te/s t 7 positive4  7#d7 ,data relat$  
to treatm5t = ,,covid-#ai1 includ+      
hospitalizations1 em]g5cy room1 &       
int5sive c>e unit admissions ( pregnant1
 bir?+1 & po/p>tum p relat$ to          
,,covid-#ai4  7#e7 ,data relat$ to      
,,covid-#ai outcomes1 includ+ total     
fatalities & case fatality 7express$ z !
 proportion ( p :o 7 infect$ )          
,,covid-#ai & di$ f ! virus7 ( pregnant 
& po/p>tum p4  7#f7 ,data relat$ to     

pregnancy & infant heal? outcomes =     
pregnant p ) confirm$ or suspect$       
,,covid-#ai1 :i* may include /illbir?s1 
mat]nal mortality & morbidity1 infant   
mortality1 pret]m bir?s1 l[-bir? weight 
infants1 & ces>ean section bir?s4  7b7  
,timel9e ,! ,secret>y %all update ! data
 made available "u ?is section n less   
frequ5tly ?an mon?ly1 dur+ ! ,,covid-#ai
 public heal? em]g5cy & = at lea/ "o    
mon? aft] ! end ( ! ,,covid-#ai public  
heal? em]g5cy4  7c7 ,privacy ,9 publi%+ 
data "u ?is section1 ! ,secret>y %all   
take all necess>y /eps to protect !     
privacy ( p ^: in=mation is includ$ 9   
su* data1 includ+ by comply+ )-- 7#a7   
privacy protections "u ! regulations    
promulgat$ "u section #bfd7;c7 ( !      
,heal? ,insurance ,portability &        
,acc\ntability ,act ( #aiif 7#db        
,u4,s4,c4 #acbj;d-#b note72 &  7#b7     
protections f all inappropriate int]nal 
use by an entity t collects1 /ores1 or  
receives ! data1 includ+ use ( su* data 
9 det]m9ations ( eligibility 7or cont9u$

 eligibility7 9 heal? plans1 & f        
inappropriate uses4  7d7 ,indian ,heal? 
,s]vice ,! ,director ( ! ,indian ,heal? 
,s]vice & ,director ( ! ,c5t]s =        
,disease ,control & ,prev5tion %all     
consult ) ,indian ,tribes & conf] )     
urban ,indian organizations on data     
collection & report+ = purposes ( ?is   
section4  7e7 ,data collection guidance 
,! ,secret>y %all issue guidance to     
,/ates & local public heal? dep>tm5ts to
 ensure t all relevant demographic data1
 includ+ pregnancy & po/p>tum /atus1 are
 collect$ & includ$ :5 s5d+ ,,covid-#ai 
te/+ specim5 to laboratories1 & ,/ate & 
local heal? dep>tm5ts & ,indian ,tribes 
are disaggregat+ data on ,,covid-#ai    
/atus 9 data on mat]nal & infant        
morbidity & mortality4 ,! ,secret>y %all
 ensure t ! guidance is develop$ 9      
consultation ) ,indian ,tribes to ensure
 t x includes tribally develop$ be/     
practices on r$uc+ misclassification (  
,am]ican ,indian & ,alaska ,native p 9  
,f$]al1 ,/ate1 & local public heal?     

surveillance sy/ems4  #f4 ,inclusion (  
pregnant p & lactat+ p 9 vacc9e &       
!rapeutic developm5t = ,,covid-#ai  7a7 
,9 g5]al ,! ,director ( ! ,national     
,in/itutes ( ,heal? %all-- 7#a7 support 
& advance ! responsible inclusion (     
pregnant & lactat+ p 9 ,,covid-#ai      
!rapeutic & vacc9e cl9ical trials :5    
safe & appropriate2  7#b7 prioritize !  
implem5tation ( f9al recomm5dations made
 by ! ,task ,=ce on ,rese>* ,specific to
 ,pregnant ,wom5 & ,lactat+ ,wom5 to    
improve ! inclusion ( pregnant & lactat+
 p 9 cl9ical rese>* :5 safe &           
appropriate1 p>ticul>ly z ^!            
recomm5dations apply to ! developm5t &  
issuance ( safe & effective ,,covid-#ai 
!rapeutics & vacc9es2 &  7#c7 ensure t  
at lea/ "o ,,covid-#ai vacc9e develop$ &
 made available = use 9 ! ,unit$ ,/ates 
is suitable = pregnant p & lactat+ p4   
7b7 ,requirem5ts  7#a7 ,report+         
requirem5ts ,! ,director ( ! ,national  
,in/itutes ( ,heal? %all collect        
in=mation f e develop] ( a drug or      

