Maternal mortality and unequal access to maternity healthcare remain significant public health concerns in the United States. Black and American Indian or Alaska Native women experience disproportionately high rates of pregnancy-related complications and deaths. These disparities are associated with several interconnected factors, including structural inequities, inadequate access to healthcare, chronic health conditions, and gaps in postpartum support. Heck et al. (2020) identify important concerns surrounding maternal mortality among American Indian and Alaska Native women, emphasizing the need to address the broader circumstances affecting maternal health.
Legislative advocacy provides nursing professionals with an opportunity to address these concerns beyond individual patient care. Policies supporting continuous postpartum insurance coverage, culturally responsive maternity services, and improved maternal health resources can help reduce barriers to necessary treatment. This personal legislative agenda focuses on maternal health equity, particularly the need for accessible postpartum care and policies addressing racial disparities. It examines Minnesota’s postpartum Medicaid coverage policy and the Black Maternal Health Momnibus Act of 2023, outlines a proposed nursing advocacy action plan, and applies Kingdon’s Multiple Streams Framework to evaluate opportunities for policy change.
Maternal health is influenced by healthcare quality, insurance coverage, economic stability, and access to appropriate services throughout pregnancy and after childbirth. Although pregnancy-related healthcare frequently receives considerable attention during prenatal care and delivery, medical complications may continue or develop during the postpartum period.
Conditions such as hypertension, cardiovascular disease, depression, and substance use disorders can require ongoing assessment and treatment after delivery. Mehta et al. (2021) emphasize the importance of maternal cardiovascular health and the need for coordinated approaches to reducing maternal morbidity and mortality.
The legislative priority of this agenda is to improve maternal health outcomes through policies that strengthen postpartum care continuity and address inequities affecting historically underserved populations. Minnesota provides a relevant state-level context, while federal maternal health legislation demonstrates how national policy can support broader improvements in maternity care.
The central problem is the unequal risk of preventable maternal complications and deaths among women from different racial, ethnic, and socioeconomic backgrounds. Insurance interruptions, limited access to healthcare professionals, inadequate mental health services, and inconsistent follow-up care can make postpartum recovery more difficult.
Black and Indigenous women may encounter additional barriers associated with discrimination, geographic isolation, and differences in healthcare resources. Heck et al. (2020) discuss maternal mortality among American Indian and Alaska Native women, demonstrating the importance of examining population-specific circumstances rather than treating maternal mortality as a uniform problem.
Inadequate postpartum coverage is especially concerning because recovery and treatment needs may extend well beyond the first several weeks after childbirth. A policy response should therefore support continuous insurance coverage, accessible follow-up appointments, mental health screening, and timely treatment of postpartum complications.
The position adopted in this legislative agenda is support for policies that expand postpartum healthcare access and strengthen maternal health equity. Such policies align with nursing responsibilities related to patient advocacy, health promotion, prevention of complications, and equitable care.
The agenda supports extending postpartum Medicaid coverage to 12 months and advancing federal initiatives that address maternal health disparities. However, effective advocacy must also consider legislative feasibility, implementation requirements, funding arrangements, and measurable outcomes.
These considerations are important because policy adoption alone does not guarantee improved healthcare access. Healthcare organizations must have sufficient staffing, resources, and coordination systems to translate legislative provisions into accessible services.
Minnesota’s extension of postpartum Medicaid coverage provides an example of state-level policy intended to improve continuity of maternal healthcare. The original sample identifies Minnesota H.F. 3 as a pending proposal, but official records establish that Minnesota had already extended Medical Assistance postpartum coverage to 12 months, effective July 1, 2022. The verified legislative history includes H.F. 521 and subsequent enacted provisions.
Consequently, the appropriate current advocacy objective is not to seek initial passage of the extension. Instead, the priority should be ensuring effective implementation, informing eligible patients about their benefits, and identifying remaining barriers to postpartum services.
Minnesota’s coverage includes access to physician visits, behavioral healthcare, postpartum depression counseling, substance use disorder treatment, and other eligible medical services.
Position: Support continued 12-month postpartum coverage and improvements in equitable access to covered services.
The Black Maternal Health Momnibus Act of 2023, H.R. 3305, was introduced in the 118th Congress by Representative Lauren Underwood. The legislation proposed coordinated federal efforts to address maternal health disparities through investments in healthcare workforce development, maternal behavioral health, social determinants of health, research, and community-based services.
The proposal recognized that maternal mortality cannot be addressed through clinical interventions alone. Housing conditions, economic hardship, access to transportation, and availability of culturally responsive healthcare can influence maternal health experiences and outcomes.
Congress.gov records H.R. 3305 as introduced and referred to the House Subcommittee on Health in May 2023. It did not become law during the 118th Congress. Therefore, the 2023 bill should be analyzed as a historical legislative proposal, with advocacy focused on advancing its policy objectives through subsequent legislation.
Position: Support the maternal health equity objectives of the Momnibus legislation and advocate for their inclusion in current federal policy proposals.