biological product = ! treatm5t or      
prev5tion ( ,,covid-#ai 9 ! cl9ical     
/ages ( developm5t t receiv$ ,f$]al     
fund+ f ! ,dep>tm5t ( ,heal? & ,human   
,s]vices & its subag5cies reg>d+-- 7,a7 
h[ evid5ce is be+ g5]at$ to evaluate !  
safety1 efficacy1 & appropriate dos+ ( !
 drug or biological product among       
pregnant p & lactat+ p2  7,b7 plans = ! 
sy/ematic collection ( data f p :o are  
inadv]t5tly expos$ to ! drug or         
biological product :ile pregnant or     
lactat+2  7,c7 plans = ! inclusion (    
pregnant p & lactat+ p1 includ+ racial &
 e?nic m9orities disproportionately     
affect$ by ,,covid-#ai1 9 cl9ical trials
 or ! rationale = exclusion2 &  7,d7    
plans = p]=m+ ,developm5tal &           
,reproductive ,toxicology /udies1 or !  
rationale = n p]=m+ su* /udies4  7#b7   
,drug approvals & biological product    
lic5s+ ,! ,commission] ( ,food & ,drugs 
%all require a drug or biological       
product develop] submit1 z "p ( an      
application = approval ( a drug "u      

section #eje ( ! ,f$]al ,food1 ,drug1 & 
,cosmetic ,act 7#ba ,u4,s4,c4 #cee7 or  
lic5s+ ( a biological product "u section
 #cea ( ! ,public ,heal? ,s]vice ,act   
7#db ,u4,s4,c4 #bfb7 = ! treatm5t or    
prev5tion ( ,,covid-#ai-- 7,a7 an       
adequate repres5tation ( ! effect ( !   
drug or biological product on pregnant p
 & lactat+ p1 ei!r ?r\gh ! inclusion (  
pregnant p & lactat+ p 9 cl9ical trials 
:5 safe & appropriate or o!r rese>*1 or 
?r\gh a sci5tific & e?ical ju/ification 
z to :y pregnant p or lactat+ p 7 n     
includ$ 9 cl9ical trials2 &  7,b7 a     
compreh5sive plan = ! collection (      
additional evid5ce ( safety & efficacy =
 pregnant & lactat+ p aft] approval "u  
su* section #eje or lic5sure "u su*     
section #cea1 or aft] issuance ( an     
em]g5cy use au?orization "u section #efd
 ( ! ,f$]al ,food1 ,drug1 & ,cosmetic   
,act 7#ba ,u4,s4,c4 #cfj;bbb-#c74  #g4  
,public heal? communication reg>d+      
mat]nal c>e dur+ ,,covid-#ai  7a7       
,public heal? campaign ,! ,director ( ! 

,c5t]s = ,disease ,control & ,prev5tion 
%all und]take a robu/ public heal?      
education ef=t to enhance access by     
pregnant p1 _! employ]s1 & _! provid]s  
to accurate1 evid5ce-bas$ heal?         
in=mation ab\t ,,covid-#ai & pregnancy1 
safety1 & risk1 ) a p>ticul> focus on   
rea*+ pregnant p 9 und]s]v$ communities4
  7b7 ,em]g5cy tempor>y /&>d  7#a7 ,9   
g5]al ,9 consid]ation ( ! grave risk    
pres5t$ by ,,covid-#ai & ! ne$ to /r5g!n
 protections = employees1 pursuant to   
section #f7;c77#a7 ( ! ,occupational    
,safety & ,heal? ,act ( #aigj 7#bi      
,u4,s4,c4 #fee7;c77#a77 & not)/&+ !     
provisions ( law & ! ,executive ord]    
li/$ 9 p>agraph 7#c71 n lat] ?an #g days
 aft] ! date ( enactm5t ( ?is ,act1 !   
,secret>y ( ,labor %all promulgate an   
em]g5cy tempor>y /&>d to protect all    
employees at occupational risk f        
occupational exposure to ,,s>s-,co,v-#b4
  7#b7 ,pregnant & po/p>tum employees ,!
 em]g5cy tempor>y /&>d promulgat$ "u ?is
 subsection %all include consid]ation ( 

! risks & ne$s specific to pregnant &   
po/p>tum employees4  7#c7 ,inapplicable 
provisions ( law & executive ord] ,!    
requirem5ts ( *apt] #f ( title #e1      
,unit$ ,/ates ,code 7commonly ref]r$ to 
z ! ,regulatory ,flexibility ,act71     
sub*apt] ,i ( *apt] #ce ( title #dd1    
,unit$ ,/ates ,code 7commonly ref]r$ to 
z ! ,pap]work ,r$uction ,act71 !        
,unfund$ ,m&ates ,re=m ,act ( #aiie 7#b 
,u4,s4,c4 #aeja et seq471 & ,executive  
,ord] #abhff 7#eh ,f$4 ,reg4 #aij2      
relat+ to regulatory plann+ & review71 z
 am5d$1 %all n apply to ! /&>d          
promulgat$ "u ?is subsection4  7c7 ,task
 =ce on bir?+ exp]i5ce & safe1          
respectful mat]nity c>e 9 response to ! 
,,covid-#ai public heal? em]g5cy  7#a7  
,e/abli%m5t ,! ,secret>y1 9 consultation
 ) ! ,director ( ! ,c5t]s = ,disease    
,control & ,prev5tion & ! ,adm9i/rator (
 ! ,heal? ,res\rces & ,s]vices          
,adm9i/ration1 %all conv5e a task =ce to
 develop ,f$]al recomm5dations reg>d+   
respectful mat]nity c>e1 includ+ safe   

bir? c>e & po/p>tum c>e1 dur+ !         
,,covid-#ai public heal? em]g5cy4  7#b7 
,duties ,! task =ce e/abli%$ "u p>agraph
 7#a7 %all develop1 publicly po/1 &     
update ,f$]al recomm5dations 9 multiple 
languages to ensure quality1 provide    
nondiscrim9atory mat]nity c>e1 promote  
positive bir?+ exp]i5ces1 & improve     
mat]nal heal? outcomes dur+ !           
,,covid-#ai public heal? em]g5cy1 ) a   
p>ticul> focus on outcomes = communities
 ( color & rural populations4 ,su*      
guidel9es & recomm5dations %all-- 7,a7  
address1 ) p>ticul> att5tion to ensur+  
equitable treatm5t on ! basis ( race &  
e?nicity-- 7i7 measures to facilitate   
respectful mat]nity c>e2  7ii7 /rategies
 to increase access to specializ$ c>e = 
^? ) high-risk pregnancies or pregnant  
individuals ) elevat$ risk factors2     
7iii7 ,,covid-#ai diagno/ic te/+ =      
pregnant & labor+ pati5ts2  7iv7 bir?+  
)\t "o's *os5 companions1 ) "o's *os5   
companions1 & ) sm>tphone or o!r        
teleheal? connection to "o's *os5       

companions2  7v7 newborn sep>ation aft] 
bir? 9 relation to mat]nal ,,covid-#ai  
/atus2  7vi7 brea/ milk fe$+ 9 relation 
to mat]nal ,,covid-#ai /atus2  7vii7    
lic5sure1 tra9+1 scope ( practice1 &    
,m$icaid & o!r insurance reimbursem5t = 
c]tifi$ midwives1 c]tifi$               
nurse-midwives1 c]tifi$ pr(essional     
midwives1 9 a mann] t facilitates       
inclusion ( midwives ( color & midwives 
f und]s]v$ communities2  7viii7 f9ancial
 support = p]9atal heal? work]s :o      
provide non-cl9ical support to p f      
pregnancy ?r\gh ! po/p>tum p]iod1 su* z 
a d\la1 community heal? work]1 pe]      
support]1 lactation consultant1         
nutritioni/ or dietitian1 social work]1 
home visitor1 or a pati5t navigator 9 a 
mann] t facilitates inclusion f und]s]v$
 communities2  7ix7 h[ to id5tify1      
address1 & treat pr5atal & po/p>tum     
m5tal & behavioral heal? conditions1 su*
 z anxiety1 sub/ance use disord]1 &     
depression1 :i* may h aris5 or increas$ 
dur+ ! ,,covid-#ai public heal? em]g5cy2

  7x7 /rategies to address hospital     
capacity conc]ns 9 communities ) a surge
 9 ,,covid-#ai cases & to provide       
*ildbe>+ p ) options t r$uce pot5tial = 
cross-contam9ation & increase ! ability 
to implem5t _! c>e pref]5ces :ile       
ma9ta9+ safety & quality1 su* z ! use ( 
auxili>y mat]nity units & free/&+ bir?  
c5t]s2  7xi7 h[ to id5tify & address    
racism1 bias1 & discrim9ation 9 !       
deliv]y treatm5t & support to pregnant &
 po/p>tum p1 includ+ evaluat+ ! value ( 
tra9+ = hospital /aff on implicit bias &
 racism1 respectful mat]nity c>e1 &     
demographic data collection2 &  7xii7   
su* o!r matt]s z ! task =ce det]m9es    
appropriate2  7,b7 id5tify b>ri]s to !  
implem5tation ( ! guidel9es &           
recomm5dations2  7,c7 take into         
consid]ation exi/+ ,/ate & o!r programs 
t h demon/rat$ effectiv5ess 9 address+  
pregnancy1 bir?1 & po/p>tum c>e dur+ !  
,,covid-#ai public heal? em]g5cy2 &     
7,d7 id5tify policies specific to       
,,covid-#ai t %\ld be discont9u$ :5     