The following action plan identifies proposed advocacy activities rather than claiming that the student has already completed them.
|
Legislative priority |
Legislative process and status |
Proposed personal advocacy actions |
Next steps |
|---|---|---|---|
|
State: Minnesota 12-month postpartum Medicaid coverage |
Implemented July 1, 2022, following state legislation and federal approval. |
Contact state legislators about continuing coverage; collaborate with nursing organizations; develop patient education materials explaining postpartum benefits. |
Assess gaps in access, support outreach to eligible patients, and recommend improvements in postpartum care coordination. |
|
Federal: Black Maternal Health Momnibus Act of 2023 (H.R. 3305) |
Introduced in 2023; referred to a House subcommittee; did not become law during the 118th Congress. |
Prepare evidence-based correspondence to congressional representatives; participate in maternal health advocacy campaigns; support professional nursing coalitions. |
Identify current successor proposals, engage federal policymakers, and advocate for maternal mental health, workforce development, and health equity provisions. |
An effective legislative action plan requires specific activities, appropriate stakeholders, and measurable objectives. For the state-level priority, the initial activity would involve reviewing Minnesota’s postpartum Medicaid eligibility and available services. This information could be used to prepare educational materials explaining coverage benefits and encouraging timely postpartum follow-up.
Collaboration with the Minnesota Nurses Association and community healthcare organizations could support outreach to populations experiencing barriers to care. These partnerships may also help identify practical challenges involving appointment availability, transportation, and coordination between obstetric and primary care providers.
For the federal priority, advocacy would begin with reviewing the legislative history of H.R. 3305 and identifying currently relevant maternal health proposals. Written communications to congressional offices should describe the importance of maternal health equity, provide credible supporting evidence, and request consideration of specific policy measures.
Additional activities could include participation in maternal health awareness campaigns, attendance at public policy forums, and collaboration with professional organizations such as the Association of Women’s Health, Obstetric and Neonatal Nurses.
The effectiveness of these activities could be evaluated by documenting legislative contacts, stakeholder participation, responses from policymakers, and opportunities for continued engagement. Such indicators measure advocacy progress without assuming that individual actions directly cause legislative outcomes.
Kingdon’s Multiple Streams Framework explains how public problems, policy proposals, and political conditions interact to create opportunities for government action. The framework is appropriate for this legislative agenda because maternal health reform requires both evidence-based solutions and political support.
|
Kingdon’s stream |
Application to the personal legislative agenda |
|---|---|
|
Problem stream |
Maternal mortality, racial disparities, interrupted care, and inadequate postpartum support establish the need for policy attention. Research concerning Indigenous maternal mortality and cardiovascular risks provides evidence of significant maternal health concerns (Heck et al., 2020; Mehta et al., 2021). |
|
Policy stream |
Minnesota’s implemented postpartum coverage extension and the maternal health proposals contained in H.R. 3305 demonstrate different policy approaches. The former addresses insurance continuity, while the latter proposes broader changes to healthcare delivery and social support. |
|
Politics stream |
Legislative priorities, public awareness, government leadership, and stakeholder coalitions influence the political feasibility of maternal health reform. Advocates must evaluate the current political environment rather than assume that earlier support remains unchanged. |
The problem stream involves presenting maternal mortality as a significant public concern requiring government intervention. Healthcare advocates can use research findings, population health reports, and clinical evidence to explain the consequences of inadequate maternal healthcare.
Heck et al. (2020) examine maternal mortality among American Indian and Alaska Native women, highlighting the importance of recognizing disparities within specific populations. Similarly, Mehta et al. (2021) identify maternal cardiovascular health as an important policy and clinical concern.
These findings strengthen the argument that maternal health improvement requires coordinated action addressing clinical risks and broader healthcare barriers.
For this legislative agenda, the problem stream provides the justification for maintaining postpartum coverage and expanding support for populations experiencing unequal maternal health outcomes.
The policy stream concerns the availability of practical interventions that policymakers can consider. Minnesota’s postpartum Medicaid extension illustrates a coverage-based approach, while the Momnibus proposal demonstrates a broader strategy involving workforce development, behavioral healthcare, and social determinants of health.
These approaches are complementary. Extended insurance eligibility can reduce coverage interruptions, but additional investments may be necessary to ensure that covered individuals can obtain services.
The policy stream therefore requires advocates to distinguish between financial access to healthcare and actual service availability. Effective recommendations should consider both dimensions.
For example, a proposal supporting postpartum mental health services should address insurance coverage, availability of qualified providers, screening practices, and referral coordination. Without these elements, expanding coverage may not fully resolve access barriers.
The politics stream reflects the influence of government priorities, stakeholder interests, and public opinion. Maternal health policies may receive support when policymakers recognize the economic, clinical, and social consequences of inadequate maternity care.
However, political conditions change over time. The introduction of the Momnibus legislation in 2023 demonstrates congressional interest during the 118th Congress, but it does not establish current legislative support.
Nursing advocates must therefore monitor active proposals, identify relevant committee members, and communicate with policymakers whose responsibilities involve maternal and public health.
Professional associations and community organizations can strengthen these efforts by coordinating messages and presenting evidence from different perspectives.
The likelihood of policy change differs between the state and federal priorities.