safely possible & ^? t %\ld be cont9u$ z
 ! public heal? em]g5cy abates4  7#c7   
,memb]%ip ,! task =ce e/abli%$ "u       
p>agraph 7#a7 %all be compris$ (-- 7,a7 
repres5tatives ( ! ,dep>tm5t ( ,heal? & 
,human ,s]vices1 includ+ repres5tatives 
(-- 7i7 ! ,secret>y2  7ii7 ! ,director (
 ! ,c5t]s = ,disease ,control &         
,prev5tion2  7iii7 ! ,adm9i/rator ( !   
,heal? ,res\rces & ,s]vices             
,adm9i/ration2  7iv7 ! ,adm9i/rator ( ! 
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices2    
7v7 ! ,director ( ! ,ag5cy = ,heal?c>e  
,rese>* & ,quality2 &  7vi7 ! ,director 
( ! ,indian ,heal? ,s]vice2  7,b7 at    
lea/ #c ,/ate1 local1 or t]ritorial     
public heal? (ficials repres5t+         
dep>tm5ts ( public heal?1 :o %all       
repres5t jurisdictions f diff]5t regions
 ( ! ,unit$ ,/ates ) relatively high    
conc5trations ( hi/orically m>g9aliz$   
populations1 to be appo9t$ by !         
,secret>y2  7,c7 at lea/ #a ,tribal     
public heal? (ficial repres5t+ dep>tm5ts
 ( public heal?2  7,d7 #a or m          

repres5tatives ( a community-bas$       
organization t addresses adv]se mat]nal 
heal? outcomes ) a specific focus on    
racial & e?nic inequities 9 mat]nal     
heal? outcomes1 appo9t$ by ! ,secret>y1 
) special consid]ation giv5 to          
organizations l$ by a p]son ( color or f
 communities ) significant m9ority      
populations2  7,e7 #a or m              
ob/etrician-gynecologi/ or o!r physician
 :o provides ob/etric c>e1 ) special    
consid]ation = physicians :o are f1 or  
"w 91 communities exp]i5c+ ! highe/     
rates ( ,,covid-#ai mortality &         
morbidity2  7,f7 #a or m nurse1 su* z a 
c]tifi$ nurse-midwife1 wom5's heal?     
nurse practition]1 or o!r nurse :o      
provides ob/etric c>e1 ) special        
consid]ation = nurses :o are f1 or "w 91
 communities exp]i5c+ ! highe/ rates (  
,,covid-#ai mortality & morbidity2  7,g7
 #a or m p]9atal heal? work]s :o provide
 non-cl9ical support to p f pregnancy   
?r\gh po/p>tum p]iod1 su* z a d\la1     
community heal? work]1 pe] support]1    

lactation consultant1 nutritioni/ or    
dietitian1 social work]1 home visitor1  
or pati5t navigator2  7,h7 #a or m      
pati5ts :o 7 pregnant or gave bir? dur+ 
! ,,covid-#ai public heal? em]g5cy2     
7,i7 #a or m pati5ts :o contract$       
,,covid-#ai & lat] gave bir?2  7,j7 #a  
or m pati5ts :o h receiv$ support f a   
p]9atal heal? work] :o provides pr5atal 
& po/p>tum support1 su* z a d\la1       
community heal? work]1 pe] support]1    
lactation consultant1 nutritioni/ or    
dietitian1 social work]1 home visitor1  
or a pati5t navigator1 or a sp\se or    
family memb] ( su* pati5t2 &  7,k7      
racially & e?nically div]se             
repres5tation f at lea/ #c indep5d5t    
exp]ts ) k or field exp]i5ce ) racial & 
e?nic disp>ities 9 public heal?1 wom5's 
heal?1 or mat]nal mortality & sev]e     
mat]nal morbidity4  #h4 ,,gao report on 
mat]nal heal? & public heal? em]g5cy    
prep>$ness ,n lat] ?an #a ye> aft] ! end
 ( ! public heal? em]g5cy decl>$ by !   
,secret>y ( ,heal? & ,human ,s]vices "u 

section #cai ( ! ,public ,heal? ,s]vice 
,act 7#db ,u4,s4,c4 #bdg;d7 on ,janu>y  
#ca1 #bjbj1 ) respect to ,,covid-#ai1 ! 
,comptroll] ,g5]al ( ! ,unit$ ,/ates    
%all submit to ! appropriate committees 
( ,congress a report on mat]nal heal? & 
public heal? em]g5cy prep>$ness1 includ+
 pr5atal1 labor & deliv]y1 & po/p>tum   
c>e dur+ ! ,,covid-#ai public heal?     
em]g5cy1 includ+ ! foll[+3 7#a7 ,a      
review ( ! pr5atal1 labor & deliv]y1 &  
po/p>tum exp]i5ces ( p dur+ !           
,,covid-#ai public heal? em]g5cy1 :i*   
%all-- 7,a7 id5tify b>ri]s to access+   
pregnancy1 bir?1 & po/p>tum c>e dur+ a  
p&emic2  7,b7 assess ! ext5t to :i*     
public & private insur]s 7 provid+      
cov]age = mat]nal heal? c>e dur+ !      
public heal? em]g5cy1 includ+ =         
teleheal? s]vices2  7,c7 to ! ext5t     
practicable1 analyze mat]nal & infant   
heal? outcomes by race & e?nicity       
7includ+ quality ( c>e1 mortality1      
morbidity1 ces>ean section rates1 pret]m
 bir?1 preval5ce ( pr5atal & po/p>tum   

anxiety & depression7 dur+ ! ,,covid-#ai
 public heal? em]g5cy & ! impact (      
,f$]al & ,/ate policy *anges made 9     
response to ! ,,covid-#ai p&emic on su* 
outcomes2  7,d7 id5tify contributors to 
population-bas$ disp>ities se5 9        
,,covid-#ai outcomes1 su* z racial      
pr(il+ (1 & bias & discrim9ation aga9/  
,black1 ,am]ican ,indian & ,alaska      
,native1 ,lat9x1 & ,asian-,am]ican &    
,pacific ,isl&] p2 &  7,e7 review !     
impact ( increas$ unemploym5t1 paid     
family leave1 *anges 9 heal? c>e        
cov]age1 & o!r social det]m9ants ( heal?
 = pregnant & po/p>tum p dur+ ! public  
heal? em]g5cy4  7#b7 ,consultation )    
mat]nity c>e provid]s1 mat]nal m5tal &  
behavioral heal? c>e speciali/s1        
rese>*]s :o specialize 9 wom5's heal? or
 mat]nal mortality & sev]e mat]nal      
morbidity1 p :o exp]i5c$ pregnancy or   
*ildbir? dur+ ! ,,covid-#ai public heal?
 em]g5cy1 repres5tatives f              
community-bas$ organizations t address  
mat]nal heal?1 & p]9atal heal? work]s :o

 provide noncl9ical support to pregnant 
& po/p>tum p 7su* z a d\la1 community   
heal? work]1 pe] support1 c]tifi$       
lactation consultant1 nutritioni/ or    
dietician1 social work]1 home visitor1  
or navigator74  7#c7 ,recomm5dations to 
improve ! public heal? em]g5cy response 
& prep>$ness ef=ts ( ! ,f$]al ,gov]nm5t 
specific to mat]nal heal?1 ) a p>ticul> 
focus on outcomes = m9ority wom51       
includ+-- 7,a7 ways to improve rese>*1  
surveillance1 & data collection ( !     
,f$]al ,gov]nm5t relat$ to mat]nal      
heal?2  7,b7 ways = ! ,f$]al ,gov]nm5t  
to factor mat]nal heal? outcomes &      
disp>ities into decisions reg>d+        
di/ribution ( res\rces1 includ+         
,,covid-#ai te/s1 p]sonal protective    
equipm5t1 & em]g5cy fund+2  7,c7 ! ext5t
 to :i* guidel9es & recomm5dations ( !  
,f$]al ,gov]nm5t relat$ to mat]nal heal?
 c>e dur+ ! ,,covid-#ai public heal?    
em]g5cy 7 culturally congru5t &         
l+ui/ically compet5t = m9ority wom52 &  
7,d7 ways to improve ! di/ribution (    

public heal? funds1 data1 & in=mation to
 ,indian ,tribes & ,tribal organizations
 ) reg>d to mat]nal heal? dur+ !        
,,covid-#ai public heal? em]g5cy4