For Minnesota, the central legislative objective of extending postpartum Medicaid coverage has already been achieved. The remaining opportunities concern maintaining coverage, strengthening implementation, and improving access to services.
For federal maternal health reform, the prospects are less certain. H.R. 3305 did not become law during the 118th Congress, and the future of its policy objectives depends on subsequent legislative proposals, political conditions, and stakeholder support.
Kingdon’s framework suggests that successful advocacy requires more than public recognition of maternal health disparities. Policymakers must also have workable proposals and sufficient political support to advance them.
It would therefore be inappropriate to assign a high probability of passage without current evidence about the relevant legislation.
The first recommendation is to improve the coordination of healthcare services throughout the postpartum year. Insurance continuity is valuable, but patients also require timely appointments, appropriate referrals, and access to healthcare professionals who can address physical and psychological complications.
Nursing professionals should advocate for standardized postpartum follow-up procedures and communication between obstetric providers, primary care practitioners, and behavioral health specialists. Such coordination is particularly important for patients experiencing hypertension, cardiovascular complications, depression, or substance use disorders.
Mehta et al. (2021) emphasize the importance of cardiovascular health in maternal outcomes, supporting the need for continued assessment and care beyond childbirth.
The second recommendation is to support policies that address differences in maternal healthcare experiences and outcomes among racial and ethnic populations. Healthcare organizations should provide culturally responsive services, improve access to appropriate patient education, and assess potential barriers to receiving timely care.
Advocacy initiatives should also include meaningful participation from communities directly affected by maternal health disparities. Community representatives can help identify service gaps and inform recommendations that reflect patients’ actual needs.
The third recommendation is to strengthen nursing involvement in public policy activities. Nurses can contribute valuable clinical perspectives to legislative discussions, particularly when communicating how healthcare policies influence patient access and continuity of care.
Professional development opportunities should include education about legislative procedures, policy analysis, effective communication with elected officials, and interpretation of healthcare research.
Nursing organizations can also support coordinated advocacy by developing evidence-based policy statements and organizing opportunities for members to engage with government representatives.
The final recommendation is to establish a consistent process for reviewing maternal health legislation and evaluating advocacy progress.
A related proposal introduced in the 119th Congress is the Advancing Maternal Health Equity Under Medicaid Act, H.R. 4150, which proposes an increased federal Medicaid matching rate for additional maternal healthcare expenditures. This illustrates an avenue for pursuing maternal health policy objectives beyond the 2023 Momnibus proposal.
Advocacy activities should focus on verified legislative developments, documented stakeholder engagement, and clearly defined policy requests. Reviewing these factors can help ensure that the personal legislative agenda remains relevant as political priorities change.
Maternal mortality and unequal access to maternity healthcare require sustained attention from nursing professionals, policymakers, and community organizations. This personal legislative agenda identifies postpartum care continuity and maternal health equity as central advocacy priorities. Minnesota’s implementation of 12-month postpartum Medicaid coverage demonstrates an important state-level policy achievement, while the Black Maternal Health Momnibus Act of 2023 illustrates the broader federal initiatives proposed to address maternal health disparities.
Kingdon’s Multiple Streams Framework provides a useful approach to understanding how evidence of healthcare problems, available policy solutions, and political conditions influence legislative opportunities. Applying the framework demonstrates the importance of preparing realistic recommendations, developing stakeholder partnerships, and engaging policymakers at appropriate times.
Nurses can contribute to these efforts through research-informed communication, community engagement, and participation in legislative advocacy. Continued attention to postpartum healthcare access, culturally responsive services, and policy implementation can support progress toward more equitable maternal health outcomes.
Centers for Medicare & Medicaid Services. (2022). Medicaid state plan amendment MN-22-0008. Medicaid.gov. https://www.medicaid.gov/medicaid-spa/2022-06-16/137031
Heck, J. L., Jones, E. J., Bohn, D., McCage, S., Parker, J. G., Parker, M., Pierce, S. L., & Campbell, J. (2020). Maternal mortality among American Indian/Alaska Native women: A scoping review. Journal of Women’s Health, 30(2). https://doi.org/10.1089/jwh.2020.8890
Mehta, L. S., Sharma, G., Creanga, A. A., Hameed, A. B., Hollier, L. M., Johnson, J. C., Leffert, L., McCullough, L. D., Mujahid, M. S., Watson, K., & White, C. J. (2021). Call to action: Maternal health and saving mothers: A policy statement from the American Heart Association. Circulation, 144(15). https://doi.org/10.1161/CIR.0000000000001000
Minnesota Department of Human Services. (n.d.). Health care coverage for people who are pregnant. https://mn.gov/dhs/health-care/pregnant-people/
U.S. Congress. (2023). Black Maternal Health Momnibus Act, H.R. 3305, 118th Cong. Congress.gov. https://www.congress.gov/bill/118th-congress/house-bill/3305
U.S. Congress. (2025). Advancing Maternal Health Equity Under Medicaid Act, H.R. 4150, 119th Cong. Congress.gov. https://www.congress.gov/bill/119th-congress/house-bill/4150
